Navigating the Stages of Dementia With the GEMS Model

April 5, 2021

Navigating the Stages of Dementia With the GEMS Model

Dementia is complex, unpredictable and is unique to each person who is diagnosed with it. It’s important to remember that it’s always changing. This can be extremely difficult especially for Caregivers because it’s a moving target and just when you think you’ve figured something out, you need to adapt again.

Teepa Snow, who is known for The Positive Approach to Care, uses the GEMS Model. It’s an excellent guide to understand the shifts in skills and cognition at any given moment. Even though the experience each person has navigating the patterns and progression of dementia are different, movement through the GEMS stages are often predictable. That said, understanding the current struggles as well as the current abilities, has such a positive influence on Caregivers and loved ones.

In the words of Teepa: “Just like gems, each person is precious, valuable and unique, and given the right setting and care, can shine.”

DIAMOND: Clear & Sharp; Routine & Rituals Rule

People in a Diamond State are still clear and sharp, but become increasingly rigid. They tend to have a lot of facets to them, but are noticeably inflexible and are able to still cut you or hurt you. Diamonds don’t do well with change, but are still very much able to shine. They are who they were, but they are different. This can make it difficult for care partners to acknowledge that the person is really living with dementia, as they still know what they’re doing but appear increasingly stubborn.

EMERALD: Green & On the Go With a Purpose

Unlike the Diamond, people living in the Emerald State are no longer clear and sharp. This is usually the state at which people begin to struggle and get identified as having something going on. Emeralds are on the go, but might get lost in time or place and their words aren’t always as clear and sharp as they used to be. An Emerald is flawed but unaware, thinking that everything is fine, so they may cast blame on someone else. In this State, care partners are likely to notice mistakes. Instead of pointing out the flaw, care partners will likely have much greater success by going with the flow.

AMBER: Caught in a Moment of Time; Caution Required

People living in an Amber State tend to be caught in a moment of time. Many Ambers are all about sensations, and what something feels like. They are therefore more curious than cautious, and lack safety awareness. An Amber is all about seeking things they like, but may strongly respond to things they don’t like. So, this is the State at which care partners often struggle to not turn into a Diamond themselves, as the person’s behavior is so inconsistent with who they used to be.

RUBY: Deep & Strong in Color; Others Stop Seeing What is Possible

In this State of dementia, fine-motor skills in a person’s eyes, fingers, mouth, and feet begin to fade. A Ruby might therefore have trouble figuring things out visually, and struggle with speech production as well as chewing and swallowing at times. While fine-motor skills get lost, a Ruby can still do larger, gross movements, like clapping hands or holding onto things. In this State the person’s strength remains fairly unchanged, so they might firmly hold on to you or miscellaneous items without knowing how to let go. It’s easy for care partners to get stressed and go Diamond in this State, so it is particularly important to take a step back, take a deep breath so you can get oxygen to your brain, and try to let go of what was so you can be a Sapphire once again.

PEARL: Hidden Within a Shell; Beautiful Moments to Behold

Similar to an oyster shell, which tend to be ugly on the outside but can hold treasured GEMS on the inside, care partners can find a Pearl in this last State of dementia if they just know where and how to look. In this State, the brain has changed so that the person’s reflexes are turned on non-stop, body systems begin to shut down, and gross motor skills are lost. The person becomes trapped, but with the right care the shell relaxes just enough to produce the amazing Pearl that is still there. In this State care partners tend to spend way too much energy on preserving the shell, but miss the GEMS that are still residing inside.

If you or a loved one has been diagnosed with dementia, we highly recommend Teepa Snow’s resources such as her website, books and online training. The summaries on the GEMS above came directly from her website:

If you are looking to get insight into your long term care and resource options that specialize in Dementia, please reach out to us to schedule a discovery call at or call (941)867-0809. We are FREE service to help you get the care and information you need. 

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