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Integrating PAC Dementia Training Across All PACE Staff: A Practical Guide for Implementation

This guide is for family caregivers and PACE program staff who want to ensure every team member—from nurses to bus drivers—has the skills to provide compassionate, effective dementia care. PACE programs are unique because they serve participants in their homes and communities, meaning staff encounter dementia-related behaviors in unpredictable settings. The good news is that the Positive Approach to Care (PAC) training can be adapted for all roles, and real-world examples show it works. Here are concrete steps to make it happen, with phrases to use and pitfalls to avoid.

Key points

  • PAC training must be mandatory for ALL PACE staff, including bus drivers, housekeeping, and administrative roles—not just clinical staff.
  • The 20-hour core training (workshops A, B, C) provides a consistent, person-centered framework that works in home and community settings.
  • Hands-on practice with role-play and real-world scenarios is essential for staff to internalize techniques like the positive physical approach and hand-under-hand.
  • Ongoing coaching, huddles, and booster sessions prevent skills from fading and build a culture of continuous learning.
  • Measuring impact through staff confidence surveys and participant feedback helps demonstrate the value of training to administrators.
  • Personalizing techniques for different dementia types (e.g., Lewy body, FTD) and stages ensures care is truly tailored to each participant.

Why PAC Training Matters for Every PACE Staff Member

PACE programs are designed to keep older adults living safely at home, but this means staff interact with participants in their own environments—not a controlled facility. As one PACE director noted, bus drivers who pick up participants each morning may suddenly face confusion, agitation, or emotional outbursts without any formal dementia training. The same is true for home health aides, social workers, and even administrative staff who answer phone calls. Without a shared framework like PAC, each person reacts differently, often escalating distress instead of calming it. Research shows that direct care staff need education that empowers them to tailor care to each person’s unique abilities and preferences, and that training must go beyond a few hours of basics. PAC provides a consistent, person-centered language that everyone can use, from the driver who says ‘I see you’re having a tough morning—let’s take a moment’ to the nurse who adjusts a bathing routine based on the participant’s life story.

The Gap Between Assisted Living and PACE: Why Standard Training Falls Short

Many dementia care environments treat memory care as ‘assisted living plus’—just adding a few extra hours of training. But PACE is fundamentally different: participants are not in a facility; they are in their own homes, with their own routines, pets, and family dynamics. A four-hour dementia course cannot prepare a home health aide for the moment a participant refuses to bathe because the bathroom lighting triggers fear, or a bus driver for the participant who becomes disoriented mid-route. The Alzheimer’s Association emphasizes that dementia care requires understanding impaired communication, disorientation, and behavioral changes—all of which demand ongoing, practical training. PAC training, which includes workshops A, B, and C (totaling 20 hours), gives staff a toolkit of techniques like ‘positive physical approach’ and ‘hand-under-hand’ guidance that can be applied in real time, whether in a living room or a van.

How PAC Training Changes Outcomes for Participants and Staff

When PACE staff learn PAC techniques, the benefits are immediate. One study found that after person-centered dementia training, staff reported more positive interactions and better relationship-building with participants. Another PACE director observed that drivers who completed PAC training felt more confident and less anxious when behaviors arose, reducing the need for crisis calls. For family caregivers, this means their loved one is met with understanding rather than frustration. The training also helps staff see the person behind the diagnosis—knowing a participant’s life story, preferences, and abilities—so care becomes tailored, not generic. As one trainer put it, ‘If they go through the training and then leave, they still have that information for somebody in their family.’ This ripple effect strengthens the entire care ecosystem.

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

Step-by-step

  1. Secure leadership commitment to mandate PAC training for every role, using the example of drivers facing sudden confusion during morning pick-ups to show why universal training matters.

  2. Find or develop a PAC certified trainer through Teepa Snow's program to serve as internal champion and tailor scenarios to PACE settings like home visits and van rides.

  3. Deliver the 20-hour core training in three sequenced workshops over several weeks: A covers dementia basics and the positive physical approach, B focuses on communication and personal care, and C addresses challenging behaviors and end-of-life care.

  4. Build skill mastery through role-play of PACE-specific scenarios such as a participant refusing to board the van, becoming disoriented in their kitchen, or resisting a bath—practice hand-under-hand technique and positive physical approach in pairs.

  5. Embed PAC into daily huddles: at shift start, have staff name one technique they will use that day, and invite them to share successful PAC wins like a driver who calmed an anxious rider.

  6. Measure impact with pre/post surveys asking staff to rate confidence (1–5) in handling dementia-related behaviors, and ask participants and family caregivers about perceived care quality to show ROI.

  7. Reinforce with semi-annual half-day booster sessions tackling evolving challenges like winter sundowning or Lewy body dementia, using video examples from the PAC library.

  8. Build PAC into new-hire onboarding from day one so staff turnover does not erode the culture of care.

What not to do

  • Do not exclude any role from training: non-clinical staff like drivers, housekeepers, and schedulers interact with participants in ways that can ease or trigger distress.

  • Do not treat training as a one-time event: commit to huddles, refreshers, and peer coaching so techniques become daily practice.

  • Do not use clinical jargon like 'behavioral management' or 'redirecting'—use person-first language such as 'helping the person feel safe' to shift mindset from controlling to partnering.

  • Do not overlook the emotional toll on staff: without regular debriefing spaces to share frustrations and successes, good people will burn out and leave.

Practical tools

  • Positive Physical Approach Card for Van Drivers

    Laminate one for every vehicle: approach from front within visual field, smile, make eye contact, state participant's name, open with friendly purpose like 'I'm here to help you get to the center.' If they resist, pause and breathe together: 'I see you're not ready—let's take a moment.' Offer a choice such as 'Would you like to hold my arm or walk on your own?'

  • Hand-Under-Hand Technique Card for Bathing Refusals

    When a participant resists care, slide your hand under theirs palm to palm with fingers curled gently rather than gripping from above—preserves dignity and gives them control. Pair with a simple choice like 'Would you like to start with your face or your arms?' and narrate each step slowly.

  • Communication Phrase Swap Card

    Pocket-sized list of replacements: instead of 'Calm down,' try 'I see you're upset—let's take a break'; instead of 'You need to take your medication,' try 'Here's something that will help you feel better'; instead of 'Don't do that,' try 'Let's try this together.' Keep copies in vans, break rooms, and aide cars.

  • Pre/Post Training Confidence & Satisfaction Survey

    One-page survey asking staff to rate (1–5) confidence in handling confusion, refusal of care, agitation, and transport challenges, plus one open question: 'What's one moment this month when you felt successful with a participant?' For participants and family caregivers, ask 2–3 simple questions about feeling treated with dignity and respect. Track trends quarterly.

Discuss with your clinician

Discuss with the PACE medical director whether any participants have medication regimens that could be adjusted to reduce agitation or sundowning, and how PAC techniques can complement those changes.

Ask the PACE pharmacist about potential side effects of dementia medications (e.g., antipsychotics, cholinesterase inhibitors) that might affect behavior, and how staff can report observations to the clinical team.

Consult with the PACE social worker about family dynamics that may affect care, especially if a family caregiver is resistant to PAC techniques or has unrealistic expectations.

Review with the PACE occupational therapist how to adapt the home environment (e.g., lighting, clutter) to reduce confusion, and whether any assistive devices (e.g., grab bars, raised toilet seats) are needed.

Discuss with the PACE dietitian if changes in eating behavior (e.g., refusing food, swallowing difficulties) require a modified diet or feeding techniques, and how PAC communication can help during meals.

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