Dementia changes how people think, feel, move, and interact. It reaches far beyond memory loss—touching communication, emotional regulation, physical ability, and relationships. These changes can be confusing and overwhelming, both for the person experiencing them and for those who care about them. Traditionally, dementia has been viewed as a process of steady decline—something to manage, fix, or mourn. But what if we looked at it differently? What if we understood these shifts not as deterioration, but as transformations—each with its own challenges, yes, but also with unique strengths, emotional truths, and opportunities for connection?

That’s the foundation of Teepa Snow’s GEMS® Method—a thoughtful, person-centered approach to understanding and supporting individuals living with dementia or other forms of brain change. Rather than forcing people into rigid stages or labels, the GEMS® Model offers a more flexible and compassionate framework. It recognizes that each person’s abilities evolve over time, and that with the right knowledge and approach, caregivers can adapt to meet them in those moments. Whether you’re a family caregiver, a healthcare professional, or someone seeking to better understand the experience of dementia, the GEMS® Method provides practical tools—and more importantly, hope—for improving communication, reducing conflict, and building genuine connection.

What Is the GEMS® Method?

Created by dementia educator and occupational therapist Teepa Snow, the GEMS® Model replaces the traditional “stages of dementia” with a more flexible, respectful, and ability-focused framework. Each stage is represented by a precious gem, emphasizing that people living with cognitive change are still valuable, even as their abilities evolve.

This model is a core component of Teepa’s broader Positive Approach to Care®, which encourages caregivers to adjust their interactions, expectations, and environments to meet people where they are—rather than trying to force them into a reality they can no longer process.

Why Gems?

Gems are durable and unique. They may be shaped by pressure or time, and their beauty lies in their variation. That same philosophy applies here: people with cognitive changes are not broken—they are different.

Each GEMS® state corresponds to a different set of cognitive, motor, and sensory abilities. People may move between states depending on time of day, stress, fatigue, or environment.

The Six GEMS® States, Explained in Detail

1. Sapphire – Healthy Aging

Sapphires represent brains that are aging normally—some slower recall, less multitasking ability, or physical slowing, but no signs of dementia or brain disease.

What it looks like:

• Occasional forgetfulness (e.g., walking into a room and forgetting why)
• Needing more light to read or more time to learn new technology
• Preferring structure, but still flexible and independent

How to support:

• Encourage continued learning and exploration
• Respect autonomy—Sapphires are still capable decision-makers
• Stay alert for early signs of brain change, but don’t assume decline

This state reminds us that not all aging is dementia—and healthy brains still need understanding and support.

2. Diamond – Sharp, Clear, but Rigid

Diamonds are still clear and capable in many ways, but they are often inflexible, resistant to change, and prone to becoming overwhelmed by new situations or demands.

What it looks like:

• Strong long-term memory, but difficulty with new learning
• “My way or the highway” thinking
• Frustration or anger when routines are disrupted
• May become suspicious, controlling, or argumentative

How it feels:
The world feels unpredictable, and sticking to routines feels safer. New environments, multitasking, or shifting expectations can trigger fear, stress, or anger.

How to support:

• Maintain routines and limit surprises
• Offer clear, concrete choices (“Do you want coffee or tea?” not “What would you like?”)
• Use calm tones and avoid confrontation

Think of Diamonds as sharp but unyielding: strong in familiar tasks, but vulnerable to anything unfamiliar.

3. Emerald – On the Go, Getting Lost

Emeralds are in a state of decline that often goes unnoticed—until something goes wrong. They can seem “fine” at first glance but often get lost in the details, forget recent events, or become confused about time, place, and sequence.

What it looks like:

• Repeating stories or asking the same question multiple times
• Struggling to follow directions or manage daily tasks
• Getting dressed in the wrong order or wandering out of the house
• Denying that anything is wrong

How it feels:
Emeralds often live moment-to-moment, unaware that they’re missing pieces. They may feel frustrated by how others treat them, not realizing their own confusion.

How to support:

• Use short, clear instructions and visual cues
• Avoid correcting or arguing; redirect instead
• Be patient—Emeralds are often trying their best but lack insight

Emeralds are like beautiful stones with cloudy inclusions: they appear whole but may have cracks in logic and memory.

4. Amber – In the Moment, Driven by Sensation

Ambers live through their senses. Their understanding of time, purpose, and safety is diminished, but their responses to touch, sound, and emotion are intense and immediate.

What it looks like:

• Picking up and handling objects compulsively
• Pulling at clothes or disrobing due to discomfort
• Resisting help, especially with bathing or dressing
• Becoming easily startled or overwhelmed

How it feels:
Ambers may not understand why someone is touching them or moving them. They’re reacting to sensation and emotion, not logic or long-term memory.

How to support:

• Avoid reasoning—speak with tone, not explanation
• Create calm, clutter-free environments
• Offer comfort items like soft fabrics, warm beverages, or hand massage

Think of Ambers as vibrant and reactive: they shine when they feel safe but can flare up when overstimulated.

If you’re adjusting the home for safety or simplicity, you can check out our blog on downsizing (The KonMari Method) for ideas that respect both form and function.

5. Ruby – Strong and Structured, Losing Fine Control

Rubies retain gross motor function—walking, dancing, even rhythm—but fine motor skills like buttoning, writing, or using utensils may fade. Their depth perception and coordination may also decline, increasing the risk of falls.

What it looks like:

• Difficulty feeding themselves or managing hygiene
• Fidgeting with objects but unable to manipulate them well
• Walking aimlessly, bumping into things, or shuffling gait
• Slurred or slowed speech, though emotional understanding may remain intact

How it feels:
Rubies may sense something is wrong but not be able to articulate it. They benefit from rhythm, music, and physical comfort more than words.

How to support:

• Use hand-under-hand support for eating or dressing
• Remove trip hazards and reduce visual clutter
• Focus on emotional connection through facial expressions, tone, and physical rhythm

Rubies shine with depth—but they need support to function smoothly.

6. Pearl – Hidden Within, Still Present

Pearls are in the final stage of life, often immobile and quiet, but still emotionally responsive. They may no longer speak, but can often hear, feel, and recognize familiar sounds or touch.

What it looks like:

• Little to no verbal communication
• Eyes may be closed; person may appear asleep or withdrawn
• May respond to familiar music, scents, or voices with a smile, hum, or squeeze of the hand

How it feels:
Pearls are often misjudged as being “gone,” but they are still aware of the world in subtle, sensory ways. They deserve tenderness, patience, and presence.

How to support:

• Speak gently, even if they don’t respond
• Play familiar music or recordings of loved ones
• Focus on physical comfort—soft blankets, hand-holding, soothing tones

Pearls are delicate, valuable, and deserve reverence.

The Value of the GEMS® Model

It Recognizes Individuality

Each GEM reflects a different way the brain processes information. It allows caregivers to recognize patterns and respond rather than react.

It Empowers Care Partners

Instead of feeling powerless, caregivers learn tools and techniques for engaging, redirecting, and comforting—tailored to the current state.

It Fosters Dignity and Connection

GEMS® is about respecting the person, not the disease. It restores humanity to caregiving relationships and brings moments of joy back into daily routines.

Practical Application: How to Start Using GEMS®

1. Observe behavior without judgment
   What do you notice about movement, language, attention, or reactions?
2. Match to a GEM state
   Use the descriptions to determine which gemstone reflects their current abilities.
3. Adapt your care
   Change your communication style, physical approach, or environment based on what they need now—not what they “should” be doing.
4. Expect shifts
   Someone may move from Emerald to Amber and back depending on time of day, stress, or illness.

For Caregivers Wanting to Learn More

For those who want guided exercises and video examples, the “Seeing the GEMS® Workbook” by Teepa Snow is a practical companion. It includes reflection activities and demonstrations to help you learn the model in more depth.

Understanding the emotional and physical needs of someone experiencing brain change is essential—but so is making sure their practical needs are met. If you’re supporting an older adult, you can check out our blog Are You Missing Out on These Senior Benefits? to explore financial, healthcare, and lifestyle programs that could ease your caregiving journey.

Conclusion: Seeing the Gem in Every Person

The GEMS® Method isn’t just a clinical framework—it’s a shift in perspective. It challenges us to move away from the impulse to “correct” or “fix” and toward a more responsive, respectful, and humane form of care. It reminds us that even when memories fade, communication breaks down, or abilities change, the person remains.

When we use the GEMS® lens, we begin to understand that every behavior has meaning. A refusal to eat might be about sensory discomfort, not defiance. A repetitive question may reflect anxiety, not stubbornness. A moment of silence might be a moment of deep feeling, not absence.

This model gives us permission to slow down, observe more thoughtfully, and act with purpose. It helps us recognize that people experiencing brain change still want to be seen, heard, touched, and understood. They still feel joy, sadness, frustration, and love—even if they express those feelings differently.

For caregivers—whether family members or professionals—GEMS® provides not only tools, but hope. Hope that meaningful interactions are still possible. Hope that caregiving can be less stressful and more fulfilling. Hope that we can still share laughter, music, touch, and connection in ways that nourish both people in the care relationship.

The reality is that brain change is complex, unpredictable, and often emotional. But when we approach it with the insight offered by GEMS®, we open up space for grace, dignity, and compassion to thrive—even in the most challenging circumstances.

Every person living with dementia is still a whole human being—not a shell of their former self. They are a gem—rare, valuable, and worthy of love and understanding.

So as you move forward in your caregiving journey, remember this: you don’t have to be perfect. You just have to be present. And if you can learn to see the person in front of you—not just their condition—you will find more peace, more clarity, and more connection.

Let the GEMS® Method be your guide—not to “cure” what cannot be cured, but to care with empathy, insight, and strength.

For those exploring long-term care or financial transitions, you can check out our blog on home equity (Unlocking Home Equity for Seniors) to learn more.