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Positive Approach to Care

Cheryl trained as a Teepa Snow Certified Consultant and Trainer in 2018. She uses Teepa’s philosophy of Positive Approach to Care alongside her 10 years of providing home care for seniors to help care partners care for aging parents.

"Until there's a cure, there's care" - Teepa Snow

Teepa Snow

Teepa Snow is a leading dementia care education specialist with over forty years of clinical experience as an occupational therapist. In 2005 she founded Positive Approach to Care (PAC), which is an approach to support and engage people experiencing changes in brain function. 

The goal of PAC is to help families and care partners grow their dementia care awareness, knowledge and skill in order to improve the quality of life for people living with dementia. 

Teepa believes in and teaches others to focus on remaining abilities, rather than what has been lost. Recognizing that the person living with dementia is doing the best they can. Also believing, that if something isn't working, it's the responsibility of the care partner to change their behaviors toward the person with dementia. 

While researchers continue to search for a cure, it's important to learn to better support those living with dementia. 


“The GEMS model, from Teepa Snow, acknowledges that everyone’s abilities can change in a moment.  Rather than focusing on the person’s loss when the brain is changing - we see individuals as precious, unique, capable and we encourage a care partnership.  We focus on what people living with dementia can do and what makes them feel purposeful and happy.”
Cheryl Doyle - Champion of People Living Well with Dementia

GEMS State Model

Dementia causes a person's abilities to be ever-changing. Given this progression, Teepa Snow, an Occupational Therapist and renowned dementia expert, created a model that allows the user to quickly identify a state and ability level for the person living with dementia that focuses on what is possible in any given moment. 

The GEMS State Model recognizes the dynamic nature of the human brain and its abilities. Unlike other cognitive models, it acknowledges that everyone's abilities can change in a moment. Take, for example, our own changing level of patience when we are hungry. Modifying environments, situations, interactions, and expectations will create either supportive, positive opportunities, or result in distress and a sense of failure. Just as gemstones need different settings and care to show their best characteristics, so do people.


Rather than focusing on a person's loss 

when there is brain change, seeing individuals as capable, precious, and unique encourages a care partnership and is the core of this model. Providing supportive settings for everyone, including care partners, allows everyone to use what they have to be their best. The GEMS State Model advocates that everyone living with brain change, when given the opportunity, will shine. 

The GEMS State Model of dementia abilities is based on work done by Claudia Allen, MA, OTR, and Cognitive Disability Theory-an Occupational Therapy-based theory.


  • True blue

  • Healthy brain

  • Normal aging 

  • Flexible 

  • Adaptable

  • Optimal cognition

  • Can provide support for other GEMS states with proper self-care and support


  • Clear - Sharp

  • Many facets

  • Lives by habit and routine

  • Likes familiar, dislikes change 

  • Blames or dismisses errors

  • Can cut and shine


  • Green

  • On the go with purpose 

  • Flawed

  • Seeks independence or connections 

  • Repeats

  • Misses details 

  • Travels in time and place


  • Orange

  • Caught in a moment of time

  • More curious than cautious 

  • Focused on sensory needs

  • Lives in the moment

  • Copies actions, not tasks

  • Resists dislikes, seeks likes

  • Can confuse objects 


  • Strong red

  • Retains strength, not skills

  • Big/strong actions 

  • Has rhythm

  • Notices tone of voice

  • In motion or still

  • Imitates actions 


  • Hidden in a shell

  • Ruled by reflexes

  • Short moments of connection

  • Mostly immobile

  • Expresses unmet needs with distress

  • Reacts to touch 

  • Can recognize familiar and liked 

  • Less peripheral awareness with age

Take the First Step

Find out if trublu is the right step for you. Every case is unique so let us tailor a plan for you and your loved one.

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