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Using the PAC Coaching Cycle: A Step-by-Step Guide for Care Partners and Staff

The PAC Coaching Cycle is a gentle, structured approach from Teepa Snow's Positive Approach to Care that helps you guide a person living with dementia through a task or interaction without taking over or causing distress. Instead of telling someone what to do or doing it for them, you use a cycle of noticing, connecting, offering support, and celebrating small wins. This method builds trust, reduces frustration for both of you, and keeps the person engaged and valued. Whether you're a family care partner, a home health aide, or a supervisor training others, this cycle gives you concrete steps to turn a difficult moment into a positive connection.

Key points

  • The PAC Coaching Cycle is a repeating loop: Observe, Connect, Offer one step, Wait, Support the attempt, Acknowledge.
  • Waiting 10–15 seconds after offering a step is critical; the brain needs time to process.
  • Use hand-under-hand guidance instead of grabbing or pulling.
  • Celebrate effort, not just success. This builds confidence and trust.
  • Adapt the cycle to the person's current abilities and the type of dementia.
  • The cycle also works for coaching other caregivers: model it, then give one small piece of feedback.

What Is the PAC Coaching Cycle?

The PAC Coaching Cycle is a skill set within Teepa Snow's Positive Approach to Care (PAC) framework. It is designed to help care partners and staff move from a directive or rescuing style of care to a supportive, empowering style. Rather than telling a person with dementia what to do or stepping in to do it for them, the coach uses a repeating loop: Observe, Connect, Offer a small step, Support the attempt, and Acknowledge the effort. This cycle is not a one-time fix; it is a rhythm you return to again and again as the person's abilities fluctuate moment to moment.

This approach is grounded in the idea that people living with dementia retain the desire to contribute and feel capable, even when their skills change. The coaching cycle honors that by treating every interaction as a chance to practice a skill, build confidence, and strengthen your relationship. For staff and supervisors, this cycle is also a tool for training others: you can model it, then coach a new caregiver through the same steps, creating a culture of patience and positive reinforcement.

Why Does the Cycle Work?

The cycle works because it matches the brain's changing ability to process instructions and sequence actions. When someone with dementia is asked to do something, their brain may struggle to hold the whole task in working memory. By breaking it into tiny steps and offering just-in-time support, you reduce overwhelm and anxiety. The cycle also taps into the power of positive reinforcement: when you acknowledge a small success, the person feels seen and valued, which motivates them to try the next step.

Research on gratitude and positive cycles shows that when a care team focuses on what is going well, it creates a ripple effect of generosity and well-being. The PAC Coaching Cycle does exactly that on a micro level. Instead of focusing on what the person cannot do, you notice what they are attempting and celebrate the attempt. This shifts the emotional tone from frustration to partnership, which benefits both the person living with dementia and the care partner.

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

Step-by-step

  1. Pause and Observe: Before acting, watch the person for 5–10 seconds. Note their body language, facial expression, and what they are focused on. Ask: 'What are they reaching for? Are they calm or distressed?'

  2. Connect with a Warm Greeting: Use their name and a gentle tone. Say: 'Good morning, Sarah. I see you are looking at your shirt.' This acknowledges them and their focus, not your agenda.

  3. Offer One Small Step: Instead of 'Let's get dressed,' say 'Would you like to start with your arm through this sleeve?' Use a visual cue or gentle hand-over-hand if needed. Avoid complex decisions like 'What do you want to wear?'

  4. Wait 10–15 Seconds for Processing: After offering the step, remain silent. The brain needs extra time to process and respond. Do not repeat the instruction unless the person shows clear distress or gives up.

  5. Respond to Their Attempt with Encouragement: If they try differently than expected, say 'Good try! That is one way to do it,' then gently guide. If they succeed, celebrate with specific praise like 'I saw you reach for that button all by yourself.' Avoid generic 'Good job' or baby talk.

  6. End with Positive Closure and Begin Again: When the task is done or fatigue shows, close warmly: 'Thank you for your help. We got that done together.' Then start the cycle over for the next small step.

What not to do

  • Do not jump in and do the task for them the moment they hesitate. This robs them of practice and can make them feel incompetent. Wait longer than you think is necessary, then offer a single word or gesture.

  • Do not use complex instructions or multiple steps at once. Break it into one step at a time and wait for each to be completed before giving the next.

  • Do not correct harshly or with frustration. Instead of 'No, the other arm,' say 'Let's try this arm instead' and guide gently. Harsh correction triggers shame and resistance.

  • Do not use baby talk or a sing-song voice. Adults with dementia are still adults. Speak in a normal, respectful tone. Condescending language can cause anger or withdrawal.

  • Do not expect the same performance every day. Abilities fluctuate with fatigue, illness, and time of day. Adjust expectations and try a smaller step or different approach if the cycle doesn't work.

Practical tools

  • The 'One Step' Verbal Script

    Keep a short list of phrases ready: 'Let's start with...', 'Your turn to...', 'I'll help with this part, you do that part.' Practice saying them slowly and calmly. Write them on a sticky note or in your phone notes.

  • Hand-Under-Hand Technique

    Instead of grabbing the person's hand, slide your hand under theirs, palm up, then guide their hand gently to the object or motion. This feels supportive, not controlling.

  • The 'Pause and Count' Timer

    After offering a step, silently count to 15 before speaking again. If anxious, take a slow breath. This prevents rushing and gives the person processing time. Use a watch or phone timer set to 15 seconds.

  • Visual Cue Cards for Common Tasks

    Create simple picture cards showing one step at a time: a hand reaching for a sleeve, a toothbrush, a cup. Place the card near the item. This reduces the need for verbal instructions and provides a visual prompt.

  • The 'Three-Breath Reset' for Yourself

    Before starting a coaching cycle, take three slow breaths: inhale for 4 counts, hold for 4, exhale for 6. This calms your nervous system and helps you enter the interaction with patience.

Discuss with your clinician

If the person becomes physically aggressive during a coaching attempt, discuss with your clinician whether a medication review or a different approach to redirection is needed.

If the person consistently cannot follow any step of the cycle and shows signs of pain or infection (e.g., new confusion, fever, change in appetite), consult their doctor to rule out a medical cause.

If you as a care partner feel overwhelmed, angry, or hopeless despite using the cycle, talk to your own healthcare provider about caregiver burnout and available support services.

If the person has a history of falls, ask the clinician or physical therapist for guidance on safe positioning during coaching (e.g., when helping with dressing or standing).

Related guides

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