Sudden new communication deficit — new aphasia or a sudden speech change — activate the stroke pathway (a positive BE-FAST); document time last-known-well.

Inability to report distress with a deterioration — a nonverbal resident showing signs of pain, respiratory distress, or a change — assess directly and escalate; do not wait for a verbal report.

Airway-related loss of communication (trach/laryngectomy) with distress — assess the airway and escalate per the Respiratory red flags.

Acute agitation from an unmet, uncommunicated need — assess for pain, toileting, or a change before attributing to behavior.