Communication in a care home

Also called Residential care and communication, Care home AAC

What good communication support looks like in a care home, and the questions to ask before you choose one.

What it is

A care home is where communication support either becomes part of daily life or disappears. The person is there all day, every day, with staff who change, and everything from breakfast to bedtime depends on whether those staff can understand them and be understood.

Good homes treat communication as care. Poor ones treat it as a therapy that happens elsewhere, and the person's world shrinks to whatever can be pointed at.

Who it can help

Anyone moving into residential or nursing care who uses AAC, signs, or has speech that is hard to follow, and the family choosing the home. That includes older people whose communication is changing with dementia or hearing loss, not only people with lifelong needs.

It is not only about high-tech devices. Most of what matters in a home is staff behaviour: waiting, offering choices, knowing the person's signs.

How it works

The Care Quality Commission inspects every registered home in England, and its standards require providers to communicate with people in ways they understand and to involve them in decisions. The Accessible Information Standard applies to homes providing NHS-funded care, and the Care Act's wellbeing principle covers the rest. See communication in care standards.

In a well-run home, communication needs are in the care plan and in the handover, not only in a therapist's report. There is a communication passport in the person's room. Staff have had basic training in the person's method, whether that is Makaton, a paper board or an eye-gaze device. Somebody is named as responsible for charging and maintaining any aid, see daily care of a device.

Speech and language therapy for care home residents comes through the community NHS team and is usually short. The home's job is to keep doing what the therapist set up after the therapist has gone.

Getting started

Before choosing, visit and ask five questions. How would you find out how my relative communicates? Who would keep the device charged? Show me a resident's care plan communication section (with names removed). What training have staff had? How do you know what somebody who cannot speak wants for lunch? Watch how staff talk to residents while you wait; that tells you more than the answers.

If the person is already in a home, ask this week for the communication section of the care plan and read it. If it is thin, write a one-page profile yourself and ask for it to be added. See communication needs in the care plan.

Ask for the home to request a community speech and language therapy assessment if there has never been one. Any home can make that referral.

Where to get help

The Care Quality Commission publishes inspection reports for every home and takes concerns. Age UK advises on choosing a home. SCIE publishes practical guidance for care staff on communication. Mencap supports families of adults with a learning disability in supported living and residential care. Your council's adult social care team can review a placement if communication needs are not being met.