Weekly Newsletter

December 6, 2023

“The Positive Approach to Care”  (PAC)

“Until there’s a cure, there’s care” - Teepa Snow

Teepa Snow is an American dementia care specialist and occupational therapist. She is a fellow of the American Occupational Therapy Association. She is a well-known and respected voice in dementia care.

What we can do as caregivers: ”Rewiring our own perceptions, attitudes, communication strategies, actions, and responses, provides the shift that promotes change for the others around us.”

First, a little about Teepa:

Teepa’s experience in neurological impairment care spans both her personal and professional worlds. Early in her life, her grandfather moved into her family’s house due to his changing abilities. However, at the time words such as eccentric then senile were used. Later on, she helped provide support for other family members with various forms of brain change. As a teenager, Teepa started by volunteering with a group in order to work with children with various developmental disabilities. This group included her much younger sister, who had developed an inoperable brain tumor by age three, leaving her with lasting severe developmental issues. By the time she started college at Duke University, Teepa had been a nursing assistant, before there was a certification, and a volunteer in day programs and hospitals near campus.

Second, her beautiful and useful metaphor:

“Many people view the Peacock as a showy bird and one that is preening, but in fact the peacock is a guardian and protector for all within a domain. Peacocks have been used as watchful defenders of what is important for centuries. The peacock at rest looks like nothing special. However, when roused, allows others to see a full array of colors presenting a high profile to help others recognize that causing harm within that space is not permitted.

When it comes to providing support and care for someone who is living with a changing brain, Teepa is firmly committed to helping all see that it is NOT ok to take over, to demand compliance, to ignore dangerous situations, to use habits that are no longer effective, or to allow an agenda to come between those who care for one another. The Positive Approach® feather serves as a symbol of just right care. The beautiful peacock feather is ever-changing in its appearance, just as a brain affected by dementia can change from one instant to the next.”

Five Tips for Dementia Caregivers

1) Step Back:

When an interaction is not going well, you have a choice: you can push your agenda and watch things get worse, or you can step back and think. What’s happening is often more complicated than it appears on the surface. In an effort to be helpful, you may have created a problem. The person who is challenging you is doing the very best they can with what cognitive abilities they have left. Stop judging them.

Learn to be a good detective. Your brain works better than theirs, so use it! Step back and assess their abilities. Know what you are working with. Try to figure out what might be driving the person. Analyze the situation. What are you seeing? What are you hearing? What might be their unmet emotional need? How about their unmet physical need? Why might they be doing what they are doing? What are they trying to communicate? You need to try to see things from their point of view.

2) Respond (Don’t React):

What you thought would happen didn’t happen. The person did not react the way you wanted (or expected) them to. You’re getting frustrated and you’re getting angry. What to do? Stop reacting and stop your behavior of trying to correct them. Stop pointing out errors or mistakes. Stop trying to fix things. Stop raising your voice, and stop pushing your agenda. “Remember, I already told you that!” Do you find yourself repeating that sentence? It’s time to stop! Don’t argue with them.

What will be more helpful is to use the words they have given you. It’s called reflective narrative language and it will support their ability to make connections. Repeat back to them what they have said to you—acknowledge and validate what they are feeling. It is not helpful to focus on who is right or wrong, but it is often helpful to apologize (for whatever happened). Say something like, “I’m sorry this happened,” or, “I’m sorry I upset you, I was trying to help.”

3) Make Plans, but Expect Them to Change:

Create a plan, think it through and get organized. Have a schedule. You know what you want to happen. However, when it doesn’t, you have to be flexible.

If your plan isn’t working, you can’t force it! It’s part of your care agenda. Adjust your plans as needed. It was just a plan! Figure out where to go or what to do instead. Having alternatives ready is necessary and helpful. Create Plan A, but always have a Plan B, Plan C or even Plan D at the ready.

4) Figure out What You Can (and Can’t) Control:

Stop trying to control what you can’t control. This is so important to realize. You can’t control their dementia or their past (who they’ve been or their routines and preferences that may now be exaggerated or problematic). And, you can’t control/fix/change their behavior.

You do have some control, however, over their environment — their physical and sensory experiences. This includes where they are, the objects they use or have access to, and how you guide or help to direct their time. Consider how you can make a difference for both of you.

Pay attention to what helps them feel valued and important, as well as when they relax and regain their energy. Try to prioritize the most important things and what must get done. Know your agenda, but don’t show your agenda. Practice recognizing if/when something doesn’t go as you hoped and managing your response.

You can figure out how to get yourself under control, and you can build your skills and knowledge about how to better live with dementia. Change what you can change and then let go of the rest

5) Take Care of Yourself:

When it’s not working, when something you tried to do didn’t work, or when you’re getting frustrated or angry, you absolutely need to learn to take time out. It’s critical to step away from the situation. Take at least three deep breaths—breathe in and out deeply!

When you are frustrated, angry or in despair, the person you are caring for picks up on and reacts to your stress level and intensity. They may not fully understand what you are feeling or why, but they will be impacted by your tone of voice, body language and emotional state. When you’re angry, you’re no good to them or to yourself.

Breathing deeply will help you get back to neutral, lower your stress level, and help you regain perspective about the situation you are trying to problem solve. Also, don’t hesitate to ask for help. Putting support systems in place for surprising times when living with dementia is critical. Dementia care is hard work!

Understanding Brain Changes

What is happening when someone has dementia? It’s important to understand the job of the brain because it is the guiding system, the maintenance system, and the managing system of the body. Learn more about the role of the limbic system, the prefrontal cortex, the sensory motor strip, and the importance of the occipital lobe for seeing and doing.

It is helpful as a caregiver to understand at some level the brain changes involved in dementia. To understand that it is a progressive disease — and will most likely continue to cause further deterioration based on the disease process. Note there are different forms of dementia and they progress differently and affect different parts and function of the brain.

Here is good website for more information: 

Dementia symptoms and areas of the brain

More support from Teepa Snow:

  • Free 30 minute consultation with one of Teepa’s trained staff members
  • Ongoing consultations with Teepa or her team of consultants
  • Trainings
  • Free newsletter: Subscribe here
  • Third Wednesday of the month: Live on Facebook or YouTube discussions
  • Virtual 5 part support series for “care partners”
  • Free YouTube videos:  Here’s an example

“Empathy and Validation for the Care Partners can benefit from receiving empathy and validation from their circle of friends and family.” 

Upcoming Event: Problem Solving with Teepa and PAC

Dec. 6, 2023 - 4pm PST / 7 pm EST

Event Link

Teepa and the Positive Approach to Care® (PAC) team are offering this free, monthly webcast where you can Ask Teepa Anything about dementia or other brain changes. Dementia Problem Solving (DPS) with Teepa and PAC events are open to anyone curious and interested in exploring more about complex issues. In each session, we focus on three or four cases after an initial consultation occurs. 

Teepa’s Books:  

  1. Understanding The Changing Brain – A Positive Approach to Dementia Care
  2. Dementia Caregiver Guide
  3. Creative Solutions to Challenging Situations Workbook

For more information, visit her website:

Susan Musicant, PT

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