Renee Kinder

EDITOR’S NOTE: The author is offering special webinars today and Wednesday to help providers and families at this challenging time.

We have all seen the videos of families at the epicenter of the skilled nursing facility COVID-19 outbreak.

They are absolutely heart-wrenching.

Loved ones looking through windows, trying to remain in contact with their family, while dealing with the painful but necessary limitations on visitors.

These initial reports were too soon followed by recommendations from numerous state governments and healthcare organizations regarding the need to limit outside contact in SNFs to protect the safety and well-being of the elderly. 

With all these recommendations, I have struggled with the fact that for some, this period of quarantine will be one of loneliness, placing an already vulnerable population at risk for increased depression and social isolation. 

Furthermore, I have seen recommendations that families have been advised to communicate via phone, FaceTime, Skype, and other various modes of communication. 

Did anyone really have time to prepare or teach a family’s loved one how to use these modes of communication? 

Did we assess what was needed regarding the sensory environment including acoustics and visual field?

What about the needed fine motor skills or cognitive abilities needed to dial, type, or comprehend interactions which are not 1:1 and face to face.

Distance communication can never serve as a replacement for true human contact. We miss significant cues, including body language, eye contact, touch and changes in vocal inflection and tone. Let’s face it: It’s just not the same.

With that said, the necessary precautions are in place for a reason, which is why I am here today to provide some pointers on what I am calling the “televisit”.

First, set a schedule and stick to it.

If you are a family coping with reduced visitation, it will decrease anxiety and a loved one’s anxiety if there is a set and expected time to communicate daily. Additionally, if the loved one experiences any form of memory loss, having a written cue in a visual place regarding daily schedule will be helpful and reduce repetitive questions to the caregivers. 

Second, consider the auditory environment. Presbycusis, age-related hearing loss, is the gradual loss of hearing in both ears and is a common problem linked to aging impacting 1 in 3 adults over age 65.

Presbycusis often affects the ability to hear high-pitched noises such as a phone ringing or beeping of a microwave. Therefore, consider if a resident can even hear the ring and set the volume accordingly for success. 

As high-pitch tones can be difficult to hear, keep an even vocal tone during calls, no elderspeak allowed! 

Don’t compete with the external environment. All communicators should limit any background sound present from a radio, television, or general facility noise.

Third, ask care teams to assist with implementing strategies for promoting the visual field. 

This can include encouraging use of glasses, lighting in the room, and when using any form of a visual or written cue ensuring the font and contrast promote understanding of the message.

Fourth, if you have time to prepare, practice any high-tech options prior to use from a distance. There is nothing worse than being ill-prepared for technology breakdowns and unexpected complexities that may evolve adding to an already pressured communication environment. 

I mean, these things stress me out, and I have spent many a day in web-based meeting platforms. 

Who hasn’t been in the presenting side of a webinar that goes sideways? Audio drops, the screen won’t “share” … talk about stressful!

What would I propose instead?

In the age of new and high-tech options also consider written notes and letters to your family. 


It will give them something to hold onto, something to reflect upon, and for those with memory loss, it will provide them with meaningful messaging to reference between phone or video chats. 

Consider letters with a daily theme: our family vacations, the crazy grandchildren, home-cooked meals we all love. Letters can flow like a natural conversation, so consider, if I were in the facility today, what would we talk or reminisce about? You can use these ideas for letter themes. 

Additionally, topics tied to long term memories should be considered for those with short-term memory loss. 

In closing, I hope you have found some meaningful tips in the piece. The limited visits and reduced personal time with loved ones in SNFs are likely only going to get worse before it gets better.

Keep lines of communication open, remain engaged at a person’s best level, and find each family’s best way for the televisit!

Renee Kinder, MS, CCC-SLP, RAC-CT, is Vice President of Clinical Services for Broad River Rehab and a 2019 APEX Award of Excellence winner in the Writing–Regular Departments & Columns category. Additionally, she serves as Gerontology Professional Development Manager for the American Speech Language Hearing Association’s (ASHA) gerontology special interest group, is a member of the University of Kentucky College of Medicine community faculty, and is an advisor to the American Medical Association’s Relative Value Update Committee (RUC) Health Care Professionals Advisory Committee (HCPAC).