Gems_LogoNursePartners’ approach to Alzheimer’s and dementia care is based on The GEMS™: Brain Change Model created by Teepa Snow. NursePartners recognizes the Teepa’s Positive Approach™ to Care as an effective method to provide care for loved ones affected by dementia. This approach categorizes dementia stages with six different gemstones, defined by unique characteristics. Click here for an overview of the classification system.

This approach to care serves as an effective method for understanding and meeting the needs of individuals affected by Alzheimer’s Disease and other forms of dementia.

Just as gemstones need different care and settings to show their best characteristics, so do people.  Rather than focusing on a person’s loss when there is brain change, seeing individuals as precious, unique, and capable encourages a care partnership that is the core of this model. The goal is to provide better support and care when someone is living with this ever-changing condition, helping them live fully in their moment.

By appreciating what is changing and what is still possible, we can have interactions that are more positive, communication that is more productive, and care that is more effective.

As described, this classification system categorizes stages of dementia by six different gemstones:


A sapphire is a “true blue.” Sapphires may feel “blue” due to changes with the aging process, although there are no significant changes in cognition and no signs of dementia. They are committed to lifelong patterns, enjoying the things the way they’ve always been.


The first stage of actual dementia, or the diamond stage, occurs with the first signs of change or signals of a stressed brain. Diamonds are “clear and sharp,” successful with established habits and routines. Diamonds like to feel competent and valued, and it is important for them to feel comfortable and in control. A diamond can still do things as they always have, but they become more territorial and less aware of boundaries.


Emeralds are green and “on the go.” Vague, and flawed internally, they may get lost in their past life, places, and roles. They may have problems with communication and comprehension, asking who, what, where, and when often. Emeralds are most comfortable when doing familiar tasks. They like to engage, help others, feel like they have a purpose.


Ambers like to live in moments of time, and are focused on sensation – manipulating, gathering and touching things. They are focused on wants and needs, and sometimes are exploratory without safety awareness. Their communication is limited with difficulty understanding and expressing needs, so activities selected need be familiar and sensory stimulating.


Rubies experience late-stage changes as fine motor skills are very limited. Loses in depth perception, as well as limited visual awareness and major sensory changes result in needed assistance with utensils, brushing, buttoning and moving. Hand-under-hand assistance helps rubies feel safe and secure.


Layered and hidden in a shell, pearls are still and quiet, unable to actively move or respond, and have a limited awareness of the world. Pearls enjoy pleasant sounds and familiar voices, grasping onto moments of connection.

Understanding each stage of the process allows carepartners to gain a deeper insight into what clients are experiencing.  After an in-home assessment, we work to create a plan of care to help your loved one live in the comfort of their home. The model allows carepartners to build activity lists and communication techniques that aid individuals through each stage.

Please understand that your loved one would like you to: 

  • See what I can do, not what I cannot do.
  • Respect me. I am an adult.
  • Know me. I am unique.
  • Meet me at eye level.
  • Do with me, not for me.
  • Give me a choice.
  • Move slowly so I am not afraid.
  • Laugh with me.
  • Don’t argue and don’t scold me.
  • Thank you for taking care of me. I know it is a hard job.