1. Caregiving Gems Teepa Snow, MS, OTR/L, FAOTA

2. Gem Stone Approach to Cognitive Levels

3. 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

4. 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

5. Now for the GEMS… Sapphires Diamonds Emeralds Ambers Rubies Pearls

6. Sapphires Us on a good day… Clear & True to Themselves May feel ‘blue’ over changes Some are ‘stars’ and some are not They can CHOOSE

7. 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

8. Diamonds Still Clear Sharp - Can Cut Hard - Rigid - Inflexible Many Facets Can Really Shine

9. 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

10. Emeralds Changing color Not as Clear or Sharp - Vague Good to Go – Need to ‘DO’ Flaws are Hidden Time Traveling

11. 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!

12. Ambers Amber Alert Caution! Caught in a moment All about Sensation Explorers

13. 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

14. Rubies Hidden Depths Red Light on Fine Motor Comprehension & Speech Halt Coordination Falters Wake-Sleep Patterns are Gone

15. 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

16. Pearls Hidden in a Shell Still & Quiet Easily Lost Beautiful - Layered Unable to Move – Hard to Connect Primitive Reflexes on the Outside

17. 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!!!