is Learning Module #4. It provides you with key types of verbal prompts to increase
your residents' ADL independence. What if you were living in a world where you
could not fail, and you felt loved and cared about? Would you define that as heaven?
Well, I may be going to an extreme to get your attention and to make a point about
verbal and non-verbal prompts, which will be covered in the next Module. But you
can go a long way to making that "heaven" for your residents by providing them
with an environment of success. This Module deals with six key types of verbal
prompts you can give your ALF resident or tenant to increase and maintain their
Types of Verbal Prompts
what exactly is a prompt, anyway? A prompt is assistance provided
to the resident, a cue, a signal, or a suggestion. You can create
an environment for ADL success by using the right prompts. The
first type of prompt to be discussed is the "choice"
prompt. This assists your resident in making a choice by being
stated in such a way as to maximize his or her independence. There
are three kinds of choice prompts that can assist your resident
in making a choice.
Choice Prompt 1 - Open Ended Questions
first type of prompt is the open ended question, which you would
reserve for your most capable and alert residents. Open ended
questions cannot be answered by yes or no. An open ended question
that prompts your resident to make a choice sounds something like
these questions: "What would you like to wear today?"
"Where would you like me to take you?" "Who was
Notice, open ended questions usually start
with who, what, when, or where. They give the resident no clue
or direction regarding their answer. So, if you have a resident,
Joe, for example, who is becoming the slightest bit forgetful,
he will have to create an answer or say, "I don't know."
However, as you are aware, if Joe has Alzheimer's, he may try
to hide his lack of understanding and create an answer. Now in
the case of dressing, if you use the open ended question by asking,
"What would you like to wear today?" he may end up with
so many layers of clothes on you will think he is going on an
Alaskan vacation. However, for a resident who can make choices,
you are doing them an injustice by limiting their choices and
not asking open ended questions.
Question #1: Open ended questions cannot be answered by what? To
select and enter your answer go to .
do you know whether to ask an open ended question or not with
Joe? You need to observe two areas; Joe's facial expression and
his behavior. In observing Joe's facial expression, note his eyes.
Does Joe look blank or confused when you ask him a who, what,
when, or where type question? Then observe Joe's behavior. Obviously,
if Joe ends up with five layers of clothes on, his choices should
Question #2: How do you know whether to ask an open ended question
or not? You observe what two things about your resident? See above
Choice Prompt 2 - Multiple Choice Questions
second type of choice prompt is the multiple choice question.
Often times in a fast food restaurant, the clerk will use a multiple
choice prompt to get you to buy more. They ask, "Would you
like fries or a drink with your hamburger?" As you can see,
you are offered a choice
are some examples with your residents. "Would you like to wear the red dress
or the blue one today?" "Do you want your hair parted on the left or
right side?" "Did you want more or less water on the cloth to rinse
choice questions are easier for your resident to answer than the
open ended questions because, unlike the open ended prompt, you
are giving them a clue to the answer as part of your question.
Question #3: Why are multiple choice questions easier than
open ended questions to answer? Because you get what in the question? .
Choice Prompt 3 - Yes of No Questions
Joe is still having problems, your third choice prompt is the
yes or no question. You structure your question so that it can
be answered by either yes or no. For example, "Do you want
more toothpaste on your brush?" "Did you want more soap
on the cloth?" "Do you want me to walk more slowly?"
"Would you like some crackers from the store again this week?"
"Did you want me to schedule your beauty shop appointment?"
some tasks lend themselves more readily to open ended questions, some to multiple
choice, and some to yes and no questions. But, it is important that you are aware
that open ended questions such as, "Where do you want me to take you?"
have an infinite number of answers, and may set your less alert resident up to
feel failure and frustrations. Remember, the goal of this section on verbal prompts
is to create an environment that does two things, provides your resident with
feelings of success, and maximizes the use of the ability he or she has.
with a resident like Joe, how can you provide an environment of
success? Look at his reaction. If he seems puzzled, hesitant, fearful, or confused, rephrase your ADL choice from an open ended,
who, what, when, where, type of question, to a multiple choice,
such as, "Do you want to do this or that?"
If your resident
or tenant still seems stumped on what you want them to do, try
making your request a yes or no question. Offering residents in
your Assisted Living Facility (ALF) a choice is crucial to the
dignity of the resident. So give a choice, then watch your resident's
facial expression, eyes, and body movement to see if you need
to rephrase. Open ended? Multiple choice? Or yes and no?
Question #4: Select the answer that numbers the following questions-types
in order from the most difficult to the least difficult. Number
one being the most difficult and number three being the least
open ended_____ multiple choice_____ yes and no_____ See above
Single Word Prompts
type of verbal prompt to increase ADL independence and create
an environment of success is the single word prompt. This single
word prompt can take two forms, both of which have been covered
in previous learning modules. But, because they are prompts this
is a good opportunity for a review.
Single Word Prompt 1 - Instructions
The first form was discussed
in Staff Training Module three on demonstration. You learned about
transferring a resident from a bed to a wheelchair, and the use
of single word instruction prompts, such as, stand, grab chair
arm, turn, and so on. So, to increase ADL independence for one
resident, you need to decide what part of the ADL needs verbal
prompting. For some residents, you may need to do prompting beyond
the word "turn," as they pivot to sit in their wheelchair.
Too many prompts, especially if not needed, can be confusing and
may be degrading to the resident.
Single Word Prompt 2 - Positive Reinforcement
second type of single word prompt was discussed in the first learning module on
positive reinforcement. If you recall, one of the basics from that module was
to give positive reinforcement frequently. Some one word prompts that encourage
are "good, great, good job, terrific" and so on. These single word prompts
go a long way to creating the environment of success, which is our goal.
a word of warning here. If single word instruction prompts are
used with a resident that does not need them for ADL assistance,
they may end up feeling incompetent. Or if your positive reinforcements
or compliments are insincere, they will definitely have a negative
impact on the resident, perhaps making them feel unimportant and
Question #5: Single word prompts are for what? .
The third type
of verbal prompt is used to get your resident's attention. Think
about how you feel right after Thanksgiving dinner, or right before
your head hits the pillow. I bet you may feel out of focus and
have difficulty concentrating. Here's an example of a way to get
your resident's attention.
Sue, Bill, Jane, Kathy, John, Bobbie, Sharon!" What am I doing? Well, let's
say that one of the names you just read was your name. Do you think I would have
gotten your attention? You bet I would have.
point of this exercise is, how do you feel when someone uses your name in a friendly
conversation? Do you feel closer to that person and a little more important? Maybe
you feel even a little better about yourself, sort of like you count.
let's take an opposite example. When you run into an old acquaintance that you
haven't seen for years, they avoid using your name, and you know that they really
don't remember your name. Do you feel just a little sad inside? I think that by
now you know where I am headed for with this personal example.
When doing ADLs,
use your resident's name. Use it often. Also, use the name that your resident
prefers to be called by. If you aren't sure, start off by calling the resident
Mr. or Mrs. or Miss, then their last name, Mr. Smith, Mrs. Jones, or Miss Phillips.
Be sure if you use a nick name like "granny" that it is the definite
preference of the resident. Document this preference in your service or care plan
listen to what a difference the use of your resident's name makes
while doing the ADL of shaving. Incidentally, in this example
I will point out several other techniques which you have learned
from this, and previous modules, for purposes of review. "Bill,
are you ready for your shave?" (sample of a yes or no choice
prompt). "Did you want to put the shaving cream on yourself
this morning, Bill?" (sample of another yes or no choice
prompt). "Good job!" (sample of positive reinforcement).
"Bill, can you puff out your cheek slightly while I shave
your left cheek?" (example of maximizing your residents ADL
involvement). "Good job Bill! Thanks!" (positive reinforcement).
"Did you want to shave your right cheek yourself today, like
you did yesterday, Bill?" (maximize resident ADL involvement).
Maintaining Dignity in Prompts
warning label comes with the use, or should I say misuse, of the
terms "hon, honey, or dear." If you are used to addressing
all others in your life by slipping in two or three "hons,"
you may have a major challenge eliminating this term. However,
with the philosophy of your ALF, to maintain resident dignity,
the use of a familiar term like "hon, honey, or dear"
can be viewed as condescending or a put down. This may place you
in a position superior to your resident and thus be viewed as
a violation of your resident's dignity.
Question #6: A good general rule, to maintain dignity when
addressing a resident for the first time, you should address them
how, until they tell you otherwise? See above
A second verbal
prompting technique to use in getting your resident's attention
is to increase the volume of your voice. Obviously, you need to
be careful with this technique, to make sure that you do not violate
your resident's dignity. However, if a resident seems hesitant
to do an ADL, try repeating a portion of the instruction in a
slightly louder tone, especially if records indicate your resident
has a possible hearing loss.
Also, it's human nature to vary the
volume of your voice depending upon your own mood and energy level.
If it's Monday morning, a cold gray day, and you have a headache,
you might be speaking in a low volume. If your resident looks
at you with a puzzled expression, increase your self awareness
of your own voice volume. You might repeat your instruction more
loudly. However, a warning here is, too loud of a volume will
have a negative effect upon your resident, and may leave them
feeling like they are being spoken down to, like a child.
summary, two ways to get your resident's attention is to use their
name, and to slightly increase the volume of your voice. The use
of one or both of these techniques may be an essential key to
getting your resident to wash her face or comb a portion of his
or her hair independently.
Question #7: Two ways to get your resident's attention are
to do what? .
The next key
type of verbal prompt to use in order to create an environment
of success is to use reminders to orient your resident to time,
place, and person as needed. Since orientation and mental alertness
definitely affect ADL independence, let's first talk about how
easy it is to become disoriented to time and place.
about your residents' lives. For many, Monday is like Saturday, is like Sunday.
They don't have a job. They lose that Monday through Friday, weekend grasp of
reality. So just like your resident's arms and legs need to exercise, so do their
minds. To assist them with the ADL of being oriented to time, place, and person,
use verbal prompts or reminders. If a holiday is coming up, mention it. Also,
occasionally mention the name of your ALF, as well as the city and state in which
it is located.
warning label, so to speak, with Reality Orientation is that you may have some
residents that are slipping from the earlier stages of Alzheimer's into the mid
stages, but they are still an appropriate placement for your ALF. If a resident
honestly believes that he has children to get off to school, and any amount of
correcting is not going to change his mind, a Validation Technique might be used,
if it seems appropriate and of value to your resident.
summary, in speaking to a resident, to help to keep them oriented,
you might mention your name, the name of the facility, the city
in which it is located, the next holiday, the season, and so on.
Question #8: Do you orient all residents to reality? (Yes or
no) See above
Tone of Voice
is the fifth and last verbal prompt to be discussed. There are
two areas to be covered here. First, if you sound supportive,
empathetic, and warm with a low tone to your voice, there is a
greater chance that the resident will trust you and perhaps risk
trying to do an additional portion of their ADLs which they had
warning label here is, if you have a bad day, make it a habit
to listen to and be aware of the tone of voice you use. It may
have a dramatic effect on your resident's ADL independence.
Question #9: To encourage maximum ADL independence, your voice
ideally should have what three qualities? See above
3 Types of Baby-Talk
area regarding voice tone is the topic of the baby talk. What
is it? And, how can it be avoided? For some staff, it may be all
too easy to fall into using baby talk unconsciously, especially
if you have small children at home. If you do not have a clear
awareness of what constitutes baby talk, you may slip into using
it unintentionally. To heighten your awareness of this type of
inappropriate speech, here are three characteristics that distinguish
baby talk from normal adult communication.
In one type of baby talk, the speaker draws out certain letter sounds
like, "F-i-i-i-i-ne job Mary-y-y, " rather than, "Fine
job, Mary." The words are exactly the same, but the meaning
and character of the talk is totally different, with little dignity
found in the first example.
A second type of baby talk is the exaggerated up and down voice tone or modulation.
There is a roller coaster voice tone change, "Good ^ job using^ that cane,
Henry^," rather than, "Good job using that cane great, Henry!"
A third type of baby talk is one that uses over emphasizing, or speaking certain
words more loudly. Here's an example, "Let me SHOW you HOW to transfer from
your BED to your WHEELchair," rather than, "Let me show you how to transfer
from your bed to your wheelchair."
warning label is obvious. Know what baby talk is, recognize it,
and eliminate it totally from your work environment. If you have
small children and are unsure whether you slip unconsciously into
using baby talk, ask another staff member. Then, listen to yourself.
Question #10: What are the three types of baby talk to be avoided? .
is a summary of the key concepts in this Module. The five key
types of verbal prompts taught are:
1. Choice prompts. Evaluate the most effective use of open ended,
multiple choice, or yes and no ADL questions.
2. Use singe word prompts as a tool for frequent positive reinforcement,
and ADL task reminders, such as when transferring say, "turn,
3. Attention getting verbal prompts used to increase ADL individual
can include the use of your resident's name, and increasing voice
4. Use frequent verbal prompts to orient the resident to time,
place, and person when appropriate for the resident's mental ability.
5. Regarding voice tone, have a voice that conveys caring and
warmth. Recognize, and avoid the use of baby talk.
these verbal prompts are combined with the nonverbal prompts instructed in the
next module, number five, you are going a long way to create an environment of
ADL success for your resident.
need to follow through to do and get what is necessary to make
this information work for you. Have verbal prompts become a tool
that you use with your residents daily. Remember, take action!
In learning module five, you will learn about nonverbal prompts
to increase ADL independence.
Peer-Reviewed Journal Article References:
Barnett, M. R., Jowett Hirst, E. S., & Boydston, P. S. (2020). A comparison of simple versus elaborative verbal prompts on acquisition of picture associations. Behavior Analysis: Research and Practice, 20(1), 24–35.
Bordne, S., Rietz, C., Schulz, R.-J., & Zank, S. (2020). Behavioral and emotional quality of life of patients undergoing inpatient geriatric rehabilitation. Rehabilitation Psychology, 65(3), 299–310.
Harris, J. A., Kwok, D. W. S., & Gottlieb, D. A. (2019). The partial reinforcement extinction effect depends on learning about nonreinforced trials rather than reinforcement rate. Journal of Experimental Psychology: Animal Learning and Cognition, 45(4), 485–501.
Yin, S., Zhu, X., He, R., Li, R., & Li, J. (2015). Spontaneous activity in the precuneus predicts individual differences in verbal fluency in cognitively normal elderly. Neuropsychology, 29(6), 961–970.