The first word to enter the scale is "no" and it is usually said within ACL 1.8. Because it is the only word spoken, the person may not mean no. When asked about their comfort / discomfort or likes / dislikes they always say no. When this problem is discovered, staff members in residential facilities share their awareness of the "no to everything" problem quickly. The usual procedure is to ignore the word and appreciate the effort to communicate.
When family and friends are involved, the visitor books are useful. It will become part of your job to keep a flow of communication going in the visitor books if they are to be useful. Simply handing them out will do no good whatsoever. A major change in orientation to visitors is required to make use of their engagement with their loved ones. In many instances, the people who enable the use of affirmative activities, are visitors and they are your best source of feedback.