All posts by Elaine M. Eshbaugh, PhD

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About Elaine M. Eshbaugh, PhD

Professor of Family Services & Gerontology at the University of Northern Iowa; Dementia Simulation House Director; Dementia Consultant to Businesses, Organizations, and Families; Spouse; Dog/cat mom; Indoor cycling instructor; Nap enthusiast http://www.uni.edu/csbs/sahs/gerontology/faculty-directory/elaine-m-eshbaugh-henninger

Dementia Friendly Retail Stores

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Many people living with dementia still go shopping, either alone or with friends, family members, or caregivers. They still want to choose their own greeting cards, find their favorite shampoo, or pick out a birthday gift for someone they love. But a typical store can be confusing, overwhelming, or just plain exhausting for a person with cognitive decline.

Being dementia-friendly doesn’t mean creating a separate section or offering special treatment. It means shaping a space—and a way of interacting—that’s easier to navigate, calmer, and more supportive for people who might be processing things differently.

Here are some practical ways stores can help:

  • Use clear, easy-to-read signs with large fonts and strong contrast. Avoid decorative or quirky restroom labels—just say “Restroom” and use familiar symbols.
  • Keep store layouts consistent. If someone has finally figured out where the peanut butter is, don’t move it to the other side of the store next week.
  • Turn the music down. Better yet, offer quiet hours with low noise. Loud environments can make people anxious or disoriented.
  • Avoid flickering or harsh lighting. Bright, even light is easier on the brain and helps reduce confusion.
  • Keep aisles wide and free of clutter. A clear path helps everyone—especially someone who might already feel unsure on their feet.

Checkout can be one of the hardest parts of the shopping trip. It requires focus, memory, number recognition, and potentially interacting with unfamiliar equipment—all while other customers wait. It’s a lot.

What helps:

  • Slow down. Give people space and time to process without pressure.
  • Use friendly, clear phrases like: “You can put your card here or tap it right on the screen.”
  • If someone seems unsure, gently offer: “Would you like me to tap or swipe your card for you?”
  • Steer people away from self-checkout if they seem overwhelmed. Those stations are often too fast-paced, too noisy, and too complicated.
  • Make sure people leave with their receipt and all of their items. Assure that they do not leave their credit card behind.

It’s also important to remember that behavior can be misunderstood.

Someone might:

  • Find their favorite snack and start eating it before they reach the checkout—not out of disrespect, but because they’re focused on the moment and not on the process.
  • Finally locate the cologne they’ve worn for 30 years and head for the exit, forgetting to pay.
  • Seem rude or abrupt—not because they’re unkind, but because the shopping trip has taken every bit of their mental energy.
  • Knock over a display or drop an item—not because they’re careless, but because they’re moving through a space that feels unfamiliar and overstimulating.

If something unexpected happens, assume good intentions. A calm, kind response can make all the difference. An employee who smiles and says, “Let’s take care of that together,” can turn a difficult moment into one of connection.

And restrooms matter. If a shopper isn’t sure they’ll be able to find or use a restroom, they may not come at all.

What helps:

  • Offer at least one private, all-gender or family-style restroom. This restroom should have room for a caregiver in addition to the person living with dementia. Ideally, include a chair for the caregiver so they do not have to stand while their person is on the toilet.
  • Use clear signage—words and symbols, no cute nicknames or “clever” graphics. “Princes” and “princesses” may seem like an adorable way to label your restrooms but can add a layer of confusion for those who live with cognitive decline.
  • Avoid requiring a key if you can. Needing to track someone down just to use the restroom adds a layer of stress.

A quick training with your team can help everyone feel more confident and prepared. A few essentials:

  • Not everyone who needs extra patience looks like they need extra patience.
  • If someone seems confused or overwhelmed, pause and respond with calm kindness.
  • Speak clearly and slowly. Offer support without drawing attention.
  • Approach individuals from the front to avoid startling them.

Most people living with dementia won’t mention that they have dementia to a retail employee. But they’ll notice if your store feels welcoming. They’ll remember if they felt rushed or if they felt seen.

Kindness is free. A little patience and a gentle tone go a long way. What helps one person—whether they’re living with dementia, overwhelmed, tired, or simply having a hard day—helps everyone.

[If you are in Iowa and have an interest in becoming a Dementia Friendly retail store, don’t hesitate to reach out (dementia.simulation@uni.edu). It’s a one hour training and you must have at least 50% of your employees present.]

AND THE GUILT.

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If you’re caring for a partner with dementia, hear this: You are not alone in your guilt.

You feel guilty.

Guilty for feeling lonely, even while your spouse sits right beside you.
Guilty for missing the conversations you used to have with your partner.
Guilty for wanting just one day when you don’t have to be the responsible one.
Guilty for snapping, for sighing, for thinking, I can’t do this another day.

Sometimes the guilt cuts even deeper:

  • Guilt over placing your spouse in a memory care community.
  • Guilt for making promises you have not been able to keep.
  • Guilt because your wedding vows echo in your ears—in sickness and in health—and you feel like you’re failing.

You are not failing.

Dementia can be a cruel thief. It steals conversations, shared memories, inside jokes, quiet comfort, and the daily rituals that make a marriage feel like home.

But here’s what it can’t steal: The fact that you have loved, and that you still love, even if that love looks different now.

Your love isn’t gone. It’s changed. But it’s still there.

Placing your spouse in care doesn’t mean you’ve stopped loving them. It means you’re protecting them. It means you’re protecting both of you.

Needing space doesn’t mean you’re abandoning them. It means you’re human.

You are grieving losses that happen while your spouse is still physically here—a grief that’s invisible to many around you. The stuff that makes your heart drop….it doesn’t even make sense to other people. And maybe you’ve stopped even trying to explain it to them. This is your journey, and it’s unique.

So if guilt is knocking on your door today, gently remind yourself:

You’re still here.
You’re still loving.
You’re still trying.

That’s enough.

And you deserve compassion, too.

Dementia and Restaurants

dementia

I was once having lunch with someone in the early stages of dementia. The menu was overwhelming—tiny font, too many choices, and clever descriptions with jargon that made it hard to tell what anything actually was.

He looked at the server, panicked.
“I’ll have… um…”
He trailed off. She looked impatient. Finally, she rolled her eyes, mumbled she’d come back later, and walked away.
He looked embarrassed.

And my heart broke a little.

But it doesn’t have to be that way.

Restaurants can be more than just a place to eat. They can be a place where someone with dementia still feels like they belong. Where a caregiver doesn’t have to brace for judgment. Where lunch feels… like lunch.

Here’s how you can help make that happen if you work in the restaurant industry:

(Note–There are a lot of other ways to be dementia friendly….these are just a few ideas to get you thinking!):

Keep the Menu Simple

Big fonts. Easy words. High contrast. Pictures help, too. It’s not about dumbing anything down—it’s about making sure more people can enjoy their meal without stress.

Be Mindful of Noise

Too much noise—whether it’s clanking dishes, loud conversations, or loud background music (is loud background music an oxymoron?) —can be overwhelming for someone with dementia. Keep music low and calming. Skip the playlists that feel like a nightclub at noon. Soft instrumental or acoustic tunes work well. If you have a quieter section of the restaurant, that’s a great place to seat guests who might benefit from a calmer environment.

Be Patient

Some folks might need a little more time to order. They might repeat themselves. Or lose their words. A little patience and a calm voice can go a long way.

Reassure people that there is no need to rush. Try saying “Take your time—I’m happy to help.”

Don’t roll your eyes when someone takes a bit longer to order. Stay tuned in and engaged.

Those small things? They mean the world.

Don’t Be Cute with Bathroom Signs

Please don’t make people decode “Lads” and “Dames” or try to read cursive signs in dim lighting. Stick with the classics signs and symbols for restrooms. Use clear, bold print and—if possible—include images. When someone has to urgently find a restroom, clarity is kindness.

Let People Know They’re Welcome

People with dementia still want to go out to eat. They still want pancakes. And coffee. And birthday dinners. And connection.

So if you’re a restaurant owner, manager, or server—thank you for considering this. Thank you for thinking beyond what’s easy or efficient. Thank you for setting the table for everyone.

I know not everyone enjoys eating out–but it is one of my favorite things to do. And I know many people feel that way. If we want people living with dementia to thrive in their communities as long as possible, we need to think about how to make restaurants more dementia friendly.

If you’re in Iowa and want to become a Dementia Friendly Restaurant, contact us at dementia.simulation@uni.edu. We’d love to help!

No Empty Shells

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People living with dementia are not empty shells.

They are human beings.

Still, I hear it all the time.

They’re gone.

They’re just a shell.

They’re not in there anymore.

People say this because they’re hurting. Because the changes they see are painful and confusing. Because it’s hard to reconcile who someone used to be with who they are today.

Someone with dementia is as human as they have been for every moment of their life.

Yes, dementia changes people. It changes memory, language, personality, and behavior.

It can make someone unrecognizable in ways that feel cruel and unfair. But it does not erase who they are at their core. It doesn’t wipe away their humanity.

They feel love. They feel fear. They feel comfort.

Here’s why remembering that matters:

If we start believing that people with dementia are “gone,” we stop trying to connect. We stop talking to them like adults. We stop treating them with the dignity they deserve. And that is when the real loss happens.

People with dementia are still here. Different, yes. But absolutely still here.

And they deserve for us to see them.

Haircuts and Dementia

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It’s easy to take certain things for granted — like sitting in a chair and getting a haircut.

But dementia has a way of turning ordinary moments into challenging ones.

A haircut might seem quick and easy to you or me. For someone with dementia, it can feel overwhelming or frightening..

Here are some of the hurdles I’ve seen — and that I wish more people understood:

  • Strange Surroundings: New places can be disorienting. Bright lights, mirrors everywhere, buzzing tools — a salon can feel like sensory overload.
  • Mirrors Can Be Confusing or Frightening: Seeing their own reflection might confuse someone with dementia. They might not recognize themselves and think a stranger is staring at them, leading to fear, anxiety, or anger. Mirrors can also make it hard for someone to tell how many people are actually in the space, which adds to confusion or a feeling of being crowded.
  • Noise and Smells: Blow dryers, scissors, clippers, hairspray — the sensory soup can be overwhelming for someone whose brain already feels overloaded.
  • Touching and Personal Space: Having someone touch their head, ears, or neck might feel invasive or even threatening. Especially if they don’t remember why they’re there.
  • Fear of Sharp Objects: Scissors near the face can trigger fear or suspicion. I’ve known people who thought the stylist was trying to harm them.
  • Difficulty Sitting Still: Dementia can bring restlessness. Sitting in a chair for 15 or 20 minutes can feel impossible.
  • Trouble Understanding Instructions: Simple directions like “Tilt your head forward” or “Look down” might be confusing. Or forgotten the second they’re spoken.
  • Emotional Vulnerability: A haircut can be a reminder of changes in appearance, aging, or hair loss — all sensitive topics, even more so for someone living with dementia.
  • Embarrassment or Shame: If someone fidgets, resists, or becomes upset during the haircut, they might feel embarrassed afterward — even if they can’t fully explain why.
  • Caregiver Proximity: Many salons or barbershops simply don’t have space for a caregiver to sit nearby. Being separated, even for a few minutes, can be terrifying for someone with dementia — and stressful for the caregiver, too.

That’s why it’s important for stylists to know if a client might be living with dementia. When they’re aware, they can adjust how they communicate, slow things down, explain each step, keep mirrors covered if needed, and create a calmer, safer environment. A little understanding can mean the difference between a stressful ordeal and a peaceful visit.

None of this means haircuts are impossible.

It just means they take more planning, patience, and understanding.

  • Go at a quiet time of day.
  • Explain each step gently.
  • Stick with the same stylist if you can.
  • Ask the stylist to cover mirrors if they cause distress.
  • Keep appointments short when possible.
  • Let the salon know ahead of time that you’d like to stay close if possible.
  • Offer lots of reassurance.

Above all, remember this:

A person with dementia isn’t being difficult. They’re having difficulty.

Going to a hair salon can be challenging for someone with dementia. A few small modifications can make all the difference.

Note: If you are looking for a Dementia Friendly Hair Salon in Waterloo/Cedar Falls, Iowa, I highly recommend Wendy Weber Salon Suite. Wendy has done training with me that is above and beyond our Iowa Dementia Friendly Business and Organization Training. She has experienced dementia in her own family and is passionate about providing comfortable salon experiences to those with dementia.

More Education = Better Care!

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I am happy to do dementia trainings for various sectors, but I am always honored to be asked to train staff at nursing homes and memory care communities.

I am honored because the employees I work with are generally CNAs or resident aides, and I would argue that how well they do their jobs is one of the most important factors–if not the most important factor–in quality of care.

Has it ever occurred to you in nursing homes and assisted livings that the people who are paid the least have the most direct contact with the residents?

I am continually amazed at the varying levels of dementia knowledge of employees.

I am surprised by how much people know. I am surprised how little people know.

And level of knowledge, anecdotally, doesn’t seem to be related to experience in the field.

In the state where I live, employees who work with those living with dementia have to do an online module to learn about dementia and meet the state requirement. And that’s it.

If you or a loved one are considering care, a great question to ask is, “What type of ongoing dementia education does your staff receive?“

Research shows that facilities that invest in more dementia education for staff provide better care to residents. That’s not surprising, is it?

Dementia education….works.

Training programs for staff have been shown to improve staff-resident interactions, increase staff empathy for residents, and create more meaningful engagement with those living with dementia.

Dementia education increases staff knowledge, improves attitudes toward people with dementia, and boosts confidence of those providing care. They not only benefit residents but also positively impact staff by increasing job satisfaction and reducing burnout. 

If you want to look at the research studies, let me know, but the evidence is overwhelming.

Dementia education is linked to improved dementia care.

There is research about what types of education and delivery methods are most effective. When I plan a training, I go back to this research in designing something to meet the needs of the facility. I don’t deliver a cookie cutter training.

Not surprisingly, standard online modules (aka cookie cutter trainings) are not recommended as the best form of dementia education. However, I understand that facilities are challenged by staff turnover. I can’t come to your facility every week to train new employees. I get it.

Facilities are doing the best they can with the challenges and limitations that exist in the industry. Long term care is incredibly complicated.

Dietary staff, CNAs, resident aides, maintenance, and everyone else….You are doing a hard job and we need to give you the tools to succeed. And I want you to enjoy the important work that you do!

A friend of mine recently went with her father to explore an assisted living that serves those living with dementia. Her father is in the early stages of Alzheimer’s and wants to put a plan in place. (Can I just say–good for him!)

The assisted living was beautiful. A grand lobby. An enviable coffee bar for the residents. The resident rooms were spacious.

My friend, at my suggestion, asked what type of ongoing dementia education is required for staff.

She was told that they do an online module within 30 days of their start, and then yearly they must complete more online training. That’s in compliance with the state law.

My friend asked if they had opportunities for ongoing education. The response was that there was a lot of stuff out there on Tik-Tok now that shows how to “treat dementia people.”

After more conversations with other employees from the community, she was not convinced that providing excellent dementia care was a priority.

She heard some of the employees using non-dementia friendly language in chatting with her.

“Dementia person”

“Dementia sufferer”

“Senile”

People who work in facilities like this should be educated on dementia friendly language.

Despite the beauty of the building, they decided it wasn’t a fit.

While it is frustrating that some nursing home employees have a low level of knowledge about dementia, that lack of knowledge isn’t their fault. People know what we teach them. Let’s teach them.

Here’s the thing about work trainings. They can be dry and boring. I promise that I am not dry and boring. I may be weird and loud but not dry and boring.

I want employees to leave MORE excited about working with residents. I want to teach them to find the joy in their jobs and celebrate the wins. I want them to gain confidence and know that their employers in investing in them.

It’s not just about what I do, of course. There are other qualified individuals who do dementia education. (Make sure you check their qualifications and education!)

Turnover among nursing home employees in challenging for communities. If we can get people to enjoy working with those living with dementia, turnover decreases, the facility saves money, and staff provides better care.

To communities that make continuing education a priority…you deserve recognition. People should know that you are taking steps to invest in and educate your employees. Please talk about this when you market your community. It’s important.

Your commitment to education and, consequently, providing better care is admirable.

When Dementia Progresses

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I recently did a Zooom consultation with a dementia caregiver. She was well-educated and it was obvious she continually sought out information to become a better caregiver.

Her husband has Alzheimer’s. She told me he had plateaued for a few years without much progression, but lately his decline had been steep.

And she wasn’t sure what to do.

After some more conversation, I realized why she had booked a consultation and what she wanted to know.

She wanted to know how to stop the decline. She wanted to know what she had done to cause the decline. She wanted to know what she was doing wrong.

But she’s not doing anything wrong.

He stayed the same. And then he declined.

She is interpreting that as what she was doing was working, and then she must have messed up or changed sometime to cause the progression.

I was interpreting it as….dementia.

I feel like I give caregivers mixed messages. I talk to them about empowerment. But I also talk to them about how they are powerless when it comes to changes that occur due to dementia.

We can change a person’s environment. We can change how we interact with that person. But we can’t stop the progression of dementia.

We didn’t cause dementia, and we can’t cure dementia.

The woman I spoke with had placed a lot of pressure on herself. She researched supplements and vitamins recommended for those with dementia. She went to online trainings for caregivers. She attended a support group to get tips on caregiving. She traveled to two different states to attend caregiving conferences.

She started cooking her husband meals based on some nutritional guidance she found online. And she knows she has to stay healthy to care for her husband, so she exercises for at least an hour a day.

Dementia had become a full time job for her.

And there wasn’t room for much more in her life.

So when he declined despite all of these efforts, all she could focus on was how she must not be doing the right things.

You can love someone and do all the right things.

No matter your efforts, dementia is progressive.

It progresses not because you did something wrong or you aren’t doing enough. Dementia progresses because it’s dementia.

We can’t beat ourselves up when someone’s dementia gets worse.

It’s not our fault.

Instead of making our goal to stop the progression of our loved one’s dementia, let’s make our goal to continue loving and caring for someone while they experience these changes.

Let’s empower ourselves to make decisions that promote quality of life for those living with dementia as their dementia progresses.

When I told this woman that dementia progresses and we can’t do anything to stop it, she said, “Wow. It’s kind of freeing to realize I don’t have the responsibility of stopping his dementia.”

And you don’t have that responsibility (or power) either.

Empowerment in Action: Culture Change through Dementia Education

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Just a reminder that there are still some seats available for the Empowerment in Action conference on June 11.

I’m excited to talk about dementia and anxiety, and there will also be sessions on improv and dementia as well as how to de-escalate challenging situations. The day will end with a panel of individuals living with dementia.

This is a great opportunity for professionals as well as those who have a loved one with dementia. A student rate is available.

We are offering CEUs for Iowa nurses as well as social workers.

See below for more information as well as an opportunity to register!

Wednesday, June 11
8:30 a.m. – 2:30 p.m.
Hilton Garden Inn | 7213 Nordic Drive, Cedar Falls, Iowa

Join us for a unique opportunity to engage and share insights about how to improve quality of life for those living with dementia and their care partners. 

We will explore the following topics:

  • Dementia and Anxiety: Understand the relationship between dementia and anxiety, and explore effective strategies for minimizing anxiety among those living with dementia.
  • Dementia and De-escalation: Learn techniques to de-escalate challenging situations and foster a supportive environment for individuals living with dementia.
  • Creating Dementia-Friendly Communities: Discover how to build inclusive communities that support individuals living with dementia and their families.
  • Improv Principles in Dementia Care: Explore how the principles of improv can enhance care practices and make interacting with those living with dementia rewarding and fun!

Participants will leave the conference with:

  • An increased understanding of dementia care practices that enhance quality of life and empower individuals living with dementia and their care partners.
  • A commitment to person-centered approaches that emphasize empathy, education, and empowerment. 

Together, we can create a brighter future for individuals living with dementia and their caregivers.

You can learn more and register for the conference here: Empowerment in Action

When You Know Your Brain

dementia

I have done some virtual cognitive screenings recently. And I have one important observation.

This should not be news to anyone, but people want to be listened to.

It’s not just about administering formal tests. It’s not just about assigning numbers. It’s about listening.

I have worked with several people who have been insisting to family and friends that there is something wrong with their brain. But their loved ones make comments like, “Everyone forgets stuff,” or “I think I’m more absent-minded than you are.” In other words, their concerns are dismissed.

People think they are being reassuring when they say things like that to those who are concerned about cognition. It’s not reassuring. It’s frustrating.

How do you feel when you express a concern and you aren’t listened to?

When I do cognitive screenings, I tell people that I trust their observations of their own brain. After all, they’ve had that brain their whole life.

If they tell me something is wrong, I believe them. I don’t know if it’s dementia. Maybe it’s depression, anxiety, a physical health condition, or a sleep disorder. Perhaps it’s a result of a stressful marriage or excessive alcohol use.

But when you tell me something is wrong with your brain, I believe you.

You know how your brain works. And, sure, there are cognitive changes that occur as people get older….typical age-related change.

Maybe you forget to get gas in your car. I’m not too worried about you, but if you forget how to get gas, I am concerned.

If you call your kids by the wrong name occasionally, I don’t think much of it. But if one of your kids tells you that they are Carrie and not Kelsey–and you don’t believe them–I’m concerned.

Not every moment of forgetfulness means dementia is on the horizon, of course. But if you are insistent that your brain is significantly changing and impacting your daily function, I want to talk about it. I want to know what’s different than 2 or 5 years ago. I want to know why you are concerned.

As dementia progresses, many individuals are not reliable reporters of their own symptoms. However, I find that many people in earlier stages are quite helpful in their own diagnostic process if we only listen.

A gentleman I know went to his doctor’s office and asked for a cognitive assessment. He had been concerned about his confusion for several months, and it took a lot of mental energy for him to make this appointment.

The doctor asked him a couple of questions and then asked him to draw a clock. At the conclusion of the test, the doctor reassured him that his responses indicated he was “normal” and left the office.

And that was that. He paid his co-pay and drove him.

He was never asked for his perceptions of how his brain was changing. He was never even asked why he wanted a cognitive assessment.

And it’s too bad. Rather than leaving the doctor’s office with a sense of relief, he left feeling unimportant.

He felt like a score or a number. Not like a human being.

He scored fine on a test. Therefore, he was fine.

But he didn’t feel fine.