Teepa Snow, a renowned occupational therapist and dementia care expert, created the GEMS model as a positive and empowering way to understand and approach dementia. Rather than focusing on what is lost, the GEMS model encourages caregivers to see the person with dementia as a precious, unique individual with remaining skills and abilities. The model emphasizes that individuals can move through different "states" throughout the day, not just linear stages. The six gemstones—Sapphire, Diamond, Emerald, Amber, Ruby, and Pearl—each represent a distinct cognitive state with unique characteristics, behaviors, and needs.
Understanding the GEMS Model
The GEMS model stands as a dynamic system for categorizing cognitive changes and is intended to guide interactions and support. It helps care partners identify retained skills and adapt their communication, environment, and physical approach to foster engagement and reduce distress. By recognizing which "state" a person is in, a caregiver can provide more effective, person-directed care.
The Six Gemstones Explained
1. Sapphire (True Blue)
- Characteristics: Represents a healthy, flexible, and adaptable brain. An individual in the Sapphire state has optimal cognitive function and is able to make informed decisions. This is often the state of a care partner supporting other GEMS.
- Care Approach: Individuals in this state are still capable of learning and adapting. If they begin to experience fatigue or pain, it can trigger temporary moments in a Diamond state, but rest can restore their Sapphire abilities.
2. Diamond (Clear & Sharp)
- Characteristics: Individuals in this state are clear and sharp, but often rigid, living by habit and routine. They may become inflexible under pressure and have a strong preference for familiar people and places. They can appear sharp but may be defensive or dismissive when making errors.
- Care Approach: Consistency and routine are key for Diamonds. Caregivers should respect their routines, avoid pointing out mistakes, and connect with them respectfully before giving instructions. Directional signs and labels can be helpful visual cues.
3. Emerald (Green & On the Go)
- Characteristics: These individuals are "on the go with a purpose" but are naturally flawed in their thinking and memory. They have a strong desire for independence but miss details and can get lost in both time and place. This is often the stage at which dementia is diagnosed.
- Care Approach: Caregivers should limit and simplify verbal communication, using things with rather than for the individual. Instead of correcting them, it is better to provide structure and guidance to their movement, allowing them to feel independent while staying safe.
4. Amber (Caught in a Moment)
- Characteristics: Ambers are guided by sensations and instinct rather than caution. They live intensely in the moment, reacting to what is happening immediately in front of them. Their curiosity can outweigh their safety awareness, and they often seek to satisfy desires and avoid what they dislike.
- Care Approach: Caregivers need to read body language and anticipate needs. Engagement should focus on sensory activities, and the environment can be modified to avoid over- or under-stimulation. Using simple language and gestures is crucial.
5. Ruby (Deep & Strong)
- Characteristics: In the Ruby state, individuals lose fine motor skills and controlled movement. Their communication becomes very limited, but they often retain the ability to use rhythm, such as humming, singing, or swaying. Others may stop seeing what is possible for them.
- Care Approach: The focus is on rhythmic, calming, and soothing interactions. Caregivers should use simple, clear cues, often paired with gestures or objects. Using Hand-under-Hand® technique can be very effective for guiding movement.
6. Pearl (Hidden in a Shell)
- Characteristics: The Pearl is in the most advanced state of dementia, largely immobile and hidden within themselves. The person's cognitive function is profoundly impaired, but moments of connection can still be found. They are ruled by reflexes and respond to familiar touches, tastes, and voices.
- Care Approach: Connect through the senses. Verbal cues should use a deep, calm tone with rhythm. Physical connection is vital, using gentle palm pressure at joints and maintaining stabilization contact. Serving food on brightly colored plates can assist with vision.
GEMS vs. Traditional Stages: A Comparison
| Feature | GEMS Model | Traditional Staging Models |
|---|---|---|
| Focus | Retained abilities and strengths. | What has been lost or deteriorated. |
| Classification | Dynamic states that can change moment-to-moment. | Linear, static stages of decline. |
| Perspective | Sees the person as unique and valuable, like a gemstone. | Can foster a negative view of increasing incompetence. |
| Guidance | Prescribes interaction techniques based on the current state. | Provides general descriptions of progression but less direct guidance for interaction. |
| Outcome | Promotes engagement, participation, and a better quality of life. | Can lead to isolation and doing "for" rather than "with". |
Conclusion
By understanding what are the six gems that Teepa describes, caregivers gain a powerful tool for shifting their perspective from loss to ability. The GEMS model is a foundation for Teepa Snow's Positive Approach to Care, providing a humane and constructive framework for supporting individuals with dementia. Rather than seeing someone as a number on a scale of decline, this model encourages caregivers to appreciate the person's unique characteristics and adapt their care to help them shine, fostering more positive and meaningful interactions throughout the dementia journey. A deeper understanding of these gem states can transform the care experience for both the individual living with dementia and their care partners.
For more resources and training on the GEMS model and dementia care, visit the official Positive Approach to Care website: https://teepasnow.com/.
