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Building a Positive Approach to Care (PAC) Community in Your Adult Day Program

This guide shows how an adult day program can adopt and spread Teepa Snow's Positive Approach to Care (PAC) philosophy. You'll learn concrete steps to train staff, engage volunteers, and create a culture where every interaction supports the 'gem states' of people living with dementia. Whether you're a founder, staff trainer, or volunteer coordinator, these practices help turn your center into a PAC-designated community that truly makes a difference.

Key points

  • Start small: train a core team, then expand. Use free videos and resources from Positive Approach to Care to build momentum.
  • The gem states are a shared language that helps everyone—staff, volunteers, families—understand and adapt to each participant's changing abilities.
  • Volunteers are engagement partners, not task-doers. Train them to 'Learn, Connect, Adapt' in every interaction.
  • Use the '15-minute activity plan' to create flexible, low-prep activities that match different gem states.
  • Create a PAC corner with visual reminders and a success story board to keep the philosophy alive daily.
  • Hold monthly PAC Circles to share successes, discuss challenges, and build a learning community.

What Is a PAC Community and Why It Matters

A PAC-designated community is a group of people—staff, volunteers, families, and participants—who commit to using Teepa Snow's Positive Approach to Care in every interaction. This isn't just a training program; it's a culture shift. The goal is to move from a task-focused model (getting things done) to a relationship-focused model (understanding and supporting each person's unique abilities and needs). In an adult day program, this means every activity, meal, and conversation is designed to meet people where they are, using the 'gem states' framework to recognize the changing abilities of someone living with dementia.

Why does this work? Because when you stop trying to keep someone inside who loves the outdoors, and instead create a safe outdoor space, you reduce distress and increase joy. As one PAC leader explains, 'If you've always been someone who loved to be outside, then you going to the door and testing the door—rather than me saying come away from the door—I've got to create a safe space for you to go outside.' This shift from control to connection transforms the experience for everyone.

The Gem States: A Shared Language for Care

The gem states are a core tool in PAC. They describe the different stages of dementia using gemstones: Sapphire (early, clear thinking), Diamond (still sharp but needing more time), Emerald (losing some words but still engaged), Amber (needing more physical help and structure), Ruby (very late stage, needing full support), and Pearl (end of life). In an adult day program, staff and volunteers learn to identify which gem state a participant is in at any moment and adjust their approach accordingly. For example, someone in the Emerald state might need simple, one-step instructions and a calm tone, while someone in the Amber state might need hand-over-hand guidance during an activity.

This shared language helps everyone—from the program director to the volunteer—be on the same page. It reduces frustration because staff stop expecting a participant to 'remember' or 'behave' in ways that are no longer possible. Instead, they learn to 'figure things out to change how things are done so that it can be a better experience for everybody.' The gem states also help families understand their loved one's changing needs, reducing guilt and confusion.

How PAC Changes the Role of Volunteers and Staff

In a traditional adult day program, volunteers might be asked to lead an activity or help with meals. In a PAC community, their role shifts to 'engagement partners.' They learn to observe, connect, and adapt. For example, instead of reading a list of questions from a script, a volunteer might notice a participant who loved gardening and invite them to water plants. This person-centered approach requires training, but it's surprisingly simple to implement once the mindset shifts.

Staff trainers and volunteer coordinators play a key role here. They model the PAC approach in every interaction—with participants, families, and each other. They use positive language, avoid power struggles, and celebrate small wins. As one PAC leader notes, 'When you can figure out some of the components, like creating a safe space for someone to go outside, it makes no sense to keep trying to keep them inside.' This philosophy extends to how staff treat each other: with respect, patience, and a focus on strengths.

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

Step-by-step

  1. Step 1: Start with a core team committed to culture change. Gather the program founder, staff trainer, and volunteer coordinator. Watch Teepa Snow's videos (like 'PAC Community Relationships' and 'An Interview with Dementia Expert and Educator Teepa Snow') together. Discuss the gem states and the core PAC principles: 'Positive Approach, Positive Action, Positive Outcomes.' This team will be the champions who spread the approach.

  2. Step 2: Schedule a formal PAC training for all staff and key volunteers. Contact Positive Approach to Care at 877-877-1671 or info@teepasnow.com to arrange a workshop or access online materials. The training should cover the gem states, hand-under-hand technique, and how to redirect without arguing. Make it interactive—role-play scenarios like a participant who wants to leave or one who is upset.

  3. Step 3: Create a 'PAC corner' in your program space. Post the gem states chart on the wall. Have a whiteboard where staff can note which gem state each participant seems to be in that day. Include a 'success story' section where staff and volunteers share a positive interaction. This visual reminder keeps the philosophy alive daily.

  4. Step 4: Revamp your activity planning using the PAC lens. Instead of a rigid monthly calendar, plan flexible 'engagement options' that match different gem states. For example, for Sapphire and Diamond states, offer complex discussions or memory games. For Emerald and Amber states, use sensory activities like music, gardening, or simple crafts. Use the '15-minute planning' method: list a theme (e.g., 'Peru'), then quickly add a music piece, a chair yoga move, a simple food tasting, and a short story. If one volunteer is sick, another can step in and 'hit play' on the plan.

  5. Step 5: Train volunteers to use the 'Learn, Connect, Adapt' framework. Before each shift, volunteers learn one thing about each participant (e.g., their favorite music, their past job). During the shift, they connect by using that knowledge (e.g., 'I heard you loved gardening—would you like to water these plants?'). If the participant resists, they adapt (e.g., 'Okay, let's just look at the flowers together'). This turns every interaction into a positive moment.

  6. Step 6: Implement a 'buddy system' for new volunteers. Pair each new volunteer with an experienced staff member for their first three shifts. The buddy models PAC language and techniques, like using a calm voice, making eye contact at the participant's level, and offering choices (e.g., 'Would you like to sit here or by the window?'). After each shift, the buddy and volunteer debrief for five minutes on what worked and what to try next time.

  7. Step 7: Host a monthly 'PAC Circle' for staff, volunteers, and families. This is a 30-minute gathering where anyone can share a challenge or a success. Use the gem states to discuss what happened. For example, 'Mrs. Jones was in an Amber state today and kept trying to leave. Instead of stopping her, I walked with her to the door, then redirected her to the garden. She calmed down.' This builds a learning community and reinforces the approach.

  8. Step 8: Apply for PAC designation. Once your team feels confident, contact Positive Approach to Care to become a 'PAC Designated Community.' This formal recognition signals to families and funders that your program is committed to best practices. It also gives you access to ongoing support and resources.

  9. Step 9: Measure your progress. Use the Positive Aspects of Caregiving (PAC) scale (available in Portuguese and English) to assess how staff and volunteers feel about their work. Higher scores on this scale correlate with lower burnout and better care. Share results in your PAC Circle to celebrate wins and identify areas for growth.

  10. Step 10: Spread the word in your local community. Offer a free monthly 'PAC 101' workshop for families and other providers. Share your success stories on social media and in local newsletters. As one PAC leader says, 'We're not just relying on me anymore—there are other people within our organization who do a great job helping people start their journey.' Your program can become a beacon of positive care.

What not to do

  • Do not force the PAC approach on staff without training and buy-in. If you just hand out a gem states chart and say 'use this,' staff will feel confused and resentful. Instead, invest in proper training and model the approach yourself. Start with a small pilot group and let their success inspire others.

  • Do not use the gem states to label or limit participants. The goal is not to say 'She's an Amber, so she can't do that.' The goal is to say 'She's in an Amber state today, so I need to offer more support.' Avoid using the gem states as a fixed diagnosis; people can shift states based on mood, health, or environment.

  • Do not ignore volunteers' own needs. Volunteers who are stressed or unsupported cannot give positive care. Make sure they have clear roles, regular breaks, and a chance to debrief. If a volunteer feels overwhelmed, pair them with a co-volunteer or give them a simpler task like greeting families instead of leading an activity.

  • Do not expect perfection. PAC is a journey, not a destination. Staff and volunteers will make mistakes—they might argue with a participant or forget to use hand-under-hand. That's okay. In your PAC Circle, treat mistakes as learning opportunities. Say, 'What could we try differently next time?' This builds a culture of growth, not blame.

  • Do not forget families. Families are part of the community too. Invite them to PAC workshops and share the gem states with them. When a family member says, 'Why can't she remember my name?', you can explain that she's in an Emerald state and needs more cues. This reduces family distress and builds trust.

  • Do not try to change everything at once. Pick one or two practices to start, like using the gem states in daily handoffs or adding a PAC corner. Once those feel natural, add another. Rushing leads to burnout and resistance. As one PAC leader says, 'We're working hard to make a positive difference'—one step at a time.

Practical tools

  • Gem States Wall Chart

    Create a large, laminated chart showing the six gem states (Sapphire, Diamond, Emerald, Amber, Ruby, Pearl) with a brief description and a photo or icon for each. Post it in the staff break room and near the activity area. Use it during daily huddles: 'Who's in an Emerald state today? Let's plan activities that match.' This keeps the framework visible and usable.

  • The '15-Minute Activity Plan' Template

    A one-page template with five slots: Music, Movement, Sensory, Story, and Snack. For a theme like 'Peru,' you fill in: Music = Peruvian flute music; Movement = chair yoga with arm circles; Sensory = touch a llama wool sample; Story = a two-minute story about Machu Picchu; Snack = quinoa crackers. Volunteers can pick any slot and run with it. If one volunteer is absent, another can 'hit play' on the same plan.

  • Hand-Under-Hand Technique Card

    A small laminated card with step-by-step instructions and a photo: '1. Approach from the front, at eye level. 2. Smile and say their name. 3. Gently place your hand under theirs, palm up. 4. Guide their hand to the object (e.g., a paintbrush). 5. Move together slowly.' Keep these cards in every volunteer's pocket. This technique reduces agitation and builds trust.

  • PAC Language Scripts for Common Situations

    Print a small booklet with phrases for common challenges. For example: When a participant wants to leave: 'I see you want to go outside. Let's walk to the garden together.' When they are upset: 'You seem frustrated. I'm here with you. Let's take a deep breath.' When they can't find a word: 'Take your time. I can wait.' These scripts help volunteers feel confident.

  • Volunteer 'Gem State' Observation Log

    A simple paper form with columns: Participant Name, Date, Observed Gem State, Activity Done, and What Worked. Volunteers fill one out after each shift. Review these logs weekly to spot patterns (e.g., 'Mrs. Lee is often in Amber after lunch—maybe she needs a quiet activity then'). This turns observation into action.

  • Monthly PAC Circle Agenda Template

    A 30-minute meeting agenda: 5 min check-in (one word about how you're feeling), 10 min share a success story, 10 min discuss a challenge using the gem states, 5 min pick one thing to try next week. Keep it positive and focused on learning. End with a round of appreciation.

Discuss with your clinician

If a participant's gem state seems to change rapidly or dramatically (e.g., from Diamond to Amber in one day), discuss with their clinician whether this could be a sign of infection, medication side effect, or other medical issue.

Before implementing any new physical activity (like chair yoga or walking programs), check with a clinician or physical therapist to ensure it is safe for each participant's physical condition.

If a volunteer or staff member expresses personal distress or burnout, encourage them to speak with a healthcare provider or counselor. The PAC approach supports caregivers too, but professional help may be needed.

When using the Positive Aspects of Caregiving (PAC) scale as a measurement tool, discuss results with a clinician or researcher to interpret them correctly and avoid over-interpretation.

Related guides

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