Dementia Expert Teepa Snow Advises Caregivers to Rethink Refusals and Written Cues

Teepa Snow, a national dementia care educator, argues that shifting the focus from cognitive decline to neurological adaptation can improve daily outcomes for families managing the condition.

Snow, an occupational therapist and the founder of Positive Approach to Care, recently spoke with the program Aging Untold about her decades of experience working with care teams. She challenged the common medical framing of the disease as a simple loss of function. Instead, she promoted the term “brain change” to describe how the brain reorganizes itself. She noted that neuroplasticity remains active regardless of the diagnosis. This perspective encourages caregivers to identify and utilize the specific abilities that remain intact rather than focusing solely on deficits.

The conversation addressed specific behavioral challenges, including refusals to perform basic hygiene tasks. Snow rejected the approach of forcing compliance through direct instruction. She suggested that caregivers break down larger tasks into smaller, manageable steps. For example, if a loved one refuses a full shower, the caregiver might ask them to wash a specific spot on their face or clean their hands before cooking. Snow explained that if a person cannot manage these minor physical interactions, a full shower is unlikely to succeed. The strategy requires the caregiver to step back and identify what is obstructing the interaction.

Snow also analyzed the limitations of written aids for people with dementia. She addressed the use of sticky notes and labeled containers for items like coffee cups and plates. She explained that executing a written sequence requires the hippocampus, the brain's learning and memory center, to access previous actions and determine the next step. She stated that the front of the brain is responsible for this sequencing process. Because this function is often compromised, written reminders frequently fail to translate into action. She advised families to provide more hands-on support rather than relying on visual cues.

In response to a question about the single most important message for families, Snow emphasized that both the person with dementia and the caregiver are acting to the best of their ability. She stated that if the current dynamic is not working, one of the parties must change. Since the person with dementia is experiencing ongoing brain change, the caregiver must develop new awareness, knowledge, and skills. She also noted that not every family member is suited for hands-on care. She encouraged relatives who excel at organization to take on that role, acknowledging that the physical work of caregiving is demanding.

The expert's guidance focuses on practical adjustments to daily routines. Her approach removes the pressure for perfect compliance and replaces it with targeted, small-scale requests. This method aims to reduce friction in the home environment. By recognizing the specific cognitive mechanisms at play, caregivers can better predict and manage behavioral responses. The advice applies to a wide range of daily activities, from personal hygiene to meal preparation. Snow's framework provides a structured way for families to navigate these interactions without relying on force or complex written instructions.