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An internal skills certification entitled, "The care relationship in situations of impaired communication" has been set up by the Paris hospitals authority (Assistance publique-hôpitaux de Paris). It enables healthcare workers practising in geriatrics to build on the practical experience they have developed. The fruit of an individual introspection helping to formalise the verbal and non-verbal methods they use in their practice, it requires a specific institutional, managerial and personal framework to be put in place.