What Is the Positive Approach to Care (PAC)?
The Positive Approach to Care™ or PAC, is an evidence-informed dementia care methodology developed by Teepa Snow, MS, OTR/L, FAOTA, one of the most respected dementia care educators in the United States.1 With more than 40 years of clinical experience and a longstanding faculty appointment with Duke University’s School of Nursing, Teepa Snow developed PAC from decades of direct observation, neurological research, and hands-on caregiving practice.
The foundation of PAC is a simple, but profound reframe, dementia is not a memory problem. It is brain failure, a progressive, neurological condition that changes the way a person processes the world around them. PAC teaches caregivers to understand what those changes actually look like in practice, and then to adjust every interaction accordingly.
Rather than fixating on what a person living with dementia can no longer do, PAC centers on what they can still do. That strengths-based lens changes everything about how care is delivered from how a caregiver enters a room to how they help someone get dressed.
Who Is Teepa Snow?
Teepa Snow is a trained occupational therapist, dementia care specialist, and the founder of Positive Approach, LLC. She has held clinical appointments with both Duke University and UNC-Chapel Hill’s School of Medicine for more than two decades and has trained thousands of care professionals, families, and organizations worldwide. Her work draws on more than 30 years of peer-reviewed research from neurology, psychiatry, and the social sciences.1
Her approach is notable not only for its clinical rigor but for its practical accessibility. PAC teaches caregivers specific, learnable skills not just theory. That emphasis on the how, not just the why, is what makes it actionable in real-world care settings.
Core PAC Techniques: What Caregivers Actually Learn
PAC training equips caregivers with a set of specific, research-informed techniques designed to reduce friction, build connection, and improve the daily experience for both the person living with dementia and the caregiver supporting them.¹
Positive Physical Approach™ (PPA)
The PPA is a step-by-step method for approaching and connecting with a person living with dementia. Because dementia affects spatial awareness, visual processing, and the ability to interpret the presence of another person, an unannounced or abrupt approach can trigger anxiety or resistance. The PPA gives caregivers a structured, predictable way to enter a person’s space that reduces the chance of agitation and creates a foundation for genuine connection before any care task begins.
Hand-under-Hand® (HuH)
Hand-under-Hand® is one of the signature techniques in PAC and is research-proven to reduce resistive behaviors during activities of daily living such as eating, dressing, and personal care.¹ By placing a hand under the person’s hand (rather than on top or around the wrist), the caregiver offers guidance and physical support in a way that activates remaining muscle memory and preserves the person’s sense of participation and control. Studies comparing Hand-under-Hand® with conventional approaches have found it elicits fewer resistive behaviors and supports greater engagement in care tasks.
Positive Personal Connectors (PPC)
These are five specific phrases used before beginning any care task. Their purpose is relational: to establish genuine connection with the person before asking anything of them. In dementia care, the relationship between caregiver and resident is not incidental to good care, it is the mechanism through which good care happens.
Positive Action Starters (PAS)
PAS are five phrases designed to reduce refusals and resistance when initiating a care task. Rather than directing or instructing, PAS frames requests in ways that invite cooperation and respect the person’s autonomy. Small changes in language produce measurable differences in how people living with dementia respond to care interactions.
GEMS™ States of Brain Change
The GEMS model is a visual, ability-based framework developed by Teepa Snow to describe six different states of brain change in dementia each named after a gemstone (Sapphire, Diamond, Emerald, Amber, Ruby, and Pearl). Rather than a simple stage system based on loss, the GEMS model helps caregivers recognize a person’s current abilities and adapt their approach accordingly. A person in an “Amber” state, for example, is processing the world differently than someone in a “Ruby” state and PAC-trained caregivers know how to adjust.
Is PAC Evidence-Based?
Positive Approach to Care™ is widely recognized as an evidence-based dementia care methodology, grounded in 30 years of peer-reviewed neurological, clinical, and caregiving research. A study published in the Journal of Continuing Education in the Health Professions examined PAC training outcomes among skilled nursing facility staff and found statistically significant improvements in both dementia knowledge and caregiver perceptions across multiple domains.2 Significant gains were observed in areas including understanding of spatial awareness, vision changes, and effective approaches to care.
The Hand-under-Hand® technique has been evaluated in experimental studies comparing its outcomes with conventional approaches, and findings consistently show reduced resistive behaviors and greater resident participation in daily care tasks.1
That said, it’s important to be clear, as with all complex, person-centered care approaches, outcomes vary by individual. PAC is not a cure for dementia, and no approach eliminates the challenges of brain change. What PAC does is give caregivers the knowledge, skills, and confidence to navigate those challenges with far greater empathy and effectiveness than traditional approaches alone.
How PAC Is Different from Traditional Memory Care Approaches
Conventional memory care has often been structured around managing behaviors by responding to resistance, agitation, or distress after they occur. PAC takes a fundamentally different approach, it equips caregivers to understand why those behaviors occur (as expressions of unmet needs or overstimulation), and to prevent them through intentional technique.
Traditional care training frequently emphasizes what to do. PAC emphasizes why it works grounding every technique in an understanding of what’s actually happening in the brain. That combination of knowledge and practical skill is what sets PAC-trained caregivers apart.
What PAC Looks Like at Silverleaf Eldercare
At Silverleaf Eldercare, every caregiver working with residents in our memory care communities and across all of our care settings is a PAC-trained caregiver, equipped with the Positive Approach to Care™ techniques before providing hands-on support. This is not a training offered to select staff or specific departments. It is the standard for every member of the care team.
Silverleaf is a PAC Designated Community, meaning we are certified by Teepa Snow’s organization as meeting the training and implementation standards required to carry that designation. We also operate PAC Training programs for other care providers across the Austin area sharing these skills with the broader caregiving community because we believe better-trained caregivers benefit everyone.
What does this means for your family? When your loved one moves into a Silverleaf community, they will be cared for by people who understand dementia at a deeper level, who know how to approach them without triggering anxiety, how to support them through daily care with dignity and skill, and how to read the signals behind behaviors that might otherwise be dismissed as confusion or resistance.
If you’d like to learn more about how PAC shapes daily life at Silverleaf, or to tour one of our memory care communities in Bee Cave or at our other Austin locations, we’d be glad to show you what person-centered dementia care actually looks like in practice. Connect with our team whenever you’re ready.
Frequently Asked Questions
What does PAC stand for in dementia care?
PAC stands for Positive Approach to Care™ an evidence-based dementia methodology developed by occupational therapist and dementia specialist Teepa Snow, MS, OTR/L, FAOTA. PAC equips caregivers with specific, research grounded techniques for connecting with, communicating with, and supporting people living with dementia in ways that reduce distress and improve quality of life for everyone involved.
Who is Teepa Snow?
Teepa Snow is a trained occupational therapist and one of the leading dementia care educators in the world. She is the founder of Positive Approach, LLC and the developer of the Positive Approach to Care™ methodology. She has held clinical faculty appointments at Duke University School of Nursing and UNC-Chapel Hill School of Medicine for more than two decades, and her training programs have reached care professionals, families, and organizations across the globe.
Is PAC evidence-based?
Yes. PAC is grounded in more than 30 years of peer-reviewed research from neurology, psychiatry, and the social sciences. Published clinical studies have documented statistically significant improvements in staff dementia knowledge and caregiver perceptions following PAC training, and the Hand-under-Hand® technique has been shown in research to reduce resistive behaviors during daily care tasks. While PAC is not a cure for dementia, it provides caregivers with proven tools for delivering higher-quality, more compassionate care.
How is PAC different from traditional dementia care approaches?
Traditional memory care has often focused on managing challenging behaviors reactively. PAC takes a proactive, understanding based approach where caregivers learn why dementia related behaviors occur as expressions of overstimulation, unmet needs, or changes in sensory processing, and are equipped with specific techniques to prevent distress before it happens. This shift from reaction to understanding, and from compliance to connection, is the core distinction.
Do caregivers need certification to use PAC techniques?
PAC offers multiple levels of training and certification, from foundational awareness through full PAC Certified Trainer designation. At Silverleaf Eldercare, all caregivers complete PAC training as part of their onboarding before working directly with residents. Silverleaf is also a PAC Designated Community, which reflects the organization’s commitment to ongoing PAC implementation, not just initial training.
This article is intended as general educational information and does not constitute medical, legal, or financial advice. Care needs, costs, and payment programs vary by individual circumstance and may change over time. Please consult with a qualified healthcare professional, elder law attorney, or financial advisor for guidance specific to your loved one’s situation.
Sources
[1] A Positive Approach to Care.
“How Much Do You Know About Dementia?”
https://teepasnow.com/about-dementia/
Positive Approach to Care (Teepa Snow).
Accessed April 2026.
[2] Ehlman, M.C. et al. Journal of Continuing Education in the Health Professions, 2018.
“Health Workers’ Knowledge and Perceptions on Dementia: The Impact of Teepa Snow’s Positive Approach® to Care Certification Course.”
National Library of Medicine.
https://pubmed.ncbi.nlm.nih.gov/30157153/
Accessed April 2026.
[3] Alzheimer’s Disease Research Center.
“Taking a Positive Approach to Dementia Care with Strategies from Teepa Snow.” https://www.adrc.wisc.edu/dementia-matters/taking-positive-approach-dementia-care-strategies-teepa-snow.
University of Wisconsin-Madison School of Medicine and Public Health.
Accessed April 2026.
Questions about care for your family? Call (512) 831-5600 or send us a message.
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