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Positive Approach to Care (PAC): A Framework for Partnership and Skillful Caregiving in Dementia

Positive Approach to Care (PAC), developed by Teepa Snow, is a practical, evidence-informed framework that shifts caregiving from a task-focused struggle to a partnership built on understanding brain changes. It teaches you to see behaviors as communication, adjust your own approach first, and use specific techniques to reduce distress for both you and your loved one. This guide gives you concrete steps, exact words to say, and tools to start using PAC today, no matter the stage or setting.

Key points

  • PAC is a practical, brain-based framework that helps you see behaviors as communication and adjust your own approach first.
  • Use the Positive Physical Approach: approach from the front, at eye level, with a smile and open hand.
  • Connect before you correct: validate the feeling, then redirect with a choice.
  • Offer two acceptable choices to give the person a sense of control without overwhelming them.
  • Use hand-under-hand touch to guide gently, not grab or pull.
  • Celebrate small wins—each moment of connection reduces burden for both of you.

What Is Positive Approach to Care (PAC)?

PAC is not about being unrealistically cheerful or ignoring the hard parts of dementia. Instead, it is a systematic way of understanding how the brain changes in dementia and then adapting your own words, body language, and actions to meet the person where they are. Teepa Snow, a dementia care educator and occupational therapist, created PAC based on decades of clinical experience and research. The core idea is that the person with dementia is not giving you a hard time—they are having a hard time. Your job as a care partner is to change your approach first, not to try to force the person to change. This is grounded in the understanding that dementia progressively damages the brain's ability to process information, control emotions, and initiate actions. When you learn to 'see' the world through their eyes, you can reduce their anxiety and your own frustration.

Why Does PAC Work?

Research on the Positive Aspects of Caregiving (PAC) scale shows that focusing on the positive, meaningful parts of caregiving—like feeling useful, appreciated, or closer to the person—can lower caregiver burden and improve mental health. But PAC as a method goes further: it gives you a step-by-step toolkit. For example, instead of saying 'No, you can't go outside,' you learn to say, 'I see you want to go out. Let's grab a jacket and I'll walk with you.' This validates the person's need while keeping them safe. The approach works because it respects the person's remaining abilities and compensates for their losses. It also helps you, the caregiver, feel more confident and less alone. As Teepa Snow says, 'When I can figure out some of the components... I've got to create a safe space for you to go outside that doesn't even make any sense to keep trying to keep you inside.' This is the heart of PAC: creative, compassionate problem-solving.

The Core PAC Principles You Can Use Today

PAC rests on a few simple but powerful ideas. First, 'connect before you correct.' Before you try to redirect or help, make eye contact, smile, and use a calm, warm voice. Second, 'use positive physical approach'—approach from the front, at eye level, with your hand out and a smile. Third, 'offer choices that are both safe and acceptable.' Instead of 'Do you want to take a shower?' (which invites a 'no'), say 'Would you like to wash your hair first or your arms?' Finally, 'celebrate the small wins.' Every moment of connection, every time you avoid a meltdown, is a victory. The PAC framework also includes specific techniques like 'hand-under-hand' touch, which is less threatening than grabbing, and using 'chunking' to break tasks into tiny steps. These are not just nice ideas—they are practical skills that reduce agitation, falls, and caregiver burnout.

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

Step-by-step

  1. Approach from the front, at eye level, palm open, with a smile.

  2. Pause before touching to allow the person to see and process you.

  3. Use a slow, calm, low-pitched voice and simple phrases.

  4. Offer one clear choice or request at a time.

  5. Name what you see or are about to do before acting.

  6. Wait at least 10 seconds for a response after speaking.

  7. If distress rises, slow down, lower your voice, and try again.

What not to do

  • Do not approach from behind or startle.

  • Do not use rapid, high-pitched, or complex language.

  • Do not give multiple choices or instructions at once.

  • Do not correct or argue; instead, validate feelings.

  • Do not rush through a task without acknowledging the person.

Practical tools

  • Positive Physical Approach (PPA)

    A scripted way to approach: front, eye level, smile, hand out, pause, then slow greeting and touch. Designed to reduce threat response.

  • Hand-under- Hand (HUH)

    Place your hand under the person's hand to guide movement with gentle support, preserving their sense of control and volition.

Discuss with your clinician

Ask your doctor: 'Are there any medications or therapies that could help with my loved one's agitation or sleep, alongside the PAC approach?'

Discuss: 'My loved one has started wandering. Is it safe to let them walk with me, or do we need to consider other safety measures like door alarms?'

Ask: 'Given my loved one's specific dementia type (e.g., Lewy body, vascular), are there any PAC techniques that might be more or less effective?'

Discuss: 'I'm feeling overwhelmed. Can you refer me to a support group or a counselor who understands dementia caregiving?'

Ask: 'Should we consider palliative care or hospice at this stage? How would that work alongside our current care plan?'

Related guides

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