Introduction to the GEMS® Model
The GEMS® model is a groundbreaking framework for understanding the changes in an individual's abilities as dementia progresses. Unlike traditional stage-based models that focus on a person's losses, Teepa Snow's GEMS model emphasizes a person-centered approach by highlighting the remaining skills and abilities. The model uses gemstones as a metaphor, suggesting that each person with dementia is precious and unique, and can still 'shine' brightly when given the right support and care. This approach shifts the perspective from what a person can no longer do to what they can still do, fostering a more positive and empowering caregiving relationship.
The GEMS: A Detailed Breakdown of Each Brain State
Sapphire: The "True Blue" State
The Sapphire represents a healthy, normal aging brain with no significant signs of dementia. Individuals in this state are flexible and adaptable, capable of complex problem-solving, and can filter their reactions. They may be slower in processing information, but their cognitive abilities remain intact. This state emphasizes the importance of respecting a person's choices and giving them adequate time to process decisions. It serves as the benchmark for normal cognitive function, and for those who will later develop dementia, it is the state they will have once known.
Diamond: The Clear and Sharp State
The Diamond state is associated with early-stage dementia or mild cognitive impairment. Individuals are still very clear and sharp, but their thinking becomes more rigid and less flexible. They rely heavily on habits and routines and may become upset when these are disrupted. Their communication skills often mask their cognitive struggles, a phenomenon sometimes called "covering." This stage requires caregivers to focus on maintaining familiar routines and to use careful, respectful communication, avoiding arguments that can lead to conflict and suspicion.
Emerald: The "Green and On the Go" State
The Emerald state represents moderate dementia, where individuals are often active and mobile but may get lost in time and place. They have a limited awareness of their changing abilities and can become easily frustrated. This is often the point at which dementia becomes more visible to others. Communication at this stage is more about listening to and validating the person's feelings rather than correcting their memory. Caregivers are encouraged to 'go with the flow' and provide purpose-driven activities that engage the person's need to be 'on the go,' such as sorting objects or simple tasks.
Amber: The "Caught in a Moment" State
In the Amber state, individuals live in the moment and are primarily guided by sensation. They have limited impulse control and safety awareness, focusing on what they can touch, taste, or feel. This is a critical period for caregivers, as the person may try to explore and investigate their environment in unsafe ways. Safety-proofing the living space is essential. Communication should be simple, direct, and rely on sensory input, such as the touch of a hand. Redirecting a person's attention with safe, repetitive tasks is an effective strategy.
Ruby: The "Deep and Strong" State
The Ruby state marks a period of late-stage dementia where fine motor skills decline significantly. A person's hands, eyes, and mouth may lose coordination, making tasks like eating, buttoning, or brushing teeth difficult. However, gross motor skills and rhythm often remain. Communication shifts from verbal instructions to physical cues, like using a gentle Hand-Under-Hand™ technique. Activities like singing, swaying, or holding hands can provide comfort and connection. The focus here is on providing a calm and supportive environment and acknowledging the person's remaining strengths rather than their diminished skills.
Pearl: The "Hidden in a Shell" State
This represents the final and very severe stage of dementia. The person is often non-verbal, immobile, and may seem completely withdrawn, like a pearl hidden inside an oyster shell. Their awareness is minimal, but they can still respond to familiar voices, touch, and rhythmic sounds. Care is focused on comfort and connection, with the understanding that the person's essence remains. Gentle touch, quiet music, and a calming presence can still create beautiful moments of connection. The goal is to provide dignified and loving end-of-life care, focusing on the person's comfort rather than their physical capabilities.
Why The GEMS Model Matters for Caregivers
Traditional approaches to dementia often focus on the deficits and stages of decline, which can lead to feelings of despair and helplessness for both the person with dementia and their family. The GEMS model offers a different, more optimistic framework. By reframing the person's behaviors as a consequence of their brain state rather than intentional actions, caregivers can reduce frustration and respond with empathy and understanding. This person-centered perspective enables caregivers to adjust their strategies to the individual's specific needs and abilities, leading to more positive interactions and a better quality of life for everyone involved. For additional resources and training on this topic, visit Teepa Snow's Positive Approach to Care.
GEMS vs. Traditional Staging Models
| Feature | GEMS® Model | Traditional Stage Models |
|---|---|---|
| Focus | Retained abilities and unique brain states. | Progressive loss of abilities (mild, moderate, severe). |
| View of Person | Precious, unique, and capable individuals. | Diminishing person with increasing incompetence. |
| Caregiver Mindset | Empowered, empathetic, and flexible. | Stressed, reactive, and focused on deficits. |
| Communication | Tailored to current gem state and sensory needs. | Often relies on verbal commands and corrections. |
| Progression | Moment-to-moment variability, not just linear decline. | Static, linear progression of cognitive decline. |
| Overall Message | Find the person's strengths and adapt. | Measure the person's losses and manage decline. |
Conclusion: Shifting Perspective, Improving Care
The GEMS® model provides a crucial shift in perspective for those navigating dementia. By moving away from a focus on loss and toward an appreciation of retained abilities, caregivers can foster meaningful connections and provide more effective, compassionate care. Understanding what are the gems of dementia and the characteristics of each state allows caregivers to become more patient, empathetic, and attuned to the individual's evolving needs. This approach not only improves the quality of life for the person living with dementia but also empowers caregivers with a more positive and manageable caregiving experience.
