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Caring for a Loved One with Dementia? Here Are 7 GEMS You Need to Know!

By Anthony Cirillo August 25, 2017 Caregiving

My friend Teepa Snow, a colleague on the Dementia Action Alliance, is one of my guests on the Caregiver Smile Summit. For that interview, we spoke about the pioneering work she is doing and its genesis.

Teepa’s Positive Approach to Care started because, frankly, there was not a lot of positive news about a dementia diagnosis. It was pretty much gloom and doom; your life is over.

The main focus always circled around doing things to or for people with dementia, instead of acknowledging that they could still be involved. In other words, there was more of a focus on what someone was losing instead of what they could contribute.

Everything You Say Matters

Language is a very deliberate process when it comes to working with people with dementia. There are things that people do not realize they can do to make a difference, including how you frame things, how you look at situations, how you behave, what you say and how you say it. They all matter.

How we behave triggers people’s reactions. How we set up the environment and how we set up a task matters. “What we don’t use are the best things that people still have,” says Teepa. These are things like music and dancing to help trigger the behaviors we desire.

I am seeing this much more in rehabilitation situations where therapists will transform what was a truly non-compliant patient into an active participant in their care simply by using the right song to go with the treatment.

Divert Respectfully and Use What They Still Have

A loved one with dementia might ask you five times about the time of their doctor’s appointment. You answer the first couple of times nicely but then get irritated because you already answered it. Trying to tell the person that she/he asked you already is futile. They don’t remember.

A better way to approach it is by saying something like, “Your appointment is at two. You know, that reminds of something. I think, a song. Do you remember it? Five foot two, eyes of blue. Yeah, that’s it. Let’s find it on the playlist.”

What just happened? You answered the question; you diverted respectfully; and you engaged them in something they still can participate in – music. Music activates something in people no matter how advanced their dementia. I see it all the time when I perform.

Focus on What They Can Do

There are models of care (scales of acuity) in dementia that tend to focus on what people cannot do. Teepa has a model that focuses on what they can do. It’s called the GEMS™ Model.

What if we saw people as precious and unique as gemstones? The key is then knowing the right setting and the right thing to do to get the gem to shine. Although, the gem shining is not just the person with dementia but the caregiver, too.


The caregiver, according to Teepa, needs to be a sapphire, true blue, holding it together. Sapphire means being flexible, willing to change.

Diamonds, emeralds, ambers, rubies and pearls categorize the person for whom you care. But they can also apply to the caregiver, in certain situations.


When a caregiver gets stressed out and becomes rigid, that’s a state of diamond. In such moments, a caregiver might say, “You can do this. I’m not going to help you.” The person with dementia may also be acting like a diamond, i.e., saying, “I don’t know why you won’t let me drive.”

Diamonds can’t see lots of things, but they have lots of facets. They can be perfectly lovely, but they can still cut you! They typically focus on resources and money, who is doing what and if that’s OK.

It’s important to recognize the gem of behavior in the moment, both for your loved one and for yourself. Then as a team, you can work through issues.


Emeralds are flawed and on the go characters.


Amber is caught in a moment in time, and it’s usually about sensation. Sensory likes, wants and needs and sensory intolerances. If you are helping someone brush their teeth and they sense you are too close to their personal space, they may freak out.

While you are trying to have a relationship, they are reacting from a sensory perspective. Again, it’s about recognizing where each of you stands in the gem spectrum.


Rubies are about big movement but have no fine motor skill. That is where music, dance and rhythm play important roles.


With pearls we see the ugly oyster shell but there is still a wonderful pearl underneath – a person whom we need to recognize.

The beauty of using the gems scale is that they describe states that you can bounce around in. When they are recognized and used correctly, they enhance the quality of life for both the caregiver and their loved one.

Doing the Right Thing Is a Learned Process

Our behavior is learned over time and hardwired in our brain. So to become a more empathic and compassionate caregiver, we need to learn and hardwire new response mechanisms.

Be Supportive, Not Confrontational

Traditional literature tells you to get in the face of the person with dementia. That creates stress. However, if you sit back and look sideways at the person, it gives them a way out and reduces their stress. That is supportive.

Substitution, Not Subtraction

Let’s say the doctor and/or family deems that the person is not able to drive any longer. In this case, you will be taking an important something away. So, you should know that it is better to substitute the loss with something else.

For instance, to keep dad engaged on the road, perhaps you should ask him to help with directions, react to billboards you see, etc. The act of keeping his car and driving it instead of yours is also important to the person.

Respond Versus React

When people do something awkward – say mom wears her bra outside her clothes – the initial kneejerk inclination is to be negative. “Oh no, no, no… You can’t do that.”

When you respond, you pause, take it in, and then you may say, “Hey, mom, that is an interesting look. Do you want to see for yourself?” Then bring them to the mirror. Chances are they will understand that maybe it needs to be worn differently. Yes, response takes longer, but it also produces better results.

If you want to learn more about caregiving, consider registering for my Caregiver Smile Summit. Register by August 31 with code “Early Bird” and receive $10 off the all-access fee. Listen to 51 world-renowned experts covering 53 topics for caregivers.

Are you caring for a loved one with dementia or another illness? What techniques do you use when caring for a loved one? Have you heard of the GEMS model before? How easy do you think it would be to implement positive strategies when carrying for your loved ones? Please join the conversation below.

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The Author

Anthony Cirillo is founder of Sage Stream, the Senior Entertainment/Education Network and president of The Aging Experience, which helps people and companies prepare for aging before it becomes a crisis. A health and aging expert, professional speaker, and media influencer, he is a Fellow of the American College of Healthcare Executives with a master’s from the University of Pennsylvania. Anthony serves as a Policy RoundTable member for Nationwide Financial and Bank of America.

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