An assistive communication device of the type on which a user can compose a message to be spoken by the device, using an input device to select items on a display to construct the message, can operate in a mode suitable for visually impaired and/or inexperienced users by aurally stepping through the available choices, explaining to the user the consequences of selecting each choice. The order in which choices are presented in these modes may differ from a mode in which they would be presented to an experienced or fully-sighted user. Even for an experienced user, the order in which choices are highlighted on the display may differ according the user's usage history. The device may be connected to external communications, including a telephone line, a data network for electronic mail, or a caregiver alert device. The caregiver alert device may be portable, or may be a caregivers' station console.