Dementia Care: The 6 Stages & Gems

As rehabilitation professionals, we face significant challenges when consulting and providing treatment plans for people living with dementia.

After figuring out which abilities our clients have retained and which abilities they’ve lost, we must determine how to best structure treatment sessions and programs. By knowing the characteristics of each stage of dementia, we can gain a deeper insight into what our client is experiencing and create a more effective support plan.

  • You can determine useful ways to modify tasks.
  • You can educate caregivers to better guide daily activities through more effective cues and support.
  • You can avoid conflict by acknowledging the warning signs and adapting to the situation.

It’s vital to enlist the cooperation of family and caregivers for better integration of the skills developed in therapy. If families and caregivers misunderstand or misinterpret behavior, the person living with dementia can lose skills prematurely.


After years of studying and working with dementia care, I developed GEMS™ – a tool to help you conquer challenges and improve your client outcomes.

My approach categorizes stages of dementia into 6 different gemstones, each with a unique set of characteristics to highlight what helps—or doesn’t help—when caring for someone at that stage.

Pearl Image

For example, most people are diagnosed at the EMERALD stage. Emeralds are green (like the traffic light) and people at this stage are “on the go” but struggling. They have little awareness of their changing abilities. You should limit and simplify verbal interaction, doing things with rather than to your client.

A note of caution: EMERALDS think they’re fine, so don’t point out their “mistakes” or you become part of the problem!

Three stages later, at the final stage of progressive dementia, are the PEARLS. They’re stuck and hidden inside their bodies, like pearls in an oyster shell. Moments of connection are brief, and people at this stage respond best to familiar voices and gentle rhythmic movements.

It’s very important that you communicate with family members and care providers in easily understood language, free of jargon. You should use familiar language and focus attention and appreciation on which skills remain, while also acknowledging those lost.

The right support and care at each stage will help your clients truly shine like the gems they are.