Teepa Explains Why She Categorizes Dementia Patients As “Gems”

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As the mental health of a person with dementia begins to deteriorate and he or she struggles more with communication and daily tasks, it is easy for caretakers to begin to treat the person differently than they would have before. If the patient is unable to speak, caretakers may act as if he or she cannot hear what they’re saying. If the patient is slow to understand or do tasks, caretakers may mistakenly treat him or her like a child.

It’s generally a simple and honest mistake, as knowing how to interact properly with a person who has dementia can be hard. But it’s also important that we bear in mind the value that a person has, no matter what his or her abilities are. Luckily, there’s now a system called the GEMS® model to help caretakers understand people with dementia better and to constantly remind everyone how valuable people with dementia are, despite the unfortunate changes in their brains. It’s called GEMS®, and it’s bringing a new level of respect to the world of dementia care.

Teepa Snow, MS, OTR/L, FAOTA, is a dementia care and education specialist with a background in occupational therapy and over 30 years of experience, which has taught her a lot about how people with dementia think and what can be done to help them cope with this horrible disease. Teepa is the genius behind the GEMS® model, and she leads classes and seminars focused on difficult dementia-related situations to help improve care and quality of life for dementia patients.

Photo: YouTube/Sonata Senior Living

Photo: YouTube/Sonata Senior Living

Within the GEMS® model, there are six different gems, five of which refer to different stages of dementia. Here is a short description of each:

Diamonds

The diamond is the first stage of dementia, when the patient is just beginning to exhibit signs of the disease. It’s often hard to detect at this stage, and the symptoms tend to come and go. However, if you pay attention, there is a noticeable difference in what the person is able to comprehend and remember. A diamond will likely still have a clear and sharp mind but might have a hard time dealing with change.

Emeralds

The green color of the emerald represents the word “go,” as in a stoplight, in reference to the on-the-go nature of this type of person. Emeralds are often active and vibrant and want to have conversations and relationships, but they’re starting to have trouble finding the right words and often get lost or forget things that happened within the same day. Emeralds often do not know they have a problem, but those around them can tell that they aren’t as sharp and clear as they once were.

Ambers

Keeping with the stoplight analogy, amber means “slow down” or “caution.” Amber dementia patients live entirely in their own moment. They have trouble understanding time, safety, and other realities of daily life. They still enjoy company and activities, but they’re only interested in what they’re interested in and nothing else. They may resist baths or other care routines and safety precautions, which can make caring for them a challenge.

Rubies

Red is the last color in the stoplight sequence, meaning “stop.” This refers to the cessation of fine motor skills in the fingers, eyes, mouth, and feet. Rubies have trouble picking up details and perceiving depths, cannot speak or chew well, stumble often due to lack of balance, and can no longer do many of their daily tasks. These patients may lack good sleep rhythm and need lots of consistency in their care.

Pearls

Pearl is the latest stage of dementia, and this particular gem was chosen for the last stage because pearls are made up of layers and are found hidden inside an oyster. Similarly, a pearl dementia patient is hidden within themselves but will give up rare glimpses of the beauty inside. Pearls are trapped in the shell of their bodies, which can no longer do much at all without help, but don’t miss out on the person hidden inside and the unique opportunity you have to interact with them on their own terms.


The sixth gem is a sapphire, and it refers to the “true blue” ideal caregiver, the person who always understands the dementia patient’s point of view and works hard to make that person feel understood, needed, cared for, and loved. A sapphire is able to adapt to the changing needs of the other gems.

Watch the video below to hear more about Teepa’s GEMS® model and how you can use this system to better appreciate and support someone with dementia.

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Elizabeth Nelson is a wordsmith, an alumna of Aquinas College in Grand Rapids, a four-leaf-clover finder, and a grammar connoisseur. She has lived in west Michigan since age four but loves to travel to new (and old) places. In her free time, she. . . wait, what’s free time?
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