Casey Shively holds a photograph of a household ski journey along with his sister, Katie, and his father, Dan, in 1996. Dan Shively died in a reminiscence care house after being violently attacked by one other resident.
Jessica Plance; snowboarding picture by Crystal Photos Pictures/KFF Well being Information
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Jessica Plance; snowboarding picture by Crystal Photos Pictures/KFF Well being Information
Dan Shively had been a financial institution president who constructed floats for July Fourth parades in Cody, Wyo., and adored fly-fishing along with his sons. Jeffrey Dowd had been an auto mechanic who ran a canine rescue and hosted a Sunday blues radio present in Santa Fe.
By the point their lives intersected at Canyon Creek Reminiscence Care Group in Billings, Mont., each have been deep within the grips of dementia and exhibiting a few of the illness’s horrible traits.
Shively had been wandering misplaced in his neighborhood, having outbursts at house, and leaving the gasoline range on. Dowd beforehand had been hospitalized for being confused, suicidal, and agitated, medical information filed in U.S. District Courtroom in Billings present. When Dowd entered Canyon Creek, managers warned workers in a be aware later filed in courtroom that he might be “bodily/verbally abusive when pissed off.”
On Shively’s fourth day at Canyon Creek, carrying a knife and fork, he walked over to a eating room desk the place Dowd was sitting. Dowd informed Shively to maintain the knife away from his espresso, in response to a witness assertion filed in courtroom. Shively, who at 5-foot-2 and 125 kilos was half Dowd’s weight and 10 inches shorter, turned to stroll away, however Dowd stood up and shoved Shively so onerous that when he hit the ground, his cranium fractured and mind hemorrhaged, in response to a lawsuit his household filed in opposition to Canyon Creek.
“The physician mentioned there’s not a lot they may do about it,” his son Casey Shively mentioned in an interview.
Dan Shively died 5 days later at age 73.
Police didn’t cost Dowd, then 66. He stayed at Canyon Creek for practically three extra years, throughout which period he repeatedly clashed with residents, generally hitting male residents and groping feminine ones, in response to facility information filed within the courtroom case. His anger would flare shortly. “I’m actually scared to loss of life of Jeff,” one nurse wrote in a filed assertion describing Dowd’s dispute with one other resident.
In courtroom, Canyon Creek denied legal responsibility for Shively’s loss of life. Its privately held company proprietor, Koelsch Communities, declined to reply questions from KFF Well being Information. Chase Salyers, Koelsch’s director of selling, mentioned in an electronic mail to KFF Well being Information that the corporate prioritizes “the well being, well-being, security, and safety of our residents.”
Dowd’s kinfolk mentioned in an announcement through textual content they might not remark as a result of that they had no firsthand information. “We have been very happy with the care Jeffrey obtained at Canyon Creek,” they added. Dowd was not named within the lawsuit and his present whereabouts couldn’t be decided.
Violent altercations between residents in long-term care amenities are alarmingly widespread. Throughout the nation, residents in nursing properties or assisted residing facilities have been killed by different residents who weaponized a bedrail, shoved pillow stuffing into an individual’s mouth, or eliminated an oxygen masks.
A current research in JAMA Community Open of 14 New York assisted residing properties discovered that, inside one month, 15% of residents skilled verbal, bodily, or sexual resident-on-resident aggression. One other research discovered practically 8% of assisted residing residents engaged in bodily aggression or abuse towards residents or workers members inside one month. Dementia residents are particularly seemingly to be concerned in altercations as a result of the illness damages the components of the mind affecting reminiscence, language, reasoning, and social conduct.
Greater than 900,000 folkswith Alzheimer’s or different sorts of dementia reside in nursing properties and assisted residing facilities. Lots of the most significantly impaired dwell within the roughly 5,000 amenities with locked dementia flooring or wings or the three,300 properties devoted completely to reminiscence care. These locations are principally for-profit and sometimes cost 1000’s of {dollars} further a month, promising experience within the illness and a secure surroundings.
Casey Shively says that as his father’s dementia worsened, it grew to become tougher for the household to handle him at house. “He would begin strolling the neighborhood and get misplaced,” Shively says. “He would activate the gasoline range however not mild the range and the room would begin filling up with gasoline. He would put clothes in unusual locations. I discovered socks in a punch bowl. It obtained to the purpose the place we couldn’t do that anymore.”
Jessica Plance
/KFF Well being Information
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Jessica Plance
/KFF Well being Information
Clashes may be spontaneous and too unpredictable to stop. However the probability of an altercation will increase when reminiscence care properties admit and retain residents they will’t handle, in response to a KFF Well being Information examination of inspection and courtroom information and interviews with researchers. Properties which have too few staffers or nonexistent or perfunctory coaching for workers have a tougher time heading off resident conflicts. Properties additionally might fail to correctly assess incoming residents or might preserve them regardless of demonstrated threats to others.
“As a lot as long-term care suppliers on the whole do their greatest to supply competent, high-quality care, there’s a actual drawback with endemic violence,” mentioned Karl Pillemer, a gerontologist at Cornell College and lead creator of the JAMA research.
“There must be way more of an effort to single out verbal and bodily aggression that happens in long-term care,” he mentioned, “and start to create a mannequin of violence-free zones in the identical means we have now violence-free zones within the colleges.”
A hazard to others
The primary indicators of Shively’s vascular dementia emerged in 2011 as confusion, however the illness accelerated in 2016, in response to interviews along with his spouse and youngsters and his medical information. He started referring to mountains he knew nicely by the flawed title and forgot how you can tie flies on his fishing line. “The decline was so gradual at first we thought we may handle,” his spouse, Tana Shively, mentioned in an interview earlier than her loss of life this yr.
Because the illness progressed, his outbursts grew to become onerous to deal with. He took a swing at considered one of his sons when upset in regards to the temperature in the home. He refused to swallow his medicines and fell repeatedly.
“He would begin strolling the neighborhood and get misplaced,” Casey mentioned. “He would activate the gasoline range however not mild the range, and the room would begin filling up with gasoline. He would put clothes in unusual locations. I discovered socks in a punch bowl. It obtained to the purpose the place we couldn’t do that anymore.”
Dowd, in the meantime, had lived in a Santa Fe nursing house and had a protracted historical past of dementia with behavioral points, main depressive dysfunction with psychotic options, and hypertension, in response to medical information filed in courtroom. Dowd entered Canyon Creek in October 2018 to be nearer to his brother, who lived close by in Wyoming, in response to an admission discover the power offered to workers that was included within the courtroom report. The discover mentioned Dowd suffered from dementia brought on by extreme and long-term alcohol use.
Two months later, Shively moved in.
Montana licenses Canyon Creek, which has 67 beds, as a Stage C assisted residing facility, which allows it to accommodate folks with cognitive impairments so extreme that they can not specific their wants or make fundamental care selections. Montana regulation says these amenities can’t admit or retain a resident who’s “a hazard to self or others.”
Within the lawsuit, Shively’s household argued that provided that regulation, Canyon Creek by no means ought to have accepted or stored Dowd. The Shively household’s lawyer, Torger Oaas, famous in courtroom papers that Canyon Creek’s consumption evaluation kind for Dowd categorized his conduct as “bodily and/or verbally abusive/aggressive 1x per 30 days.” Oaas additionally wrote in courtroom papers that in Dowd’s first weeks at Canyon Creek, he mocked and threatened to hit different residents and threw somebody’s silverware to the bottom throughout dinner.
In its protection filings within the lawsuit, Canyon Creek mentioned the Montana statute was too broad to be the premise of a negligence declare and argued that every one reminiscence care residents are unpredictable. And whereas Dowd had yelled and cursed at different residents at Canyon Creek, he hadn’t had bodily confrontations — or any conflicts with Shively, Canyon Creek mentioned. “The accident was not fairly foreseeable,” Canyon Creek argued.
Within the days after Shively’s fall, nurses famous that Dowd was “extra anxious, offended towards others.” Dowd yelled at a nurse to get off the cellphone and “do your job,” a nurse wrote in a logbook entry filed in courtroom.
“He obtained into my face,” the nurse wrote. “It appeared like he was going to hit me — he had his hand/fist raised.”
Canyon Creek Reminiscence Care Group in Billings, Mont., the place Dan Shively died, is licensed as a Stage C assisted residing facility. Stage C amenities are permitted to accommodate folks with cognitive impairments so extreme that they can not specific their wants or make fundamental care selections.
Jessica Plance for KFF Well being Information
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Jessica Plance for KFF Well being Information
“As unhealthy as I’ve ever seen it”
Individuals with dementia will lash out as a result of they now not have social inhibitions or as a result of it’s the one means they will specific ache, discomfort, concern, disagreement, or nervousness. Some widespread triggers — overstimulation from loud noises, a frenzied ambiance, unfamiliar faces — are hallmarks of dementia care establishments.
“We will’t count on somebody who is consistently and unfailingly disoriented to adapt to the environment anymore,” mentioned Tracy Wharton, a licensed scientific social employee and dementia researcher in Florida. “We’ve got to adapt to them.”
Eilon Caspi, a College of Connecticut researcher, analyzed 105 deadly incidents involving dementia residents and located 44% have been deadly falls during which one resident pushed one other. “Some individuals are aggressive, and a few are violent,” Caspi mentioned, “however in the event you look intently, the overwhelming majority are doing their greatest whereas residing with a severe mind illness.”
Holly Harmon, a senior vp on the American Well being Care Affiliation/Nationwide Middle for Assisted Residing, an business commerce group, mentioned in a written assertion that conflicts can’t all the time be averted regardless of facility operators’ greatest efforts. “In the event that they do happen,” she mentioned, “suppliers reply promptly with interventions to guard the residents and workers and forestall future occurrences.”
However Richard Mollot, government director of the Lengthy Time period Care Group Coalition, a resident advocacy group, mentioned many operators of assisted residing facilities, together with reminiscence care models, are pushed by the underside line. “The difficulty that we see very often is that assisted residing retains folks they need to not,” Mollot mentioned. “They don’t have the staffing or the competency or the construction to supply secure care.” Conversely, he mentioned, when amenities have sufficient rooms crammed with paying clients, they’re extra more likely to evict residents who require an excessive amount of consideration.
“They are going to kick them out in the event that they’re too cumbersome,” Mollot mentioned.
Teepa Snow, an occupational therapist who based Optimistic Strategy to Care, an organization that trains dementia caregivers, famous that the area inside many amenities, with double rooms, tight widespread areas and restricted outside entry, can gasoline conflicts. She mentioned the pandemic degraded circumstances in long-term care, as dementia residents with restricted social expertise atrophied in isolation of their rooms and staffing grew even sparser.
“It’s as unhealthy as I’ve ever seen it,” she mentioned.
“Quite common matches of rage”
The next account of Dowd’s time at Canyon Creek is predicated on 44 pages of nurse’s notes, witness statements, and inside resident-on-resident altercation reviews; all have been contained within the facility’s information and filed as displays within the courtroom case. After Shively’s loss of life in December 2018, Dowd was given new prescriptions, though the courtroom report is unclear if the change was due to Shively’s loss of life. Nonetheless, the information present, Canyon Creek was unable to move off recurring altercations involving Dowd.
Some have been verbal threats. As soon as, Dowd yelled at residents in the lounge to close up, referred to as them “retards” and informed them they need to all die, a caregiver wrote in a witness assertion. He grabbed one resident’s face and threatened to kill him, in response to a nurse’s be aware. One other time, Dowd went as much as a resident sitting on a settee and grabbed his walker. Dowd shook it and informed him to close up. Based on a witness assertion, as a nurse took the resident to the lavatory, Dowd muttered underneath his breath: “Stuff his head in the bathroom.”
Different conflicts have been bodily. Dowd shoved a resident “down on his again so onerous his head bounced off the ground,” a nurse recorded in a be aware. In a distinct incident reported by a nurse, Dowd pushed a resident who had been agitated and cursing right into a chair. On separate events, Dowd hit two residents on the pinnacle, as soon as inflicting bleeding, in response to two resident altercation reviews.
The notes element that Dowd was not all the time the initiator. As soon as, Dowd’s roommate scratched and punched him after Dowd informed him to make use of the bathroom moderately than pee on the ground, leading to a battle. Caregivers separated the 2. One other day, a resident named Invoice wandered into Dowd’s room and pulled Dowd’s hair and beard. Dowd informed the nurses he “felt unsafe and VERY offended,” a nurse’s be aware mentioned. The nurse led Invoice out of Dowd’s room, however Dowd adopted, yelling at Invoice that he was “a fats bastard” and saying he was going to make Invoice’s spouse a widow.
“Jeff stored making a closed fist as tho he was going to hit Invoice,” the nurse wrote in a witness assertion. “I used to be legit scared as a result of there was nothing I may do to defuse the state of affairs. I’m actually scared to loss of life of Jeff. I’m scared to strategy him and discuss to him when he will get into these quite common matches of rage.”
Dowd finally went again to his room and a employee locked his door so no different resident would go in.
The information describe how Canyon Creek caregivers intervened after altercations started, typically separating the combating residents and updating Dowd’s brother on the clashes. Nurses would take away Dowd or the opposite resident from a room and discourage such acts. “Tried to clarify it was inappropriate to harm others,” one nurse wrote after one incident.
Salyers, the corporate advertising and marketing director, mentioned in his electronic mail that the employees at Canyon Creek and different Koelsch amenities are “extremely certified” and “extensively skilled.” He mentioned the corporate’s reminiscence care communities are “distinctively designed and staffed” for folks with Alzheimer’s and different types of dementia.
“It’s good to have a girlfriend”
The nursing notes and statements within the courtroom file counsel that incidents have been frequent sufficient that nurses commented on Dowd’s occasional serenity. “No agitated or aggressive behaviors this shift,” one be aware mentioned. One other nurse be aware mentioned Dowd “continues to isolate at meals, sitting at a desk by himself.” Whereas Dowd loved studying books and doing puzzles, he was overheard saying he was depressed and was “questioning if he wouldn’t be higher off if he wasn’t round anymore.”
Nurses famous Dowd repeatedly exhibited sexual conduct that was both inappropriate — making “crude oral gestures whereas taking a look at youthful females” — or ambiguous, similar to inserting his hand on a resident’s shoulder and commenting, “It’s good to have a girlfriend.” Somebody noticed Dowd “grabbing on a number of residents[’] non-public areas,” a witness assertion mentioned. When nurses caught the conduct, they separated these concerned and rebuked Dowd. A workers member wrote in an announcement that Dowd was inappropriate all through her shift, making sexual jokes and “making an attempt to seize me.”
Based on nursing notes, in summer time 2021, Dowd informed one feminine resident he needed to see her genitals and later touched her breast. In August, a caregiver walked into Dowd’s room and located him touching the identical resident underneath her shirt and pants. The caregiver informed Dowd to “cease it and never ever try this once more” and introduced the lady out to fulfill her household, who had come to go to her.
After that incident, Canyon Creek despatched Dowd to the emergency room at Montana State Hospital, a public psychiatric facility, in response to a nurse administrator’s testimony in a deposition filed in courtroom. The nurse testified Dowd was now not at Canyon Creek. That’s the final point out of Dowd’s whereabouts within the public report. A spokesperson for the Montana Division of Public Well being and Human Providers, which oversees the hospital, wouldn’t verify whether or not he was a affected person.
At a pretrial listening to, the choose excluded dialogue about Dowd’s altercations after Shively’s loss of life. In a courtroom submitting, Shively’s lawyer requested permission to share proof with the jury that Canyon Creek gave its government director a bonus any month when 90% or extra of the beds have been crammed so he may argue Canyon Creek had a monetary motivation to confess Dowd. However the choose additionally barred that data from the trial, which Canyon Creek mentioned in a courtroom submitting was irrelevant.
The Shively case went to trial in 2022 earlier than a federal civil jury in Billings. Regardless of the exclusions, the jury determined Canyon Creek’s negligence brought about Shively’s loss of life. It awarded the household $310,000.
“For us, the cash wasn’t an enormous issue,” mentioned Spencer Shively, one other of Dan Shively’s sons, who referred to as the damages so modest as to be a victory for Canyon Creek or its insurer. “A minimum of they have been negligent per se. However I don’t realize it actually modified something. For me, I obtained some closure. I really feel like these amenities are simply persevering with to do the identical issues they’re going to do as a result of there hasn’t been systemic change.”
KFF Well being Information is a nationwide newsroom that produces in-depth journalism about well being points and is likely one of the core working applications at KFF — an impartial supply for well being coverage analysis, polling, and journalism.
