The gems© Approach 

To get an idea of how we think about connection and dementia take a look at our Being in Connection page

Hover over each Gem and click on each word for more information

All words from:

https://teepasnow.com/about/about-teepa-snow/the-gems-brain-change-model/

Teepa Snow and Positive Approach to Care© have developed a wonderful system for identifying ‘where people are at’ with dementia. Teepa’s system is called GEMS. It is based on understanding how dementia affects someone’s ability to connect with us, and our ability to connect with them, and how this changes over time.

We want to express our deep gratitude for what the expertise, love and care they bring to the dementia space and for graciously allowing us to use their beautiuflly dveeloped resources, ideas and philopshies. Please take a look at their website here https://teepasnow.com/ and her.

The GEMS are six precious things formed in nature. The model looks at how each material is formed naturally and applies that to a dementia state or stage.We see it as really quite beautiful.

 From Teepa Snow's Positive Approach to Care   website 

 

The model recognizes the dynamic nature of the human brain and its abilities.

 

Just as gemstones need different settings and care to show their best characteristics, so do people.

 

Rather than focusing on a person’s loss when there is brain change, seeing individuals as precious, unique, and capable encourages a care partnership

 

Providing supportive settings for everyone, including care providers, allows them to use what they have to be their best.

Everyone living with brain change when given the opportunity will shine.

 

https://teepasnow.com/about/about-teepa-snow/the-gems-brain-change-model/ 

lets look at the gems a little closer

Different types of dementia have different expressions, especially in the early stages, but the general progression of these diseases tends to be very similar, especially as time goes on.

 

We need to know what capacities are strong and which are not – this will change over time and can shift within a day (!) – the progression is not predictable, and people can move in and out of different abilities/capacities from one hour to another

 

Being able to identify what ‘state’ someone is in can help us connect well – being able to gauge what we can expect, how we should adapt, etc.

We provide a little more information about each Gem states below. We describe what each state generally looks like and provide some supports and skills you can develop to connect and interact. Remember that even though progression over time continues in a linear direction, someone may move in and out of more than one state per day, these gem states are not fixed, but guidelines or sigals.

Their Abilities and Ways We Can Stay Connected sections:

These tables are taken from Teepa Snow's resource The GEMS State Tool©. It provides some guidance on abilities in each state and some tips and suggestions as to how we can stay connected with a person experiencing each tate

Much of the below has been taken from Teepa Snow's book Dementia Caregiver Guide (we highly recommend purchasing it) and The GEMS State Tool. We again thank Teepa Snow and Positive Approach to Care©  for allowing us to make use of their wonderful resources. Please see their website for more information. 

Cathy Greenblat has produced beautiful photos that pan all states of the GEMs model. Do take a look if you can. See her website below:

https://www.cathygreenblatphotography.com/love-loss-and-laughter

sapphire

Someone who is in a sapphire 'state' is ageing normally, their brain mostly stays the same, it will be a little slower but still intact. There might be moments of feeling blue about changes and/or losses. They can do and learn new things, but it may take more effort. Life-long patterns will mostly prevail. Still, recognising changes experienced as ageing occurs can help with connecting and interacting positively.[1]

Their Abilities

Ways We Can Stay Connected 

Copyright © 2006 - 2019 Positive Approach, LLC and Teepa Snow. May not be dupictaed or resued without prior permission.

diamond

Teepa [1] sees that a diamond has many facets – it shines, it is hard, cutting and sharp, but nevertheless beautiful and expensive. She uses these descriptions to look at another state of dementia, the diamond state. 


As diamonds are strong and hard, the person will begin to become more rigid, they may say hurtful or mean things without seeming to notice or care. They also might get stuck on talking about money and costs. Some family members will not be sure whether these changes are dementia or just the person being stubborn, mean or forgetful. 


The person will do best when operating in established routines and rituals. They will shine.

Their Abilities

Ways We Can Stay Connected 

Copyright © 2006 - 2019 Positive Approach, LLC and Teepa Snow. May not be dupictaed or resued without prior permission.

emerald

Teepa sees that the green of the emerald represents being on the go, whether that is back in time or going forward. It implies a little bit of chaos, lack of cognition or understanding. But again, there is beauty. 


Teepa explains [1]:
‘Clearly no longer able to be independent. Making mistakes and not noticing or getting upset, but not being able to fix it. Will either want to be in charge or will look for someone to take over or guide and direct. Wants to be seen as an adult and competent. Language and comprehension are more vague. Seems to travel back in time and place. They need meaningful engagement to fill the day but may not know that and so may get frustrated. Might get lost in asequence of events – (forget what they are doing when completing tasks). They may not pick up on internal cues – so may have bathroom accidents, skip meals or eat too often, they may miss baths/showers and not change clothing’ [1]

Their Abilities

Ways We Can Stay Connected 

Copyright © 2006 - 2019 Positive Approach, LLC and Teepa Snow. May not be dupictaed or resued without prior permission.

amber

Amber is golden yellow.  It is a 'gem' made up of pine sap. An object, often a small insect or leaf will get stuck on the sap and then sap will continue to cover it. Teepa sees that it can represent something caught in a moment.

 

Teepa explains [1]:

This state represenets living in a moment of time,  this 'time' or 'moment' is not the past but instead the present. There is a focus on sensation - what can be seen, what can be heard, what can be touched or felt etcThe cognitive process of someone in an amber state is one that is focussed on what can be done with the space and sensations in front of them, now. The person may have a lack of safety awareness - the yellow of amber representing a caution light - the person will be focussed on sensory needs and whether they can tolerate these - frustration may occur if there is sensory overload. The person will not be aware of tasks as much and instead would respond to situations as to whether they like it or not. They will have no abliity to delay need or gratification. It also may be harder to connect and spend time with the is person, as they are caught up in waht is being presented to them sensorily. This may mean speaking quietly, touching softly. It may mean they are distracted by other senses and cannot refocus - you might have to problem solve as to what is distracting someone or holding their attention if you feel it would be good for them to have some time connecting with you [1].

Their Abilities

Ways We Can Stay Connected 

Copyright © 2006 - 2019 Positive Approach, LLC and Teepa Snow. May not be dupictaed or resued without prior permission.

Ruby

Teepa explains [1]:

A ruby is deep red and has hidden depths, a persons skills are stopping and they may get stuck moving or being still, they can’t easily switch and takes more time to change gears, to slow down.

They are able to do big movements but not able to do fine details skills. They will be able to copy you but they will not know what the things they are copying mean. For example, you may ask a question, they may repeat this back to you but not realise that an answer would usually be expected of them. They will have monocular vision only – they are beginning to loose depth perception.  They will more likely repeat what they are doing. A switch to doing something new will onlt happen if  clear, strong, mulit-modal cues help this to happen. They will be slowing down in all areas of ability, trying to get someone to speed up in this state may cause shut down , resistance, a wanting to get away or feelings of fright. You should be careful of oversensitive areas - for example, lips and feet. There may be weight loss, watch for signals of hunger or thirst as the person often won't know what they are feeling. They will often respond to rhythm – singing, humming, praying, rocking, swaying, danceing. [1][2]

Their Abilities

Ways We Can Stay Connected 

Copyright © 2006 - 2019 Positive Approach, LLC and Teepa Snow. May not be dupictaed or resued without prior permission.

pearL

Teepa explains [1]:

The pearl, as a gem, is hidden in a shell, the outside of the shell is ugly, there are layers upon layers within the shell, the pearl sits still and quiet in its shell. The shell will close reflexively with disress. The pearl within glows.

 

The person in a pearl state is becoming immobile, curled into a foetal position, the person we know is locked away most of the time. The body is failing as the brain is failing, but the person will still have moments of connecting, there will be moments when they reappear – layer by layer. Reflexes are overwhelming or missing. Connections must be made slowly and can’t be maintained for long. We need to be able to let them go, not give up, but let go as they are leaving us. [1]

Their Abilities

Ways We Can Stay Connected 

Copyright © 2006 - 2019 Positive Approach, LLC and Teepa Snow. May not be dupictaed or resued without prior permission.

These photos from Cathy Greenblat capture the beauty, vulnerability and pearl like moments at the end of life and the care given and received. They might be helpful for you in coming to terms with this stage of life and dementia.

https://www.cathygreenblatphotography.com/eolc

[1] Snow, T. (2012) Dementia Caregivers Guide, Cedar Village Retirement Community: Mason, Ohio, pp. 22-23.

[2] Snow, T. (2012) Dementia Caregivers Guide, Cedar Village Retirement Community: Mason, Ohio, pp. 81-82.

 
 
 
 
 
 
 
 

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