Visual-Verbal-Touch Cuing and Why It’s Important

Teepa Snow’s team at Positive Approach to Care emphasizes the importance of visual, verbal, and touch cuing to communicate effectively with someone living with dementia. As someone progresses through the disease, we need to adjust our approach in an effort to “join their world”. Here are some helpful tips for how to do exactly that!

Diamond (Clear, Sharp, and Rigid – Early Stage Dementia)

Overall Approach: Respect autonomy, provide choices, and avoid being overly directive. They may resist help and want things “their way.”

• Visual Cues:
  • Maintain eye level contact and good lighting so they can see your face clearly.
  • Offer written reminders (calendar, post-its) and visual choices (e.g., hold up two shirts).
  • Use a calm, open body posture to signal collaboration, not control.
• Verbal Cues:
  • Use respectful, adult language — avoid “elderspeak.”
  • Provide clear, brief explanations (“We’re going to your doctor appointment at 2 PM.”).
  • Validate emotions before redirecting (“I hear you don’t want to take your pills — can we do it after breakfast?”).
• Touch Cues:
  • Light, respectful touches (on the hand or forearm) after asking permission.
  • Handshakes, pats on the shoulder, or supportive arm-in-arm when walking.
  • Avoid startling them — always approach from the front.

Emerald (Green, On the Go – Moderate Stage Dementia)

Overall Approach: Provide guidance and structure, as they may get lost in time or place and resist care due to fear or misunderstanding.

• Visual Cues:
  • Approach from the front, enter their visual field slowly.
  • Use gestures to demonstrate (“Like this!”) when giving instructions.
  • Offer fewer choices (just two options at a time).
• Verbal Cues:
  • Speak slowly, use short sentences (“Let’s eat lunch now.”).
  • Pair words with action (“Here’s your shirt” while holding it up).
  • Use reassurance phrases (“You’re safe,” “I’ll stay with you”).
• Touch Cues:
  • Use the Hand-under-Hand™ technique to invite participation.
  • Gentle guiding touch to initiate movement (e.g., toward the bathroom).
  • Pair touch with visual/verbal cue to prevent surprise.

Amber (Caught in a Moment – Mid to Late Stage Dementia)

Overall Approach: Meet sensory needs, keep interactions simple, and reduce overstimulation. Focus on comfort and safety.

• Visual Cues:
  • Present objects one at a time, within their visual field.
  • Use bright colors to attract attention to items they need (e.g., utensils).
  • Minimize background clutter and movement to reduce distraction.
• Verbal Cues:
  • Use rhythmic, soothing tones — fewer words, more melody.
  • Avoid complex questions; use yes/no or this/that choices.
  • Narrate actions gently (“Warm washcloth on your face now”).
• Touch Cues:
  • Use slow, firm, reassuring touch — not too light (can startle).
  • Offer comfort with gentle hand-holding, shoulder rubs.
  • Guide movements by starting the action with your own body (they may mirror you).

Ruby (Deep and Strong – Late Stage Dementia)

Overall Approach: Support mobility and comfort; communication is mostly sensory and rhythm-based.

• Visual Cues:
  • Position yourself in their line of sight — come close enough for them to focus.
  • Use facial expressions and exaggerated, slow gestures.
  • Keep environment simple and well-lit to prevent visual misinterpretation.
• Verbal Cues:
  • Speak slowly and warmly, use familiar phrases or songs.
  • Pair words with rhythm (singing, chanting) to encourage engagement.
  • Avoid correcting — go along with their reality to reduce stress.
• Touch Cues:
  • Maintain constant contact when providing care — it helps them stay calm.
  • Use hand-under-hand to stabilize and reassure.
  • Offer gentle massage or pressure to reduce stiffness.

Pearl (Hidden Within – End of Life Stage)

Overall Approach: Prioritize comfort, dignity, and sensory connection. Communication is primarily through touch and presence.

• Visual Cues:
  • Keep lighting soft and gentle; maintain a calm visual environment.
  • Your facial expressions matter most — convey warmth and safety.
  • Slow, smooth movements so they can track you visually.
• Verbal Cues:
  • Speak in soft, soothing tones even if they cannot respond.
  • Use familiar prayers, songs, or comforting sounds.
  • Narrate gently what you are doing to maintain connection.
• Touch Cues:
  • Gentle, consistent touch — hold hands, stroke arm slowly.
  • Use warm hands; cold touch can startle.
  • Prioritize comfort touch over task touch — the goal is connection, not correction.