Friday, March 5, 2021

Caregivers Learn Importance of Change


Teepa with an audience member at one of her presentations. Submitted Photos

Teepa with an audience member at one of her presentations. Submitted Photos

Teepa Snow, one of America’s leading educators on dementia, spoke in Bonita Springs recently for a fundraising event benefitting the Alzheimer’s Support Network of Naples. I’d listened to tapes of Teepa Snow on various subjects, but to see her in person is to see the force of her personality, the energy and passion she brings to working with those who have dementia and the wisdom she imparts to caregivers and all in the audience. With her on stage was her daughter, Amanda Bulgarelli, who participated with Teepa in various role plays.

One minute Teepa is a dementia patient distracted because a little boy needs rescuing, while in another, she’s a caregiver telling her spouse who is recently deprived of driving, that yes, she’s driving today but she wants his help to cue her if she goes the wrong way. “If you take something away,” she said, “you give something back.”

Teepa (right) demonstrates the hand-underhand technique with her daughter, Amanda Bulgarelli.

Teepa (right) demonstrates the hand-underhand technique with her daughter, Amanda Bulgarelli.

Along with the role plays, Teepa educated listeners about dementia. “At the end stage with Alzheimer’s disease, only one-third of the brain is left. If my left side is more damaged, I repeat things. What remains strong,” she said, “despite brain decline, is music, rhythm, and prayer.”

Early on she asks, “Can the person with dementia change? No, we have to change.” This was the overarching theme of Teepa’s performance, helping the caregiver change to make life better for both the dementia patient and the caregiver.



Teepa Snow is a graduate of Duke University and received her MS degree from the University of North Carolina in Chapel Hill. She has worked as an occupational therapy director in a head injury facility, a clinical specialist in geriatrics for a Veteran’s Administration Medical Center, and a therapist and restorative care coordinator for long-term care facilities. Her hands-on caregiving experience includes providing direct care in rehabilitation settings.

Teepa’s company, Positive Approach to Care, LLC, was founded in 2005 and “offers education to family and professional care partners all over the world. Her training is available through video, online education, and in-person training and consultation.” Teepa’s daughter, Amanda, is COO of the Approach to Care team. Other team members are listed on their website,

Teepa and her team members show some caregiving skills.

Teepa and her team members show some caregiving skills.

Teepa’s advocacy for understanding those with dementia was evident in her vibrant role play and teaching. She stated, “The last part of the brain to develop is the executive brain center that receives incoming data. When it functions well we can reach logical, rational conclusions. But when it is not working, as in the person with advanced dementia, he cannot take in the whole situation.”



Also, if the hippocampus is declining in a person, “he may go somewhere and not know how to get back. Or he may not remember when he went to the bathroom or where it is… or may not recognize home because he is looking for his childhood home or the home when his children were young.”

“Will the caregiver be able to connect with someone with Alzheimer’s disease?” she asked. Not in the advanced stage. That person is lost in time, place, and in relationship. You can ask her, “I’m having a hamburger for lunch, what do you want? Well, I don’t know.” “At that point, an eighty or ninety-year-old with the disease might be compared to an 18 month-old child or a three-year-old. The difference is, the child has self-awareness. Self awareness has disappeared for the person with dementia.”

For example, “when a person with dementia has a urinary tract infection and testing for it is not conclusive, the dementia person’s brain does not recognize there is an infection. His brain is saying, ‘I don’t know I have it.’”

To caregivers, she suggests saying, “I’m trying to live with dementia in my life.” Teepa emphasized this because when a loved one has dementia, the whole family is affected. All “have dementia in their lives.” Teepa repeated the four skills possible if the front part of the brain is not damaged. One can be logical, reasonable, rational, and reach conclusions. But sometimes overworked caregivers will ask, “Why can’t I remember things?” Teepa tells them, look in the mirror: “You’re old, so try learning something new every day that’s visual, verbal, has movement. Partner dancing is very good for the brain if you’re partner is still able to dance. It’s good exercise, and the physical contact is important too.”

“Caregiving is not a job description for those who are perfect. If being perfect is important for you, find another job. It’s by making mistakes that you find what you need to do.” Teepa suggested caregivers say, “I can’t fix the dementia but I can support my spouse, mother, father with it.”

Teepa compared an aging body with dementia to an RV that is breaking down. It’s dented, has rust spots, the fluid leaks, and the carburetor stops working. This can be true for caregivers too, not just those with dementia. “We need white space on our calendars and our bodies need rest, because now, as a caregiver you are in charge of two aging RVs. You may say, ‘I want my life back.’ Or you may let that go and celebrate what is in front of you asking what could we try rather than what we’ve been doing.”

In addition to helping caregivers change to meet the demands of the patient with dementia, she emphasized getting assistance. “All caregivers say, ‘I don’t need any.’” But, caregivers, Teepa said, can lose ten years of their life when stress is not dealt with adequately. She suggests the caregiver spend less and less time with a loved one as his disease progresses (while he is cared for by others) with the bonus for the caregiver that she can love him more.

Teepa continuously sprinkled her talk with little gems of knowledge. For example, a person with advanced dementia will possibly have speech issues as they lose the ability to hear sharp consonants. They may hear only the vowel sounds and not be able to understand another’s speech. They may have visual issues. When a person doesn’t see well, offer them your hand. With your hand under her hand you can both help to button her blouse, brush her hair. To help him decide what shirt to wear, use, “this or that.” For example, “Which shirt do you want to wear today, the red or the blue one?” Or at bedtime, “Do you want to sleep on the couch or in bed?”

Teepa Snow’s online site has a wealth of information, much of it in video clips on various subjects. In several, she demonstrates the technique of a caregiver’s hand under the hand of the person with dementia. In another, how to overcome the fear of water and bathing by introducing the idea of a spa treatment for a woman’s dry skin, and also, one on responding to challenging behavior.

In your online searches, don’t fail to check out Teepa’s feather, that of the peacock. When a peacock is aroused it is a guardian and defender of all that is within. “Its high profile helps others recognize that causing harm within that space is not permitted.” Teepa’s commitment is to help all see that “it is NOT okay to take over, to demand compliance, to ignore dangerous situations, to use habits that are no longer effective, or to allow an agenda to come between those who care for one another,” when relating to one with dementia. The Positive Approach feather serves as a symbol of “just right” care.

When thinking about my interactions when caring for my late husband and mother, both with Alzheimer’s disease, I remember coming on a little strong at times. Dental care was one of the issues of contention with both. I could have used a peacock feather then to remind me to tread lightly, with love. Actually, that’s not a bad reminder for any relationship.

Shirley Woolaway has an M. Ed. in counseling and worked in journalism, in business, and as a therapist in Pennsylvania. She has 25 years personal experience with dementia as a caregiver for family members with Alzheimer’s disease, and nine years as the coordinator of an Alzheimer’s Association memory loss/ caregiver support group, earlier in Pennsylvania and now on Marco Island. We believe that Shirley’s insights will prove helpful to many of our readers.

For help on all aspects of Alzheimer’s disease and other dementias call the national Alzheimer’s Association confidential, 24/7 helpline at 800-272-3900 or the local Bonita Springs office at 239-405-7008 for care consults and support group information. Also helpful with local educational programs, workshops, and support groups, is the Naples Alzheimer’s Support Network, 239-262-8388.

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