Caregiving Gems

Teepa Snow, MS, OTR/L, FAOTA

Gem Stone Approach to Cognitive Levels

Rationale• 3 systems – all use numbers • Each has value – together confusing• People are not numbers• Until we begin to the see the beauty and value

in what the person is at this point in time – we will never care for them as we should

• Gems are precious and unique – common language and characteristics

• Based on Allen Cognitive Levels – – Cognitive Disability Theory – OT based

• Creates a common language & approach to providing –– Environmental support– Caregiver support & cueing strategies– Setting expectations regarding retained abilities and

lost skills– Promotes graded task modification for success

Now for the GEMS…

SapphiresDiamondsEmeraldsAmbersRubiesPearls

Sapphires

Us on a good day…Clear & True to Themselves

May feel ‘blue’ over changesSome are ‘stars’ and some are not

They can CHOOSE

Sapphires

• Can connect ABCs – make contracts• May have other health issues that affect

behaviors• Recognize life experiences, achievements &

values in ABCs• Can follow written info & hold onto it • Will still need us to work with them• Can typically CHOOSE their behaviors

Diamonds

Still ClearSharp - Can Cut

Hard - Rigid - InflexibleMany Facets

Can Really Shine

Diamonds• Know Who’s in Charge – Respect Authority• Can do OLD habits & routines • Become more territorial OR less aware of

boundaries• Like the familiar – FIGHT CHANGE• Can pull it together to make you look bad• Know how to push your buttons• Want to keep roles the same• Tell the same stories ask the same ?s

Emeralds

Changing colorNot as Clear or Sharp - Vague

Good to Go – Need to ‘DO’Flaws are Hidden

Time Traveling

Emeralds• Think they are FINE• Get emotional quickly• Make mistakes – don’t realize it• Do over and over OR Skip completely• Ask – “What? Where? When?”• Like choices• Get lost in past life, past places, past roles• Need help, DON’T know it or like it!

Ambers

Amber AlertCaution!

Caught in a momentAll about Sensation

Explorers

Ambers

• Get into stuff• Fiddle, mess, touch, taste, dig, tear, fold…..• Move toward action and noise OR away• Sensory tolerance• Sensory need• Mouth, fingers, feet, genitalia• Can’t figure it out… react physically

Rubies

Hidden DepthsRed Light on Fine Motor

Comprehension & Speech HaltCoordination Falters

Wake-Sleep Patterns are Gone

Rubies

• Fine motor stops• Hard to stop and hard to get going• Limited visual awareness• One direction – forward only• Can’t figure out details – but do copy us• SLOW to change• On the go or full stop• Use music and rhythm

Pearls

Hidden in a ShellStill & QuietEasily Lost

Beautiful - LayeredUnable to Move – Hard to ConnectPrimitive Reflexes on the Outside

Pearls

• Can’t move• Limited awareness of the world around –

most of the time• Problems swallowing• Hard to get connected• How we touch and help matters• May know familiar from unfamiliar• SLOW!!!