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Ruby GEMS State Communication: Slowing Down to Connect

When someone you care for is in the Ruby GEMS state, their world has slowed down. They may seem withdrawn, repetitive, or easily overwhelmed—not because they are being difficult, but because their brain is processing information at a much slower pace. This article offers concrete, step-by-step ways to adjust your communication style so you can meet them where they are, reduce their anxiety, and build moments of genuine connection. You are not alone; small shifts in your approach can make a big difference.

Key points

  • Slow down your speech, movements, and expectations to match the person's Ruby-state pace.
  • Use gentle touch from the front, not from behind, and only after making eye contact.
  • Join their repetitive activity before asking for a change—this builds trust and reduces resistance.
  • Break all tasks into one-step directions and give long pauses for processing.
  • Create a calm, quiet environment and allow for downtime after any stimulating event.
  • Use visual cues and simple choices instead of open-ended questions.

What Is Happening in the Ruby GEMS State?

In the Ruby GEMS state, a person is moving through a phase where their brain is operating at a slower speed. Think of it like a computer that has too many programs open—it lags, freezes, and can only handle one simple task at a time. For the person with dementia, this means they may want to do a repetitive activity, like raking leaves or rocking in a chair, and they do not want to be interrupted or rushed. They are still strong physically, but their ability to process language, follow directions, or understand complex requests has dropped significantly. Teepa Snow describes this as a state where 'I just want to rake the yard—I don't talk to anybody, I don't do anything.' They may be perfectly content in their own world, but if you try to push them into your faster-paced reality, they can become panicky, confused, or resistant.

Why Slowing Down Is the Key

The single most important shift you can make is to slow your own pace—your speech, your movements, your expectations. When a caregiver moves too quickly, the person in the Ruby state feels overwhelmed. As Teepa Snow explains, 'if we get too quick they get almost panicky and they pause and they can't do it right now.' This is not stubbornness; it is a neurological shutdown. Their brain literally cannot keep up. By deliberately slowing down, you give them the time they need to process what you are saying, decide what to do, and respond. This also means giving them longer pauses between sentences and between actions. Your brain may feel bored or restless, but theirs needs that stillness to function.

The Role of Touch and Environment

Touch can be a powerful tool for communication in the Ruby state, but it must be used carefully. A gentle, slow touch on the arm or hand can help guide someone to start or stop an action without needing words. However, if you are too quick or too forceful, touch can feel invasive and trigger a fight-or-flight response. The environment also matters greatly. Loud noises, busy backgrounds, or multiple people talking can be deeply stressful for someone in this state. As one care partner noted, 'if you are in a loud environment for a period of time, you will need down time afterward.' Creating a calm, quiet space—or at least minimizing distractions—helps the person stay regulated and more open to interaction.

General caregiving information, not medical advice. Check medications and major care changes with your clinician.

Step-by-step

  1. Pause before you speak. Take a slow breath and look at the person. Wait until they are not actively engaged in their repetitive activity (like rocking or raking) before you try to communicate. If they are mid-motion, wait for a natural break.

  2. Use a slow, gentle voice. Lower your pitch and speak at about half your normal speed. For example, instead of 'Time for lunch!' say, 'I am going to get lunch ready now... it will be ready in a few minutes.' Leave long pauses between phrases.

  3. Approach from the front, not from behind. Move into their line of sight slowly, with your hands visible. Smile softly and wait for them to acknowledge you before you speak. This reduces startle response.

  4. Use simple, one-step directions. Instead of 'Let's go to the bathroom and wash your hands,' say, 'Let's stand up.' Then pause. After they stand, say, 'Let's walk to the sink.' Then pause. Break everything into tiny, manageable pieces.

  5. Incorporate touch to guide, not to control. Place your hand gently on their forearm or back, and wait for them to look at you. Then use your hand to gently guide them in the direction you want them to move. Keep your touch light and slow.

  6. Match their pace. If they are rocking, rock with them for a moment before speaking. If they are walking slowly, walk beside them at their speed. Mirroring their rhythm builds trust and reduces resistance.

  7. Use their preferred repetitive activity as a bridge. If they love raking, join them with a second rake for a minute. Then, while still raking, say, 'I am going to get a drink of water. Would you like to come with me?' This keeps them in their comfort zone while introducing a transition.

  8. Give them time to respond. After you ask a question or give an instruction, count to ten in your head before repeating or rephrasing. Their brain may need 30 seconds or more to process and respond. Do not fill the silence with more words.

  9. If they say 'no' or resist, do not push. Back off, wait a few minutes, and try again with a different approach. For example, if they refuse to eat, try offering one small bite on a spoon while they are engaged in their activity, rather than asking them to sit at the table.

  10. End interactions with a calm, predictable phrase. Say something like, 'I will be right back,' or 'I am going to check on the laundry,' and then leave slowly. This gives them closure and reduces anxiety about your departure.

What not to do

Practical tools

  • The 'Slow Down' Script

    A set of phrases to use in common situations. For meals: 'I have your soup here. It is warm. I will set it down. You can eat when you are ready.' For transitions: 'I am going to walk to the door now. I will wait for you.' For refusals: 'That is okay. We can try later.' Keep a printed copy near the care area.

  • The One-Step Checklist

    A small whiteboard or notepad where you write ONE task at a time in large, simple words. For example, 'Sit down' or 'Drink water.' Show it to the person, say it aloud slowly, and then point to the action. This combines visual and verbal cues.

  • The 'Join First' Technique

    A mental reminder to always spend 60 seconds doing what they are doing before you ask for a change. If they are folding laundry, fold alongside them. If they are humming, hum along. This builds rapport and makes your request feel like a natural extension of their activity.

  • Calm Environment Kit

    A small basket with items to reduce sensory overload: a soft blanket, a pair of noise-canceling headphones, a dimmable lamp, and a timer. Use the timer to remind yourself to pause and assess the environment every 20 minutes. If the room is loud or bright, adjust before interacting.

  • The 'Pause and Assess' Routine

    Before you speak or act, take three slow breaths. Ask yourself: 'Is she busy with something? Is she holding something? Is her body relaxed or tense?' Wait until she has both hands free and is looking at you before you start. This prevents interrupting her focus.

  • Visual Cue Cards

    Create a set of 3x5 cards with simple drawings or photos: a cup for 'drink,' a toilet for 'bathroom,' a spoon for 'eat.' Show the card while saying the word. This reduces the need for verbal processing and can be a bridge when words fail.

Discuss with your clinician

If the person in the Ruby state is refusing all food and fluids for more than 24 hours, discuss with their doctor whether a feeding evaluation or medication adjustment is needed.

If they show signs of pain (grimacing, moaning, guarding a body part) but cannot tell you, ask the clinician about a pain assessment tool for non-verbal patients.

If they are having frequent falls or injuries because they wander off during Ruby-like activities, discuss fall prevention strategies and possible medication reviews with their healthcare team.

If you notice a sudden change in their behavior—such as becoming more agitated or withdrawn than usual—talk to the doctor to rule out infection, dehydration, or medication side effects.

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