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Using the Gem state model to predict wandering

Key points

  • Wandering is not random—it is a purposeful action driven by the person's current Gem state and unmet needs.
  • Learn the six Gem states (Sapphire through Pearl) to recognize when your loved one is at risk of wandering.
  • Observe daily patterns: time of day, triggers, and shifts in Gem state help you predict and prevent wandering.
  • Intervene early with redirection, meaningful activities, and environmental adjustments—not punishment or restraint.
  • Use the Gem model to communicate with family, staff, and clinicians about wandering risks and strategies.
  • Prepare an emergency kit and a wandering safety plan, including a recent photo and local Silver Alert info.

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

Step-by-step

  1. 1. Learn the Gem states: Start by familiarizing yourself with the six gems—Sapphire, Diamond, Emerald, Amethyst, Ruby, Pearl. Use Teepa Snow's free resources or a quick online search to understand the abilities and challenges of each state. This is your foundation for prediction.

  2. 2. Observe your loved one's current Gem state daily: Spend a few minutes each day noting their mood, energy, and cognitive clarity. Ask yourself: Are they calm and engaged (Sapphire/Diamond)? Or are they restless and confused (Emerald/Ruby)? Write down what you see so you can spot patterns.

  3. 3. Identify triggers that shift them to a lower Gem: Common triggers include fatigue, hunger, overstimulation (loud noises, crowds), changes in routine, or even a long conversation. For example, if you talk too long about a complex topic, they may 'shut off' and drop from Diamond to Pearl. Note these triggers in a journal.

  4. 4. Watch for early warning signs of wandering: When a person is in a lower Gem state, they may start pacing, asking repetitive questions about going home, looking for a coat or purse, or standing near the door. These are not random—they are the beginning of a wandering episode.

  5. 5. Intervene before they act: Once you see the warning signs, use a calming, redirecting approach. For example, if your loved one is in an Emerald state and starts pacing, say gently, 'I see you're looking for something. Let's walk together to the kitchen and have a cup of tea.' Offer a meaningful activity that matches their Gem—like folding laundry (Diamond) or sorting photos (Sapphire).

  6. 6. Create a safe environment that matches their Gem: For a person in a Diamond or Emerald state, reduce visual clutter and noise. Use signs or pictures to guide them to the bathroom or their bedroom. For a person in a Ruby state, ensure doors are locked or have alarms, and remove shoes or coats from sight if they trigger exit-seeking.

  7. 7. Use the Gem model to plan your day: Schedule activities during their highest Gem states (often morning for many) and plan rest or quiet time during lower states. If you know your loved one tends to wander in the late afternoon (sundowning), prepare a calming routine—like a short walk, soft music, or a familiar movie—to prevent restlessness.

  8. 8. Reassess after each episode: After a wandering event, ask yourself: What Gem state were they in? What triggered the shift? What helped them settle? This reflection will sharpen your ability to predict and prevent future episodes.

What not to do

  • Do not assume wandering is deliberate or defiant. It is not a behavior problem—it is a response to a need they cannot express. Punishing or scolding will only increase their anxiety and make wandering worse. Instead, use the Gem model to ask, 'What need is this person trying to meet?'

  • Do not try to reason or argue with them when they are in a lower Gem state. If they are in a Ruby state and insist they need to 'go home,' logical explanations like 'You are home' will not work. They are living in a different reality. Instead, validate their feeling and redirect: 'Tell me about your home. What did you love most about it?'

  • Do not leave them alone in a room if they are in a restless Gem state. A person in an Emerald or Ruby state may wander off within seconds. Stay within sight or use a baby monitor. If you need to step away, ensure the environment is secure first.

  • Do not ignore the role of environment and interaction. The Gem model shows that a person can shift states based on what's around them. A noisy, cluttered room can push them from Diamond to Amethyst. A calm, familiar space can help them stay in a higher Gem. Adjust the environment before you adjust the person.

  • Do not rely on physical restraints or medications as a first response. These can increase agitation and confusion. Instead, use the Gem model to find the root cause—are they bored? Anxious? Need to move? Address that need with a safe activity or a walk.

Practical tools

  • Gem State Quick Reference Card

    Create a simple card listing the six gems and their key traits: Sapphire (sharp, independent), Diamond (clear but slower), Emerald (confused but can follow routines), Amethyst (needs step-by-step help), Ruby (very limited, needs full assistance), Pearl (end-stage, minimal response). Keep it in your wallet or on the fridge. When you see wandering signs, glance at the card to identify the current Gem and choose the right response.

  • The 'What's the Need?' Checklist

    When wandering starts, run through this quick mental list: 1) Are they hungry or thirsty? 2) Do they need to use the bathroom? 3) Are they in pain or uncomfortable? 4) Are they bored or under-stimulated? 5) Are they overstimulated (noise, crowds)? 6) Are they searching for a person or place from the past? Each need maps to a different Gem state and intervention.

  • Redirection Phrases by Gem State

    For Diamond/Emerald: 'I need your help with something important—can you fold these towels with me?' For Amethyst/Ruby: 'Let's go see what's in the garden. I'll walk with you.' For Pearl: Use gentle touch and a calm voice: 'I'm here. You're safe. Let's sit together.' Avoid asking 'why' or giving complex instructions.

  • Daily Gem State Log

    Keep a simple notebook or use a notes app. Each day, jot down: time of day, Gem state observed, any triggers (e.g., 'loud TV, nap, argument'), and whether wandering occurred. After a week, look for patterns—like wandering always happens after 3 PM or after a visit from a certain relative. Use this to predict and prepare.

  • Safe Walking Path Setup

    If your loved one is in a restless Gem state (Emerald or Ruby), create a safe indoor walking loop. Clear hallways of clutter, add handrails, and place interesting objects along the way—a photo wall, a basket of soft fabric, a wind chime. This allows them to satisfy their need to move without leaving the house.

  • Emergency Wandering Kit

    Prepare a small bag with: an up-to-date photo of your loved one, a list of their medical conditions and medications, a description of their typical clothing, and contact numbers for neighbors, family, and local police. Keep it by the door. If they wander despite your best predictions, you can act fast.

Discuss with your clinician

Ask your doctor: 'Based on my loved one's current Gem state, are there any medications that could help reduce anxiety or restlessness that might trigger wandering?'

Discuss with a neurologist: 'Can the Gem model help us track disease progression and adjust our care plan?'

If wandering becomes frequent or dangerous, ask: 'Should we consider a wearable GPS tracker or a medical alert system? What are the risks and benefits?'

For late-stage wandering that leads to falls, ask: 'Are there safe movement options, like a wheelchair or a padded walking area, that could reduce fall risk?'

If your loved one has a history of elopement, ask: 'Should we register with the local Silver Alert program or the Alzheimer's Association Safe Return program?'

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