6 GEMS® You Need to Know For A Positive Approach to Dementia Care

6 GEMS® You Need to Know For A Positive Approach to Dementia Care post page

By Valerie FeurichJuly 10th, 2019

6 GEMS® You Need to Know For A Positive Approach to Dementia Care

Caring for a person living with dementia is not easy. Not only can challenging situations arise at any moment, but the traditional medical model caregivers might be confronted with by their well-meaning physician exudes a very negative outlook. Commonly used scales, such as the Global Deterioration Scale / Reisberg Scale, exclusively focus on what a person has lost as they transition through the different stages of dementia.

Yes, as of the time of this writing, there is no cure for dementia.

And yes, all types of dementia are terminal.

But what none of the commonly used scales take into consideration, is that people living with dementia can still enjoy a rewarding life. This is particularly the case if their caregiver, or care partner as we like to call them here at Positive Approach to Care® (PAC), is using Teepa Snow’s GEMS® dementia state classification model.

Unlike the traditional models, the GEMS States Model focuses on the skills and abilities a person still has, not what they have lost. Instead of looking at people as less, Teepa’s model encourages care partners to see what the person living with dementia still has left and is still able to do.

By being able to recognize a person’s GEMS State and thereby noticing the skills and abilities a person still has, care partners are able to provide the right support and care to help the person shine.

Additionally, it is important to recognize that in dementia there isn’t one static disease-stage or level of lost ability. Instead, people living with dementia will experience a variety of GEMS States throughout each day and over time (which is why we here at PAC rather refer to it as dementia states instead of stages).

What are Teepa Snow’s Six GEMS States?

Have a look:


A Sapphire is a brain that is aging normally, flexible, organized, and is able to work with all the other GEMS. People in a Sapphire State are the ideal care partners for someone living with dementia, as they possess the adaptability to go with the flow and appropriately interact with the GEMS State of the person in their care.

Note: When stressed, even a healthy brain can slip out of the Sapphire State. When that happens, the best thing you can do is to take a deep breath and a break (if possible) to help get yourself back into that calm and collected state.


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.


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.


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.


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.


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.

The question for all of us is, can we see the precious and unique?

By seeing the person living with dementia as the valuable GEMS they are and offering them the right care and setting, we’re giving them the opportunity to shine.

Caring for a person living with dementia isn’t easy, but with the right skills and tools, the journey can be significantly more rewarding.

Learn how to determine the correct state of your person living with dementia, and get the skills and know-how to adjust your care approach to get the most positive outcomes.

Browse Teepa Snow's GEMS Tools Now >>

11 Comments on “6 GEMS® You Need to Know For A Positive Approach to Dementia Care”

  1. My husband was diagnosed two years ago. He does not remember the testing and so, as I read, I put him in the Diamond stage. George will reach his 81st birthday this month. He was also diagnosed as a Type 2 Diabetic. He disregards all talk of what or not he should be eating or doing regarding this.
    I, frankly, did not know how to handle the news of my highly educated well spoken husband and fearfully walked through the door with him. As a result I broke my ankle this past Christmas by taking his night medications in error (in total frustration) of the days happenings. Since going through this I have somehow made the transition to understanding I need to curtail my anxieties for George. I will turn 80 in September. I am hopeful your information will continue to educate me.

  2. Teepa and company,
    I am totally committed to acknowledging and responding to the pearl that lies within the person with dementia at whatever level it exists. I don’t really see the relationship between your gem designations and the different dementia presentations (alzheimers as opposed to Lewy body or frontal temporal dementia) so I don’t see how the gem designation actually helps me to relate better to my client with anxiety and hallucinations, especially where I’m trying to manage medication and relieve anxiety.

  3. Wow! Great info! So true as to how these sweet souls are moving along this mentally and physically debilitating path! I am a geriatric nurse and appreciate all the education that is available on this site. Thank-you!☺️

  4. this is very interesting . . . theoretically. I do wish that *every time* you published something theoretical, you would include an activity that can be done with a dementia person. He gets so *bored:* can’t read, can’t follow the story of a TV show or movie, can’t go out by himself. If there is an activity he could do by himself, that would be the best!

  5. I understand how important activity is for him. Perhaps activities like
    Simple puzzles, some solitary games using
    cards like Bingo, Dominos, 21. Arts and crafts. Best of luck.
    Join a social group if possible.

  6. Important food for thought. this is helping me to also look into my self and treasure my husband more.

  7. I have been caring for people with dementia for the 7 years I have been with the company I work for. From the first,I have followedTeepa,read books,gone to seminars….I have laughed,cried with a lot of clients and families.
    The gems are a sweet way of putting which stage of dementia they are in. I like it better than using numbers. I could go on and on. Thanks Teepa and staff.

  8. these videos give a lot of real insight to what you or your care partners may not be realizing

  9. I will be very interested in how this process will affect Kevin and hopefully enable me to provide him with greater opportunity for interaction with other members of his family

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