For the third article in our series highlighting November as National Caregiver Month, communication is the goal. We all use communication in some form or fashion numerous times a day. This communication might be made with our hands, face, spoken words or sounds, writing and typing, pictures, and/or emojis. We also need to be able to understand and interpret these expressions from others in order to have true communication. What happens, though, when part of this system is challenged by speech, language, hearing, or cognitive difficulties? This article provides supports for these changes.

A key principle of effective communication is connectedness. We are able to share our thoughts, ideas, fears, needs, and wants with others and listen to theirs. When we are heard and understood, and we, in turn, hear and understand our loved ones, we feel confident and more comfortable in these relationships. What can we do to help increase the likelihood of these positive interactions? The first thing is to examine environment to maximize input. The list at right provides the key environmental components and issues to consider, especially if your loved one has difficulties with communication or cognition.

Once the environment is ideal for communication, then we need to also consider how we communicate. Think about non-verbal communication first…get on the same level as your loved one (if he/she is in a wheelchair, sit beside), make eye contact, and listen with your heart. It can be challenging as a caregiver to focus on these details when you have so many other demands for your attention (i.e. medication, safety, fatigue, daily tasks); however, these details set the tone for interactions. Additionally, when the ability to process and understand language becomes more challenged, these non-verbal actions are things that bring feelings of safety, security, and comfort to your loved one. Below are suggestions for improving communication with an individual who has a neurological deficit such as dementia.

   ~ Stay calm and give yourself grace—you don’t have to be perfect to show you care. Be patient with yourself and your loved one.

   ~ Use gestures or show what you mean to improve understanding. For example, if assisting with teeth brushing, model or even brush your teeth at the same time.

   ~ Use short sentences, questions and/or instructions: Tell him/her what to do rather than what not to do. For example say “Please turn down the TV” rather than “Please don’t turn up the TV.”

   ~ Use a gentle, audible voice with positive uplift. Consider how the tone of voice affects how one feels and perceives language.

   ~ Use writing, pictures, and simple gestures as much as possible with spoken words. To help supplement verbal information and assist with memory (recall), write down important details. This increases understanding and enables one to process and even remember better. If hearing or memory are challenged, text and pictures provide another form of input and increase connection and understanding. Gesturing is mentioned again as it is such a strong partner to speech.

   ~ Validate your partner: Engage with your loved one where he/she is now. BE with him/her in the moment. When cognitive challenges increase, one’s recall or orientation does not have to be accurate. For example, if he/she is living in a memory of childhood, engage. Ask questions about emotions and activities rather than trying to orient to the current environment…his/her brain may not have the capacity for processing the present. 

The above topics all help to encourage person-centered communication and set the tone for interactions. Realize that there are times when we can’t establish all of those principles in settings or interactions, and that is part of life. However, keeping them in mind and practicing them is what helps us grow.

The next part of communication is what we say to our loved one. It is important to use specific language. These suggestions can help improve understanding.

   ~ Ask simple questions: “Would you like a cookie or a donut?”

   ~ Provide gentle instructions with context: “It’s time for the service to start; I’ll walk with you to church.”

   ~ Provide one question or direction at a time.

   ~ Pause: Count to yourself for five to 10 seconds to allow your partner time to process and respond.

   ~ Repeat: Try to repeat verbatim rather than changing the wording.

   ~ Adjust: If he/she persists with difficulties responding, use visuals or yes/no questions. As cognitive challenges advance, making decisions and choices are more overwhelming and confusing. Therefore, if one is not able to answer a binary choice (cookie or donut), then present both items for seeing, smelling, touching to make the choice. Additionally, you could ask “Would you like a donut?” which may be easier to answer with a yes/no.

Daily communication between the caregiver (care partner) and person with a disability is fluid, keep swimming and adjust your stroke for different environments. Try evaluating the items discussed here over time. If something doesn’t “work” one time, try again later. No two experiences are going to be exactly the same, so keep trying.

Other areas of communication to address are caregiving from afar and relationships with others (other family members, friends).  In regards to caregiving from a distance, it is critical to establish connections with other local people who are involved with your loved one. For example, neighbors, doctors, and church members may have more frequent contact with your loved one. Additionally, consider all of the items for improved communication noted earlier in this article. When engaged in phone or video conversations, ensure your loved one has materials needed to take notes of the conversations and ask him/her to read it back to you. Too often, caregivers will call with multiple questions or instructions, and the loved one isn’t able to remember all the details or misunderstand a date, time, or other important detail. By asking one to take notes, you are empowering your loved to be more independent, confident, and engaged. Lastly, model the positive communication strategies discussed here to friends and social groups. This can help alleviate some of their worries or insecurities of how to communicate with your loved one with a communication or cognitive difficulty. Leading by example is powerful in every part of life. Your loved one is still the person you have known and loved, however his/her ability to interpret the world and react to it may have changed…join him or her in the moment and remember, keep heart at the center of communication.