Episode Transcript:
Christina Chartrand: Hi, this is Christina Chartrand and David Chandler! Welcome to LIFE Conversations. We are so glad to see you today and have you a part of our next podcast series. And I am so excited to have our very special guest, Teepa Snow from Positive Approach™ to Care. We've known each other, ooh, 12 plus years? Maybe a little more than that now. Actually, I think it's even longer. But Teepa Snow has, there's a lot of information that you'll be able to read in her bio. But when I talk about her, I say to people, she is a guru in Alzheimer's and Dementia care space. I mean, absolute legend, legend. You cannot visit an a...
David Chandler: Legend. Legend.
Teepa Snow: Yeah, me and John. Me and John Legend, that's it.
Christina Chartrand: You would not be able to walk into an Alzheimer's Association or a memory care unit and mention the name Teepa Snow when they wouldn't know who she is, right? Do agree, David?
David Chandler: Oh my gosh, Teepa, this is an honor for me to be on with you today because for many years in the senior care coming from senior living, we used your trainings all the time for our memory care communities. So thank you so much for taking some time to join us today and share some of your expertise and share about yourself with our audience.
Teepa Snow: I'd rather do the expertise, but I understand there's an interest in learning a little bit about what came first, the chicken or the egg.
Christina Chartrand: I think so. I think so. This is a this I'm very excited about this conversation because normally this is not what I'm asking Teepa. I'm typically asking her her expertise on helping a family with a loved one who has dementia and what are some tips and strategies behind it and what what can we do to help someone and this time I really am excited to be able to talk about how you got to where you are today and how all of this training and expertise and information that has gone over the world, the world, you know, and learn about your legacy because you are certainly leaving a legacy.
David Chandler: Yeah, absolutely. So Teepa, tell us about how did you get into dementia care? Take us back to the beginning.
Teepa Snow: Okay, well, when I was first involved in dementia care, I actually had no idea I was involved in dementia care. My grandfather moved in when I was young, after my grandmother died, and I thought we had just an eccentric old guy that was moving into the house. I was also at that time, and a little bit later, I was working with kids, including my sister with developmental disabilities due to... Hers came from a brain tumor they couldn't operate on and she's 10 years younger than me. And so when she was small, you we were trying to figure out what the heck is going on because she started off fine and then she developed a tumor in her brain down near the pituitary. And so all of a sudden things were really different and she had to have emergency care and you know, it was really pretty messy. So I was the older sister in this. And so I learned quickly how to be supportive. My brother's one year younger.
So I learned how to be supportive when family's in crisis. And at that same time, then my grandfather was also developing his dementia, which we thought at the time was not dementia. We just thought he was getting eccentric because he had black lung disease from working in coal mines during the depression and he had emphysema. so we were giving, you know, that was just because he wasn't real clear about things. So it wasn't until I went to take care of him in high school, because now I'm in high school. I mean, we did the care all the way through. In high school, however, it had gotten to the point. Middle school, was like, "Mom, I'm not sure Dad should be, or Grandpap should be driving anymore." "Oh he's fine, just tell him when to turn!" I was like, okay. So I was getting him to turn at the right, "Stop sign, stop sign, Grandpap, stop, stop, stop, car coming, car coming, okay. There we go, good, good!" and hoping he'd get back home okay to where I was driving then in high school. And that's when we thought we can't, my mom was like, "I can't do this anymore" because she was not great. So we were thinking about placing. And so we placed him in a skilled nursing facility and I became a nursing assistant, which at the time, yeah, this was in Pennsylvania. What you did is you went on site.
You followed somebody around for three days, they showed you what to do, you had a partner, and honestly, this was 50 plus years ago, what you would do is you'd go down the hallway, the two of you, you'd untie people, you'd dry people up, and then you'd tie them back up. That was a lot of the care for people who had impairments. I mean, yeah, it was back in the day.
We hadn't yet gotten Haldol involved, so we were tying people up in their chairs against the wall, using sheets often. This was, I mean, these were the dark ages. And when we came out with the restraints, those were like, exciting because now we don't have to use sheets. We actually have things like Posey vests and we have things like wrist restraints. I mean, so I've lived through all that and my grandfather unfortunately didn't do well in the facility. So we were cared for him at home again, relatively shortly.
But I was a nursing assistant before there was a C. There was no certification. It was just learn and do. So I got exposed early on, but we still didn't call it dementia. What some of those people had were Organic Brain Syndrome back in that time. I so I, yeah, if people were senile, they had Senile Dementia and they had Organic Brain Syndrome. And I thought, boy, this is really grim, but you know, I was pretty good at it. I could, I could get the job done. But then I was called back home to take care of grandpap. And then I went off to college and grandpap ended up having more and more challenges and ended up passing before too long. But what also happened is my grandmother on the other side started developing a dementia. So it was like, "Oh boy!" So now hers, we did again, didn't know what it was. She was just getting more and more senile. So I was in that time period.
And then when I went to college, I was working at a nursing home in North Carolina for sort of weekends and doing care. Yeah, make money and be a Duke, because I was Duke undergrad. Yeah. And got some experience, worked at the VA, did some work there and learned more and more about this thing that people were experiencing. And that's when we started using Haldol, Haloperidol, a lot. And so people were very drugged to the point of part of dyskinesia.
Christina Chartrand: Right.
Teepa Snow: And then I went and worked in a day center for kids with developmental disabilities and adults with dementia in the basement of a church for a while. And was like, huh, wow. And then I went to OT school, ta -da. And I first started working again with adults with developmental disabilities, stroke, head injury, did a lot of head injury, stroke, rehab, and then started working in dementia and taught at the medical school. And that's when I really got into dementia on the Program On Aging's team. So there it all started. And from there, look back.
Christina Chartrand: That's amazing! So, you know, no, no, think it's fascinating. I think it's fascinating.
Teepa Snow: Now that wasn't necessarily what you thought you were going to hear, but that's it all comes from early adventures of not liking it. Yeah. What do you do?
Christina Chartrand: So what kind of, you I think back, you know, at that point, how much, you know, was there specific training on dementia? Was there any specific curriculum or what to do? Or was there anything out there or you were just like, you're winging it?
Teepa Snow: Nothing. There was absolutely nothing. The only thing that people were starting to look at was reality orientation. So there were classes on how to run reality orientation classes so we could get these people back to reality. So we would actually, know, part of our job was to go down the hall, run these little groups. So you would get them all together. "What's today? What's the date? What's the day of the week? Okay, why are you here? You know why you're here? Your family can't take care of you. This is your new home. This is where you stay. No, no.
This is where you stay. It's time for this. No, you just had that. What'd you have for breakfast?" You had this. I mean, our goal was to reorient people and that's what we were supposed to do. And both my friend, Melanie Bunn, who's a nurse practitioner, had similar kind of events. We're going down, one of us was going and then the other one actually, it's interesting how we had similar stories. I had two ladies and they said, "What's today? She's gonna ask." And I was like, "My God, what am I doing? Why am I doing this?"
And so I decided to run sensory stimulation courses. So what I did instead is I brought in an orange and I brought in a coffee grinder and I bought in coffee beans and I brought in a percolator and I brought in cotton and I brought in mint. And I started going, what if we ran and what would happen is people would talk and they would talk about making coffee and they would talk about orange juice and we'd squeeze the oranges and they'd taste it and they'd say, that's too much pulp. don't know. But all of a sudden, wow, that was a real different experience. But there was no guide sheet on how to do that. But I saw really different people when I changed what I did.
Christina Chartrand: All right. That makes sense. So, you know, you had had this job. This is what you were doing. And then what made you kind of go, "OK, I'm going to start creating. I'm going to start putting these ideas together and start talking about it, sharing it with people." When did that start?
Teepa Snow: Well, when I graduated from OT school, people were saying you should do some continuing ed because everybody needs continuing ed. You're an occupational therapist. Part of your job is to help people learn how to help people do things that they want to do. Get dressed, shave, take a bath. And so I would be doing that and they would say, "Yeah, but I can't get her to do, I mean, she won't even let me X." And I'm watching them and I'm going, well, you your problem is you're standing right in front of her and you're leaning in and you're actually yelling at
Like you're saying, "You need to get up, get up. Come on, I can't help you if you're sitting, lean forward." And it's like, well, there's nowhere for her to go. I don't know where you think she's leaning. And so I'd watch the interaction and think, wow, clueless. And so I started doing the continuing ed about positive physical approach. So that was my very first piece. And then the second piece was you need to show, then you tell, and only then should you touch. Cause I kept watching these interactions where it was like "Get your hands off of me!" And it was like, "Ooh, there's something wrong here. I think we're missing the what's going on." And here you'd brush your teeth and we were shoving things at people and it's like, "Ooh, bad idea." "You ready to take your shower?" "No." Okay. "Well she refused." It's like, "Wait a minute. No, thank you. I'm fine."
So I was watching a lot of like, well, you know, I do the work as an OT, but then I'm turning it back over at the end of my care plan. And it's like, nothing's going to be followed through on. And I'm watching this and it's like, well, then we've got to change that. That's got to change. So I started doing training on these kinds of things. And then, then it was like, okay, this, this is bigger than this. This is, this is more than this.
Because what we had was we were throwing drugs at people to the point where they couldn't move. And then we were complaining that they were total care. And it was like, but when you reduce the drugs, then people couldn't figure out what to do. So I started, I was working in the VA Medical Center by then as part of what I was doing. I was also working in community care and I was working with the area health education centers in North Carolina, teaching at UNC School of Medicine, part of the program on aging, but also running the care option program to have people, it was CAP program, having people stay at home rather than go to a facility with the right care plan. And that meant we had to assess situations and come up with care plans that would work. And so we started, I started working with other groups to try to improve awareness and knowledge about what is this thing that we are now calling Alzheimer's.
Because back then we thought everything was Alzheimer's, all Alzheimer's, senile dementia Alzheimer's type. And we would see younger people and it was like, wow, she's got an extreme case of this and it's really young. But we didn't know a lot of other options back then. And this was in the mid 80s, early 90s. And so what started happening is I started going, okay, well, let's develop a care plan. And then I started working with the Alzheimer's Association, developing workshops that we could actually train facilities and workers in facilities and workers in care, home care and families. So they'd better understand what was going on. Cause if you don't know what's going on, I found the brain slides that came out of the University of Alabama. And for me, that was the game changer as far as helping people believe.
"So, so she's not doing this on purpose?" I mean number of times I heard, "My God, this is what's happening in her brain? Oh my God, no wonder. Wow!" And then when I would say, "Okay, so this is about how much she can see or this is or this," then all of sudden the aha moment of,
So if I, yeah, and then all of a sudden the acknowledgement and the ownership of, well, you know, like a life sort of like pause of, "Wow, now I have a way to reframe this that makes sense." And for me, that was probably the most life altering finding for me was finding those slides and working with them to get permission.
Christina Chartrand: I will have to say that, you know, they are still the most impactful part of your training.
David Chandler: You never forget them once you see that you never forget.
Teepa Snow: We never do.
Christina Chartrand: No, and you're right and it's you say it all the time, but if you know, it's the visual part because nobody can see dementia, right? No one can see your brain changing And those photos and and explaining that you know, I talk about it the way I teach is like I talk about Teepa's tour of the brain Right. Let's do a tour of of the brain and and talk about it and it is I think it's one of those absolute aha moments— It still wows me!
Teepa Snow: It's still wows. And the other cool part is we can then figure out how do we take a moment to find laughter in the pain because it can't all be dark and gloomy. So I'll say, now I would bet you that if we watch David's brain and it got down to one third its original size, we would all go, Oh, crap! David's not gonna be able to do what he used to do." But because your skull doesn't, it makes it harder for us to notice that.
You know, if my brain swole up and you think, wow, she's really good at this, I might just have a big head. You never know, you know, but until you do something with me and that's how you'll figure out what's going on with her. Is this real or is this just, she's tired. So then we can start to play with it a little bit and see ourselves in this brain change thing and realize both of us are going to have to have brain change. One is voluntary and the other one is not.
Christina Chartrand: Yeah. Exactly. It's amazing. Okay, so obviously, you know, your techniques and strategies with the possible physical approach, as well as understanding visual verbal touch and using, you know, from hand under hand. I'd forgotten about hand under hand. Sort of forgot about that one. Yeah, yeah, yeah. That was in there too. Yeah, yeah. And then came the gems, huh?
Christina Chartrand: Yes, let's talk about that. I mean, that's what everybody, they're like "The gems, the gems, Yes, Teepa's gems."
Teepa Snow: Yeah. Yeah, so at first there wasn't. So at first I just knew that we couldn't talk about global deterioration. I just could not. I saw the brains, but people were still people first. And talking about them doing nothing but deteriorating, it's like, "But she's still interacting, she still does stuff. Come on, give her credit for what she can do. I mean, she's still trying to use her arm!"
So, let's relook. And so I went to my background, which was OT, and I went to Alan cognitive levels. And that's where at first I was really focused, okay, well, there's different levels of ability. And so for the longest time, I was looking at levels and I thought, well, how can we see this is not so negative and awful? And I thought, well, if you think about the person as having value and the value is different, but they're still valuable.
Maybe we could think about them as these gems and then we give them the right setting and the right care and they shine. And so that was really an aha moment for me. And then I started looking at what would the colors of the gems be and why and what would be the characteristics. And then I had to go to what I know about gems and sort of figure some of that out. And at first I will tell you that I just saw people living with dementia or people with disability as being the gem states. And then I realized, actually, you know, I do this every day. When I'm sleeping, I'm in a Pearl state, know, really and truly. mean, it's, you know, if you don't do Pearl every day, you'll be dead before too long or else not doing well. And there are times I just want to go rake the grass. Don't mess with me. I'm just, I'm doing that and I'm not real skillful, but I just want to get it done. I want to get it done. Don't mess with, I'll do it when I stop.
David Chandler: Hey, Teepa, if somebody isn't familiar with the gems, where could they go to learn more about what we're talking about?
Teepa Snow: Mm -hmm. Well, it turns out that one of the first things that Senior Helpers decided, "Ooh, this is a really good model." I mean, we have the Senior Gems, which is the variation that they took on it. And you guys have been using for ages and on our website, we have gems, but we have lots of info on the gem states because, now we talk about gem states, not gem stages, because people come and go and they flip around all over the place but they tend to settle in a space for most of a day, morning, afternoon, and it can shift. But we have a lot of it. It was.
Christina Chartrand: Were you surprised that it took off like that as big as it did? Like if you look back on it, you go and, okay, well, I was just sitting here thinking, well, yeah, blue, normal aging.
Teepa Snow: Yeah, like the ocean, like the sky.
Christina Chartrand: I mean, you have to look back on it now and go, my gosh.
Teepa Snow: I just, I'm still sort of like when people say, "Yeah, this is what we teach at our university." It's like, "Okay, well good. I mean, I had no idea." You you know, you do stuff and you hope for the best. That's sort of my theory about life is I'll do what I can. I'll send it out in the world. I'll check on it. Let's see how it goes. And you know, that's sort of every time I come and spend time with folks with Senior Helpers and there's just that, this is so cool. You know, when I was where it was like, It's the aha stories are so fun to listen to where people make their discovery with stuff.
Christina Chartrand: They are, they are.
Teepa Snow’s incredible journey into dementia care shows how personal experiences can drive lasting change in the healthcare field. Through her Positive Approach™ to Care program, she has revolutionized how we understand and support those living with Alzheimer's and dementia. Join us for Part 2, where Teepa shares actionable strategies to improve dementia care and support families and caregivers alike. You won’t want to miss the continuation of this important conversation!
