Building rapport with a person living with dementia

Building rapport with a person living with dementia

Sarah Reed

June 2023

Without doubt, good interpersonal relationships are essential to everyone’s happiness. We all know people who are able to connect well with others, creating a sense of harmony, affinity and trust in minutes. It might seem like natural ability, but when understood, it can also be nurtured and improved. This is rapport.

Rapport helps us make meaningful and harmonious relationships with people. It’s that sense of connection that you get when you meet someone you like and trust, whose point of view you understand, with a bond that comes from sharing some of each other’s values and priorities in life. This mutual understanding and acceptancebetween someone caring for a person with dementia and the person themselves is a crucial part of well-being.

Rapport with someone means being both focused on and interested in what they are thinking and saying; being friendly, positive, showing care and concern for the other person, feeling ‘in sync’, with some shared common understanding.

Rapport can deliver helpful results, like greater awareness and similar, shared energy levels and more nuanced body language. It can appear instantly, as when you find yourself just ‘clicking’ with someone – or it may build slowly, over time. It can grow naturally, without intent, or it can be quite deliberate and grow through meaningful conversation. And as for the best conversations, it’s surprisingly simple really – nearly all of us enjoy talking about ourselves.

As brain scans show, one reason why we enjoy talking about ourselves so much, is that when we do, the mid-brain regions that deliver dopamine, – the ‘feelgood’ chemical associated with pleasure and reward, light up brightly. In one study, research subjects were even willing to forgo money to disclose their stories, with the rewards of sharing them being enough just in themselves. Honestly, you couldn’t make it up!

Here are some tips for engaging in conversation with a person living with dementia that can create greater rapport. And like all good dementia skills, they still apply to conversations you might have with anyone…

Feeling safe and positive matters.

A person with dementia needs to be able to trust you and know that you are on their side. Don’t patronise them – the person has a life time full of rich experiences. Always accept that their reality is real to them and avoid logic and reasoning, which can prompt arguments.

Sincerity matters.

A lot. Sincerity and rapport are interlinked. A person with dementia can still discern when it’s missing, so it’s important to be authentic and genuine.

Self-awareness matters.

Be observant of the person and of yourself. Having insight into why you feel the things you feel, why you behave in particular ways and how others might see you, is all part of building rapport.

Listening matters.

However difficult to do, it really does! Perhaps more than any other skill, listening actively is the key to rapport, – and therefore all our relationships. Resist the urge to switch off!

Empathy matters.

Empathy is the ability to sense another person’s emotions and to envisage what they might be feeling, showing compassion and understanding (not to be confused with sympathy). 

Body language matters.

It’s good to remember that it is a major part of your communication. Ensure that yours is open and similar to the person you are with. Remember, your face will convey that you are listening – if you turn towards them, with your eyes focused on them, at the same level whenever possible.

Smiling matters.

Smiling decreases cortisol in the body, helps heart health, lowers blood pressure and reduces stress. A simple smile, whether given or received, prompts the brain to produce endorphins and serotonin, the ‘happy hormones’ that trigger positive emotions. There’s nothing like some merriment – sharing things you have in common that are humorous and amusing are a great fast-track for building rapport.

“Tell me about...”

is a wonderful starting point for a conversation to develop rapport. As both a suggestion and an enquiry, “tell me about…” implies curiosity to explore more about the person and their life ­– and promises attentiveness to their answer.

The more you show genuine interest in and appreciation of any person, the more likely they are to relax and open up. If you can tempt them to talk about themselves, you’re making progress. If you can show them that you’re really listening to them, rapport will surely follow.

merriment – sharing things you have in common that are humorous and amusing are a great fast-track for building rapport.

Mapping Stories

Let’s consider drawing as a means of remembering and telling our stories

Sarah Reed

February 2023


All the creative arts can bring solace and reassurance, as well as fun to our lives. Being sharing experiences, for a person living in the midst of the existential loneliness that is dementia, they can be an important part of what makes life worth living.

When enjoying time with a person living with dementia, I always try to make sure I’m sitting alongside rather than opposite them, so that we can observe the world (and do things) together – but still connect with one another in a warm and friendly way. Sitting at, say, a kitchen table together, with a cup of hot tea or coffee offers an atmosphere of conviviality and enjoyment.


Having pencils, crayons and fresh paper to hand can be useful, so that the person can express themselves with writing or drawing if they would like to. There is always much to learn. I might suggest, “let’s draw something together … how about a face… a flower… a house… a tree…” Though I say ‘together’, the drawing is always theirs, my role is merely to admire, enquire, support and occasionally nudge a little. Drawings are helpful because they so often lead to conversations. Many people think that they can’t draw, but in my experience this is rarely true and anyway, it’s about creating participation, not great art. Generally, what’s needed is some sincere encouragement.

Judging anything a person draws is an absolute no-no – the aim is to tempt them to express themselves however they would like to, as freely as they can. That means they need to feel safe and good about themselves. An enthusiastic, upbeat “that’s so interesting / lovely / great!” is almost the only opinion anyone wants to hear.

The (academic) quality of the drawing is entirely irrelevant, what matters is the process, which offers a form of expression that doesn’t require words. This is definitely NOT a competitive activity. Apart from the general enjoyment it offers, if anything, it’s about providing meaningful engagement and pleasure, while helping open windows onto the person’s past and hopefully, building their self-esteem.


I might ask questions about a drawing, like “how did that feel?” or “is that you?… or someone you know? …  tell me about it…”; or, with a nature drawing, “what are your favourite flowers/trees/places?” or “tell me more…”. The point of drawing is to draw the person out  (no pun intended) and give them an opportunity to share an experience of something, someone or somewhere. Their drawing is their drawing, so I’d never invade it, adding nothing but the date as a record.


Some years ago, I met a lady with vascular dementia who had lost much of her language, so communication was a struggle. Intrigued to know about her life, I suggested that she might like to draw a map of her house and street in the south coast town where she had lived. Starting tentatively, with some positive nurturing and admiration, she grew in confidence. A complex and fascinating drawing grew in scale over time to include other roads and familiar landmarks like the park, her school, the church, shops and so on.

These features gave her an opportunity to share stories from her past and gave me an insight into some subtle aspects of her childhood that I could never have known: her love of dancing and her close attachment to her aunt, who taught her. It was wartime and the map included elements of social history: a harbour with naval ships, a big old house billeted for Royal Navy crewmen and wonderful small details, like drawings of apples from her mother’s garden which they shared with the sailors.


The original piece of A4 paper wasn’t large enough for all the details, so we just extended it by taping extra sheets on at random angles as they were needed. Finally, we attached a few early photos as well, creating what became for her, a map of her emotional childhood geography.

As it developed, weekly, over a couple of months, sharing the pleasurable memories boosted her mood, her memories and her sense of self-worth, enriching her relationship with her daughter – and of course, ours, too.


What might your map look like, I wonder…?

How everyday objects can improve quality of life for people with dementia

The Guardian reports on a new training programme in care homes that demonstrates how seemingly mundane tasks, like making a drink or polishing is good for residents’ wellbeing:

Juliet Rix, 14 January 2021

“When you woke this morning the clothes you planned to wear were gone. The shower gel smelt weird – it wasn’t your usual. There was no hairdryer to dry your hair. You wanted to make a hot drink but you had no access to a kettle … How is your day going? How do you feel? Welcome to the lives of many people with dementia living in care homes.”

This, The Guardian reports, is the opening of a new training programme for care home staff developed by Dr Kellyn Lee, chartered psychologist and research fellow in ageing and dementia at the University of Southampton. Called ‘material citizenship’, the programme aims to get staff thinking about the importance of mundane, functional objects to our lives and identities, and how giving their residents agency over these things can significantly improve their wellbeing.

As Rix points out, “some 850,000 people in the UK are living with dementia and about 70% of care home residents have the condition or severe memory problems. So as Charlotte Gilbert, manager of Brendoncare Knightwood, a care community near Eastleigh, Hampshire, which includes the 20-bed Knightwood Court care home says, “anything that delivers a better quality of life to these people without a huge input of resources is very valuable.”

She and the care home’s senior care assistant, Becci Fletcher, were among five staff from Knightwood who participated in the first one-day material citizenship course (moved online due to Covid). They credit the training with improving their practice as well as making them feel good about their work and the difference they can make – a welcome morale boost, mid-pandemic. Crucially, they say, it has “definitely” made life better for people in their care.

“One of our residents really wanted to polish her own room with a particular polish,” says Gilbert. Initially this was seen as unnecessary: the cleaning staff were there to clean. “But now we’ve got her the polish she wanted. She polishes her room and it makes it smell like home.”

“Another resident goes around collecting up all the trays after breakfast,” adds Fletcher. “Before the training we would say, ‘don’t worry, we’ll do that’ but now we let her do it. She enjoys it. She feels she’s looking after people and it gives her more sense of worth.”

Rix reports that Lee first became concerned about the culture in care homes while working in the sector as a 19-year-old student. “It was awful – all these people sitting in chairs waiting for something to happen, or getting agitated and being labelled ‘challenging’.” The idea that ordinary objects might prove a key to improving wellbeing came later through her work as a therapeutic psychologist.

“I had a client who was struggling with her relationship with her mother who was in a care home. One day my client said she had had a really good visit after taking in a flask of tea. She had no idea why the flask made a difference.” Lee suggested it might be because it gave her mother control – she did not have to ask the staff to bring their tea, instead pouring it out herself as she chose.

From this grew Lee’s Phd: qualitative research in two care homes in southern England, which found that residents with dementia often moved in directly from hospital, without a chance to go home and select possessions, writes Rix. They were frequently excluded from the decision-making process and objects were even removed from their rooms without their knowledge or permission. In the risk-averse atmosphere of residential care, says Lee, few residents had access to functional objects, let alone freedom to use them as they wished. She concluded that a better understanding of “material citizenship” could “support a rights-based approach to dementia care by using functional objects as an enabler to balance protection and empowerment”.

With funding from the Economic and Social Research Council’s Impact Acceleration Account, Alzheimer’s Society and Brendoncare, Lee developed the training that has now led to Fletcher and Gilbert putting this into practice: “We have a resident who is very wobbly on her feet, but really wanted to go into the kitchenette and make herself a cup of tea. There was obviously a risk of her spilling boiling water and burning herself, so we had a discussion about it. Now she goes in and puts the tea bag and sugar and milk into the cup. Then we go in and add the boiling water. It’s become part of her routine and she’s really happy with that,” says Gilbert.

“Another lady is very particular about her bed,” Fletcher observes, “She wanted to make it herself but we were afraid she might fall – you can’t hold on to a frame and make a bed. Now we stand with her and do it together”.

“They are such simple things,” says Gilbert, “we don’t usually think about them, but they are part of who we are.” And they have been even more important during the pandemic, she says. Although Knightwood Court, which looks after 20 residents, has had no cases of Covid-19, like all care homes it has had to deal with the loss of visits, outings, and for a while even collective meal times, making “the little things of daily life more important than ever”.

“Material citizenship has given us more of a can-do attitude,” Gilbert continues. “Instead of just thinking about the risks, we think round it. It’s a change of mindset.” This is exactly the change Lee was hoping her project would spark. “Having dementia doesn’t mean you aren’t an individual capable of some decision-making and taking part in aspects of everyday life,” she says, but many care homes are much more restrictive than Knightwood. “If we can start really simply with everyday objects, the hope is that we can build a shift in approach, a culture change across the sector.”

Fletcher and Gilbert are in no doubt of its value, writes Rix and they feel passionately that everybody should have this training. “If you take people’s everyday things away they lose independence and who they are,” they say. It may only mean changing 10 minutes of the day, but it can make a massive difference.”

“Reflection on Lockdown Storytelling Project” Free workshops

"Reflection on Lockdown Storytelling Project"

Free workshops!

This A friendly Zoom get-together for people over 50 where you can learn more about creative writing and story-telling and develop your existing skills.

You can dip into one of the sessions, or join us throughout the month to develop your writing. This interactive workshop will boost your understanding, confidence and ways of telling your stories, supported by a range of strategies, tips and tools.

Age Cymru is gathering the reflections of older people during the Covid19 lockdown and hope that you will be inspired to share your experiences after attending the workshops.

All workshops sessions will be 1.5 hours. Use the Eventbrite links to book your place and you’ll receive the Zoom link 24 hours beforehand.

Register with Eventbrite here 

Good Practice Guide

The Good Practice Guide

Essential advice for ensuring a successful move into a care home

This guide focuses on the practical and emotional issues people often encounter when making the decision to support someone to move into a care home.

It aims to raise awareness of the needs of older carers and the value of engaging them as experts in the care of the person they care for. It also provides insights from care home staff.

This guide will:

• Share some supportive strategies to ensure the best transition possible

• Share real life giving examples of transitions to care homes from older carers

• Raise awareness of the needs of older carers and families who are caring for someone who is moving to a care home

• Hear from care homes about what works well for them, and how they actively support families and older cares

• Share a reflective practice training resource for care home staff.

You can download a copy of the guide here >

You can download a copy of the guide here 

Age UK 'Later Life'

*• One in five people aged 50–64 are carers in the UK
• 65% of older carers (aged 60–94) have long-term health problems or a disability themselves
• 68.8% of older carers say that being a carer has an adverse effect on their mental health
• One third of older carers say they have cancelled treatment or an operation for themselves because of their caring responsibilities

*Source: Age UK

Well I know now

"Well I Know Now"

Pippa Kelly interviews Sarah Reed

Sarah Reed was an award-winning creative producer and single mother of two, when two events shattered her world. 

The first was a brush with death when a burst appendix left her unconscious for nine hours in A & E, followed by a four-day stint in intensive care. Four weeks later her dad called to say that her mum, Mary, had been diagnosed with Alzheimer’s disease.  Sarah describes this as one of the worst days of her life.

Before the diagnosis she and her mum hadn’t been that close; Sarah had left their home in Faversham, Kent for art school at 16, since when her life had been busy, revolving around her demanding film work and bringing up her children.

Over the next decade, as Mary’s dementia progressed, a newfound bond developed between them. “We learnt a new, more grown-up confidence with one another”, says Sarah. “And learnt how to laugh at our shortcomings”. Sarah and her siblings supported their parents as best they could but their father struggled to cope and in 2000 Mary moved into a care home. 

Sarah soon realised that while kindly and well-meaning, the staff had little or no communication training – and her frustration developed into a passion to try to help carers provide better care. Over the course of the next few years, as her dad died and her mum was forced to move care homes, twice, Sarah’s knowledge of dementia grew and with it a belief that staff couldn’t hope to develop a relationship with their charges if they didn’t know anything about them, and in order to find out about them they needed to be able to communicate with them. Sarah decided to act. 

At a personal level she compiled an album of photographs from her mother’s early childhood right through to her years as a great grandmother. When Mary saw the album she glowed with pleasure – although confused by the present, her mum was brought alive by the past.

And thus the idea for Sarah’s award-winning Many Happy Returns Chatterbox Cards was conceived. Painstaking research into not just dementia, but compassion, philosophy and reminiscence therapy, led to cards skilfully designed to prompt conversations with older people. Two thousand cards based around the 1940s were launched in 2008. The sets sold out in three months. Today, some 9,000 sets – of 1940s and ‘50s cards – can be found in care settings, libraries, schools and private homes around the UK. 

Sarah went on to develop interactive communication workshops to help care staff communicate more meaningfully with residents. She believes that “Good communication sits at both the heart and pinnacle of good care”.  

Mary died in 2009, aged 92.  Dementia may have taken her mum from her, but Sarah tells me that it also, in a way, gave back. “Caring for a loved one helps teach you a love you did not know was possible”, she says. “It’s a feeling of understanding, forgiveness and, eventually, closure”. 

 You can also listen to every Well I Know Now podcast by clicking any of the following: AppleiTunes, Acast, Spotify, Google, Podtail or Castbox.


Pippa Kelly

One of the foremost writers of the day on the elderly, social care and health, particularly dementia. Winner of Older People Media Awards 2014.

Hilary Woodhead Tuesday Afternoon Tea with Danuta Lipinska

Hilary Woodhead Tuesday Afternoon Tea with Danuta Lipinska - Sex is an activity too!

In her compassionate book, Dementia, Sex and Wellbeing, our wonderful colleague Danuta Lipinska shows that the human need for intimacy, attachment and sexual expression can be just as important for supporting the wellbeing and personhood of a person with dementia as communication and care. 
She examines the cognitive changes that occur in dementia and what they mean in the context of sexual behaviour and consent. Taking Carl Rogers’ Core Conditions and Tom Kitwood’s psychological needs of persons living with dementia as a starting point, Lipinska offers a unique model for person-centred conversations about sex and sexuality. 
In this fascinating Zoom webinar, she discusses the issues with Hilary Woodhead, Executive Director of NAPA (National Activity Providers Association) over a nice cup of tea. As she says, despite sexuality, sex and intimacy being integral parts of all our identities, they might still be considered to be the Last Taboo in dementia care, so often seen as ‘problem behaviours’ to be stopped and dealt with. Essential viewing for anyone working with people living with dementia.

With thanks to Danuta Lipinska 

About Danuta Lipinska

A passionate specialist in the understanding and care of any older person and those with dementia, successful author, counsellor, supervisor, Action Learning facilitator, trainer and International speaker.

Zoe Harris – Introduces ‘My Future Care Handbook’ in an interview with Sarah Reed

Zoe Harris - Introduces 'My Future Care Handbook' in an interview with Sarah Reed

Zoe Harris has created the My Future Care Handbook. With over 60 pages packed with information, with links to further online resources.

Its the perfect one-stop shop for all things related to later life and beyond, from compiling a bucket list to writing a Will, from creating a music play list to considering how you might want to live and/or be cared for if you need support, and much, much more.

Here’s what some people have said about the Handbook..

“I can’t recommend this strongly enough. Whether for an ageing relative or for your own information, education and action, it cuts through red tape to focus on decisions you might want made on your behalf if/when you can’t.” Neville

 “This is a really great resource. Accessible and simple to follow with some important wins just by working through the book. We loved it.” Philip

“The Handbook is literally a one-stop-shop for anything and everything future care related. What makes this resource particularly useful is how accessible it is. It takes what is a really tough topic and makes it as easy to address as it’s ever going to be.” Beth

With thanks to Zoe Harris

Zoe Harris

Specialist in improving people’s experience of care. Founder/creator, Care Charts UK, Mycarematters and My Future Care Handbook. HSJ Innovator and Nesta Radical 2014.

Queens Court Care Home under lockdown

Queens Court Care Home under lockdown

Interview with Shaaron, 18  May 2020

Shaaron Caratella is our care home specialist advisor to REAL Communication Works.

Originally an RGN nurse in the NHS, she went on to gain a BSc in Nursing Studies, a Diploma in Orthopaedics and an MSc in Health Sciences. Her passion for the good care of older people shines out of her and she has been the Manager of Barchester Queens Court Care Home for 23 years, what she doesn’t know about nursing home care, is hardly worth knowing.

Queens Court locked down early in March and this means that my fortnightly conversation group with residents, which has been going for about a decade, also had to be temporarily suspended. I really miss the lovely residents in my Sarah’s Chats group, but have stayed in touch with them with intermittent postcards from the coast. Reassuringly, one of our group has even taken up occasional correspondence with me!

Last week, Shaaron and I had a phone conversation, as I was keen to hear how she and everyone else is coping. She sounded comparatively cheerful, given the circumstances, which pose so many challenges….

“The staff have been really shell-shocked. We have lost some staff through natural wastage – one of our full-time staff left to work at a different care home early on in the Lockdown. Only the really brave care workers were coming in for about the first month and I was very concerned about the psychological state of the staff – we were all very sad.

‘We had to implement special protocols for infection control from day one’.

And then there are the reports… the endless reports. Everyone wants reports, Public Health England, Merton Council, the CQC, the London Capacity Tracker. Everybody wants it written down, which means a lot of extra work.

The laundry has been really challenging, because nothing can be worn or used more than once without fastidious cleaning, so the washing machines have been very busy and our maintenance man has been living from moment to moment to ensure that everything keeps running. He has never had to work so hard.

Barchester Healthcare has been really good and has really invested in the care staff. They had a strategic plan by mid-March. We do a daily Covid update with all manner of detail, including infection control and deep cleaning, right down to meeting and greeting.

Every Monday, we do a thank you for the care staff that comes straight down from the (Dr) Pete Calveley, ourChief Executive and the reviews have been very useful. There is been a lot of good feelings towards care homes and we have been celebrating the kindness. We are trying to be mutually supportive. There is a huge amount of respect for the staff and a huge amount of responsibility for them, too. But they understand it. They get it. Right from the early days, the staff and residents have been very supportive to each other, even though the first two months were a baptism of fire – it was relentless.

The situation with families has been very challenging. Although they have been able to Skype or phone, the lack of visitors is really a problem in the care area. Of course, their new isolation means that a few of the residents have become quite depressed, but we’re doing our best to keep them connected to their families and to one another. Our good relationship with families has paid off. We are on first name terms with them now in a way that we never were before. There is a huge amount of trust and our team knows that, so we try even harder to be there all the time for our residents.

As far as health matters in the home are concerned, we are proud that the results of Whole Home Testing showed that we are Covid negative. Residents have had some hearing aid issues and some have needed to be seen by the optician – it’s good that our GP visits all dressed in PPE. It’s been very good for the team to use all their skills including hairdressing. Since it’s been warmer, the residents have been socially distancing in the garden and having ice cream and doing a quiz or just taking in the sun.


‘There’s been a lot of kindness and we all laugh and giggle together. Of course, you feel absolutely exhausted at the end of the day, but there’s nothing like a glass of wine to cheer you up’!

Hospitals aren’t discharging residents to some care homes – they are only using contract beds, even in this time of Covid. Of course, hospital staff don’t have time to develop the deeper relationships with the residents the way that we do. Sadly, they can forget – and lack respect for, the great age and needs of these special older people in our small community.

Face Masks and Dementia Care

What is the person saying?

By Sarah Reed 

How facemasks affect how we communicate.  The importance of emotional perception, expression and reciprocity in non-verbal communication is bound to impact the outcome of any doctor/patient or carer/cared-for interactions. 

Studies have demonstrated the impact of doctors’ and carers’ empathy and person-centred care on the enablement and health outcomes for the person in receipt of care with both chronic and acute conditions. In a large randomised controlled trial in 2014, it was found that the “wearing of facemasks by doctors had little effect on patient enablement and satisfaction but had a significant and negative effect on patients’ perceptions of the doctors’ empathy”.

We must hope that eventually, mask makers will recognise that clear panel masks are really the only ones worth using and start manufacturing them. However, in the meantime, the following tips are good for all our interactions with anyone at any time whether they have dementia or not, but are especially important now with the additional social distancing that masks create.

In communication, most of us rely on language – often at the expense of many other types of communication. However, nonverbal communication is just as important as the words we use. During these times of the Covid-19 pandemic, the use of facemasks has become ubiquitous and they present serious communication difficulties which should not be under-estimated, for the wearer and the person they are talking to, alike. 

Lockdown is one thing, but facemasks are prisons that limit the range of our actions and words.

In covering our facial expressions, face masks hide our emotions. For example, pleasure, sadness, frustration, annoyance and fear are all emotions that we show on our faces without ever having to say a word. And unspoken communications tend to be the same across most cultures. Given the increasing use of facemasks, this means of communication is becoming increasingly challenging.

Non-verbal communication is often the most effective element of communication when connecting with a person who has limited or impaired cognition or is living with dementia. People with dementia increasingly lose their ability to communicate verbally, but their body and para-linguistic interpretive skills are retained longer in most conditions and may even be retained right to the end of their life. They are usually able to interpret facial signals correctly and can be skilled interpreters, understanding when we are relaxed or stressed or conveying other subtle messages, making sense of things from the sound and inflection of our voice, our speed of speech, our posture and the way we move around. We know that when people have difficulty understanding, they will fill in the gaps by reading our facial expressions, the sound of our voice and body movements and posture.

Carers who are more alert to nonverbal cues are often well-practiced at reinforcing the other person’s perception of their sincerity, compassion, appreciation, dedication and competence. This improves their relationships with those they care for as well as their colleagues and also increases their ability to provide meaningful care.

Nonverbal communication provides unique opportunities to connect, so it is important to pay greater attention to our nonverbal communication in this time of social distancing and masked faces.

The following tips can impact and improve interactions with older people while wearing masks. Being focused on the challenge of this is key to success.

1. Pause and be mindful. Be self-aware

If things are busy and stressful, try not to let that be reflective in your voice. Make sure there is enough time for any interaction. Taking a moment or two for yourself immediately before an encounter can make a big difference to the experience. Creating a mental ritual to focus your attention before seeing someone, can help. For example, reflecting on the many varieties of communication that older people and their carers encounter in care settings, such as expert-layperson, healthy-sick, independent-dependent, cognitively healthy–cognitively impaired, young-old and family and so on, might be an option.

2. Be Calm. Smile inside – and outside

Show absolute respect. It is essential to approach the person from the front. This will help them to process who you are and what you are saying. Respect the person’s personal space and make sure you speak to them on the same eye level.

Good eye contact is most important. Use your eyes and eyebrows. Let your eyebrows tell the story. Remember to smile! The person may not be able to see your mouth, but they will be able to read the emotion in your eyes which will allow them to feel more comfortable and in control. They are very likely to be able to detect your body language, so remember that any sudden movements can cause distress and make it harder to communicate.

Be straightforward and try to stay calm. Project a positive, calm attitude and avoid any body language that shows frustration, anger or impatience. Try not to interrupt them and give them your full attention. Be flexible and patient.

Don’t just rely on giving information verbally. Using images, gestures, even written words, phone translation/text apps can be helpful. If the person is still able to read, it may be useful to leave any written version of verbal information that you use with them, so that they can refer to it later.

3. Speak clearly

Avoid noisy environments that might overwhelm with additional stimulus. It is useful to remember that 11 million people in the UK have hearing problems or are deaf. There are a number of hearing apps available on the market which can help. Firstly, create a safe space. and maintain your social distancing with a clear path. Ensure that any physical barriers that could block your view or further challenge your voice being heard behind the mask are removed.
Observe first, even if briefly.

Remember to smile! Always ensure that the older person is wearing their glasses or hearing aids. Your tone of voice includes your speed, tempo and pitch which can be as impactful as the words you are speaking.

Slowly communicate one point at a time. Use short, simple sentences and underline your words with appropriate gestures. Make your statement or ask your question and then pause. Keep your voice even, gentle in tone, and moderate your speed of speech. Go slow!

Lip-reading cues that many with hearing disabilities use to compensate will be absent, so make sure you articulate your words clearly without sounding forced, which may be taken as condescension.

Consonants matter! Speak louder if necessary but without raising your voice or its tone, because this might be perceived as aggression. Using NLP (Neuro Linguistic Programming) techniques of mirroring and matching the person’s gestures, vocal tone or mood can be re-assuring for them and help them feel better understood.

The messages we convey might be harder to interpret so we need to develop new habits, ensuring that we underline everything we say with gestures and pantomime. Going slowly with the person will make connection easier.

4. Remember to listen well

Listening is a vital part of communication as well. Making space to listen is very important in any encounter. However, in one randomised trial in 2010 it was found that “64% of the nurse participants had a weak knowledge of verbal communication skills and only 36% had relative knowledge about listening and speaking skills. This is while verbal communication skills are considered as the foundations of communication in everyday life”. your view or further challenge your voice being heard behind the mask are removed.

Observe first, even if briefly.

Remember to smile! Always ensure that the older person is wearing their glasses or hearing aids. Your tone of voice includes your speed, tempo and pitch which can be as impactful as the words you are speaking

5. Remember that our bodies speak as well

It is vital that we think about the ways in which we typically communicate, such as gestures and tone we use when we are not inhibited by distance and PPE. Once we become more aware of our characteristic gestures and body language, it is easier to align our nonverbal signalling with our spoken message.

Body language is vital to deliver meaning well and communicate effectively. Together, hand gestures and posture are very important. Our non-verbal cues should send message of kindness and empathy. Try to relax your shoulders. Remember to avoid crossing your arms in front of your body and keep your hands off your hips and out of your pockets.

It is always helpful to nod and add ‘mm’ and ‘yes’ when appropriate, as it acknowledges that you are listening and understanding.

Happiness can be seen by raised eyebrows, raised cheeks and crow’s feet. Remember to smile! On the other hand, eyebrows pinched together and eyes drooping can indicate sadness and when in a “V” shape can express anger.

The person with cognitive impairment may not recognise you at all in any encounter if you are wearing a facemask, even if they have spent time with you over many months, but we still need to make each connection count. As one wise soul once perceptively observed, “I may not remember what you said, but I will remember how you made me feel.”

Facemasks and perception of empathy

Here is an article from NCBI  – US National Library of Medicine National Institutes of Health. It is regarding a randomised control study that was conducted to explore the effects of doctors wearing facemasks on patients’ perception of doctors’ empathy, patient enablement and patient satisfaction. 

The report can be viewed here and it is titled  ‘Effect of facemasks on empathy and relational continuity: a randomised controlled trial in primary care’


About Sarah Reed

Sarah Reed is the founder and lead at REAL Communication Works.

Sarah lectures in Health departments at Kingston and City Universities. She now works with other highly skilled dementia care learning facilitators to deliver interactive REAL Communication workshops.

She has served on the SUCAB Service User and Carer Advisory Board in the School of Health Sciences at City University since 2017.

She is a Trustee of and thirty-year volunteer co-ordinator and monthly driver for national older people’s charity, Re-Engage (formerly Contact the Elderly). In 2015, she served on NCVO’s Volunteering in Care Homes advisory board. She is a member of the DH Quality Matters board.