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Positive Approach to Care (PAC): A Practical Guide to Teepa Snow's Philosophy, Training, and Resources

Positive Approach to Care (PAC), created by dementia care expert Teepa Snow, is a compassionate, skill-based philosophy that shifts how we understand and respond to brain change. Instead of focusing on what's lost, PAC emphasizes what remains possible and how caregivers can adapt their own approach to reduce distress and build connection. This article walks you through the core ideas, the specific techniques like Hand-Under-Hand, and the training and community resources PAC offers so you can start using these strategies today.

Key points

  • Positive Approach to Care (PAC) is a practical, skill-based philosophy created by Teepa Snow that focuses on adapting the caregiver's approach to match the person's current brain abilities.
  • The Hand-Under-Hand technique is a simple but powerful way to provide physical support without triggering a defensive reaction—practice it until it becomes automatic.
  • The GEMs model (Sapphire through Pearl) helps you understand your loved one's stage of brain change and tailor your care tasks and communication accordingly.
  • PAC offers free resources including a YouTube channel, a podcast (Dementia Care Partners Podcast), downloadable guides, and a directory of PAC Designated Communities for facility care.
  • Small daily practices—like the Five Appreciations and Five Dissatisfactions—build caregiver awareness and resilience over time.
  • The PAC philosophy is not about being positive in a fake way; it's about being effective, compassionate, and realistic about what you can change: your own approach.

What Is Positive Approach to Care?

Positive Approach to Care (PAC) is not about pretending everything is fine or ignoring the hard parts of dementia. Instead, it's a practical framework developed by Teepa Snow, a registered occupational therapist with decades of experience. The core idea is that brain change—whether from Alzheimer's, Lewy body, vascular dementia, or another condition—alters a person's abilities, perceptions, and behaviors. But the person themselves is still there, and the caregiver's job is to learn new ways to connect, communicate, and provide care that work with the brain's current state, not against it.

PAC teaches that most 'problem behaviors' are actually expressions of unmet needs, discomfort, or confusion. When a person with dementia becomes agitated, resists care, or repeats the same question, it's not intentional misbehavior—it's their brain trying to make sense of a world that no longer makes sense to them. The caregiver's approach—tone of voice, body language, pace, and the words we choose—can either escalate or calm the situation. PAC gives you specific tools to become a more effective, less stressed care partner.

The philosophy rests on small, everyday moments. As Teepa Snow says, each interaction is an opportunity to make a positive difference. PAC encourages caregivers to notice five things they appreciate and five things they find dissatisfying each week, not to dwell on the negative but to build awareness and intentionality. This practice helps caregivers stay grounded and focused on what they can change—their own approach.

Key Techniques: Hand-Under-Hand and GEMs

One of the most well-known PAC techniques is Hand-Under-Hand (HUH) care. Instead of grabbing a person's hand or arm from above (which can feel threatening or controlling), you slide your hand under theirs, palm up, and gently support their hand. This gives the person a sense of control and safety—they can pull away if they need to, and they feel your presence as support, not restraint. HUH is used for everything from guiding someone through a transfer to helping them hold a utensil or toothbrush. It works because it respects the person's autonomy while providing the physical cue they need to follow your lead.

Another foundational PAC concept is the GEMs (Gemstone) model, which categorizes brain change into different stages based on the person's remaining abilities. The stages are: Sapphire (very early, subtle changes), Diamond (still high-functioning but needing cues), Emerald (moderate, needs more hands-on help), Amber (significant cognitive loss, high emotional sensitivity), Ruby (very late stage, primarily sensory and comfort needs), and Pearl (end of life). Knowing where your loved one falls on this spectrum helps you tailor your communication, environment, and care tasks to their current abilities, reducing frustration for both of you.

PAC also emphasizes the importance of 'positive physical approach'—approaching from the front, at eye level, with a warm smile and relaxed posture. You slow down, use simple language, and give the person time to process. These small adjustments can prevent a cascade of confusion and agitation before it starts.

Training and Resources Offered by PAC

Teepa Snow's Positive Approach to Care organization offers a wide range of training and support resources for family caregivers, professional caregivers, and care communities. Their website (teepasnow.com) is a hub for online courses, live webinars, and a library of free videos and podcasts. The 'Dementia Care Partners Podcast' is a weekly show where Teepa and her team answer real caregiver questions and explore specific situations. You can also find a YouTube channel with hundreds of short, practical videos demonstrating techniques like Hand-Under-Hand, how to handle bathing resistance, or what to do when someone repeats the same question.

For organizations, PAC offers a 'PAC Designated Community' program. This is a certification process for facilities and agencies that commit to embedding PAC principles into their daily care. If you're looking for a care home or home care agency, you can search for PAC Designated Communities on their website—these are places that have undergone training and are actively working to create a more positive, person-centered environment. For individual caregivers, there are also virtual support groups and one-on-one coaching sessions.

PAC also provides free downloadable resources, including cue cards with phrases to use, checklists for creating a dementia-friendly home, and guides to understanding the GEMs stages. The organization's mission is to make this knowledge accessible to everyone, because as Teepa says, 'Until there's a cure, there's care.'

General caregiving information, not medical advice. Check medications and major care changes with your clinician.

Step-by-step

  1. Visit teepasnow.com and watch short videos on the Positive Physical Approach, Hand-Under-Hand, and the GEMs model, then practice HUH with a friend.

  2. Use the Positive Physical Approach every time: pause at the edge of their visual field, smile, say their name warmly, then move slowly to their front at eye level and wait for acknowledgment before speaking or touching.

  3. Use visual cues and demonstration more than words—hold up the toothbrush, gesture to the chair, mime brushing—because a brain with dementia processes what it sees more easily than what it hears.

  4. Identify your loved one's GEM stage using the free assessment on teepasnow.com, noting current abilities in communication, mobility, and self-care; reassess every 3–6 months.

  5. When your loved one becomes agitated, stop, take a slow breath, lower your voice, and use the 'I wonder' technique—'I wonder if you're feeling scared' or 'I wonder if you need a break'—to validate the emotion without demanding an explanation.

  6. Post cue cards for recurring care tasks (bathing, dressing, mealtimes) with 2–3 simple, calm phrases per task as a reminder to stay regulated and use positive language.

  7. Connect with PAC for ongoing learning: family caregivers can sign up for a virtual support group or coaching session; facility or agency staff can call 877-877-1671 or email info@teepasnow.com about the PAC Designated Community program.

  8. Subscribe to the PAC YouTube channel and the Dementia Care Partners Podcast, build a playlist of videos matching your current challenges (e.g., wandering, sundowning, refusal to bathe), and watch one each morning before caregiving.

What not to do

  • Don't grab the person's hand from above—this feels controlling and can trigger a fight-or-flight response; instead, use Hand-Under-Hand: slide your hand under theirs, palm up.

  • Don't correct or argue when the person says something inaccurate—this increases confusion and distress; instead, validate the feeling and redirect: 'You're worried. Let's look together.'

  • Don't approach from behind or the side—this can startle and cause a defensive reaction; always approach from the front, at eye level, with a warm expression and slow pace.

  • Don't use complex sentences or open-ended questions like 'What do you want for dinner?'; instead, offer two simple choices: 'Chicken or fish?' or hold up two items and let them point.

  • Don't assume a person who cannot speak cannot understand—many still comprehend tone and emotion; speak with respect, avoid talking about them as if they're not there, and address them directly.

  • Don't try to force a care task when the person is agitated—forcing escalates the situation and damages trust; instead, step back, take a break, and try later with a different approach (snack, walk, or favorite song).

Practical tools

  • Hand-Under-Hand & Positive Physical Approach Toolkit

    For PPA: pause at their visual field edge, smile, say their name, move slowly to front at eye level, wait for acknowledgment, then speak in a calm low voice. For HUH: slide your hand under theirs, palm up, wrap fingers around their palm with thumb on top so their hand stays on top of yours; you can now guide motion (brushing, eating, walking) while they feel in control. Practice both with a friend first.

  • GEMs Stage Assessment Checklist

    Download the free chart from teepasnow.com listing observable behaviors for each stage (Sapphire through Pearl). For each area—communication, mobility, eating, bathing, toileting—check what your loved one can still do. Reassess every 3–6 months as the disease progresses.

  • 'I Wonder' Phrase Card

    Keep a small card with phrases like 'I wonder if you're scared,' 'I wonder if you need a break,' 'I wonder if something hurts.' Reach for it when distress spikes—validates the experience without requiring an explanation, and phrases become automatic with practice.

  • PAC YouTube Channel & Dementia Care Partners Podcast Playlist

    Search 'Teepa Snow Positive Approach to Care' on YouTube, build a 5–10 video playlist matched to your challenges (e.g., 'Hand-Under-Hand for Bathing,' 'How to Handle Repetitive Questions,' 'GEMs Overview'). Pair with the Dementia Care Partners Podcast for real-time guidance; listen to one short piece each morning before caregiving.

  • Care Task Cue Card Template

    For any recurring care task: write the task name at the top, then 2–3 calm, short phrases to use (e.g., for bathing: 'Let's get you warm,' 'I'll help you rinse,' 'Almost done'). Tape the card in the bathroom, kitchen, or where needed as an in-the-moment reminder to slow down and stay regulated.

Discuss with your clinician

If your loved one is on medications that affect behavior (like antipsychotics or benzodiazepines), ask the doctor whether a PAC-based behavioral approach could reduce the need for these drugs. Some medications can actually increase confusion or agitation in people with dementia.

If you notice sudden changes in behavior (like new aggression or withdrawal), discuss with the clinician whether there might be an underlying medical cause (infection, pain, medication side effect) before attributing it to dementia progression.

For professional caregivers: if your facility is considering PAC training, ask the medical director or administrator about integrating PAC principles into the existing care plan and medication management protocols.

If your loved one has a history of falls, ask the clinician or physical therapist how to adapt PAC techniques like Hand-Under-Hand for safe transfers and mobility assistance.

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