Seeing the Person, Not the Disease: Inside Teepa Snow's Positive Approach to Care
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Stepping into a conference room filled with 250 eager attendees, I wasn't quite sure what to expect. Professional caregivers, family members, and healthcare providers had all gathered in Raleigh, NC for a day-long workshop hosted by the Dementia Alliance of North Carolina. We shared one common thread – our lives had been touched by dementia. What I didn't expect was how one dynamic woman would transform my understanding of dementia care in just a few hours.
Teepa Snow walked onto the stage with the confidence of someone who has dedicated over four decades to revolutionizing how we care for people with dementia. With a mischievous smile and infectious laugh, she immediately dispelled the heavy atmosphere that often surrounds discussions of dementia.
“We’re going to let go of what was and embrace what is”
Who is Teepa Snow? A Pioneer Redefining Dementia Care
Teepa Snow isn't just another healthcare professional with impressive credentials – though her background as an occupational therapist with specializations from Duke University and the University of North Carolina at Chapel Hill certainly qualifies her as an expert. What sets Teepa apart is her ability to translate complex neurological concepts into practical, compassionate care strategies.
Over her 40+ year career spanning roles at the Veterans Administration Medical Center, long-term care facilities, and the Alzheimer's Association, Teepa developed what she calls the Positive Approach to Care (PAC). This methodology represents a seismic shift away from traditional dementia care models that focus primarily on deficits and losses.
Instead, Teepa's approach emphasizes recognizing and working with a person's retained abilities – what they can still do, rather than what they've lost. This fundamental reframing changes everything about how we interact with people living with dementia.
Dementia as "Brain Change"
"It's not just memory loss," Teepa explained to our attentive audience, demonstrating with expressive hand gestures exactly which parts of the brain are affected. "This is brain failure – structural and chemical changes that affect everything from perception to movement to emotional regulation."
By reframing to dementia as "brain change" rather than simple forgetfulness, Teepa helps caregivers understand why their loved ones behave in ways that might seem puzzling or frustrating. That agitation isn't defiance – it's the brain's attempt to communicate distress. That repetitive question isn't meant to annoy – it's because the information literally didn't register the first time.
One of the workshop attendees near me whispered, "I've been thinking about this all wrong." I nodded in agreement, feeling a weight lift as I realized many of Ed’s behaviors weren't choices but neurological realities.
The GEMS® State Model: A Revolutionary Perspective
Perhaps Teepa's most transformative contribution to dementia care is her GEMS® State Model, which replaces traditional "stages" of dementia with a more dynamic understanding of how brain changes affect individuals differently from moment to moment.
"Each person is like a precious gem," Teepa told us, as she walked through the six states:
Sapphire (True Blue/Clear): Normal aging with occasional memory lapses but generally sharp cognitive function
Diamond (Clear but Sharp): Early dementia with rigidity in thinking and routines
Emerald (Green and on the Go): Mid-stage with significant spatial-temporal confusion but retained verbal abilities
Amber (Caught in a Moment): More advanced state with sensory focus and exploration
Ruby (Red and Unpolished): Significant motor and speech difficulties but responsive to rhythm and music
Pearl (Hidden in a Shell): Late-stage with minimal responsiveness but still deserving dignity and comfort
What struck me most about this model was how it emphasized the unique qualities each person retains, rather than just cataloging losses. "No one is 'just a Pearl,'" Teepa emphasized. "We all have moments when we function at different GEMS states – even those of us without dementia!"
The woman sitting next to me – caring for her mother with Lewy Body dementia – wiped away tears. "This helps me see Mom as still valuable, still beautiful," she whispered.
Hands-On Learning: The Power of Hand-under-Hand
Theory is valuable, but Teepa Snow doesn't stop there. What made her workshop truly exceptional was the practical, hands-on techniques she demonstrated and then had us practice with each other.
I found myself partnered with another caregiver as we attempted to master Teepa's signature Hand-under-Hand™ technique. Rather than doing things for a person with dementia or physically manipulating their movements (hand-over-hand), this approach involves placing your hand under theirs, creating a supportive but dignified connection.
"This isn't as easy as I make it look," Teepa laughed as she circulated among us. "I've been doing this every day for 40 years!"
She was right. What looked effortless when she demonstrated required concentration and practice. Certified PAC trainers moved through the room, gently correcting our form and explaining the benefits of this approach.
When done correctly, Hand-under-Hand™ provides subtle tactile cues that help the brain organize movement, reduces resistance by preserving autonomy, and creates meaningful connection without confrontation. I was amazed at how such a small shift in approach could make such a profound difference.
The Emotional Journey: Learning to Let Go
Throughout the day, I noticed both tears and laughter rippling through the audience – sometimes simultaneously. Teepa has a remarkable ability to address deeply painful topics with humor and humanity that makes them bearable. She doesn't sugarcoat the challenges of dementia care, but she offers a framework for finding meaning and even joy within them.
"You have to let go of who they were," she told us with a gentleness that acknowledged how difficult that is. "But when you embrace who they are now, you can discover new ways to connect."
Looking around the room at the other attendees – a mixture of professional caregivers and family members like myself – I saw heads nodding in recognition. We were at different points in our caregiving journeys, but we shared the struggle of loving someone whose brain was changing in ways beyond their control.
One particularly powerful moment came when Teepa role-played a challenging interaction with her teaching partner as the dementia patient. First she showed the typical way many of us approach someone with dementia – with logic, reason, and increasing frustration when these don't work. Then she showed the PAC way – meeting the person in their reality, using visual cues alongside words, and moving with rather than against their responses.
"I'm not asking you to be perfect," she assured us. "I'm just asking you to try a different way."
Resources Beyond the Workshop
One unexpected benefit of the workshop was discovering just how many local resources exist for caregivers. The venue featured numerous vendors representing caregiving services, respite care options, therapy providers, and even a specialist in music therapy. Each came prepared with information packets and a genuine willingness to answer questions.
It was amazing to see the robust support network available right here in our community – something many caregivers don't discover until they're already overwhelmed. From memory cafés to support groups to in-home care options, I collected information that would have taken weeks to research on my own.
Bringing PAC Home: First Steps for Caregivers
As the workshop drew to a close, Teepa offered practical advice for implementing PAC techniques in everyday care:
Start with yourself: Learn to manage your own reactions and expectations before trying to change your loved one's behavior. As she said, “First, breathe.”
Become an observer: Watch for patterns in your loved one's behavior and try to identify which GEMS state they're in at different times of day.
Modify your approach: Practice the Positive Physical Approach® (PPA) by approaching from the front, at eye level, with a friendly greeting and extended hand.
Create success: Break activities into manageable steps and focus on the process rather than the outcome.
Build a support team: No one can provide dementia care alone – identify and nurture relationships with people who can help.
The Takeaway: A New Perspective on Dementia Care
Driving home from Teepa Snow's workshop, I felt both emotionally drained and strangely energized. The day had been intense – full of new information, emotional revelations, and connections with fellow caregivers who truly understood the journey.
What stayed with me most was Teepa's core message: dementia changes the brain, but it doesn't erase the person. When we shift our focus from what's been lost to what remains, we open ourselves to new ways of connecting that honor both the relationship's history and its present reality.
As Teepa said, “Dementia does not rob someone of their dignity. It’s our reaction to them that does.”
For caregivers navigating the challenging terrain of dementia, that permission to adapt – to let go of what was and embrace what is – might be the most valuable gift of all.
If you're caring for someone with dementia and would like to learn more about Teepa Snow's Positive Approach to Care, visit the Dementia Alliance of North Carolina or check out resources for families and friends on Teepa's website.
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