What is the Teepa Snow Positive Approach for Dementia?

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Understanding Teepa Snow’s Positive Approach to Dementia Care


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Teepa Snow is a trained occupational therapist and a pioneer in caring for people living with dementia. Her Positive Approach® to Care centers around recognizing a person’s abilities and strategically shifting care tactics to meet them where they are — acknowledging that as the dementia progresses, the caregiver and the care strategy must evolve with it.

We proudly follow this revolutionary methodology at each Ridge community to encourage positive outcomes for people living with dementia, and to build relationships rooted in authenticity, empowerment, compassion and curiosity.

First, What is Dementia?

A cornerstone of Teepa Snow’s positive approach to dementia care is the recognition that this condition is made up of a series of changes in the brain, bringing with it dramatic structural and chemical failures. Dementia is not a memory problem; it’s brain failure.

The Many Phases — and Facets — of Dementia

With her GEM model of brain change, Teepa Snow ties each stage of dementia to a precious gem. This
is to encourage caregivers to focus on the unique and valuable abilities retained by the person with dementia, rather than focusing on what they’ve lost.

Sapphire: This could be a person in the very early stages of dementia, or — honestly — it could be the caregiver. Either way, this person is true-blue — flexible in their thinking, able to suppress and filter their reactions based on their environment, able to make informed decisions and transition easily. Care partners are encouraged to be a sapphire and retain their flexibility when problem-solving.

Diamond: Within the framework of routines and rituals, a diamond maintains clear thinking and can really shine. However, a diamond is also rigid and self-focused; they feel a heightened sense of want, like and dislike. They react well to mutual respect and can interact socially. They also still trust authority figures, but may be unhappy with new people telling them what to do.

Emerald: Emeralds are on the go — they feel a sense of purpose. They’re still naturally curious and wish to be independent. However, with their changes in abilities, emeralds may feel lost and require support in their daily routines. They may have intense reactions in the face of fears, desires or unmet needs. The best help for emeralds is to meet them where they are and, if necessary, modify the environment.

Amber: Like a fly caught in amber, these people feel caught in a moment of time. They focus strongly on sensations; they want to do what they like and avoid what they dislike. In pursuing their desires, they may cross boundaries with caregivers. They may have strong reactions to their environment and require those around them to exercise caution as well as patience. If an amber is resisting, a caregiver may need to try several different tactics to solve a problem.

Ruby: The strong color of a ruby can pull focus from the fine detail. For people in this stage of dementia, their capabilities can be lost in the outward manifestations of their condition. A ruby can deeply enjoy music — sing, hum, dance, clap and sway. Though they may not process reactions, instructions or subtle gestures, rubies can still act in big, strong movements, can mimic and can understand magnified facial expressions and voice rhythms. And, most importantly, they can still experience moments of joy.

Pearl: Hidden beneath the outer shell of the condition like a pearl in an oyster shell, pearls retain their innate personhood, even though changes in the body are extreme. They can recognize familiar touches, faces, tastes, aromas and voices.

How to Provide Specialized Care

Once you recognize the phase your loved one is in, the next step is to provide the right care for their abilities. Knowing that we all want to support those living with dementia as best as we can, the Positive Approach to Care outlines four guidelines for care partners.

  1. As the person’s brain changes, respond to the differences in their abilities without being hurtful or offensive.
  2. Practice responding thoughtfully and intentionally to the person with dementia in a way that will enhance quality of life for everyone involved.
  3. Try to always remember that the person living with dementia is doing their best. If an aspect of care isn’t working, the caregiver should determine what can be handled differently and alter their approach.
  4. Take careful stock of the environments surrounding the person with dementia and make changes as needed.
Specialized Care in Action

Teepa Snow offers many concrete suggestions to provide a personalized level of care. Each of these adjustments requires practice and patience, but at The Ridge, we’ve found they encourage a safe and positive environment for our residents to feel engaged.

Reframe challenging behaviors. Try to see challenging behaviors as signals the person is providing, clues to what may be upsetting them. Work with the person from a place of empathy rather than judgment, so you can better meet the need they’re trying to communicate.

Find better ways to connect. One of the signature practices in the Positive Approach to Care is the Hand-under-Hand™ technique, which is a technique to guide and assist someone in a way that feels friendly and soothing, rather than domineering.

Focus on the person and not the problem. We always try to find ways to empathize with a resident and acknowledge the real emotions they’re feeling. One way to practice this empathy when a person is agitated is to say, “I’m sorry” in a way that feels authentic: “I’m sorry I made you angry,” “I’m sorry I embarrassed you,” or even a simple “I’m sorry that happened.”

Design meaningful activities. Teepa outlines four categories of activities that make days and moments meaningful.

  1. Work – Everyone wants to make a difference.
  2. Leisure – Both passive and active activities that bring us joy.
  3. Self-Care – Attending to ourselves and our environment.
  4. Rest & Restoration – Activities that renew someone’s spirit.

Make it musical. Music and rhythm are preserved skills throughout the course of the condition. Music can promote a sense of meaning and purpose or a feeling of calm and relaxation. It can also touch emotions and elicit positive feelings.

Find Out More

There are so many revolutionary ideas and powerful observations within Teepa Snow’s Positive Approach to Care. Explore our website to find out how we integrate this and other impactful programs into our communities. And don’t hesitate to reach out using the contact form on this page. We’re more than happy to answer any questions you may have.