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Part 2: Communication & Changes in Condition 

(Text Used from CTDSSMAPS Training (9/23/2020). 



Conversational Skills

Getting to know clients and what makes the person happy helps to create a person-centered approach to caregiving.  Familiarity with topics the person enjoys may help to calm or distract the person if he/she is resisting or refusing care at some point.


Helpful Topics:

  • Family, friends

  • Favorite foods

  • Television shows

  • Movies

  • Books

  • Music

  • The past – childhood, school, jobs, pets


To communicate well, you need these skills:

  • Make eye contact.

  • Listening

  • Ask good questions.

  • Observe non-verbal communication. There are sometimes movements, gestures, facial expressions, and even shifts in the client’s body that indicate something may be going on that they are not telling you.

  • Speak openly and honestly to solve problems.

  • Allow the client to express needs, wants, or opinions without getting irritated, frustrated or angry.

  • Speak to the other person with respect.

  • Be respectful of the client’s race, ethnicity, religion, country of origin.

  • Participate in activities like playing cards and games.


Dementia, Alzheimer’s disease, stroke, acquired brain injury, and other conditions may make communication more difficult. Don’t use too many words or long explanations because this may be confusing. Don’t give too many instructions or choices at once. You may not understand what the client is saying because they may be talking about things that happened in the past.  Some clients may understand non-verbal gesturing better (like hand signals) if they are confused or hard of hearing. 


Alzheimer’s Disease and Dementia - Communication


Communication requires patience and understanding. Alzheimer’s disease affects the whole brain. When the client is in the early stage, the ability to talk and be understood may only be slightly affected. The client may have a hard time thinking of words. Over time, difficulty thinking of the correct words will worsen as well as being able to understand what others are saying.  


Techniques to help:

  • Tell the person or show the person you’re trying your best to understand.

  • Reassure the person and tell the person it is okay.

  • Encourage the person to keep talking and don’t interrupt.

  • Try to figure out what they’re trying to tell you by associating the words with their facial expression, the situation, their emotion, and body language.

  • If nothing makes sense, ask the person’s family or other supporters.  Ask the family or others who know the person about the best way to communicate. 



Listening is not just hearing, but doing your best to understand what the person means. Ways to be a good listener:

  • Ask questions if you are not sure you understand.

  • Be patient and let the client finish speaking.

  • Give the client your full attention.

  • Pay attention to the client’s body language, such as facial expressions, tone of voice, or body posture.


There are sometimes movements, gestures, facial expressions, and even shifts in the client’s body that indicate something may be going on that they are not telling you.


Aphasia is a condition that affects the client’s ability to talk and communicate. It can affect the ability to speak, write and understand language, both verbal and written. Aphasia typically occurs after a stroke or a head injury.  If the client has difficulty speaking, let the client write out what he/she wants to say.  Some clients may use a communication board.


Examples of Types of Communication Boards




Because the caregiver spends a lot of time with the client, the caregiver acts as the eyes and ears on the client’s well-being. The client’s condition can change quickly and must be reported immediately.


Changes in a client’s condition should be reported immediately.

Skincare involves keeping the skin clean, preventing pressure on the skin for long periods of time, good nutrition, and exercise if possible.  It is important to regularly check the client’s skin for color changes, signs of soreness, breakdown, and infection.


Skincare after toileting is very important.  Urine and fecal matter can cause skin irritation and rashes.  If a client is incontinent and uses Depends, skincare is very important. genital and rectal care should be done gently, from front to back, using gentle strokes rather than scrubbing. If there are areas that are very sore, squeeze water over them and pat dry.


Changing Depends®


Check for:

  • Red areas

  • Bruises and Cuts

  • Bed Sores

  • Tears in the skin


If the client has skin tears, do not grab the client’s arm.  Skin can become very fragile and even the simplest bump can cause a tear.


Clients who cannot change position in bed or in a chair on their own must have the PCA change their position every two hours. 


How to Recognize Signs of Skin Damage

  • Red or pink areas on the skin that do not go away

  • Skin that appears shiny around the elbow

  • Blisters

  • Dark, discolored skin


Severe, untreated wounds may cause fatalities. Infections occurring due to severe wounds may cause death from deep tissue infection, bone infection, gangrene, or blood infection. Spotting it early and getting help is extremely important. Clients who cannot get out of bed or a chair are at greater risk.   PCAs are required to report sores and wounds to their supervisors. Wounds are easier to treat in the early stages.


Stage 1: red area with pain, burning or itching.


Stage 2: swollen, painful, warm, and/or red; may ooze clear fluid or pus. Recovery time: 3 days to 3 weeks.


Stage 3: looks like a crater, may have a bad odor, with red edges, pus, heat, and/or drainage. The tissue in or around the sore is black if it has died. Recovery time: at least one month, and up to 4 months.


Stage 4: deep, big, black sore; shows signs of infection with red edges, pus, odor, heat, and/or drainage; may see tendons, muscles, and bone. These wounds need immediate attention. Recovery time: from 3 months or even years to heal.



The PCA plays an important role in detecting changes in appetite, fluid intake, and preventing possible complications.  Good reporting can make a big difference in helping the client. Poor appetite is a common problem in older people. It can contribute to unhealthy weight loss, nutritional deficiencies, and serious health problems. Loss of appetite may be due to poor-fitting dentures making it difficult to chew. A gradual, slow decline in appetite and thirst may mean the client has a medical condition and should be reported. A sudden loss of appetite must be reported to your supervisor immediately.  Also, monitor how much the client drinks to avoid dehydration.  If the client is having difficulty urinating, constipation, or frequent diarrhea, report this to your supervisor.   


Behavior Changes

Any gradual or sudden changes in a client’s behavior must be reported to your supervisor.  If family members are involved in the client’s life, it is good to tell them, but you must also report it to your supervisor. Behavior changes may mean the client has a medical problem like a urinary tract infection or dehydration.  Examples of behavior change:


  • Becoming very tired and sleepy

  • Sleeping for very long periods of time

  • Dizziness

  • Restlessness, pacing, repeating the same thing over and over, asking for a lot of attention, complaining and swearing

  • Aggressive behavior, yelling, saying mean or hurtful things

  • Doing strange things the client has not done before

  • Self-neglect, such as refusing to let you help with bathing, dressing; or refusing to eat

  • Talking about deceased loved ones and wanting to join them, talking about wanting to die

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