Caring for older adults: everyday skills

• Choice and safety: when a resident wants to take a risk
• Communication: hearing, sight, memory and language
• Culture, faith and identity: respecting who residents are
• Dignity: privacy, respect and the words we use
• Families: partners in care, even when it’s hard
• New residents: helping someone settle in
• Person-centred care: the person first, the tasks second

• Residents’ mood & behaviour: hurtful words, agitation, sudden confusion, depression and loneliness
• Looking after yourself in care work: boundaries, compassion fatigue, moral distress, shifts and support at work
• When a resident dies: your grief, saying goodbye, rituals and supporting families

• Caring for someone with dementia: the basics, plus guides on behaviour, daily care and later stages
• Elder abuse & financial exploitation: signs and how to report
• Healthcare workers: pressures, moral injury and shift work across health care
• Independence & care in later life: written for older adults and families
• Serious illness & end of life: hospice, palliative care and dying

Knowing that a resident was a teacher, a farmer, a soldier or a mother of six gives you things to talk about, clues about what comforts them, and respect for who they are.

Ask about

• Daily routines they have had for decades
• Music, food, faith and hobbies they love
• What they are proud of
• What upsets them, and what helps
• Work, family and where they grew up

In U.S. nursing homes, residents have the right to make their own schedule, choose their activities, and decide when they go to bed, get up and eat.

Everyday choices

• “Shall I help, or would you like to try first?”
• “Shower now or after breakfast?”
• “Would you like the blue sweater or the red one?”
• “Would you like to sit by the window or near the TV?”

When time is short, it is tempting to do everything for a resident. But doing too much can take away skills, confidence and pride.

• Ask for their help: folding towels, setting the table, watering plants
• Hand them the washcloth and let them wash their face
• Let them choose and button their own shirt, with help if needed

• Ask the family about favourite photos, a blanket or a chair
• Keep their morning routine as close to home as you can
• Learn their favourite drink and how they take it
• Put things where they can see and reach them

• Introduce them to a resident with something in common
• Invite them to one activity, and walk with them there
• Tell them your name each time, and who will be on next shift
• Show them the call bell, the toilet and the dining room more than once

Short, regular check-ins show you care and help you notice if someone is not settling. Changes in eating, sleep or mood are worth passing on to the nurse.

• Ask before touching, and tell them where you will touch
• Close doors and curtains, and keep the person covered as much as possible
• Explain what you are about to do before you do it
• Knock and wait before entering
• Respect any preference about the gender of the carer, where you can

“Elderspeak” is the sing-song, simplified way some people talk to older adults, like “Are we ready for our bath, sweetie?” A review found older adults generally feel patronized by it, and see the speaker as less respectful. Exaggerated tone can even make speech harder to understand.

In people living with dementia, elderspeak also makes resistance to care more likely.

Instead

• Say “you”, not “we”, when you mean them
• Skip “honey”, “dear” and “sweetie” unless they ask for it
• Use a normal adult tone, a little slower and clearer if needed
• Use the name they prefer, like “Mr. Johnson” or “Bea”

Talking over a resident’s head to a coworker or relative, as if they weren’t there, is one of the most common ways dignity slips. It tells them they don’t count.

• Keep personal or work chat for outside their room
• Never discuss one resident in front of another
• Turn to the resident first, even if they can’t answer fully

• Wants a late night: agree a check-in time and leave a light on
• Wants to walk alone: plan a route with rails, good shoes and a call bell
• Wants a favourite food: ask the nurse or kitchen about a safer version
• Wants to go outside: arrange a buddy, a coat and a set time

If a resident may not be able to understand a decision, for example because of advanced dementia, that is for the care team and their chosen decision-maker to work through together.

• Check hearing aids are in, clean and switched on
• Face the person in good light, so they can see your mouth and expressions
• If something isn’t understood, say it a different way, or write it down
• Speak a little slower and clearer, without shouting
• Turn off the TV or move somewhere quieter

• Describe what you are doing before you touch them
• Keep belongings in the same places, and tell them if anything moves
• Keep glasses clean and within reach
• Say your name as you come in, and say when you are leaving
• Use good lighting and strong colour contrast, like a dark plate on a light tablecloth

• Allow time to answer, and don’t rush to fill silence
• Get their attention first, using their name
• Give one step at a time
• Go along with their reality where it does no harm, rather than arguing
• Use gestures and show objects as well as words

U.S. national standards for culturally and linguistically appropriate care say language help should be free and timely, and that untrained people and children should not be used as interpreters.

• Ask about faith objects and handle them with care
• Ask about prayer times and help create quiet space
• Ask about wishes for faith leaders and rituals near the end of life
• Help residents get to services, or join them online
• Respect food rules, fasting and holy days

• Ask about modesty and the gender of carers for personal care
• Ask who in the family makes decisions, and what the resident wants
• Find out about favourite foods from home
• Learn how to say their name correctly
• Mark holidays and festivals that matter to them

A review found LGBTQ+ older adults often fear discrimination in long-term care, which leads many to hide their identities. Experts recommend staff training, inclusive forms and policies, and not assuming anyone is straight or cisgender.

• Ask “Who is important in your life?” rather than “Are you married?”
• Challenge jokes or gossip about residents’ identities
• Treat partners and chosen family as family
• Use the names and pronouns people ask for

Many families feel guilty about moving a loved one into care, even when it was the right choice. Watching a parent decline is grief. When families criticize small things, it is often because they feel helpless about the big things.

1. Choose a private place and a time when you won’t be rushed.
2. Start by asking what worries them most, and listen.
3. Share what you have seen, with facts and kindness.
4. Be honest about what you can and can’t answer. Bring in the nurse, manager or social worker for medical or big decisions.
5. Agree on a next step and when they will hear back.

• Keep personal phone numbers and social media private
• Share information only in line with your workplace’s privacy rules and the resident’s wishes
• You can say: “I want to help. That’s a question for the nurse, and I’ll ask her to call you.”
• You don’t have to accept shouting or insults. Say calmly that you will get your supervisor

If families raise serious concerns that aren’t resolved, every U.S. state has a free Long-Term Care Ombudsman program that helps with problems in nursing homes and assisted living.

• Ask families what they would like you to know about their loved one
• Invite them to bring photos or music from home
• Share small good news: “Your dad sang along at music today”
• Tell them who to contact, and when, if they have questions

Sudden confusion, a big change in behaviour, or talk of not wanting to live needs to go to the nurse at once. The “Residents’ mood & behaviour: for care staff” guide explains what to look for and what to say.

If you believe a resident is being abused or neglected, report it through your workplace process straight away. The Elder abuse & financial exploitation guide explains signs and reporting.

The Long-Term Care Ombudsman program works to resolve complaints made by or for residents, in every state.

The Eldercare Locator is a free public service that connects older adults and families to local services. Call 1-800-677-1116 or visit eldercare.acl.gov.

The Looking after yourself in care work guide covers burnout, boundaries and support at work. After a resident’s death, see the “When a resident dies: grief for care staff” guide.