​Communication is key when providing quality care to residents because those living in long term care environments experience increased vulnerability. Good communication can often be likened to a dance. When synchronized, it is beautiful to watch. However, one misstep can lead to injury or hurt feelings. Lack of communication can result in missed appointments, medication errors, adverse events, rehospitalization, and even death. This article offers tips to facility leadership on how to improve communication with residents and their families, staff, and outside partners.

Communication with Residents

Many issues can arise for a resident, and even an experienced nurse’s assessment skills have limits. If a resident is not feeling well but has no visible signs or symptoms of illness, the nurse cannot determine the issue unless the resident communicates how they are feeling. Staff can improve communication with the resident by keeping these suggestions in mind:

1. Be attentive. Be present and listen to the resident carefully to build trust and rapport.
2. Ask open-ended questions. Encourage the resident to talk more about what is going on.
3. Be curious. Ask yourself, “What is going on with this resident, and how can I help?”
4. Summarize. Repeating back what was said at a few points during the conversation with a resident helps ensure an accurate understanding. This technique can also lead to further discussion, and it affirms to the resident that staff are attentive and caring.
5. Use the right tone. Don’t talk down to the resident. Use simple and concise language.
6. Be aware of the situation. No two residents experience things the same way. Be open to each resident’s temperament. A person-centered, holistic assessment will provide better management of each situation.
7. Communicate in different ways. Every person has a unique way to communicate. For example, staff may need to use pictures or simpler sentences for a resident with a cognitive impairment.1

Communication with Families

Family participation is vital, especially if residents have dementia or cannot speak for themselves. Encourage family members to take part in planning the resident’s care. Their participation not only improves quality of care, but it also empowers family members to voice concerns and perhaps get involved in any changes the facility may need to make.

It is important to be transparent and communicate with family members often. Family members who feel uninformed or out of touch may become angry or distrustful. They may feel the facility isn’t doing all it can for their loved one. However, when communication occurs as it should, the family and staff can concur on the resident’s care. This agreement can reduce the family’s anxiety and cultivate a trusting relationship between staff and family, who share a mutual goal of providing the best care for the resident.

Communication Between Staff Members

Communication used to care for residents could be compared with the Irish step dance teams often seen on television or at festivals. One wrong move (or communication, in this analogy) by a staff member can cause others to misstep. Those mistakes can lead to care issues, such as medication errors, lack of needed interventions, or even harm. Nursing staff must not only communicate with each other in their department, such as between shifts, but also with other departments.

Caring for residents is a team effort involving staff assigned to nursing, social services, therapy, dietary services, and many others. Each person offers expertise and a “dance step” regarding the holistic care of the resident. Only when we put these steps together is the dance complete, and residents receive the holistic care they need.

The director of nursing services (DNS) can improve communication between staff by following these suggestions:

• Have clearly defined procedures for communication (both inter- and intra-
• departmental). Procedures should include when and how to communicate, along with any forms staff should utilize.
• Lead by example. Communicate often and effectively with staff to give them a model to follow.
• Encourage transparency. Promote a safe culture that encourages transparency and does not penalize people for mistakes.
• Provide resources to improve communication. For example, suggest using short written notes or lists, visual aids, and simplified medical terms when talking to a resident.

Communication with Outside Partners

Outside partners often provide the resident with services the facility itself cannot, adding additional steps to the dance. Communication with and between outside partners, such as professionals offering dialysis, hospice, and behavioral health services, is crucial, allowing for a holistic approach to the resident’s care.
As with most areas in long term care, federal regulations guide a facility’s collaboration with outside organizations (e.g., notification of changes and maintaining a collaborative care plan). When reviewing requirements on how the facility communicates with outside organizations, facility leaders can refer to the following F-tags,2 along with the coinciding Centers for Medicare & Medicaid Services (CMS) Critical Element Pathways, located in the Survey Resources folder3 found on the CMS website.

• F637 Comprehensive Assessment After Significant Change
• F656 Develop/Implement Comprehensive Care Plan
• F657 Care Plan Timing and Revision
• F684 Quality of Care
• F698 Dialysis
• F740 Behavioral Health Services
• F745 Provision of Medically Related Social Services
• F770 Laboratory Services
• F771 Blood Bank and Transfusion Services
• F776 Radiology/Other Diagnostic Services
• F825 Provide/Obtain Specialized Rehab Services
• F841 Responsibilities of Medical Director
• F842 Resident Records: Identifiable Information
• F849 Hospice Services
• F866 QAPI/QAA Data Collection and Monitoring

Remove Barriers to Communication

Collaboration between organizations inevitably includes missteps, but the key to getting past these barriers is communication. Cultivating that communication starts with training. Facility staff should be educated on topics like these:

1. The services provided by outside partners and how the services are provided.
2. What regulations must be followed when collaborating with outside partners.
3. The role of each entity.
4. When to refer a resident to an outside partner.
5. How to contact the outside partner.

Conduct additional education as needed or when issues arise.

Pat MacMillan, founder and CEO of Triaxia Partners, said, “Excellent communication doesn’t happen naturally. It is a product of process, skill, climate, relationship, and hard work.”4 The DNS can use the tips described here to improve the team’s communication skills and ensure a strong communication process is in place, thus improving the quality of the dance and the quality of care for all residents.

Denise Winzeler, BSN, RN, LNHA, DNS-MT, QCP-MT, is a curriculum development specialist for the American Association of Post-Acute Care Nursing (AAPACN).

References
1. Chan, S. (2020, January 9). 16 ways to improve your communication skills with patients. https://www.bhf.org.uk/for-professionals/healthcare-professionals/blog/16-ways-to-improve-your-communication-skills-with-patients
2. https://www.cms.gov/medicare/provider-enrollment-and-certification/guidanceforlawsandregulations/downloads/appendix-pp-state-operations-manual.pdf
3. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/Nursing-Homes
4. The Vibe Team. (2002, May 5). 35 quotes about communication for inspiring team collaboration. https://vibe.us/blog/35-quotes-about-communication/