A Cognitive Communicative Deficit is defined as an impairment in organization/ thought organization, sequencing, attention, memory, planning, problem-solving, and safety awareness. As Skilled Nursing Facilities around the country are treating more medically complex patients, along with these chronic conditions can come cognitive communicative deficits. Speech-Language Pathologists can be a tremendous resource and provide valuable insight into the overall clinical picture of the patient. According to ASHA, some of the most common etiologies related to cognitive communicative deficits include:

  • Alzheimer’s Disease
  • Dementia
  • Brain Tumors
  • Stroke
  • Traumatic Brain Injury (TBI)

The potential consequences of Cognitive Communicative Impairment can be significant.  They include:

  • Reduced awareness/ ability to initiate and effectively communicate needs
  • Reduced awareness of impairment and its degree (i.e., loss of ability to assess one’s own communication effectiveness)
  • Reduced memory, judgment, and ability to initiate and effectively exchange routine information
  • Difficulty performing personal lifestyle management activities effectively (i.e., pay bills)
  • Reduced ability to anticipate potential consequences, with reasonable judgment and problem solving
  • Reduced social communication skills and/or ability to manage emotions, often causing loss of relationships
  • Disruption of ability to fulfill educational or vocational roles, including the potential loss of employment
  • At risk for injury due to inability to communicate in an emergency and/or anticipate the consequences of own actions

Did you know that Speech-Language Therapists are valuable assets in treating Cognitive Communicative Deficits?


  • Are trained to look for CHANGES.  Changes in environment, routine, orientation, or staff can negatively affect the residents’ ability to communicate.
  • Review QUALITATIVE DATA such as nursing documentation for pieces of valuable information related to communication such as family/staff interviews, behaviors, safety during ADLs, Prior Level of Function, and discharge plan
  • Utilize QUANTITATIVE DATA including structured evaluation/screening tools (MMSE, MOCA/ MOCA-B, BCRS, SLUMS, Observation Checklists, etc.)

These tools are used to make informed interpretations/implications in regard to resident function. Organizations that provide Speech Therapy for Skilled Nursing Facilities will need to hone their cognitive therapy skills in anticipation of PDPM.

At the SNF setting consider a referral to speech therapy for changes in:

  • Mood (e.g., increased frustration)
  • Communication ability
  • Ability to participate in ADLs
  • Orientation
  • PO intake

Have any thoughts or questions?  I’d love to hear!  There’s a comment box below.

About the Author: Originally from Everett, Massachusetts, Jaclyn Gregg, MS, CCC-SLP is a graduate of the College of St. Rose Communication Sciences & Disorders Program. Jaclyn, her husband, and her daughter live in Upstate New York.  In her spare time, Jaclyn enjoys hot yoga and spending time with family.