Standard 6: Communication

Amara Communication feels like the module everyone assumes they are already good at.

Nadia Which is why it causes clinical harm. When communication fails in care the consequences are not hurt feelings. People go without pain relief because nobody understood them. People get recorded as refusing care when they were asking for a different carer. People get labelled confused when actually they are deaf and the hearing aid battery is flat.

Amara That last one cannot be common, surely.

Nadia It is extremely common. Before you decide anyone is confused, check four things. Hearing aid. Glasses. Dentures. Lighting. A very large proportion of apparent confusion is unaddressed sensory loss, and it gets written into a record where it follows the person around for years.

Amara Is there a legal duty here or is this just good practice?

Nadia There is a duty in England, the Accessible Information Standard. Identify the need, record it, flag it so it is visible, share it with others providing care, and meet it. Note that a need sitting in a file nobody opens has not been met. The standard is about action, not documentation.

Amara Let us talk about adapting. Because I have heard people adapt in a way that made me wince.

Nadia Then you have heard elderspeak. Higher pitched, sing song, calling a woman of ninety sweetheart. Slower and simpler is fine. Talking to an adult as though she were three is not, and I promise you she can tell.

Amara Give me the dementia list. The things that genuinely work.

Nadia Approach from the front, at eye level. Say who you are every single time, and do not test whether they remember. One instruction at a time. Then wait, and wait longer than feels comfortable, because processing can take many seconds.

Amara How long is longer than comfortable?

Nadia Count to ten in your head. Most people give up at three and fill the silence with a second question, which resets the whole process. Use gesture and demonstration alongside the words. And do not argue with a false belief. Respond to the feeling underneath it.

Amara Example?

Nadia She says she has to go home, her mother is waiting. Do not say your mother died in 1987. Say tell me about your mother. The feeling is that she is needed somewhere and she is anxious. That is the thing you can actually help with.

Amara Interpreters. Realistically, if a resident's daughter is standing right there and speaks English, why would I not use her?

Nadia Because she may edit. She may have an interest in the outcome. In a safeguarding context she may be the source of the problem. And she is not bound by any professional standard, so nobody can hold her to accuracy.

Amara So when must it be professional?

Nadia Consent. Diagnosis. Safeguarding. Complaints. End of life discussions. For the weather and the football, family is fine. And one absolute rule: never use a child as an interpreter. Not for a moment, not for convenience.

Amara Anything practical about how to use one?

Nadia Speak to the person, not to the interpreter. Keep looking at the person while the interpreter is talking. Say what did you eat today, not ask her what she ate. It sounds small and it changes who the conversation belongs to.

Amara What about my own body language? I never think about it.

Nadia Then it is communicating for you without supervision. Standing over somebody in a chair signals authority. Sitting at their level signals time. Doing the task while facing away signals that they are a job rather than a person. And watch your hands, because rushed hands read as rushed whatever your voice is doing, and rushed reads as unsafe to a frightened person.

Amara Last one. A daughter rings and asks how her mother has been. What do I say?

Nadia Answer the relationship rather than the question. I am not able to share that, but I can let her know you rang and she can call you back. You have not breached confidentiality, you have not been cold, and you have put the decision back where it belongs, with her mother.