Effective communication is the bedrock for functional eldercare teams. In many disputes related to care of an elderly or disabled person, poor communication is at the core of a dysfunctional team that cannot work together to provide optimal care for the client.

Caregiving is a team sport complicated by the fact there is usually more than one team – and the teams overlap! For example, in an urgent healthcare situation, there could be multiple teams – a hospital surgical team, discharge planning team, family caregivers, family health team, etc.

Communication among multiple teams becomes complicated, and the risk of transmitting incorrect information about the client goes up. How can we improve communications and provide better care? The solution is not as simple as Ernest Hemingway suggested when he said, “When people talk, listen completely. Most people never listen.” Communication is much more than talking and listening, especially in complicated situations like caregiving.

The word communication comes from the Latin communicare, which means to share. Communication is the process of understanding and sharing meaning (Pearson & Nelson, 2000). A process is a dynamic activity which can be affected by numerous things, such as the sender and how they send the message or the environment in which the message is received. Understanding means we interpret the message according to our beliefs, prior knowledge etc. Sharing may mean sharing such things as your thoughts, feelings, and insights. And the meaning of a word or term can mean different things to different people[1]. So, communication is also how, when, where, and what we understand, share, and mean. It’s far more than talking and listening.

A Typical Scenario in Eldercare: Communication Breakdown

Consider a typical scenario in eldercare. A frail 90-year-old gentleman with mid-stage Alzheimer’s and vascular dementia was discharged from the hospital after a total hip replacement due to a fall. He received a few days of physical therapy and was then released to his eldest daughter’s home to rehabilitate before returning home to his own condo with a new live-in caregiver. The daughter is the eldest of three siblings, all of whom live in the same city but do not get along.

To prepare for his discharge, the surgical team communicated with the nursing and physical therapy teams, who then talked to the discharge planner. But the discharge planner could not reach the eldest daughter, so instead of leaving a message, she called the middle daughter. The middle daughter did not give the correct message to the eldest daughter. And so, at the very start of his journey home, communication unraveled. Information crucial to his caregiving and recovery was missed.

There is a high risk that information is misunderstood, misinterpreted, or forgotten when there are so many points of contact with overlapping teams. However, if we understand more about communication processes and use standard communication protocols, there is a better chance of success.

The Eight Components of Communication

Researchers break down the communication process into eight distinct functional components.

1. Source – the source determines their message, creates it, and sends it.
2. Message – the message is the meaning you intend to convey.
3. Channel – how the message travels such as voice, pictures, written, etc.
4. Receiver – receives the message and interprets it either correctly or incorrectly.
5. Feedback – messages the receiver sends back to source to see how well the message is received.
6. Environment – physical and psychological surroundings that can impact the activity.
7. Context – setting the scene and expectations with the individuals involved.
8. Interference – anything that blocks or changes the intended message.

When communications break down, and disputes emerge, it’s helpful to analyze the eight components and pinpoint where the message got stuck. Communication is more complex, and accuracy can suffer when teams overlap. Thinking of teams in this context, it is easier to understand why messages can be misinterpreted or simply get lost in transition. And if a caregiver ‘receiver’ gives different messages to different team members, then one can see why conflicts arise over caregiving plans.

If communications have completely broken down between caregivers, what are some ways to facilitate effective communication? It’s helpful to borrow from the information technology world and establish communication protocols. The Internet of Things, for example, has standardized rules and formats for transmitting data across a network so that networked devices can talk to each other[2].

Adopt Communication Protocols in Caregiving

If we apply the same concept to caregiving across a network of people, we could standardize rules and formats to share information among and across teams. No single type of protocol is suitable for every situation. Caregiving can be complicated, and getting the wrong message without a standard protocol for information sharing is easy. Understanding the team’s needs and creating a standard protocol for the format and rules about sharing information is time well spent.

Improve Caregiving Communication

Once communication protocols are in place, how else can we encourage effective communication?

1. Determine the most appropriate forum for people to share information. Is it a video call or in-person meeting? Who are the key participants? Who chairs the meeting? Who documents decisions and actions?
2. Set regular updates. Participants may have busy calendars, so schedule updates in advance.
3. Use clear language and understandable terms. Written and verbal communication should use clear language. Not everyone will be fluent in medical terms, for example.
4. Think small agendas with desired outcomes. Use the KISS principle, especially when there are disputes about next steps.
5. Listen to hear, not to reply.

Caregiving is hard work that takes heart and smarts. Older people can have complex needs that are complicated to understand and even more difficult to communicate. You can make it easier by learning how communication works, creating standardized protocols, and finding ways to make it more effective. As John Powell said, “Communication works for people who work at it.”

 

[1] https://open.lib.umn.edu/businesscommunication/chapter/1-2-what-is-communication/

[2] https://www.techopedia.com/definition/25705/communication-protocol

Photo by Alex Andrews