Teepa Snow, an occupational therapist with over 40 years of experience, developed the Positive Approach® to Care (PAC) to transform the dementia caregiving experience. Her core philosophy is that challenging behaviors are not intentional but a result of brain changes, and it is the caregiver's responsibility to adjust their approach. By fostering a deeper understanding of the person's altered reality, PAC aims to create more respectful, dignified, and positive interactions for both the person with dementia and their care partner.
The GEMS® Model: A Shift in Perspective
Instead of viewing dementia as a series of losses, the GEMS® model uses a gemstone analogy to categorize a person's abilities at any given moment. This model emphasizes that individuals are precious and unique, and their cognitive state can shift throughout the day. The goal is to provide a supportive setting that allows each person to shine, just as a gem needs the right setting to be displayed beautifully.
The Six GEMS® States
- Sapphire (True Blue, Healthy Brain): Represents a healthy, flexible, and adaptable mind, able to appreciate multiple perspectives. Individuals in this state can still learn new things, though they may require more time.
- Diamond (Clear and Sharp): Characterized by a strong reliance on routines and rituals. Individuals can be capable and shine with their abilities but may become rigid and self-focused when stressed, reacting strongly to changes.
- Emerald (Green and On the Go): Individuals see themselves as independent and purposeful but have limited awareness of their changing abilities. They live in moments of clarity mixed with loss of logic and reasoning, often wanting to 'go home'.
- Amber (Caught in a Moment of Time): Represents a state where caution is required. Individuals are driven by sensation and instinct, acting on what they want and avoiding what they dislike. They may have limited peripheral vision and strong reactions to their environment.
- Ruby (Deep and Strong): In this stage, a person's obvious cognitive losses can mask their remaining strengths. Individuals still have strong gross motor skills, can move rhythmically to music, and respond to magnified facial expressions but have difficulty with nuanced communication and fine motor skills.
- Pearl (Hidden Within a Shell): Even in the final stages of dementia, the person's innate self remains. Individuals respond best to familiar senses like touch, voices, faces, and smells. They may be non-verbal, and care partners' role is to provide comfort and connection.
Effective Communication and Interaction Techniques
Central to Teepa Snow's approach are practical techniques designed to foster connection and reduce agitation by meeting the person with dementia in their reality.
- Positive Physical Approach™ (PPA): A method for approaching and connecting with someone to create a sense of welcome and safety. It involves approaching from the front, speaking from the side at eye level, using a calm tone, and offering your hand for a Hand-under-Hand™ greeting.
- Hand-under-Hand® (HuH): An evidence-based technique where the care partner's hand is under the person's hand, offering support and guidance. This non-intrusive method allows the person to feel a sense of control and independence while utilizing retained muscle memory.
- Positive Personal Connections (PPC): Involves using a series of phrases to build rapport before attempting a task, prioritizing the relationship over the immediate goal.
- Positive Action Starters (PAS): Utilizes specific phrases to prompt action and reduce refusal when beginning a task.
Comparison of PAC with Traditional Dementia Care
Teepa Snow's Positive Approach to Care (PAC) differs significantly from traditional dementia care models by focusing on empathetic understanding and customized strategies rather than generalized symptom management.
| Feature | Teepa Snow's Positive Approach to Care (PAC) | Traditional Dementia Care Models |
|---|---|---|
| Core Philosophy | Person-centered, focusing on remaining abilities and dignity. | Often disease-focused, emphasizing lost cognitive function and symptoms. |
| Behavior Interpretation | Views challenging behaviors as a result of brain change and unmet needs, not willful opposition. | May label behaviors as problematic, requiring control or restraint. |
| Communication Style | Adaptive, using modified verbal and nonverbal cues, tone, and pacing to match the person's current cognitive state. | May use typical communication that can be confusing or frustrating for the person with dementia. |
| Caregiver's Role | The caregiver, or "care partner," is trained to be the adaptable party, changing their actions to improve interaction. | Caregivers are trained to manage symptoms and enforce routines, with less emphasis on self-adjustment. |
| Assessment Tool | Uses the GEMS® model to identify retained skills and personalize interactions. | Often relies on standardized scales that document loss and progression. |
| Engagement Focus | Promotes active and meaningful engagement through strengths-based activities. | Can lead to isolation or withdrawal by focusing on limitations. |
Conclusion
Teepa Snow's Positive Approach to Care is a transformative philosophy that provides caregivers and professionals with a comprehensive framework for understanding and supporting those living with dementia. By shifting perspective from loss to remaining abilities, using the empathetic GEMS model, and applying practical communication techniques like Hand-under-Hand®, PAC aims to foster authentic connections and reduce distress for everyone involved. This strengths-based and person-centered approach upholds the dignity of individuals with dementia, enabling them to experience moments of joy and purpose throughout their journey. Ultimately, Teepa Snow's work proves that until there is a cure, there is still profoundly meaningful and positive care.
Learn more at Positive Approach to Care.
