An intern’s perspective: Series by Jessie Donaldson (part 2 of 5)

Topic 2: The Art of Communication in a Long-Term Care Setting

Effective communication lies at the core of every patient interaction. For RDs and interns in long-term care (LTC) facilities, there are some unique challenges to overcome when communicating with residents. During my time as a student-intern, I learned about these obstacles and saw the unique ways in which they can be overcome.

Factors that affect communication with long-term care residents:

 Hearing Difficulties
o Many older adults suffer from some degree of hearing loss. Some may be completely deaf, while most are hard of hearing in one or both ears.
 Speech Problems
o Residents with dysphagia or motor/movement disorders may have trouble speaking clearly and not slurring their speech.
o Given the high prevalence of dementia in this population, it is common for residents to become confused and have difficulty forming words or finding the right words. Sometimes they may not comprehend questions they are asked and may become agitated or upset.

Thankfully, each of these issues can be resolved with the following approaches:

 Assess hearing status and adapt by speaking loudly
o This can usually be done by simple observation. While conducting intake interviews, it was common for a resident to immediately tell me they’re hard of hearing. They might say that they use hearing aids or ask me to speak loudly. Other times, they would just gesture that they couldn’t hear. Sometimes I didn’teven need to wait until I met the resident; there was a note in the EMR stating that the resident is HOH (hard of hearing).
o Occasionally, a resident may prefer written communication for this reason, particularly if there are speech issues as well. This is where white boards prove their usefulness.
 Identify speech issues and adapt accordingly
o When a resident has significant speech impairment, the first step an RD or intern can take is to simply slow down, devote their full attention to the resident, and see if they can understand. If this isn’t possible, they can work with the resident to find a suitable alternative.
o As mentioned above, white boards (or other writing implements) can be helpfulin these cases. Residents who are still able to write may find this less frustrating.
o Many residents have a healthcare proxy, often a family member, who acts as liaison between the resident and care providers. This is often the easiest and most reliable way to get information to and from residents.
 Keep it simple
o When speaking with residents with dementia and memory issues, the most important thing to remember is to keep questions and answers simple. Avoid using excessively descriptive words, asking several questions at once, or looking around while speaking with a resident.
o Instead, make eye contact with the resident and ask one simple question at a time. 
o Residents with advanced dementia may rely heavily on their healthcare proxies or nursing staff to relay information to and from the RD or interns.

Special Considerations:

While navigating communication barriers, it is vital that the RD or intern always does so while respecting the resident’s dignity and intelligence. Having a hearing, speech, or memory impairment does not mean a person is of lower intelligence. The RD or intern can show respect by always first assuming that a resident will understand them (and adapting accordingly if they don’t); always addressing the resident directly, until notified that the resident prefers to use a proxy or alternative means of communication; and speaking in a way that is simple, slow, and clear without being patronizing or demeaning.

The time leading up to my initial patient interactions created some anxiety for me. I was nervous about saying the wrong thing, not being able to understand someone or causing confusion or agitation for residents. I quickly found, however, that there was no need for this fear. When an RD or intern approaches each resident interaction with confidence and genuine respect, every barrier can be overcome.

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