Understanding Teepa Snow’s SENSI and GEMS Frameworks

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I am neither a fan nor a critic of the caregiving philosophy promoted by Teepa Snow. If I am honest, some aspects of the way her training programs package and market caregiving knowledge feel uncomfortable to me. That said, there are genuine insights within her system that many caregivers find helpful, and some of those ideas are worth sharing.
Teepa Snow is an occupational therapist and dementia care educator known for developing the Positive Approach to Care, a widely taught system for helping caregivers communicate with people living with dementia. Two of the most widely used frameworks in her teaching are SENSI, which focuses on sensory communication, and the GEMS model, which describes how the brain changes as dementia progresses.

SENSI Technology

When Teepa Snow refers to SENSI as a “technology,” she is speaking about sensory-based caregiving techniques. She often describes these as the “sensory technologies” of the human body rather than machines or devices.
In Snow’s teaching about dementia care, caregivers themselves are considered the most powerful tools available. In this context, SENSI refers to using the human sensory system intentionally to communicate with and support a person living with dementia.
Below is the concept as it is typically used in her training.

SENSI: Sensory-Based Interaction Technology

In Snow’s framework, SENSI describes the use of the human sensory channels as tools to reach a brain that can no longer process information primarily through logic or language.
These sensory channels include:

• Sight – facial expressions, body posture, visual cues, and positioning relative to the person
• Sound – tone of voice, rhythm, pacing, music, and vocal reassurance
• Touch – hand-under-hand guidance, reassuring contact, and tactile cues that support movement
• Smell – familiar scents that trigger emotional memory, such as favorite foods or perfumes
• Movement / Proprioception – rhythm, walking together, rocking, or physical cues that help regulate the nervous system

In practice, SENSI encourages caregivers to communicate through sensory channels rather than relying primarily on verbal reasoning, which often becomes unreliable as dementia progresses.
In people with dementia, the cognitive brain often weakens while sensory and emotional pathways remain relatively strong. Snow teaches caregivers to shift from verbal instruction to sensory communication.

Why She Calls It “Technology”

Snow uses the word technology in a broader sense than machines. She means a tool or system that reliably produces an outcome.
For example:
Traditional approach
“Please sit down in the chair.”
SENSI approach
• Make eye contact
• Smile
• Offer your hand
• Gently guide movement
• Use a calm voice
The sensory cues guide the brain more effectively than words alone.
In this way, the caregiver’s body, voice, and touch become a communication technology.

Practical Examples

Some common SENSI strategies taught in Snow’s programs include:
Hand-under-hand assistance
Instead of grabbing someone’s arm, the caregiver offers their hand from underneath, preserving the person’s sense of control.
Approaching from the front
This reduces the startle response and allows visual recognition.
Rhythmic cueing
Using rhythm or gentle rocking to help someone stand or walk.
Facial emotional cues
A relaxed, friendly expression can regulate anxiety in someone whose language processing has declined.

Why This Matters in Dementia Care

In many forms of dementia—especially Alzheimer’s disease and Lewy body dementia—the brain gradually loses the ability to process abstract language and multi-step instructions.
However, sensory and emotional processing often remain functional much longer.
That means:
• Touch may work when words fail
• Music may trigger recognition
• Rhythm may enable movement
• Facial emotion may communicate safety
Snow’s approach teaches caregivers to “speak the language of the remaining brain.”

A Short Way to Think About It

In Teepa Snow’s philosophy:
Words are not the primary technology of caregiving.
Human sensory connection is.
The caregiver’s eyes, voice, hands, posture, and rhythm become the tools that reach a brain that can no longer rely on reasoning or memory.

The GEMS Model

Another framework widely used in Teepa Snow’s toolkit is GEMS.
The GEMS model describes how the brain changes over time in conditions such as Alzheimer’s disease, Lewy body dementia, and frontotemporal dementia.
Instead of describing people primarily in terms of loss or decline, the model uses gemstones to illustrate remaining abilities and changing patterns of behavior. Each “gem” represents a different way the brain processes information.
The purpose is practical: when caregivers recognize the “gem state,” they can adapt communication, environment, and expectations to match the person’s remaining abilities.

The Six GEMS

1. Sapphire – Clear and Intact Thinking

People at the Sapphire stage have a brain functioning with typical adult cognitive abilities.
Common characteristics:
• Logical thinking
• Ability to plan and reason
• Awareness of time and place
• Ability to learn new information
• Independent daily functioning
Care approach:
• Treat the person as a capable adult
• Provide clear information
• Encourage independence
Sapphire represents the baseline cognitive functioning a person had before dementia-related changes altered how the brain processes information.

2. Diamond – Brilliant but Hard

In the Diamond stage, thinking is still present but becomes rigid and intense.
Common characteristics:
• Strong routines and preferences
• Difficulty tolerating change
• Anxiety when things are unfamiliar
• Desire for control
• Strong opinions or arguments
The brain can still think, but it becomes less flexible.
Care strategies:
• Offer choices rather than demands
• Avoid direct confrontation
• Maintain routines
• Provide reassurance

3. Emerald – On the Go but Misguided

In the Emerald stage, the brain becomes active and curious but less accurate.
Common behaviors:
• Constant activity
• Searching or rummaging
• Moving from place to place
• Asking repeated questions
• Getting into other people’s belongings
• Reduced safety awareness
The brain is busy but disorganized.
Care strategies:
• Provide safe places to explore
• Use simple directions
• Redirect rather than correct
• Offer structured activities

4. Amber – Sensory Driven

At the Amber stage, the person lives primarily in the sensory world.
Common characteristics:
• Language ability declines
• Walking may become rhythmic or wandering
• Objects may be touched, tasted, or handled repeatedly
• Emotional responses become stronger
• The person reacts more to tone and touch than to words
This is where sensory communication becomes essential.
Care strategies:
• Use touch and rhythm
• Speak slowly and simply
• Maintain calm emotional cues
• Provide safe movement opportunities

5. Ruby – Deeply Changed Brain

In the Ruby stage, both thinking and movement decline significantly.
Common patterns:
• Limited mobility
• Difficulty speaking
• Increased muscle rigidity
• Greater dependence on caregivers
• Emotional reactions may be strong but brief
Care strategies:
• Gentle touch
• Soothing tone of voice
• Slow movements
• Comfort and reassurance

6. Pearl – Fragile but Still Present

The Pearl stage represents the final stage of the model.
Common characteristics:
• Minimal movement
• Limited speech
• Difficulty swallowing
• Long periods of sleep
• Very limited awareness of surroundings
Despite this, sensory awareness may still exist.
Care strategies:
• Soft touch
• Familiar voices
• Calm environment
• Music or gentle sensory stimulation

Why the GEMS Model Is Helpful

Traditional descriptions of dementia often focus on deficits—memory loss, confusion, or disorientation.
The GEMS model instead asks a different question:
What can this brain still do?
This shift helps caregivers:
• Reduce frustration
• Improve communication
• Prevent unnecessary conflict
• Preserve dignity

A Key Principle of the GEMS Model

One of Teepa Snow’s central insights is simple but powerful:
People with dementia are not being difficult.
Their brains are simply working differently.
When caregivers adjust their approach to match the current “gem state,” interactions often become calmer, safer, and more compassionate.
In that sense, the GEMS model is less about categorizing decline and more about helping caregivers meet people where they are—preserving connection even as cognition changes.

Conclusion

What I am a big fan of is anything that helps us get our arms around the immense challenges of dementia caregiving. It is incredibly difficult to comprehend what people living with dementia are experiencing, and even more difficult to keep that perspective in mind as we interact with them day after day. This is made even more difficult by the fact that the way dementia manifests in our loved ones is constantly changing—within a single day (as with sundowning), from one day to the next depending on rest, health, and other factors, and across the longer arc of the disease as it progresses.

Caregivers are asked to live in two worlds at once: the world of practical responsibilities and the inner world of a loved one whose brain is gradually changing. Maintaining a mindset that allows us to respond in ways that are both effective and compassionate—while preserving the dignity of the person we love—is no small task.

If frameworks like those offered by Teepa Snow help caregivers better understand what their loved ones are going through and respond with greater patience, clarity, and kindness, then I am entirely in favor of using them.

Anything that helps us meet people where they are—and care for them with greater dignity—is worth our attention.

(Note: About Us, and if relevant, a reference bibliography, related books, videos, and apps can be found at the end of this article.)

Disclaimer: As a Senior Health Advocacy Journalist, I strive to conduct thorough research and bring complex topics to the forefront of public awareness. However, I am not a licensed legal, medical, or financial professional. Therefore, it is important to seek advice from qualified professionals before making any significant decisions based on the information I provide.

Copyright: All text © 2026 James M. Sims and all images exclusive rights belong to James M. Sims and Midjourney unless otherwise noted.

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