Communicating with People Who Are Frail

Frailty is a journey of physical, social, cognitive (mental), sensory or mobility issues that combine in many different ways to cause loss of strength and lowered activity. Frailty often becomes a spiral of decline, as weight loss results in loss of muscle mass and strength, precipitating a fall, further hindering mobility and often appetite, causing more weight loss, and so on. Frail people often have unique communication needs that must be considered if volunteer visitors are to effectively engage in meaningful conversations.

Level of Care
The basic level of care of the person being visited will offer valuable cues for communication. If the person is at the independent living level, where he or she is reasonably able to meet the activities of daily living on his or her own (eating, moving about, toileting, bathing and dressing), then the individual generally can engage easily in conversation.

People at the assisted living level need more help with their activities of daily living, may have a greater degree of dementia/confusion, and have a harder time communicating effectively.

People at the skilled nursing level have great need for assistance with activities or daily living and much more difficulty with communication. People who are living at home in the community will still fall within these basic care levels, even though they are not living in a care facility.

The First Step – Pray!
The first step in any communication with frail people is to pray and invite the Holy Spirit to help guide your words and increase the receptiveness of those you are visiting. Pray that your words will be understood and the person you are visiting will be blessed.

Pause and Assess
Before you approach someone to visit, take a few seconds to decide what level of care the individual needs. Use the cues you have:

• Is he or she walking independently?
• Is he or she using a walker?
• Is he or she in a wheelchair?

A good general communication rule is the higher the level of care (skilled nursing, being the highest), the slower you should be in your movements and speed of your speech.

Be Seen and Heard
An important key to beginning a visit is always approach people from the front and be on the same level they are. Before speaking, move into the person's line of vision so he or she can see you and react. If an individual is standing, stand in front of him or her. If the person being visited is sitting, get in front of him or her and kneel or sit down so you are at the same eye level. If the individual is lying down, move to a point at the bedside so he or she has the potential to see you; then kneel, sit, or bend down so you are at the same eye level. Being at a person's eye level honors that person and gives him or her the potential to read your lips.This position removes distractions so that the individual may focus on your face. If necessary, gently touch the person's arm or hand to get his or her attention before you speak.

Let those being visited know who you are, even if you have visited before.
Wear a large printed name tag and verbally identify yourself. (Hello, I'm ….. from ….).

Try to refrain from sitting on the beds. They have little personal space they can claim as their own. Sitting on the bed can infringe on this space and -- perhaps -- feel too personal.

Once you have been seen, do what you can to be heard. Many frail people have hearing loss, and it is important to speak in a lower tone and pitch. Speak slowly (and sometimes fairly loud) so you can be heard. If you try a sentence one way and people don't seem to hear (or understand), try rephrasing it in a more simple way that can be responded to with yes or no replies. (For instance, "How are you doing today?" could be rephrased as "Are you OK?") Many people have one ear with better hearing than the other, and sometimes you need to speak directly into the "good ear" to be heard.

Listen, Listen, Listen
It is so important for the frail person to be heard, and that can happen only if you listen carefully. Don't be in a hurry when you visit. Give yourself time to have a meaningful conversation and to pay complete attention to the people you are visiting. Don't discount what they say if it doesn't make sense. Don't talk FOR them when they are slow to answer, interrupt before they can finish, or talk about them as if they are not there. Concentrate on what they are saying rather than focusing on your own thoughts or what you will say next. Silence is often uncomfortable, but it is acceptable. Your very presence can speak volumes.

Communicating with People Who Are Confused
It takes special skills to communicate effectively with people who are confused, but three helpful tips are:

1. Go where they are.
2. Don't argue.
3. Redirect.

People who are confused are not "oriented to time and place." They are not capable of being in the same reality as you are. It is highly unlikely you will be able to "clear them up," so a respectful way to communicate is to "go where they are." If a person talks as though he is on Normandy Beach on D Day, ask him about it. If a woman talks about her baby being asleep in the crib in the next room, ask about the baby. Enter their world and let them share it.

If and individual persistently goes over and over a thought (called perseverating, such as "Where's my mother" when she is 90 years old), it is not likely that you will be able to convince her otherwise. You will probably not "win" an argument. Instead of repeatedly saying, "Don't you remember" and correcting, ask the individual to tell you about the thought he or she is repeating with sight, sound or smell questions such as, "Did your mother bake bread? Did the sewing machine make whirring noise when she made your clothes? Did she call you to dinner every night?" Using all their senses may reconnect them with positive memories in the past that can bring them peace and comfort.

This goes hand in hand with redirecting. If people have short term memory loss, ask them about things they do remember (typically far in the past). Use simple sentences. If they get agitated, it's best to end the conversation with prayer and move on to return another day.

Remember to Keep Safe Boundaries
Sign in at the desk and let the staff of the facility know who you will be visiting. If you are visiting in a room, keep the door open so you can be easily observed from the hallway. Don't touch unless gently holding a hand and don't discuss personal issues. Don't touch or examine people's possessions.

If you are visiting someone in an apartment, be extra vigilant with maintaining personal space and touch, especially when women are visiting men or men are visiting women. If necessary, move with the person from the private apartment to a commons area to visit.

Boundaries are important for the visitor as well. If someone speaks inappropriately to you or gets too close in a way that is outside your comfort zone, simply end the visit with prayer and contact your volunteer coordinator.

Keep it Short and Simple and Close the Conversation with Prayer
Remember that a visit is an opportunity to connect with the frail individuals, reassure them that they aren't forgotten, and offer healing and hope through prayer. The visitor should not expect to solve their problems or do counseling. If the person being visited has needs, report them to your volunteer coordinator. Visits should be short (no more than twenty minutes for those at the independent leve; ten minutes at the assisted level; and five minutes at the skilled level).

Reading Scripture verses that are familiar can bring great peace and comfort as the frail person continues on his or her journey. People often seek reminders of grace, forgiveness and assurance of a new life to come. Suggestions are:
Psalm 23
Psalm 121
Isaiah 40: 28 – 31
John 3:16
Romans 8:28-39
Philippians 4:4-9

Always close the communication time with prayer. The best prayer to share is The Lord's Prayer, as the person being visited may be able to speak at least some of the words with you. Even very frail people remember this powerful prayer of hope and healing.

As You Leave
As you conclude a visit, pause and ask God to continue to be present with the person as he or she goes forward. Trust that you have made a difference in that day. Remember, you have answered the call from Psalm 71:9: "Do not cast me off in the time of old age; do not forsake me when my strength is spent" (NRSV).

Karla Woodward is Pastor of Silver Link Ministries at The United Methodist Church of the Resurrection in Leawood, Kansas.

Copyright © 2010 The United Methodist Church of the Resurrection, 13720 Roe Avenue, Leawood, KS 66224, 913-897-0120, www.cor.org. Permission granted to reproduce materials for education and ministry.