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Dementia Care and the GEMS State Model

Dementia Care and the GEMS State Model

| May 05, 2020

We were honored to have Lisa Hunter with Interim HealthCare join us this week on our Life Planning 101 podcast. Lisa shares with us the Teepa Snow Positive Approach to Care and information about the GEMS State Model. Below is a summary of the GEMS State Model. If you would like more information about Interim HealthCare and the services they provide, you can check out their website:

What are GEMS® States?

Interim HealthCare has developed a dementia program that addresses the needs of those living with this diagnosis based on the Teepa Snow Positive Approach to Care™. As a part of this program, they've incorporated the use of GEMS States, a model which helps identify the current state of a person living with dementia. Using the GEMS States summarized below, their caregivers, nurses and therapists can gain a deeper insight into what their clients are experiencing and create a more effective support plan that focuses on positive daily activities.

Identifying the GEMS® States

My brain is “true blue”. I am aging normally and do not have dementia. It’s hard to find words, but I can describe what I am thinking so you understand. I may talk to myself because I am giving myself cues and prompts. I can learn new things and change habits, but it takes time and effort. Honoring my choices and preferences, when possible, is important. I need more time to make decisions. Give me the details and let me think about it before you need an answer. I am able to remember plans and information but supports are helpful. I like specific prompts such as notes, calendars, and reminder calls. Health changes in vision, hearing, balance, coordination, depression, anxiety, pain, or medication may impact my behavior, but my cognitive abilities remain the same.

My brain is clear and sharp. I can be cutting and hard to deal with. I have many facets, so everyone sees me differently. This can cause conflict among my family or care team as it is hard to tell if I am just being stubborn or truly experiencing change in my abilities. I can socially chit chat and have good cover skills. I want to keep habits and environments as they have always been, even when they are not working. I am often focused on finances or expenses, and will resist most change including new expectations, routines, or environments. I can become accusatory-thinking others are trying to trick or conspire against me. Short brief visits will not expose my true struggles. Even if you are around all the time, you may not notice how much I am changing because instinctively you fill in the gaps for me.

I have little awareness of my changing abilities. You assume I can take care of myself, but my personal care is slipping, often resulting in poor nutrition and hygiene. I can chit-chat, but struggle with words, and understand only about ¾ of what you say. I know you are unhappy with me by your tone of voice or expression. If I am lost in life, accept the moment I am in, listen and stay calm. Because I am easily frustrated, I often lose control of emotions and may blow up unexpectedly. When I feel afraid or confused I will want to “go home.” I remember strong feelings but won’t remember details. My brain sometimes makes up information to fill in the blanks, which makes you think I am lying. If you argue, I may become resentful or suspicious of you. I can’t be rational and will not want your help if you make me feel incompetent.

I am caught in time and focused on sensation. I know if I like you based on how you look, sound, move, smell and respond to me. It may surprise you when I take, investigate, touch, smell, taste or take apart items, but it is a function of my brain processing information and it soothes me. I need to do things over and over and like simple tasks. I will resist what I can’t tolerate, and I have limited safety awareness. I have no ability to stop myself and, for safety reasons, you need to respond to me immediately. I am typically incontinent, may not feel hunger or thirst, and can’t express my needs. My mouth, hands, feet and genitalia are highly sensitive due to changes in my nervous system. Therefore, activities like eating, taking medication, mouth care, bathing, and toileting may distress me. Please notice my cues and stop if I am resisting. Wait a few minutes, connect with me, and try a different approach.

My brain is in late stage change. Transition is difficult for me. I like simple instruction, and would rather you show me, one step at a time, instead of telling me what to do. My fine motor skills are very limited, and I will need assistance with utensils, zipping, buttoning, or brushing teeth. I tend to hold, pinch, and manipulate items with my thumb rather than using my fingers. Because I can’t control the muscles in my mouth, I have difficulty swallowing. My vision has changed, and I have no depth perception. I may misjudge distance, trip over large objects, or get stuck behind doors. I have gross motor reactions and will have either a desire to move or an intense fear of falling. Pulling or pushing me feels like you are trying to hurt me and make me fall. Using Hand-Under-Hand assistance helps me to feel safe and secure. I still have automatic verbal and rhythmic response. I enjoy music, your presence, and a willingness to be quiet with me.

My brain is losing its ability to control my body and I am at the end of my journey. Like an oyster, I am hidden in a shell, but will have moments when I become alert and responsive. Use our time to be with me, not just care for me. And please don’t talk about me as though I am not still here. I respond best to familiar voices and rhythmic gentle movements. I am ruled by reflexes and will startle easily. I appreciate it when you slowly and gradually shift me. When taking care of me, I am comforted when you place one hand securely on my body while using the other. I have trouble coordinating my swallowing and breathing and am prone to infection because my brain doesn’t organize a response. I may not be able to leave my body without permission from you. Your greatest gift to me is to let me know it is alright to go.

The GEMS State model and Positive Approach to Care techniques, strategies, and overall approach to care were created, developed and are copyrighted by Teepa Snow and Positive Approach, LLC. © 2006-2019. Interim HealthCare is an Equal Opportunity Employer. Each Interim HealthCare franchise is independently owned and operated. Not all services are available at all franchises. ©2019 Interim HealthCare Inc.


  1. Interim HealthCare Website:
  2. Interim HealthCare Blog:
  3. Interim HealthCare Alzheimer's and Dementia Education Center:
  4. Teepa Snow Website: