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using the GEMS model to see dementia as a disability

Key points

  • Dementia is a brain-based disability, not a choice or bad behavior. Treat it like any other disability: accommodate, don't correct.
  • The GEMS model (Sapphire, Diamond, Emerald, Amber, Ruby, Pearl) gives you a kind, visual way to understand what your person needs at each stage.
  • When you reframe behavior as brain change, you stop taking it personally and start finding solutions that actually work.
  • Adapt your communication, environment, and expectations to match their current gem. What works at one stage may not work at the next.
  • Use the GEMS language with family and professionals to reduce blame and get better support.
  • Reassess regularly—dementia progresses, and your approach must pivot with it.

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

Step-by-step

  1. Learn the six GEMS stages and their key characteristics. Start with a simple chart: Sapphire (no dementia, but stressed), Diamond (early, aware, but rigid), Emerald (mid-stage, easily lost, needs visual cues), Amber (late-mid, cautious, stuck in routines), Ruby (advanced, emotional, needs sensory comfort), Pearl (end-stage, fragile, needs total care). Post it where you can see it daily.

  2. Observe your person for a full day without trying to change anything. Note what they can do independently, what frustrates them, and what calms them. Write down specific examples: 'At 10am, she could not find the bathroom even though she walked past it three times.' This is your baseline for matching them to a GEMS stage.

  3. Match their current abilities to a GEMS stage. If they can still manage simple tasks but get lost in new places, they are likely Emerald. If they repeat the same question and get anxious when you change the routine, they are Amber. Use the stage to guide your expectations—do not expect an Emerald to remember a new route, and do not expect an Amber to handle a surprise visitor.

  4. Change your communication style to match their gem. For Diamond: speak clearly, give choices, and respect their need for control. For Emerald: use short sentences, point to what you mean, and avoid open-ended questions. For Amber: use a calm, slow voice, give one-step instructions, and allow extra time. For Ruby: use touch, music, and simple comforting phrases. For Pearl: speak softly, move slowly, and focus on comfort and presence.

  5. Adapt the environment to reduce disability. If they are Emerald, put a sign on the bathroom door with a picture of a toilet. If they are Amber, remove clutter from pathways and keep furniture in the same place. If they are Ruby, dim harsh lights and play familiar music. Every change you make is like adding a ramp for someone in a wheelchair—it removes a barrier their brain cannot overcome.

  6. When they struggle, ask yourself: 'What is their brain unable to do right now?' instead of 'Why are they doing this to me?' For example, if they refuse to bathe, their brain may be unable to process the sensation of water or the sequence of steps. Your job is to simplify the task, not to convince them they are wrong.

  7. Use the GEMS language with family and professionals. Say 'She is in her Emerald stage, so she needs visual cues and a consistent routine.' This helps everyone understand what to expect and how to help. It also reduces blame and shame, because the focus is on the brain change, not the person's character.

  8. Reassess every few months. Dementia is progressive, and the person may move from one gem to another. What worked at Emerald may not work at Amber. Be willing to pivot. Keep a journal of what helps and what doesn't, and share it with their doctor or care team.

What not to do

  • Do not argue or correct them when they say something inaccurate. Their brain cannot process the correction, and it only causes distress. Instead, validate the feeling behind the words and redirect. For example, if they say 'I want to go home' when they are already home, say 'Tell me about your home. What did you love there?'

  • Do not expect them to learn new things or remember instructions. Their brain has lost the ability to form new memories easily. Instead of teaching, use visual cues and routines. For example, instead of saying 'Remember to use the call button,' put a picture of a bell next to the button.

  • Do not rush them or interrupt their pace. Their brain processes information more slowly. Rushing triggers anxiety and resistance. Give them twice as much time as you think they need. If they are struggling with a zipper, wait or offer help gently, not impatiently.

  • Do not take their behavior personally. When they lash out or refuse care, it is not about you. It is their brain's response to overwhelm, pain, or confusion. Step back, take a breath, and remind yourself: 'This is the dementia, not them.' Then try a different approach.

  • Do not assume they cannot understand you. Even in later stages, they may still hear and feel your tone. Speak with respect, not as if they are a child. Use their name, make eye contact, and speak in a warm, calm voice. Your emotional state affects theirs.

  • Do not try to force them into a stage they are not in. If they are Diamond, do not treat them like Emerald. Respect their remaining abilities and involve them in decisions as much as possible. Over-helping can feel demeaning and cause resistance.

Practical tools

  • The GEMS Stage Quick-Reference Card

    Create a small laminated card with the six gems and their key traits. On one side, list the gem name and what the person can typically do. On the other side, list what they struggle with and what helps. Keep it in your pocket or on the fridge. When you feel frustrated, pull it out and remind yourself: 'They are Amber right now. They need slow, simple steps.'

  • The 'Brain Change, Not Bad Behavior' Mantra

    Write this phrase on a sticky note and put it on your bathroom mirror: 'Their brain is changing. This is a disability. I can adapt.' Say it out loud every morning. When a difficult moment arises, take three slow breaths and repeat it silently. This simple reframe can lower your stress and help you respond with patience instead of frustration.

  • Visual Cue Kit for Emerald Stage

    Gather a set of simple picture cards or use a whiteboard with drawings. For example, a picture of a toilet for the bathroom, a picture of a cup for drink time, a picture of a bed for nap time. Place these at eye level near the relevant area. Point to the picture when giving a direction. This bypasses the verbal processing difficulty and gives their brain a direct visual signal.

  • The 'One-Step' Script for Amber Stage

    Write down a list of common care tasks (bathing, dressing, eating) and break each into one-step instructions. For bathing: 'First, let's sit on this chair.' Pause. 'Now, let's take off your slippers.' Pause. 'Now, I'm going to wet this cloth.' Use a calm, low voice. Do not combine steps. If they resist, stop and try again later. This reduces overwhelm and gives their brain time to process.

  • Sensory Comfort Kit for Ruby Stage

    Assemble a small box with items that engage the senses: a soft blanket, a familiar song playlist, a lavender-scented sachet, a smooth stone, a photo album with simple images. When they are agitated, offer one item at a time. Watch their face for a calming response. This provides comfort when words fail.

  • The 'Pivot' Journal

    Keep a small notebook where you note what worked and what didn't each day. For example: 'Tuesday: tried to help with shower at 9am, she refused. Wednesday: tried at 2pm with music playing, she accepted.' Over time, patterns emerge. Use this to adjust your approach. Share it with their doctor or a dementia care specialist for additional ideas.

Discuss with your clinician

Ask your clinician: 'Based on my person's current abilities, which GEMS stage do you think they are in? Can you help me confirm this with a cognitive assessment?'

Discuss: 'Are there any medications or treatments that might help with the specific challenges of their current stage, such as agitation in Amber or sleep issues in Emerald?'

Ask: 'What local resources (support groups, occupational therapy, dementia care specialists) can help me learn more about using the GEMS model in daily care?'

If the person has sudden changes in behavior or cognition, ask: 'Could this be a medical issue (infection, pain, medication side effect) rather than a progression of dementia? Should we rule that out first?'

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