Resident on Resident Altercations

NPR had a great article on resident to resident altercations in long term care facilities. Violent altercations between residents of long-term care facilities are very common. Throughout the country, many residents in nursing homes or assisted living centers have been killed due to these resident-to-resident altercations. These residents have weaponized a bed rail, shoved pillow stuffing in another resident’s mouth, or even removed an oxygen mask.

A recent study by JAMA Network Open of 14 New York assisted living facilities found that 15% of residents experience verbal, physical, or sexual resident-on-resident aggression. An additional study found that 8% of assisted living residents engage in physical aggression or abuse towards residents or staff within
one month of their residency.

Residents who have dementia are more likely to be involved in these alterations due to the disease’s damaging traits. Dementia damages parts of the brain that
affect things like one’s memory, language, reasoning, and social behavior. More than 900,000 people with Alzheimer’s or other various types of dementia reside in nursing homes and assisted living facilities.

Nursing homes warehouse seriously impaired in closed quarters with other vulnerable adults. These places are mainly for-profit and usually charge thousands of extra dollars a month as these places promise “expertise” in this disease and a safe environment for the residents. These clashes between residents can be unpredictable and spontaneous.

Dan Shively and Jeffery Dowd were two residents of Canyon Creek Memory Care Community in Billings, Montana.  Dan and Jeffery crossed paths at the nursing home in Montana, and both were suffering from dementia. They both exhibit some of the disease’s most terrible traits.

At times, Shively was found wandering his neighborhood, having outbursts at home, and leaving the gas stove on. Dowd had previously been hospitalized due to his outburst of confusion, suicide, and agitation. Upon entering Canyon Creek, managers warned employees of Dowd’s behavior, saying he could be “physically/verbally abusive when frustrated.”

On Shively’s fourth day at Canyon Creek, he was seen carrying a knife and fork over to the dining room table where Dowd was sitting. According to a witness statement, Dowd told Shively to keep the knife away from his coffee, and as Shively turned to walk away, Dowd stood up and shoved Shively. Shively was 5-foot-2 and weighed 125 pounds, which was half Dowd’s weight and height, which led to Shively’s skull fracture and brain hemorrhage.

Shively’s son, Casey, said the doctors said there was not much they could do about it. Dan Shivey passed away five days later at the age of 73.

Dowd resided at Canyon Creek for nearly three more years after police did not charge him. Throughout these three years, Dowd repeatedly clashed with residents, hit male residents, and groped female residents, according to facility records filed in the court case. Dowd’s anger flared quickly. One nurse said she was “literally scared to death of Jeff.”

According to court papers, within the first week of Dowd’s residency at Canyon Creek, he mocked and threatened to hit other residents and threw women’s silverware to the ground during dinner.  Canyon Creek denied liability for Shively’s death. The Shively case was trialed in 2022 before a federal civil jury in Billings. The jury decided Canyon Creek’s negligence caused Shively’s wrongful death and awarded the family $310,000.

According to KFF Health News, the chances of an altercation increase when memory care units bring in too many residents that they can not manage. Homes with fewer staffing or low-level training for employees have a more difficult time dealing with resident conflicts. Homes also may fail to properly assess incoming residents or may keep them despite their poor behavior with other residents.

Karl Pillemer, a gerontologist at Cornell University and lead author of the JAMA study, said:

“As much as long-term care providers in general do their best to provide competent, high-quality care, there is a real problem with endemic violence” and “There needs to be much more of an effort to single out verbal and physical aggression that occurs in long-term care, and begin to create a model of violence-free zones in the same way we have violence-free zones in the schools.”

Residents with dementia will lash out because they no longer have social inhibitions or because it’s the only way they can express their feelings of pain, discomfort, fear, disagreement, or anxiety. Common triggers can be overstimulation from loud noises, a chaotic atmosphere, or unfamiliar faces.

The executive director of the Long Term Care Community Coalition said that greed and the bottom line drives operators of assisted living facilities.

“The issue that we see quite often is that assisted living retains people they should not” and “They don’t have the staffing or the competency or the structure to provide safe care.”