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Approaching a Person in the Ruby State: Slow, Clear, and on Their Terms

When someone living with dementia is in the ruby state, they are often intensely focused on a repetitive or solitary activity—raking, rocking, walking, or singing—and may resist any interruption. This article explains why rushing or touching without warning can trigger panic or refusal, and gives you concrete, step-by-step ways to approach them calmly, use your voice and body language wisely, and get cooperation for care tasks like eating or bathing. You are not failing; you just need a slower, more patient rhythm.

Key points

  • Approach from the dominant side and announce yourself before getting close.
  • Slow your pace dramatically—both your movements and your speech. Pause for 10 seconds between actions.
  • Use very short, one-step instructions. Do not give lists or ask open-ended questions.
  • Join their activity before trying to redirect them. Do not force them to stop abruptly.
  • If they resist touch, stop and wait. Try again later with a different approach.
  • Your calm presence is more important than the task. If you are rushed, they will sense it and shut down.

What the Ruby State Feels Like for the Person

In the ruby state, a person’s brain is processing information much more slowly than yours. They may be completely absorbed in a simple, repetitive action—like raking leaves, rocking in a chair, or humming a tune—and any sudden change or fast movement can feel overwhelming, almost panicky. As one expert describes, if you get too quick, they will pause and simply cannot do what you are asking right then. It is like their mental gears grind to a halt. They are not being stubborn; their brain is protecting itself from too much input. They may also be very strong physically but have few skills left, so they can make big mistakes without realizing it—like wandering off or using a tool unsafely. They do not want to be messed with, and they may not want anyone touching them, even if their body needs care.

Why Your Natural Urge to Hurry Backfires

Your brain, as a caregiver, is wired to stay busy and do multiple things at once. You want to get the task done—get them to eat, take a shower, or come inside. But when you speed up, the person in the ruby state feels like you are being 'squirrely' (too busy, too fast), and they shut down. For example, helping someone eat in a ruby state often fails because the caregiver moves too quickly with the spoon or the next bite. The person becomes overwhelmed and is 'done with the eating business' entirely. The same thing happens with bathing or dressing: if you rush, they may resist or become agitated. The key is to slow your own pace dramatically—longer pauses, slower movements, and fewer words. Think of it like walking with a toddler who stops to look at every leaf: the journey is the destination, and you cannot force them to hurry.

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

Step-by-step

  1. Approach from their dominant side (the side of their writing hand). Most people are right-handed, so come up on their right side. This is because they will visually attune to things on their dominant side more quickly. If they are left-handed, approach from the left.

  2. Before you get close, announce your presence with your voice. Say something like, 'Hi, it’s me, [your name]. I am coming over to sit with you for a minute.' Use a warm, low, slow tone. Do not startle them by appearing suddenly.

  3. Stop a few feet away and wait. Do not move closer until they acknowledge you—even if that means waiting 10 or 20 seconds. Let them finish their current action (like a rock or a rake stroke) before you speak again.

  4. Use very short, clear instructions about what is about to happen. For example, 'I am going to sit down next to you now,' or 'I am going to help you take a bite of this apple.' One step at a time. Do not give a list of tasks.

  5. If you need to touch them, do so slowly and on their arm or shoulder, not their face or head. Use a gentle, steady pressure—not a grab. Say what you are doing: 'I am going to put my hand on your arm now.' Wait for their reaction before proceeding.

  6. If they resist or pull away, stop immediately. Do not push through. Give them a full minute of quiet, then try again with a different approach—maybe just sitting nearby and humming along with their song, or handing them the object they are using (like a rake) and letting them continue.

  7. When helping with eating, place one bite of food on the table or in their hand first, rather than bringing the spoon to their mouth. Let them see it and decide. Pause between bites for at least 5–10 seconds. Do not rush the next spoonful.

  8. If you need to redirect them from an unsafe activity (like walking into traffic or using a tool dangerously), first join their activity. For example, if they are raking, pick up a rake and rake beside them for a minute. Then slowly guide them away by saying, 'Let’s rake over here,' and lead them to a safer spot.

  9. End the interaction slowly. Do not just walk away. Say, 'I am going to go now. I will be back in a little while.' Then step back, turn, and leave at a calm pace.

What not to do

  • Do not approach from behind or from their non-dominant side. They will not see you coming and may startle, leading to a panic reaction or a swing. Instead, always approach from their dominant side and announce yourself.

  • Do not use long sentences or ask multiple questions. For example, do not say, 'Would you like to come inside for lunch now because it is getting cold and I have your favorite soup ready?' That is too much information. Instead, say, 'Time for lunch. Come with me.'

  • Do not touch them without warning. Even a gentle hand on the shoulder can feel like an attack if they are deeply focused. Instead, always say what you are going to do before you do it, and wait for a sign of acceptance.

  • Do not try to force them to stop their repetitive activity (like rocking or raking) to do something else. This can cause agitation or a meltdown. Instead, join them in the activity for a minute, then slowly transition to the new task.

  • Do not get frustrated or speed up when they pause. Your natural instinct is to fill the silence or move faster, but that will overwhelm them. Instead, take a deep breath and wait. Count to ten in your head before speaking again.

Practical tools

  • The 'One-Bite' Pause

    When feeding or offering food, place only one small bite on a plate or in their hand. Then wait a full 10 seconds before offering the next. This gives their brain time to process the action. Use a phrase like, 'Here is a bite of apple. Take your time.'

  • The 'Join and Redirect' Script

    If they are doing something unsafe (e.g., raking in the street), do not yell or grab. Instead, pick up a rake yourself and start raking nearby. Say, 'I love raking too. Let’s rake over here by the porch.' Then slowly guide them to a safer area without stopping the activity.

  • The 'Slow Voice and Slow Body' Checklist

    Before approaching, take three slow breaths. Lower your voice pitch. Move your arms and legs as if you are moving through honey. Use only 3–5 words per sentence. Repeat the same phrase if needed, like 'Time to eat' or 'Let’s walk.'

  • The 'Music Match' Tool

    If they are humming or singing, hum or sing the same tune softly along with them for a minute before speaking. This creates a connection without words. Then, after a minute, you can say, 'That is a pretty song. Let’s go inside and listen to more music.'

  • The 'Visual Cue' Card

    For tasks like bathing or dressing, hold up the object (a washcloth, a shirt) and point to it while saying the one-word name. For example, hold up a washcloth and say, 'Wash.' Then wait. This uses their visual processing, which is often stronger than auditory processing in the ruby state.

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 or a dietitian whether a feeding evaluation is needed.

If they are engaging in repetitive movements that cause injury (e.g., hitting their head or rubbing skin raw), ask a clinician about possible pain, discomfort, or medication side effects.

If they become aggressive when approached (hitting, biting, kicking), discuss with a physician or dementia care specialist whether a medication review or behavioral intervention is appropriate.

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