The COVID-19 pandemic profoundly disrupted healthcare delivery, forcing providers to rapidly adapt communication practices-especially when working with older adult populations. In geriatric care settings, the need for infection control led to strict protocols such as social distancing, mask mandates, and visitation restrictions [1,2]. While these measures were vital in limiting viral transmission, they also worsened pre-existing conditions like memory loss and physical decline among older patients [3,4] and significantly altered the way care teams interacted with patients and families.

In addition to physical barriers, emotional and psychosocial concerns such as loneliness and social isolation (SI) grew more pronounced. Prior research has shown that SI and loneliness can significantly affect older adults’ health and well-being [5,6]. The pandemic intensified these risks by eliminating in-person interactions and reducing supplemental care from family members and volunteers. Healthcare workers, particularly in long-term care, experienced increased emotional burden and burnout as they tried to meet residents' psychosocial needs under unprecedented constraints [7,8].

Despite widespread agreement on the health implications of SI, studies show that many healthcare providers rarely engage their patients in conversations about loneliness or isolation. For example, [9] found that providers exhibited low communication levels and only moderate comfort when screening older adults for loneliness and social isolation, suggesting that more systematic training and support are needed. Similarly, [10] emphasized the need to equip providers with tools and validated instruments to screen for SI early in the care process.

Effective communication is essential to person-centered care and positive provider-patient relationships [11,12]. However, the shift to virtual modalities during the pandemic disrupted these relationships and posed unique challenges for older adults, who often face digital literacy, sensory, or cognitive barriers. While most studies have centered on patient outcomes and institutional infection control, few have directly examined how these changes in communication affected provider satisfaction-particularly in geriatric care [13-15]. Moreover, providers in nursing homes and aging care settings often struggled to balance infection control with the emotional and social needs of their patients [16].

This study employed a cross-sectional mixed-methods survey to examine healthcare providers’ experiences with communication before and during the COVID-19 pandemic. The target population included healthcare professionals working with older adults in healthcare and long-term care settings. A total of 59 providers completed the online survey.

Survey Design and Measures

The survey consisted of both quantitative and qualitative items. Quantitative questions included multiple-choice and Likert-scale formats assessing communication methods (e.g., in-office, phone, virtual, email, or mixed modes) used before and during the pandemic, as well as provider satisfaction with patient communication. Satisfaction was measured using a 5-point Likert scale ranging from "very dissatisfied" to "very satisfied." Additional items collected demographic and professional background data, including discipline and care setting.

Two key open-ended questions explored provider perspectives on communication changes and improvement strategies:

• In what ways has communication with patients changed since the development of COVID-19 and social distancing recommendations?
• What recommendations do you have to increase the effectiveness of communication and interactions between healthcare providers and patients during the COVID-19 pandemic?

Participants who completed the survey received a small gift card incentive.

Data Analysis

Descriptive statistics were used to summarize demographic characteristics and communication patterns. Open-ended responses were analyzed using thematic analysis, a widely used qualitative method for identifying, analyzing, and interpreting patterns within data [17]. Thematic analysis followed an inductive approach: initial coding was conducted independently by the principal investigator and her research assistant, followed by identification of recurrent themes through iterative review. Themes were refined and grouped to represent shared provider experiences and suggested strategies related to virtual communication.

Data were collected anonymously using an online survey platform, and all procedures were approved by the university's Institutional Review Board (IRB).

Sample Characteristics

The study included healthcare providers with an average age of 46 years, most of whom were female (70%) and white (67%). Respondents had an average of 17 years of clinical experience and represented diverse disciplines: occupational, physical, or speech therapy (35%), nursing (28%), medicine (17%), healthcare administration (11%), social work (7%), and others (2%).

Shifts in Communication Practices

Before the COVID-19 pandemic, provider communication with older adults primarily occurred through in-office visits (41%), phone calls (10%), or a combination of methods (32%). Provider satisfaction with these communication practices was high, with 52% reporting being very satisfied and 39% satisfied.

During the pandemic, over 70% of providers reported increasing their use of telemedicine and virtual platforms, while in-person visits dropped to 27%. Use of phones (15%), email (5%), and mixed methods (44%) also rose. However, satisfaction declined: fewer than 25% of providers remained very satisfied, and 58% were satisfied, indicating a notable reduction in high satisfaction levels.

Four key themes emerged from analysis of open-ended responses: (1) Barriers to In-Person Communication, (2) Trust and Relationships in Care, (3) Challenges in Addressing Sensitive Topics, and (4) Technology Limitations in Virtual Care.

Barriers to In-Person Communication

Providers consistently reported that personal protective equipment (PPE), especially masks, significantly hindered in-person communication. This barrier was particularly challenging for patients with hearing loss, anxiety, or cognitive impairment.

“In-person communication is hindered by the requirement to wear PPE. Patients with anxiety or hearing difficulty have trouble with the masks.”

“Definitely wearing masks has been a communication barrier, being unable to see your patient’s facial expressions and vice versa... especially when communicating with dementia/patients with cognitive disorders and those hard of hearing.”

The muffling effect of PPE on speech, combined with the loss of visual facial cues, complicated understanding. Providers adapted by speaking more slowly or clearly, and using gestures when possible:

“Needs to pronounce the words clearly to communicate, and at times with visual cues.”

Trust and Relationships in Care

Despite pandemic constraints, long-standing relationships helped maintain communication quality. Familiarity and emotional safety were emphasized as critical for effective interaction.

“I am close to most of my residents so speaking to them is easy for me. In fact, I have known a lot of my residents for 10 or more years.”

“Having a relationship with the patient. Having a calm atmosphere and place where the patient can speak freely.”

When virtual care replaced in-person visits, providers expressed concern about rapport building, especially with new patients. Many continued seeing patients in person for non-urgent concerns, despite public health guidance.

“We tried to encourage patients not to come to in-person visits; however, we continue to see many patients that have come for non-emergent issues that could have otherwise been taken care of over the phone or virtually.”

“Make sure that patients are using telemedicine when needed, but to also trust that we have a safe environment for them to come to face to face.”

Challenges in Addressing Sensitive Topics

Providers expressed difficulty initiating and managing discussions about sensitive emotional or psychosocial topics, particularly in virtual settings:

“Lack of training, and general uneasiness with personal questions.”

“Lack of ways to help manage the sensitive topics.”

Cultural sensitivity was an additional challenge. Providers emphasized the importance of adapting communication styles to meet patients “where they are,” especially when generational or religious beliefs differed.

“You need to understand what the patient believes and be at their level. This can be difficult if it's different from your own beliefs.”

“Sometimes the older generations do not feel comfortable showing any emotion or weakness. To be sensitive to cultural and religious differences, I try to let the patient educate me on their customs and beliefs and take it from there.”

Technology Limitations in Virtual Care

Although providers appreciated telemedicine’s value, many noted persistent challenges for older patients, including hearing loss, visual impairments, and lack of familiarity with digital tools. Audio and video quality issues hindered emotional expression and accurate communication.

Several providers also highlighted the increased communication load during the pandemic due to reduced family or caregiver support:

“Health care provider involved more due to less support from others.”

Some suggested using simpler technologies like the telephone or employing visual aids to assist communication through PPE, rather than removing PPE altogether.

Provider Recommendations

Respondents emphasized the importance of communication skills, clinical experience, and patient rapport in navigating communication challenges. Many highlighted that trust-building and sensitivity to patients' emotional comfort levels were essential, especially in the context of virtual care.

This study examined healthcare providers’ experiences communicating with older adults before and during the COVID-19 pandemic, revealing shifts in satisfaction, care delivery methods, and emerging communication challenges. Quantitative data showed increased reliance on telehealth and multimodal communication, while qualitative responses illuminated frustrations with PPE, technological limitations, and the erosion of interpersonal connection. These findings reflect the multifaceted challenges providers’ face, particularly when navigating communication in constrained or technology-mediated contexts.

Telemedicine: Opportunity with Caution

Telemedicine emerged as both a vital tool and a source of strain during the pandemic. While it increased access and flexibility-particularly for addressing isolation and depression among older adults [15] - providers also described significant usability barriers. These included poor audio/video quality, patient difficulties due to cognitive or sensory impairments, and challenges in building rapport through a screen. Such concerns align with broader literature on digital exclusion among older adults [4].

Similarly, [10] found that providers reported only moderate comfort with virtual screening for social isolation and emphasized the need for age-appropriate telehealth design. These findings reinforce the importance of improving platform usability, training providers in virtual communication strategies, and supporting patients with low digital literacy.

While telemedicine holds long-term promise-such as reducing transportation barriers, offering language services, and enhancing care continuity for isolated individuals-its limitations for geriatric populations remain significant. Until systems are better tailored to older users, providers often shoulder the burden of technical troubleshooting, compounding emotional and workload stress [8]. Future research should explore how different virtual modalities can best support aging-in-community goals, particularly among those with cognitive decline or limited technology access.

Clinical Communication Competencies in Geriatric Care

A central theme emerging from the qualitative data was the significance of provider expertise and interpersonal communication skills in sustaining care quality, particularly in virtual contexts. Respondents consistently emphasized the importance of trust-building, cultural sensitivity, and the value of established patient-provider relationships. These findings are consistent with [18], who identified communication competence as foundational to building trust in clinical interactions.

Moreover, the challenges of addressing sensitive topics-such as grief, isolation, and patients’ cultural or religious values-were amplified during technology-mediated care. Providers reported uncertainty and a lack of formal training in managing such issues through virtual modalities, where nonverbal cues are often diminished. In diverse aging communities, these challenges underscore the need for culturally competent communication frameworks supported by institutional training and reflective practice [3].

Emotional Labor and Provider Strain

The findings also highlight the increased emotional labor reported by providers, exacerbated by pandemic-related constraints such as limited family involvement and reliance on digital platforms. These burdens reflect a broader trend of occupational stress among geriatric care staff, as noted in prior research on burnout and workforce strain during COVID-19 [13,8].

This study aligns with [9], who found that while nearly 60% of providers supported regular screening for loneliness and social isolation (SI), actual communication about these issues remained low. The disconnect between intent and practice suggests that emotional and systemic barriers may inhibit provider engagement in such conversations [10]. Further emphasized providers' moderate comfort levels with loneliness screening, reinforcing the need for targeted communication training and workflow integration to support these efforts.

Notably, fewer than one-quarter of respondents in the current study reported high satisfaction with patient communication during the pandemic, particularly under constraints imposed by personal protective equipment (PPE) and technological limitations. These results call attention to the influence of communication modalities on provider satisfaction, confidence, and the likelihood of addressing sensitive psychosocial concerns. As healthcare increasingly incorporates virtual modalities, systematic efforts to enhance provider capacity for empathetic, culturally sensitive virtual communication are warranted.

Implications for Aging in Community

These findings contribute to ongoing efforts to support older adults in aging within their communities by emphasizing the importance of sustained, meaningful communication with healthcare providers. Whether in-person or virtual, such interactions play a vital role in promoting emotional security and continuity of care, particularly for individuals experiencing social isolation.

The expansion of telehealth offers opportunities to rethink care models-potentially reducing unnecessary visits while creating more frequent touch points for preventive and emotional support. However, to realize these benefits equitably, healthcare systems must invest in provider training, digital infrastructure, and access to technology, particularly in underserved settings.

Importantly, the decline in provider satisfaction reported during the pandemic underscores the need to design communication systems that also support provider well-being. Building on [9,10] findings of low communication and moderate comfort levels in addressing loneliness and isolation, this study reinforces the call for structural interventions that bolster provider confidence and reduce barriers to sensitive communication. Future research should further explore how communication workflows and tools can mitigate emotional labor, enhance staff retention, and strengthen relational continuity in community-based aging care.

This study underscores the dual challenges and opportunities in provider communication with older adults during the COVID-19 pandemic. While PPE and distancing protocols hindered face-to-face interactions, they also accelerated the uptake of telemedicine, revealing its potential to extend care into patients’ homes and communities.

However, the current limitations of telemedicine-especially for geriatric populations-highlight the need for improved design, training, and support to ensure accessibility and effectiveness. Provider experience and interpersonal skills were central to trust-building and sensitive conversations, emphasizing the need for ongoing investment in workforce training, emotional support, and cultural competence.

As healthcare systems continue to evolve toward hybrid and community-based models, effective and compassionate communication remains foundational to aging in place. Strengthening both technological infrastructure and provider capacity will be critical to achieving equitable, high-quality care in the post-pandemic landscape.

The author gratefully acknowledges Adam Reres for research assistance and preliminary analyses conducted during the early stages of this project.

1. Dosa D, Jump RL, LaPlante K, Gravenstein S. Long-term care facilities and the coronavirus epidemic: practical guidelines for a population at highest risk. J American Medical Directors Association. 2020; 21: 569-571.
2. Watts T, Tucker M, Gray C, Lee K, Modina K, Gray Z. Lessons learned in preventing COVID-19 within a skilled nursing facility during the early pandemic. Geriatric Nursing. 2021; 42: 1388-1396.
3. Garibaldi PM, Ferreira NN, Moraes GR, Moura JC, Esposito DL, Volpe GJ, et al. Efficacy of COVID-19 outbreak management in a skilled nursing facility based on serial testing for early detection and control. Braz J Infect Dis. 2021; 25.
4. Paananen J, Rannikko J, Harju M, Pirhonen J. The impact of Covid-19-related distancing on the well-being of nursing home residents and their family members: a qualitative study. International journal of nursing studies advances. 2021; 3: 100031.
5. Holt-Lunstad J, Smith TB, Baker M, Harris T, Stephenson D. Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspectives on Psychological Science. 2015; 10: 227-237.
6. Valtorta NK, Kanaan M, Gilbody S, Ronzi S, Hanratty B. Loneliness and social isolation as risk factors for coronary heart disease and stroke: Systematic review and meta-analysis of longitudinal observational studies. Heart. 2016; 102: 1009-1016.
7. Levere M, Rowan P, Wysocki A. The adverse effects of the COVID-19 pandemic on nursing home resident well-being. J American Medical Directors Association. 2021; 22: 948-954.
8. Low LF, Hinsliff-Smith K, Sinha S, Stall NM, Verbeek H, Siette J, et al. Safe visiting at care homes during COVID-19: A review of international guidelines and emerging practices during the COVID-19 pandemic. Int J Geriatric Psychiatry. 2021; 36: 1825-1835.
9. Hou S-I. Navigating social isolation screening: Exploring healthcare provider comfort factors. Innovation in Aging. 2024a; 8: 208.
10. Hou S-I. Loneliness and social isolation-To screen or not? Providers’ communications and comfort ability. Global J Aging & Geriatric Research. 2024b; 3.
11. Afriyie D. Effective communication between nurses and patients: An evolutionary concept analysis. British J Community Nursing. 2020; 25: 438-444.
12. Levinson W, Lesser CS, Epstein RM. Developing physician communication skills for patient-centered care. Health Affairs. 2010; 29: 1310-1318.
13. Van der Roest HG, Prins M, van der Velden C, Steinmetz S, Stolte E, van Tilburg TG, et al. The impact of COVID-19 measures on well-being of older long-term care facility residents in the Netherlands. J American Medical Directors Association. 2020; 21: 1569-1570.
14. McGarry BE, Grabowski DC, Barnett ML. Severe staffing and personal protective equipment shortages faced by nursing homes during the COVID-19 pandemic. Health Affairs. 2020; 39: 1812-1821.
15. Giri S, Chenn LM, Romero-Ortuno R. Nursing homes during the COVID-19 pandemic: A scoping review of challenges and responses. European Geriatric Medicine. 2021; 12: 1127-1136.
16. Gaur S, Dumyati G, Nace DA, Jump RLP. Unprecedented solutions for extraordinary times: Helping long-term care settings deal with the COVID-19 pandemic. Infection Control & Hospital Epidemiology. 2020; 41: 729-730.
17. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006; 3: 77-101.
18. Ozaras G, Abaan S. Investigation of the trust status of the nurse–patient relationship. Nursing ethics. 2018; 25: 628-639.