Positive Approach to Care (PAC): A Complete Guide to the Method That Changes Everything

If you have ever felt like traditional dementia care leaves you and your loved one stuck in a cycle of frustration, confusion, and burnout, the Positive Approach to Care (PAC) method offers a radically different path. Developed by Teepa Snow, PAC is not about managing behaviors or enforcing routines—it is about seeing the world through your loved one's eyes and using that understanding to create moments of genuine connection, purpose, and joy. This guide will walk you through exactly what makes PAC different, why it works, and how you can start using its principles today to transform your caregiving experience from a battle into a partnership. You are not alone, and there are concrete, step-by-step tools you can use right now.

Key points

PAC shifts the focus from managing behaviors to understanding the person's unmet needs and emotional state.
Use the GEMs model to match your communication and assistance to your loved one's current abilities, not their diagnosis.
The Positive Physical Approach (PPA) and hand-under-hand technique reduce anxiety and build trust.
Replace 'no' and 'don't' with validation and redirection to reduce resistance and agitation.
Create a 'Yes' environment by modifying the physical space to promote independence and reduce confusion.
You are a care partner, not a manager. Your emotional state directly affects your loved one, so take care of yourself too.

The Core Difference: From 'Managing Behaviors' to 'Understanding the Person'

Traditional dementia care often operates from a deficit-based mindset: the person with dementia has lost abilities, so the caregiver's job is to manage, redirect, and control. This approach sees behaviors like wandering, agitation, or refusal to bathe as problems to be fixed. In contrast, PAC starts from a place of deep respect for the person who is still there. As Teepa Snow explains, the method is built on the belief that every person, regardless of their cognitive changes, has a fundamental need for purpose, value, and connection. The goal is not to eliminate behaviors but to understand the unmet need or the emotional state driving them. When you shift from 'how do I stop this' to 'what is this person trying to communicate or feel,' everything changes.

The 'Opening Window' Phenomenon: Seeing Possibility Instead of Loss

One of the most powerful concepts in PAC is what Teepa calls the 'opening window'—a way of looking at dementia that reveals opportunities for connection, learning, and even joy, rather than only focusing on what is being lost. In traditional care, a person who repeatedly asks to go home might be seen as confused or disruptive. In PAC, that same behavior is a window into their emotional state: they may be feeling unsafe, bored, or longing for comfort. By addressing the feeling rather than the fact, you open a door to a meaningful interaction. PAC also emphasizes that people living with dementia can still contribute, still have a voice, and still make a difference. The 2021 PAC Virtual Conference featured people living with dementia as co-presenters, not just as subjects of discussion. This inclusive, empowering stance is a hallmark of the method.

The Science of Connection: How PAC Changes the Brain's Response

PAC is grounded in an understanding of how the brain changes with dementia. Traditional approaches often rely on verbal reasoning, memory, and logic—skills that are progressively lost. PAC instead uses what remains: emotional memory, procedural memory (how to do familiar actions), and sensory processing. By using a calm tone, matching the person's emotional energy, and offering simple, step-by-step cues, you can bypass the damaged parts of the brain and connect with the parts that still work. This is why a person who cannot remember your name can still feel your warmth, and why a person who cannot follow a complex instruction can still participate in a familiar task like folding laundry. The method is not about tricking the person; it is about meeting them where they are, neurologically and emotionally.

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

Step-by-step

Use 'care partner' language instead of 'caregiver' to emphasize partnership; replace 'I' and 'you' with 'we' and 'us' (e.g., 'We are getting ready together').
Watch for 'opening windows'—moments of heightened presence—and engage with music, photos, a short walk, or hand-holding; when the window closes, rest and wait for the next one.

What not to do

Do not use threatening or condescending tones: no loud or high-pitched voice, no baby talk or sing-song delivery, and never speak about your loved one as if they are not in the room.
Do not correct or argue when your loved one says something factually inaccurate.

Discuss with your clinician

Discuss with your clinician whether any behavioral symptoms (agitation, aggression, hallucinations) might be caused by a medication side effect or an untreated medical condition like a urinary tract infection or pain. PAC techniques can help, but medical causes must be ruled out first.

If your loved one has Lewy body dementia, discuss with the clinician the risks of antipsychotic medications, which can cause severe side effects. Ask about non-pharmacological approaches like PAC before starting any new medication.

Discuss with the clinician the appropriate time to transition to hospice care. PAC can help maintain quality of life, but hospice provides additional support for end-of-life care. Use the Medicare hospice guidelines (e.g., FAST scale, weight loss, recurrent infections) as a starting point for the conversation.

If your loved one is in a facility, discuss with the clinician how to integrate PAC principles into their care plan. Ask if the facility has any staff trained in PAC or if they are open to training.