Private Duty

Review documentation to ensure it’s written in understandable language

Ensure caregivers speak to clients in a way that clients can comprehend and that any documentation your agency provides is understandable as well. A huge percentage of U.S. adults have some form of literacy issue, notes Misty Kevech, project coordinator for the Home Health Quality Improvement (HHQI) National Campaign. And clients who are 65 years old and older in the United States are likelier to only have basic literacy skills.

Without engaging clients and truly communicating information to them, agencies will achieve worse outcomes, contends Salim Bhinderwala, CEO and owner of T.O.N.E. Home Health Services in Royal Oak, Mich. Changes agencies can make are simple, but many agencies don’t purposefully take the time to consider health literacy, Kevech says.

Steps to improve all documentation

Write to a fifth- or sixth-grade level. That’s the average grade level agencies should write to, though some areas of the country might have even lower average grade levels, Kevech says. Ensure your documentation uses common one- to two-syllable words if possible.

There are several free tools available for agencies to assess reading level. Consider the Flesch-Kincaid Grade Level (U.S. school grade levels); Flesch- Kincaid Reading Ease; and the Simple Measures of Gobbledygook (SMOG) Index, Kevech says. Find the tools at

Avoid the use of medical jargon that might confuse clients. Among the words Kevech and her colleague Cindy Sun mentioned during an ElevatingHome webinar about health literacy: diagnosis; immunization; diabetes; recognize; annually; eliminate; medication; and examine. Examples of how to avoid the wording: Instead of annually, say every year; and instead of eliminate, say get rid of. Bhinderwala also contends that instead of saying lower extremity, agencies might want to say legs or feet.

Kevech adds that instead of writing 50th percent, agencies should use the word half. “It is confusing, and [patients] gloss over those types of words,” Kevech says. “Half is very meaningful to them.” Consider having your family members or other caregivers review general documentation you plan to provide all clients, Bhinderwala says.

Take a deep dive into your fonts. Don’t use small fonts. While literature states that font size should be 12 to 14, Kevech contends that 12 is too small and ideally agencies should use font size 14. As for which font to use, Kevech recommends agencies select a few different font options and ask a handful of clients which font they prefer.

 Font treatment is also important. Use bold type to emphasize information as needed — but don’t overuse bold because then nothing looks important. Limit your use of italics, underlining and all caps because it makes information harder for some people to read, Kevech says.

Consider how you organize content. Having white space on the page is good for the eyes — clients will be able to see the content more appropriately, Kevech says. Also consider providing content in chunks. Use bullets instead of sentences if possible. “You’re going to lose the reader — even after the first paragraph,” Kevech says. “Get the most important message there first.”

Subtitles or headers help organize things for clients when they’re reading. You also could provide information in boxes or sections. And you could circle or highlight important information.

Consider the color of words and pages you provide. Black letters on light colored paper is best because it makes the words stand out, Kevech says.

Punctuation is important. Use a period to show the end of thoughts.

Pictures can be helpful to accompany text, but more so if the pictures are meaningful to the client. Pictures should be culturally appropriate to your clients and resemble people like them. For example, an elderly, weak client in a wheelchair might not identify with a photograph of a younger person holding weights.

— Josh Poltilove (