Predicting wandering with the GEMS model

Identify your loved one's current GEMS state by observing their behavior over a few days. Use the GEMS chart (available from Teepa Snow's Positive Approach to Care) to see if they are in the Sapphire (early, mostly independent), Ruby (early-mid, needs cues), Amber (mid, needs hands-on help), Pearl (late, needs total care), or Coral (end-of-life) state. This will tell you the most likely type of wandering.

For the Sapphire state: If they get lost on a familiar walk or drive, do not scold them. Instead, say calmly, 'I think we took a wrong turn. Let's pull over and I'll help us get back.' Use GPS tracking on their phone or a simple device like a Tile or AirTag in their shoe or pocket to help locate them quickly. Practice the route with them at a different time of day when they are less tired.

For the Ruby/Amber state: When they start talking about 'going home' or 'going to work,' do not argue. Instead, validate the feeling: 'It sounds like you really miss your old job. Tell me about it.' Then redirect: 'Let's have a cup of coffee first, and then we can figure out a plan.' Keep a 'go bag' ready with a coat, hat, and a familiar object (like a photo of their childhood home) to use as a distraction if they try to leave.

For the Amber/Pearl state: If they are pacing or wandering aimlessly, create a safe, circular walking path indoors. Use brightly colored tape on the floor to mark the path, and place chairs at intervals so they can rest. Play calming music or offer a repetitive task like folding towels while they walk. This meets their need to move without risking elopement.

Use the 'ABC' approach (Antecedent, Behavior, Consequence) from the James L. West Center: Before wandering happens, ask yourself what triggered it. Was it a loud noise, a change in routine, or a feeling of boredom? Address the trigger. For example, if they wander after a stressful visit, schedule quiet time before and after. If they wander when they are hungry, offer a snack first.

Install simple environmental cues: Put a black mat in front of the door (it can look like a hole to someone with depth perception issues), or use a door alarm that chimes when opened. For the Amber state, cover the doorknob with a cloth or use a childproof knob cover. For the Pearl state, use a pressure-sensitive mat that alerts you when they step out of bed.

Communicate with neighbors and local police. Give them a recent photo of your loved one and a brief description of their condition. Let them know that if they see your loved one walking alone, they should approach gently and say, 'Hi, I think you might be looking for your house. Let me help you.' Do not say 'You are lost' as that can cause fear and resistance.

Create a 'wandering safety plan' that includes a list of emergency contacts, a current photo, a list of medications, and a description of their usual clothing. Keep this by the phone and in your car. Practice what you would do if they go missing: call 911 immediately, tell them the person has dementia, and give them the photo and description.