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Communicate With Seniors and People With Disabilities

Research has shown that people with disabilities have less access to health care services and therefore experience unmet health care needs. This section offers resources to help health care providers (1) be more aware of limitations of seniors and people with disabilities; and (2) know how to communicate with seniors and people with disabilities. Materials are made available by the Harris Family Center for Disability and Health Policy at Western University of Health Sciences.

General tips on interacting with seniors and people with disabilities

A disability may be present from birth, or occur during a person's lifetime. A disability may be physical, cognitive, mental, sensory, emotional, developmental or some combination of these.

Below are general tips to communicate with seniors and people with disabilities.

  • Focus on the person, not on the disability.
  • Offer people with a disability the same dignity, consideration, respect, and rights you expect for yourself.
  • If you don't know what to do, allow the person to help put you at ease.
  • Do not be afraid to make a mistake. Relax.
  • Do not patronize people by patting them on the head or shoulder.
  • Treat adults as adults. Address people with disabilities by their first names only when extending the same familiarity to all others present.
  • Do not assume that a person with a disability needs assistance.
  • Ask before acting. If you offer assistance, wait until the offer is accepted. Then wait for or ask for instructions.
  • Respect the person's right to indicate the kind of help needed.
  • Do not be offended if your help is not accepted. Many people do not need help.
  • Insisting on helping a person is the same as taking control away from them.
  • If the person with a disability is accompanied by a friend or family member, look at and speak directly to the person with the disability rather than to or through the other person.
  • Do not assume that a person with a disability is more fragile than others. These feelings may make you reluctant to ask certain questions that should be asked.
  • If service counters are too high for some users, such as people of short stature and people using wheelchairs, step around counters to provide service.
  • Know the location of accessible routes including parking spaces, rest rooms, drinking fountains, dressing rooms, and telephones.
  • Understanding disability access issues and responding accurately, quickly and respectfully to requests for information, directions or assistance conveys true welcome.
  • Watch for and remove these common barriers:
    • Vehicles blocking ramps
    • Housekeeping and cleaning carts blocking hallways and restroom
    • Potted plants, benches, ashtrays, trash cans and other items blocking access to ramps, railings and elevator call buttons
    • Parking personnel using an accessible parking space as waiting areas
    • Snow and ice on walkways, ramps and parking areas

Ettiquette tips when providing services for seniors and people with disabilities

Interacting with People with Visual Disabilities

Having visual disabilities may mean a person has no vision or low vision, or requires large print.

  • When offering help, identify yourself and gently touch the person's arm.
  • When serving as a guide, ask "Would you like to take my left (or right) arm?"
  • Speak directly facing the person, and speak in a natural tone.
  • Avoid pointing when giving directions. Be specific on directions such as "the restroom stall is about 7 steps in front of you."
  • When leading a person through a narrow space, put your arm that the person is holding onto behind your back as a signal for the person to walk directly behind you. Give verbal instructions as "We will be walking through a narrow row of chairs."

Interacting with People with Cognitive, Intellectual or Psychiatric Disabilities

A cognitive, intellectual, or psychiatric disability can affect a person's understanding, memory, language, judgment, learning and related information processing and communication functions.

  • Offer information in a clear, concise, concrete, and simple manner.
  • Use common words and short simple sentences. Try to limit sentences to one idea per sentence.
  • A slow response or lack of response does not necessarily mean the person is not aware of you or what you said. Allow time for people to process your words, to respond slowly and to respond in their own way.
  • When offering help, wait until your offer is accepted before doing anything.
  • Don't assume all people can read or read at all. Use simple pictures or drawings to show instructions.

Interacting with People with Physical Disabilities

Mobility and physical disabilities can be mild or can cause significant limitations. Physical disabilities can limit movement, strength, and endurance.

  • Avoid leaning or holding onto the person's wheelchair. Leaning onto a person's wheelchair is similar to leaning onto a person.
  • When pushing people using a wheelchair, let them know that you are ready to push. Avoid sudden turns or speed changes and carefully watch for changes in levels and pavement cracks.
  • Ask for permission before moving someone's cane, crutches, walker, or wheelchair.
  • When giving directions, be specific about distance and barriers such as steps, stairs, ramp, and construction areas.
  • People with limited hand use or who use prostheses can usually shake hands. If people have no arms, lightly touch their shoulder.

Interacting with People with Hearing Disabilities

Hearing loss falls along a continuum, from people who are totally deaf to many more who are hard of hearing and may or may not use a variety of sound amplification devices. Sometimes an individual's ability to speak is also affected.

  • Ask people how they prefer to communicate.
  • To get the attention of a person, lightly touch the individual or wave your hand.
  • Look directly at the person and speak clearly, slowly and expressively to establish if the person can read your lips. Not all people can lip-read. For those who do, be sensitive to their needs by positioning yourself facing them and the light source.
  • Keep your hands and food away from your mouth when speaking.
  • Avoid chewing gum and smoking while speaking.
  • Use a normal tone of voice unless you are asked to raise your voice. Shouting or exaggerating your words will be of no help.
  • Slow your speaking rate if you tend to be a rapid speaker.
  • Make sure you have good light on your face.
  • Do not run your words together.
  • Avoid complex and long sentences.
  • Pause between sentences to make sure you are understood.
  • If you are giving specific information such as time, place, addresses, or phone numbers, it is good practice to have the information repeated back to you.
  • If you cannot understand what is said, ask people to repeat it or write it down. Do not act as if you understand unless you do.

Interacting with People with Speech Disabilities

There are people whose speech is difficult to understand. There are also people who are unable to speak so others can understand them. People unable to communicate using natural speech may use a variety of methods that allow them to communicate. Some (not all) people with limited speech also have difficulty understanding what people say to them because of their disability, age, a hearing loss, cognitive difficulties and/or language differences.

  • Do not raise your voice. People with speech disabilities can hear you.
  • Give individuals your full attention and take time to listen carefully.
  • Always repeat what the person tells you to confirm that you understood.
  • Ask questions one at a time.
  • Give individuals extra time to respond.
  • Take time to understand the message when a person is using a communication device such as a letter, a word board or a device that produces speech.
  • Pay attention to pointing, gestures, nods, sounds, eye gaze and eye blinks.
  • Do not interrupt or finish individuals' sentences. If you have trouble understanding a person's speech do not be afraid to ask them to repeat what they are saying, even three or four times. It is better for them to know that you do not understand than to make an error.
  • If you still cannot communicate, try using paper and pen or ask them to spell the message. Do not guess.
  • Teach and ask them the following commands
    • "Show me how you say YES." Yes = move your left hand.
    • "Show me how you say NO." No = move your right hand.
    • "I don't know." = blink one time.
    • "Please repeat." = blink two times.
    • "I don't understand." = blink three times.

Video trainings for directors and managers in medical, customer service, and grievance and appeals

Language tips and preferred terms

Language Best Practices

  • Choose disability terms that describe diversity in accurate and respectful ways.
  • Disability-specific language should be precise, objective, and neutral in order to avoid reinforcing negative values, biases and stereotypes.
  • Avoid referring to people by their disability i.e., "an epileptic." A person is not a condition. Rather, they are "people with epilepsy" or people with disabilities.
  • People are not "bound" or "confined" to wheelchairs. Wheelchairs are used to increase mobility and enhance freedom. It is more accurate to say, "wheelchair user" or "person who uses a wheelchair."
  • It is not necessary to avoid these expressions when around people who are blind:
    • "Did you see that game?"
    • "See you later."
  • Or around people who are deaf:
    • "Did you hear about John?"
  • Or around people who use wheelchairs:
    • "Let's walk to the store."
    • "Run over to the dorm to pick it up."

Examples of Preferred Terms Regarding People wtih Disabilities

Acceptable - Neutral* Unacceptable - Offensive
He had polio
She has multiple sclerosis
He was afflicted with, stricken with, suffers from, victim of polio, multiple sclerosis, etc.
He has arthritis He is arthritic
She has cerebral palsy She is cerebral palsied, spastic
A person who has had a disability since birth
A congenital disability
Birth defect
A person who uses a wheelchair
A wheelchair user
Confined to a wheelchair/wheelchair bound
A person who has a speech disability
A person who is hard of hearing
A person who is deaf
Dumb, deaf mute, dummy (implies an intellectual disability occurs with a hearing loss or a speech disability)
A person who has a spinal curvature A hunchback or a humpback
He has an emotional disability
He has a psychiatric disability
He is chronically mentally ill, a nut, crazy, idiot, imbecile, moron
People of short stature Midgets, dwarfs
A person who has a speech disability Mute
A person without a disability as compared to a person with a disability Normal person, whole person, healthy person, able-bodied person as compared to a disabled person
She lives with a disability Overcame her disability
A person who has a developmental disability or intellectual disability Retard, retardate, mentally retarded, feebleminded, idiot
Use only when a person is actually ill Sick
Use only when a person is actively being seen or treated by a health care provider Stroke patient, multiple sclerosis patient
Seizure Fit
Older people with disabilities Frail

* Always subject to change and continuing debate

Other words to avoid because they are negative, reinforce stereotypes and evoke pity include:

Abnormal
Invalid
Misshapen
Burden
Lame
Spaz
Disfigured
Maimed
Burden
Unfortunate

Exerpted from: Kailes, J., Language is More Than a Trivial Concern, Edition 10, 2010: KAILES - Publications, Revised 1984-2010. http://www.jik.com

Ettiquette for augmentative and alternative communication (AAC)

Communicating using an augmentative and alternative communication (AAC) system is often significantly slower than communicating through natural speech. This significant difference in rate can alter the basic flow of conversations. The gaps of silence or pauses in the conversation that occur as the communicator who is using AAC composes their messages can feel very awkward and this provides more opportunity for others to be unintentionally impolite. It can therefore be helpful to keep a few tips in mind about how you can politely accommodate this difference in your interactions with people who use AAC. As you look at this list of conversational tips, you might realize that these tips relate to being polite when talking with anyone, but they are particularly helpful to keep in mind when talking with someone who communicates slowly using AAC.

Conversational Foul #1

Never talk about someone who is present during a conversation. Talk to them.

Conversational Foul #2

Don't "hog" the conversation. Be sure to provide adequate time for others to respond, even if it means giving extra pauses and time for them to take their conversational turn.

Conversational Foul #3

Don't fire quick questions at people during conversations and avoid presenting bunches of questions that can be answered just by "yes" or "no". Give people time to answer your question and consider using openā€ended questions.

Conversational Foul #4

Always check with people before you start finishing their sentences and guessing about what they are going to say. Though these strategies may be well intended, some people just don't like it and it can get the conversation off track if you guess wrong.

Conversational Foul #5

Be honest. Let people know when you don't understand what they were trying to communicate. You might think you are being nice by just nodding your head politely, but it is really disrespectful. It suggests that what the person is communicating is not important and it also does not lead to finding out what they were really trying to say.

Conversational Foul #6

Don't make assumptions and judgments about others based on appearances. Avoid talking "down" to others or talking unnecessarily loudly. Not everyone who has a speech impairment or who is in a wheelchair has problems hearing or understanding what you are saying.

Conversational Foul #7

Always respect the personal space of others. Keep in mind that items such as wheelchairs and trays, AAC devices, and other adaptations are part of the personal space of people who use them. It is always polite to check in with people prior to touching or even assisting with their wheelchairs, AAC devices, etc.

Conversational Foul #8

People who use AAC often must plan ahead for situations where there is a lot to communicate in a short time frame, such as giving a presentation during a staff meeting. Fortunately, today's AAC devices offer the option of preparing messages needed in advance of situations. With that in mind, it is extremely helpful for people who use AAC devices to know as far in advance as possible what topics, questions, or other communication expectations are coming up, allowing them to be as prepared as possible for these situations. Any time you are a good listener in a conversation, you are demonstrating respect and confirming that what others are communicating is important to you. Patient, respectful listening is never more important than when you are talking with someone who uses an AAC system. Hopefully these tips and strategies will help you avoid being a conversational klutz!