8.14.22 -- “Stages of Dementia: Teepa Snow’s Positive Approach”
From Donna Garner

Having recently lost my precious husband of 58 years who died of Lewy body dementia, I want to share with the public the work of Teepa Snow.  I have never met her, but the head nurse (at one of the eight healthcare facilities through which my husband and I sought help during those seven months) introduced me to Teepa Snow and her truly meaningful guidance.

Teepa’s purpose is to try to help family members, friends, and caregivers to focus on what the patient can still do rather than dwelling on what the patient can no longer do.

Please see below two free “gifts” from Teepa Snow which I found on the Internet: 

(1)  A super good video where Teepa explains the various stages of dementia

(2)   Teepa’s Living Gems – an explanation in written form of the six stages of dementia using six precious gems to provide clarity



This is an excellent video that explains the various stages of dementia.

Teepa Snow – The Living Gems -- https://teepasnow.com/about/about-teepa-snow/the-gems-brain-change-model/



“What are Teepa Snow’s Six GEMS?”


Have a look:

 Sapphire: Sapphire is a brain that is aging normally, flexible, organized, and is able to work with all the other GEMS. People in a Sapphire State are the ideal care partners for someone living with dementia, as they possess the adaptability to go with the flow and appropriately interact with the GEMS State of the person in their care.  Note: When stressed, even a healthy brain can slip out of the Sapphire State. When that happens, the best thing you can do is to take a deep breath and a break (if possible) to help get yourself back into that calm and collected state.

 Diamond: People in a Diamond State are still clear and sharp, but become increasingly rigid. They tend to have a lot of facets to them, but are noticeably inflexible and are able to still cut you or hurt you. Diamonds don’t do well with change, but are still very much able to shine. They are who they were, but they are different. This can make it difficult for care partners to acknowledge that the person is really living with dementia, as they still know what they’re doing but appear increasingly stubborn.

 Emerald: Unlike the Diamond, people living in the Emerald State are no longer clear and sharp. This is usually the state at which people begin to struggle and get identified as having something going on. Emeralds are on the go, but might get lost in time or place and their words aren’t always as clear and sharp as they used to be. An Emerald is flawed but unaware, thinking that everything is fine, so they may cast blame on someone else. In this State, care partners are likely to notice mistakes. Instead of pointing out the flaw, care partners will likely have much greater success by going with the flow.

 Amber: People living in an Amber State tend to be caught in a moment of time. Many Ambers are all about sensations, and what something feels like. They are therefore more curious than cautious, and lack safety awareness. An Amber is all about seeking things they like, but may strongly respond to things they don’t like. So, this is the State at which care partners often struggle to not turn into a Diamond themselves, as the person’s behavior is so inconsistent with who they used to be.

 Ruby: In this State of dementia, fine-motor skills in a person’s eyes, fingers, mouth, and feet begin to fade. A Ruby might therefore have trouble figuring things out visually, and struggle with speech production as well as chewing and swallowing at times. While fine-motor skills get lost, a Ruby can still do larger, gross movements, like clapping hands or holding onto things. In this State the person’s strength remains fairly unchanged, so they might firmly hold on to you or miscellaneous items without knowing how to let go. It’s easy for care partners to get stressed and go Diamond in this State, so it is particularly important to take a step back, take a deep breath so you can get oxygen to your brain, and try to let go of what was so you can be a Sapphire once again.

 Pearl: Similar to an oyster shell, which tend to be ugly on the outside but can hold treasured GEMS on the inside, care partners can find a Pearl in this last State of dementia if they just know where and how to look. In this State, the brain has changed so that the person’s reflexes are turned on non-stop, body systems begin to shut down, and gross motor skills are lost. The person becomes trapped, but with the right care the shell relaxes just enough to produce the amazing Pearl that is still there. In this State care partners tend to spend way too much energy on preserving the shell, but miss the GEMS that are still residing inside. The question for all of us is, can we see the precious and unique? By seeing the person living with dementia as the valuable GEMS they are and offering them the right care and setting, we’re giving them the opportunity to shine.  

Caring for a person living with dementia isn’t easy; but with the right skills and tools, the journey can be significantly more rewarding.