Scared to Death: Nurses and Residents Confront Rampant Violence in Dementia Care Facilities

Dan Shively arrived in prison from banking, constructing floats for the July Fourth celebration of Cody, Wyoming and loving to fly-fish with his sons. Jeffrey Dowd was an ex-auto mechanic with a dog rescue, Santa Fe based blues radio show host every Sunday. 
 
Both met as residents of Canyon Creek Memory Care Community in Billings, Montana and both were significantly afflicted with dementia and had manifested some of the awful symptoms of the disease. 
 
Shively had been lost near the neighborhood, used to have temper tantrums at home, and used to leave the gas stove on. Dowd prior to this had already been admitted in the hospital for confusion, for symptoms of psychosis to the point of attempting suicide, and for agitation, records from the U. S district court in Billings indicate. When Dowd joined Canyon Creek, the management of the store issued a note to its employees later produced in court about the man, stating that he could be physically/verbally abusive when frustrated. 
 
One day when Shively was in Canyon Creek having been there for fourth day, he was holding a knife and a fork and went directly to a dinning room table where Dowd was. A statement filed in court also revealed that, Dowd warned Shively not to put the knife near his coffee. Instead, Shively, who weighed only 125 pounds and was 5-foot-2 in contrast to 210 pounds that Dowd was, stood up to make an attempt to walk away from Dowd, but Dowd pushed him with sufficient force that, when Shively fell to the floor, his skull also, burst and his brain started bleeding as the family of Shively described in a lawsuit against Canyon Creek. 
 
‘The doctor said there was nothing they could do about it,’ Casey Shively said in an interview. 
 
Dan Shively passed on exactly five days later at the age of 73. 
 
Police did not bother to charge Dowd who was 66 at the time. He remained at Canyon Creek for approximately two and a half more years and often got into physical confrontations with residents, pushing male residents and touching female residents, based on records of the facility that was submitted to the court trial. A main character could easily become angered at any situation. Thus, one of the nurses stated in the filed affidavit concerning the confrontation of Dowd with another resident: “I am literally scared to death of Jeff. ” 
 
As expected, Canyon Creek opposed legal responsibility for Shively’s death in the court. Koelsch Communities is a privately held corporation that owns this corporate facility and, per their policy, did not respond to KFF Health News questions. Chase Salyers, Koelsch’s director of marketing, claimed in the email to KFF Health News that the company cares about “the health, well-being, safety, and security of our residents. ” 
 
Dowd’s relatives said in a text-message statement that they would not speak to The Chronicle because they would only be making up things they did not witness. “We were very pleased with the care Jeffrey received at Canyon Creek,” they said further. The former priest Dowd was not even mentioned in the lawsuit and his current address remains unknown too. 
 
Physical aggression between elderly people in LTC is, however, rather frequent. In houses and old-age assisted facilities across the country, people die from being attacked by fellow residents who used a bedrail as a weapon, stuffing pillows into a person’s mouth or taking off the oxygen mask. 
 
In the study conducted by JAMA Network Open of 14 assisted living homes situated in New York, it was revealed that one in every 14 Old aged residents got involved in verbal, physical, or even sexual abuse by fellow residents in one month’s time only. Physical abuse or aggression into assisted residents or staff members was witnessed by the subject of another study to be at 7. 9 percent within one month period. Dementia residents are likely to be involved in altercations because due to the disease, different areas of the brain that manage memory, language, reasoning, and social orientation are affected. 
 
As of the year 2000, there were over 900 000 Alzheimer’s or other type of dementia, that live in nursing homes and assisted living facilities. Some of the more disabled reside in the approximately 5,000 nursing and assisted living centers that have locked dementia floors or wings; or in one of the 3,300 facilities that is solely dedicated to dementia care. Many of these are commercial places that cost thousands of extra dollars per month and offer specialized knowledge of the disease and a secure environment. 
 
Conflicts sometimes may occur and are in some ways too unsuitable to be avoided. However, the likelihood of aggression rises when memory care homes accept and keep patients they can’t handle, as a KFF Health News analysis of inspection and court records and interviews showed. Hired staff homes that are understaffed or have no-staff-training or only-general staff training experience more resident aggressiveness or begin to see conflict control slip through their fingers. Homes also may not make adequate screening of the incoming residents, or may retain them in spite of their propensity for violence. 
 
Despite the intentions that LTC providers in general may have, exercising competence and delivering high quality care, “there is a very serious issue with structural violence,” said Karl Pillemer, gerontologist at Cornell University and the author of the JAMA study. 
 
“There has to be much more of an effort to identify verbal and physical aggression that takes place in LTC and start building violence free places in similar way that many schools have done. ” 
 
A Danger to Others 
 
Shively’s vascular dementia symptoms were first observed in 2011 as confusion, but the disease progressed in 2016, based on interview with his wife and children and patient’s medical records. He began to address mountains that he knew very well by the wrong names and even failed to know how to attach flies about the fishing line. The slowdown was initially so incremental, his spouse, Tana Shively, said in an interview before her death this year, that they thought they could deal with it. 
 
On April 21, he only worked in the morning; in the evening his outbursts became too severe to manage. One of the witnessed abuses involved taking a swing at one of his sons when bothered by the warmth in the house. He was unable to cooperate and ate his drugs; he also bolvanted many times. 
 
“He would start walking the neighborhood and get lost and just get waves of customer patronage, occasionally,” Casey said. “He would turn on the gas stove but not light the stove, and the room would start to fill up with gas; He would place his clothes in rather peculiar places; one day I found socks in a punch bowl; Suddenly, it reached a point where we could no longer do this. ” 
 
While, the second suspect who died, Dowd, was a nursing home patient, in Santa Fe, she had prior records of dementia, with behavioral problems, major depressive disorder with psychotic symptoms, and hypertension. Canyon Creek is a facility that Dowd joined in October 2018, and he was admitted because he wanted to be closer to his brother who lived close to Wyoming though permanent residence was in Montana, as per an admission which the facility gave to its employees and which is found in the records of the court. The notice stated that Dowd had dementia and this was due to alcohol consumption and its prolonged use.

Two months later that is in February, Shively joined them and made the house his home. 
 
Montana grants a level C assisted living license, that allows Canyon Creek which has sixty-seven beds for residents, to care for individuals with such severe forms of dementia that they cannot manage or convey their needs and therefore cannot make even basic decisions about their care. Montana law confirms that these facilities must not admit or continue to keep a resident if the latter is “a danger to self or others. ” 
 
In the lawsuit Shively’s family noted that by that law Canyon Creek should have never accepted or retained Dowd. In the documents submitted to the court the Shively family attorney Torger Oaas stated that the form Canyon Creek filled for Dowd included his behavior based on which he was described as physically and or verbally abusive or aggressive once a month Oaas also stated in the court documents submitted that in the first few weeks of Dowd being with Canyon Creek he mimic and threatened to hit other residents and upon the resident not liking this threw their silverware across 
 
The company’s response to the lawsuit filings noted that Montana statute was overreaching to be a basis of a negligence claim and asserted that all residents of memory care are unpredictable. Canyon Creek said Dowd had yelled and cursed at other residents at Canyon Creek and had abused and threatened other residents, but he had not physically assaulted or fought with Shively. “The accident was not reasonably foreseeable,” Canyon Creek stated. 
 
Retrieved from the court records, the nurses’ logbooks indicated that in the days after Shively’s fall, Dowd was moodier, angry at the others and she yelled at a nurse who had been taking a phone call to ‘get off the stupid telephone and get your lazy behind and do your job’. 
 
It was like this that this nurse penned, “He got into my face. ” ‘’He was like going to whack me — he had his hand/fist up. ’’ 
 
The systematic condition of the us mental health care system discussed ‘As bad as I’ve ever seen it’ 
 
A person with dementia will strike out because social manners are but a dim memory or maybe the only way they know how to convey anger, pain, fear, disagreement or anxiety. Certain stimuli such as loud noise which forms part of a busy environment, strangers who are entitled to the patient’s care are some leading indicators of dementia care facilities. 
 
For Wharton, a patented clinical social worker and a dementia consultant in Florida, the lack of orientation is incomparable: “We can’t expect a person, who is lost all the time and always and every time, to adjust to whatever environment was mentioned anymore. ” “Thus, it must be admitted that one has to follow them. ” 
 
University of Connecticut’s researcher Eilon Caspi investigated 105 end-of-life events regarding dementia residents and identified that 44% of them were fatal falls, in which one of the residents shoved the other. “There is an aggressiveness and there is a violence and yet for the majority of people with schizophrenia and other psychotic disorders the best is being tried in a very difficult circumstance with a very serious brain disorder. ” 
 
AHCA/NCAL senior vice president Holly Harmon said in a statement that sometimes, conflict cannot be avoided no matter how hard the assisted living facility operators try. “If they do occur,” she said, “providers immediately come up with measures that will safeguard the residents and the staff as well as ensure that such incidences do not happen in the future. ” 
 
Richard Mollot, the executive director of the Long Term Care Community Coalition, which is a residents’ advocacy group, argued that many operators of assisted living centers, with a focus on memory care, are primarily motivated by profits. “The problem that we observe quite frequent is that assisted living admits people they should not,” added Mollot. “They do not have the staff, the expertise, or the framework to deliver adequate care. ” On the other hand, he stated that once the centres target halls are occupied with paying clientele, the residents who are a lot of trouble are shown the door. 
 
“They will cut down on them if they become a challenge,” Mollot said. 
 
Teepa Snow, an occupational therapist and the founder of Positive Approach to Care which is a company that offers dementia caregivers training, corroborated the notion that the environment inside most of the facilities; with small and cramped living spaces, double occupancy rooms, crowded shared corridors and minimal opportunities to access fresh air, is highly likely to instigate aggressive behaviors. They engaged staff reported the deterioration of conditions, stating that dementia residents with low social interactiveness regressed to lying in their rooms independently for hours and that staffing was even scarcer. 
 
‘This she said was worse than she has ever seen it. ’ 
 
‘‘Extremely Frequent Episodes of Anger’’. 
 
The information detailed on this case of Dowd concerns 44 pages of nurses’ notes; witness statements, and; internal resident-on-resident attack reports from the records of Canyon Creek facility, which were presented as exhibits in the case. Shively passed on in December 2018, and Dowd was later prescribed with some more with the court records being inconclusive if the change of the prescription was due to the death of Shively. However, as the records bear testimony, Canyon Creek failed to prevent the occurrence of successive incidents with regards to Dowd. 
 
Some were verbal threats. There was one time when Dowd screamed at residents sitting in the living room demanding them to be quiet, the caregiver mentioned in witnesses’ statement, whereby he also called them retards finally saying that they all should die. He threw a plate at another resident, called another a dirty baby, and then snapped the resident’s neck, choking him until he almost passed out, a nurse wrote. Another case is when Dowd approached a resident who was seated on a sofa and woman took his walker. Dowd grasped it and muttered to him to stop it. According to a witness statement, as a nurse took the resident to the bathroom, Dowd muttered under his breath: It was during this exchange that Moira punched Sinead and a wrench was put in the mouth of one of the characters, just in case words were not enough: “Stuff his head in the toilet. ” 
 
Other conflicts were physical. The following is a nurse’s documentation of one of Dowd’s abuse, he ‘forcibly placed one resident down on his back so hard his head bounce off the floor’. As narrated by a nurse in one of the incidences, Dowd forcefully took a resident who was verbally abusive and cursing pushed the old man into a chair. Two residents have said that Dowd has smacked his head on at least two separate occasions, and once bleeding, as per two resident altercation reports. 
 
The notes include information concerning the fact that sometimes, Dowd was not the first one who made the first step. This has caused a fight after which Dowd’s roommate scratched and punched him each time Dowd insisted on him to take a toilet instead of fouling the floor. Caregivers separated the two. For example, one day Bill a resident went to Dowd’s room and pulled Dowd’s hair and beard. An anxious note was written by one of the nurses, saying that ‘Dowd told me he ‘’felt unsafe and VERY angry’’. The slamming of the door stilled, and the nurse, who was with Bill during his visit, accompanied him out of the room, which Dowd chased after, calling Bill all sorts of names that included a ‘fat bastard’ and telling him that he would ensure his wife died before he released him.

I also note down the words of the nurse testifying the event who said, “JEFF continued to make a closed fist as if he wanted to punch BILL. ” “I was actually afraid because there is nothing that legally I could do so that the situation could calm down I am really deathly afraid of Jeff now I am afraid to go and reason with him when he is in one of his extreme rages, which are very typical for him. ” 
 
Dowd, however, went back to his room and a worker closed his door and made latch to prevent any other resident from entering it. 

The records explain the actions taken by Canyon Creek caregivers as soon as the fights started, they report who escalated conflicts and physically restrained the aggressive nursing home residents, telling Dowd’s brother about the fights. Nurses would physically move Dowd or the other resident out of a room and embark on manners that would dissuade the same. “Attempted to reason that it was wrong to cause people pain,” noted another nurse after the above event. 
 
In his email, Salyers, the company marketing director, stated that Canyon Creek and other facilities of Koelsch have highly qualified and extensively trained workers. The memory care communities are distinctly designed and staffed for people with Alzheimer’s and other forms of dementia. 
 
It said ‘It’s Nice To Have a Girlfriend’, and that suits the purpose of the billboard very well since it is a simple message. 
 
The reports, which were recorded in the nursing notes and the statements found in the court file, imply that episodes were recurrent enough for a nurse to note Dowd’s moments of calm. ‘There was no case of anxiety or anger motive during this shift’ this was some of the notes written. In another note of the nurse, Dowd accepted solitary during meals as he sits in his own table alone. Dowd was listen attentively solving books and puzzles but overheard by the nurse he stated that he was depressed allegedly even wished to die he was wondering if he wouldn’t be better off if he wasn’t around anymore. 
 
In this statement the nurses said that, Dowd manifested sexual behavior whether improper as if creating improper oral gestures while looking at the younger females or of questionable sanity when putting his hand on a resident’s shoulder and saying to him, “It’s nice to have a girlfriend. ” A witness statement stated that Dowd used to touch the er multiple resident’s private parts. Whenever other fellow nurses observed the behavior, they would segregate the involved and scold Dowd. A staff member said in a report that Dowd was obscene for the entire shift which she was on and was making sexual remarks and was “coming at me. ” 
 
Summing up, the notes revealed that in summer of the year 2021, Dowd uttered to one female resident he wished to see her vagina, and proceeded to grope her breast. A month later in August, a caregiver who was on duty positively identified Dowd moving his hands under the clothes, touching the same woman naked behind her clothing. The caregiver scolded Dowd telling her not to ever do that again and then took the woman out to introduce her to her family that had come to visit. 
 
Between that and subsequent events detailed in the deposition of a nurse administrator, Canyon Creek sent Dowd to the Montana State Hospital’s emergency room, which is a public psychiatric facility. The nurse stated that she informed the jury that Dowd was not there at Canyon Creek anymore. That is the last sighting of Dowd’s location in the available material and documents. The ownership of Stewart, Montana’s only hospital lies under the Montana Department of Public Health and Human Services and a public relation office did not acknowledge if the man was a patient. 
 
In a pretrial hearing, Shively’s and Dowd’s fight was limited by the judge from instances that occurred after Shively’s death. In a court document, Shively’s attorney requested leave to produce the evidence that Canyon Creek’s executive director received a monetary incentive for that employee’s performance if ninety or more of beds were occupied so he or she could convince the jury that Canyon Creek had a financial incentive to grant Dowd admission. However, the judge had excluded that information from the trial as irrelevant which according to Canyon Creek was a strategy of its competitor. 
 
Another Shively related trial was the civil trial in the federal court before the jury of twelve civilized citizens of the United States District Court for the District of Montana in Billings in 2022. Still, they excluded those arguments and returned a verdict that Canyon Creek was negligent that led to Shively’s death. It awarded $ 310,000 to the family. 
 
“For us, the money was not the big issue,” declared Spencer Shively, one more of the sons of Dan Shively, stating that the received damages did not exceed the actual goal of Canyon Creek or its insurer. “They admitted, at least they were negligent per se. But I don’t know it really turned anything around For me, it was a relief I guess cause I got some closure I feel like these facilities are just continuing to do the same things they’re gonna do because there hasn’t been systemic change. ”