Choosing Respect

Teepa Snow’s Positive Approach to Care better serves people living with dementia

When Teepa Snow was a little girl, her grandfather, who was living with dementia, came to stay with her family. That experience planted a seed of empathy and respect that has informed her 40-year calling as a care provision partner. 

Snow began working in health care as an occupational therapist doing hands-on, clinical therapy with people living with neurological impairment, including dementia, brain injuries or strokes.

The North Carolina native went on to become a teacher, consultant and researcher with programs such as the University of North Carolina at Chapel Hill’s School of Medicine’s Program on Aging.  

Through her work, she recognized that people with dementia were not being well-served — care approaches were more controlling than caring and were dictated more by deficit than by asset. The emphasis was on compliance, rather than conversation.

Snow became committed to changing the culture and practice of dementia care. Since the mid-2000s, she has travelled the world promoting a framework of practice that helps loved ones and professionals serve people with dementia in a more respectful way. It is called Positive Approach to Care (PAC). 

“We don’t have a cure for this thing [dementia],” she says. “But there are better ways to manage it. With the right environment, expectation, cueing, timing and support, you can get a very different outcome.”

PAC is a humanistic and inclusive way to engage people who are compromised by cognitive decline. It emphasizes relationships based on authenticity, empowerment, compassion and curiosity. PAC works with people in the strength of the moment and focuses on what capacities they have retained, instead of those they have lost. 

For example, people living with dementia often have challenges processing verbal information and finding the right words. Discussions can be fraught with confrontation and frustration. So, if they are struggling with conveying a message, Snow suggests saying, “You want something? Tell me more about it.” That message offers encouragement, fosters a partnership between the two parties and moves the conversation forward. Snow suggests continuing with, “Is it something to eat or something else?” etc. 

All questions should be accompanied by physical demonstrations (showing the individual an apple, pretending to put on a sweater) that provide context. “Vision intake is often better preserved than auditory processing,” Snow says. 

PAC trainees (typically care facility staff and spouses or care partners) report less stress and more positive well-being when they adopt PAC practices. They often have “a-ha” moments when they learn that behaviour is related to the brain malfunctioning. “They can separate the person from the dementia,” says Snow. Care facilities report fewer incidences of client distress and fewer transfers to hospital. 

PAC celebrates individuals living with dementia every step of the way. 

“It is your life and we are trying to help you live it,” says Snow. “PAC is not a strategy where you are doing something to someone. If you are not doing something with someone, you’d better be asking, ‘Why not?’” [ ]