The Positive Approach to Care: An Interview with Teepa Snow

As part of its two-year educational collaborative, “Changing the Lens on Dementia,” Hospice of the Western Reserve’s clinical teams are participating in a web-based educational series called the Positive Approach® to Care (PAC).
Developed by Teepa Snow, MS, OTR/L, FOTA, the innovative skills and training place the person living with dementia in a pivotal role as a partner in their care. Clinical Connections interviewed Teepa Snow to learn more about the some of the key tenets of the program.

Q: How does your Positive Approach to Care methodology shift the focus of care from the task to the relationship?
A: The techniques and strategies in Positive Approach to Care (PAC) seek a connection and permission as a critical part of offering support and care. The human being dwelling inside the body and the brain is still present and must be included in all that is done in the name of care. The person is changing and will continue to change as the condition advances. These changes alter the brain’s and body’s ability to take in, process, and react or respond to what is happening, but do not consistently make the person insensate. We should never assume the person is unable to feel, see, hear or experience what is happening. It is highly probable that he or she is simply unable to figure things out or use accurate words or polite behaviors to express preferences, needs or emotions.

Q: How do you view the role of professional healthcare providers?
A: When it comes to dementia care, our goal is to offer care and support that help each person live life as well as possible. We must provide a safety net that is acceptable and care that is respectful and involves the person as a full partner, not a recipient.
We have a responsibility to provide input or data to help the person “get it.” By adapting our own communication skills and techniques, we provide options for the person to consider. We can better assess their willingness to allow us into their space, time and situation. Establishing a friendly, familiar, functional and forgiving connection encourages the person to attempt, and then complete, tasks with less distress and more participation.

Q: How does this approach change the care partner’s behavior rather than the behavior of the person living with dementia?
A: One of my key messages is: “Do with, not to, people living with dementia.” My teaching focuses on increasing the care partner’s awareness about dementia, knowledge about the symptoms and impact of dementia on the brain and on the behavior of the person living with the condition. When someone is living with dementia, it is more important than ever to determine what is okay with the them and what is not. Specific skills and tools help guide and direct behavior into better actions and responses. By forming new synaptic patterns and pathways of firing, the care partner is able to implement the new behaviors into routines and habits that reduce distress for all concerned and support the person living with dementia.

Care provision is like learning to dance with a partner. As their brain abilities vary second by second and over time, we must constantly adjust and adapt so that we are in sync and working together to get what is needed completed. Dementia does ultimately rob the person of abilities. As care partners, we do not have to participate in the theft.

Q: What does joy looks like for someone living with dementia at the end of life?
A: The response may be large or quite small, it may last through an entire visit or only for a brief moment. It could be a hand grasping yours, eyes looking clearly at you, or a huge smile. Whatever it is, it signals, “I am here, and I like something or someone.” It also is a gift that is one of the absolutely best in the world. It is a thank you for being with me and for loving me home.

Teepa Snow, MS, OTR/L, FOTA, is a leading advocate for those living with dementia. Her career spans a variety of settings, including Duke University Medical Center’s Neuro-Rehabilitation Team, University of North Carolina at Chapel Hill’s Geriatric clinic, OT director in a head injury facility and clinical specialist in Geriatrics for a Veteran’s Administration Medical Center. She founded Positive Approach® to Care (PAC) to provide dementia care training, services and products for professionals and families.