In December 2024, Marjorie Tingley\u2019s adult sons received an urgent email from the dementia care unit at Vista Grande Villa, a Michigan senior living community. They were told that their 85-year-old mother was a major safety threat.<\/p>\n
On at least 10 days the previous month, Tingley had hit, kicked, or elbowed aides when they were trying to help change her briefs, get dressed, bathe, or go to the bathroom, according to Vista Grande behavior logs. Vista Grande wanted permission to sedate her.<\/p>\n
Into the new year, Tingley\u2019s sons and Vista Grande fiercely wrangled over one of the most contentious topics in long-term care: the use of antipsychotic medications to pacify agitated people with dementia. The medications come with risks: The Food and Drug Administration requires pharmaceutical companies to warn that these potent drugs increase the chance of death in older people with Alzheimer\u2019s and similar diseases.<\/p>\n
More than 5 million Medicare beneficiaries<\/a> have a diagnosis of dementia. Despite a 14-year campaign by the federal government to reduce the use of psychotropics, 1 in 4 Medicare beneficiaries with dementia are potentially inappropriately prescribed antipsychotics and other brain-altering medications that can cause delirium, falls, and hospitalizations, a JAMA study<\/a> estimated.<\/p>\n While some families and guardians agree that the benefits of these drugs outweigh the risks, those with misgivings confront a wrenching choice: consent to drugging loved ones or risk eviction from a long-term care facility.<\/p>\n As the Tingleys alternately acquiesced to and resisted Vista Grande\u2019s insistence on medication, administrators started calling 911 after altercations, according to ambulance and police dispatch records. Tingley was repeatedly taken to the emergency room for assessment, hospital records show.<\/p>\n After four trips, Vista Grande gave Tingley a 30-day eviction notice, and it sent her to the hospital four more times while the family was arranging a new placement, medical records show.<\/p>\n \u201cI want her out of here,\u201d a flustered administrator told an ambulance crew, one entry shows.<\/p>\n Marjorie Tingley was taken to an emergency room eight times after a series of incidents in which she exhibited aggressive behavior at her memory care facility, according to medical and facility records. A pending lawsuit by her family alleges Vista Grande Villa, the senior living center in Michigan, initiated the ER trips in retaliation for disagreements with the family about Tingley\u2019s care. Vista Grande and its director have denied the allegations. (David Tingley)<\/p>\n Tingley died at another facility in January 2025. The cause was plaque buildup in her brain, a hallmark of Alzheimer\u2019s<\/a>, a degenerative brain disease and the most common type of dementia.<\/p>\n \u201cThey just wanted to have her drugged up,\u201d David Tingley, one of her five sons, said about Vista Grande in an interview. \u201cIt\u2019s a lot easier to take care of someone who\u2019s just out of it.\u201d<\/p>\n Her sons\u2019 lawsuit against Vista Grande and its director at the time accused them of negligence, causing emotional distress, and wrongful eviction. The suit also asserted Vista Grande initiated the ER trips in retaliation for the family\u2019s disagreements about Tingley\u2019s care. Vista Grande and its director have denied the allegations. Their attorneys and the director did not respond to requests for comment.<\/p>\n In a legal filing, Vista Grande called the drugs recommended to the Tingleys \u201croutine medication\u201d and said it sent their mother to the hospital \u201cbecause of her family\u2019s refusal to allow Ms. Tingley to be treated on site.\u201d<\/p>\n A Michigan Circuit Court judge has dismissed the negligence claim on legal grounds. A trial is scheduled for early next year on the remainder of the lawsuit if mediation fails.<\/p>\n Earlier this year, Vista Grande, which was a nonprofit, became a wholly owned subsidiary of Otterbein SeniorLife, which renamed it Otterbein Jackson SeniorLife Community. Otterbein is not named in the lawsuit, and representatives did not respond to requests for comment.<\/p>\n Dangers of Aggression<\/strong><\/p>\n Diseases that cause dementia damage the parts of the brain that regulate impulse control and perception. Impaired people can become aggressive because of fear \u2014 especially when they no longer recognize their caregivers \u2014 or because they have no other way to communicate that they are in pain, are hungry, or have some other need.<\/p>\n Altercations between agitated people with dementia and other residents or workers charged with caring for them are disturbingly common<\/a> in long-term care facilities and private homes. KFF Health News previously found that federal inspectors have cited nursing homes more often for resident-to-resident abuse<\/a> than for any other type of abuse, neglect, or exploitation.<\/p>\n Those dangers are particularly true in the more than 6,000 assisted living facilities<\/a> that specialize in dementia care, usually in locked buildings or units populated by people with cognitive damage. These memory care facilities promise specially trained staff and meaningful activities for residents and usually charge more than standard assisted living.<\/p>\n The long-term care industry\u2019s reliance on tranquilizing medications has been a concern of Congress for half a century. A 1975 Senate report<\/a> stated that \u201can ugly pattern of prescription drug misuse, with harsh consequences to patients, exists in many nursing homes of the United States.\u201d<\/p>\n A National Campaign<\/strong><\/p>\n In 2012, the Centers for Medicare & Medicaid Services launched its Partnership to Improve Dementia Care<\/a> to target overprescribing. It has shown some success with reducing the use of antipsychotics, which the FDA has approved primarily for people with schizophrenia. Excluding those patients, antipsychotics were given to 1 in 7<\/a> nursing home residents in 2025. An inspector general report released in March<\/a> identified \u201calarming instances of inappropriate use of antipsychotic drugs.\u201d<\/p>\n Nationally, nearly half of the 1 million people<\/a> in assisted living facilities have Alzheimer\u2019s or other diseases and conditions that cause dementia. Unlike nursing homes, assisted living facilities don\u2019t provide skilled medical care around the clock, but they help people with fundamental activities like bathing and eating. States regulate them, not the federal government.<\/p>\n A study published in 2023 in JAMDA, the journal of the society representing post-acute and long-term care medicine, found that, on average, assisted living residents with dementia were prescribed an antipsychotic<\/a> for 13% of the time they lived there. Other researchers looking at prescribing trends<\/a> through 2017 concluded the federal campaign \u201cdid not appear to affect antipsychotic prescribing\u201d in these residents.<\/p>\n Lauren Gerlach, a geriatric psychiatrist and an associate professor at the University of Michigan Medical School, said there is evidence that aggressive behaviors are better addressed by non-medication interventions, like looking for underlying medical issues or heading off situations that typically upset the person. But, she said, \u201cfor some patients, these behaviors are so severe that medications will be required.\u201d<\/p>\n A Steady Decline<\/strong><\/p>\n The details of Marjorie Tingley\u2019s time at Vista Grande \u2014 as alleged in documents filed in the lawsuit; records provided by the Tingleys and their lawyer, Ron Marienfeld; and interviews and emails with the family \u2014 provide an unusually intimate look into what can happen when families and caregivers clash over brain-altering drugs.<\/p>\n A Detroit native, Tingley was a volunteer reading teacher in the Jackson, Michigan, public school system and worked in the general office. Later, she was a certified financial planner. Her sons said she was successful but made less money than she might have, because she didn\u2019t direct investments to get the highest commissions. Instead, she did what she thought was best for clients.<\/p>\n \u201cShe was just so honest,\u201d David Tingley said.<\/p>\n She was an active member of the Catholic Church. Her husband, Eugene, died in 2010.<\/p>\n Vista Grande Villa gave Marjorie Tingley an eviction notice after her sons resisted requests to sedate their mother with medications, medical records show. She died less than two weeks after moving to a new facility. (David Tingley)<\/p>\n Around 2018, her sons noticed she was becoming forgetful, not taking her regular medications or recognizing aides they had hired. David and his brother Mark, who shared power of attorney, said in an interview that their mother\u2019s memory deteriorated further after a head injury in a 2019 car collision.<\/p>\n They hired caregivers to help at her home in Jackson, but by 2021, they decided she needed to be in a facility, choosing the assisted living unit at the nonprofit Vista Grande.<\/p>\n In 2023, Vista Grande told them that their mother\u2019s dementia had progressed and that she needed to go into the memory care unit or leave. Vista Grande\u2019s memory care marketing materials said its \u201cdedicated team creates an individual program of support for each resident\u201d and \u201cprovides for the precise services you need.\u201d<\/p>\n David said they reluctantly agreed to the move but thought the quality of care was better in general assisted living, even though memory care cost more. Vista Grande charged Tingley $9,150 a month for memory care, her lease shows.<\/p>\n \u2018These Pills Have Side Effects\u2019<\/strong><\/p>\n Vista Grande first contacted the Tingleys in early December 2024 about behavioral incidents. According to facility records, Marjorie Tingley pushed an aide trying to help her use the bathroom and the aide almost fell. She yelled and kicked at staff trying to put on her shoes and socks. She wandered into another resident\u2019s room and took a walker.<\/p>\n The facility requested permission to medicate Tingley, but her sons said they first wanted her checked for a urinary tract infection, which they said had caused her agitation in the past. \u201cThese pills have side effects,\u201d Mark said. \u201cI thought, \u2018Personally, I don\u2019t want her to have that.\u2019\u201d<\/p>\n Vista Grande collected the sample but didn\u2019t ensure it was tested by a lab for more than a week, by which time the test had to be redone, according to facility and medical records.<\/p>\n In mid-December, Vista Grande sent Tingley to Henry Ford Jackson Hospital for a mental health evaluation, at which psychiatrists could decide whether she required involuntary hospitalization. Doctors did not find that necessary, but they confirmed a urinary tract infection and she was given antibiotics. Vista Grande declared she could not return unless the family agreed to sedating medication, according to hospital records.<\/p>\n In a court filing, Vista Grande said Tingley had become a \u201cdanger to herself and others.\u201d Mark recalled feeling at the time that: \u201cIt\u2019s like they\u2019re holding her ransom unless I say she can have that pill.\u201d<\/p>\n Medication Begins<\/strong><\/p>\n The specific medications were prescribed either by hospital doctors or a nurse practitioner working for a medical group that serviced residents of Vista Grande and other long-term care facilities, medical records show. David said Vista Grande had encouraged the family to replace their mother\u2019s longtime physician with that medical group. The lawsuit did not name the nurse, the medical group, or the hospital as defendants. Henry Ford Health declined to comment.<\/p>\n The brothers allowed Vista Grande to give their mother the drug Ativan, the brand name for lorazepam<\/a>, as needed. Ativan is not an antipsychotic but a benzodiazepine that the FDA has approved<\/a> for people with anxiety. The label says it can cause dizziness<\/a>, unsteadiness, and weakness and is supposed to be used \u201cwith caution\u201d in patients with breathing problems \u2014 like Tingley, who had sleep apnea. It can cause \u201cparadoxical\u201d reactions such as agitation and rage.<\/p>\n After a week, Vista Grande workers gave \u201cmixed reports\u201d about whether the Ativan was calming Tingley, according to her medical records. Employees said she still would yell and was \u201cvery agitated.\u201d<\/p>\n The family said they authorized Vista Grande to replace Ativan with a low dose of Zyprexa, the brand name for the antipsychotic medication olanzapine<\/a>, which the FDA has approved to treat schizophrenia and bipolar disorder. The FDA requires Zyprexa to carry a black box warning<\/a> stating that it is not approved for the treatment of patients with dementia-related psychosis and places them at greater risk of death.<\/p>\n Nonetheless, Zyprexa has a long history of being prescribed that way. Eli Lilly, the drug\u2019s manufacturer, pleaded guilty in 2009 to allegations that it improperly promoted the use of Zyprexa for dementia with long-term care providers and primary care physicians. The company agreed to pay<\/a> a criminal fine and civil settlement totaling $1.4 billion.<\/p>\n The black box warning on Zyprexa alarmed the sons, and their online research made them worried that Zyprexa could damage their mother\u2019s heart, since she had atrial fibrillation<\/a>. While the family approved the prescription, they authorized only 2.5 grams of Zyprexa a day, half the starter dose recommended by Eli Lilly.<\/p>\n \u2018She Could Barely Function\u2019<\/strong><\/p>\n On both New Year\u2019s Eve and New Year\u2019s Day, Vista Grande sent Tingley to the emergency room. On Jan. 2, Vista Grande gave the family the 30-day eviction notice. \u201cWe have determined we are unable to meet the level of care and expectations required for your mother\u2019s well-being,\u201d it said in the letter.<\/p>\n While the family started looking for another facility, Vista Grande sent Tingley to the ER four more times.<\/p>\n Vista Grande Villa gave Marjorie Tingley an eviction notice after her sons resisted requests to sedate their mother with medications, medical records show. Tingley\u2019s family said she was being excessively sedated. \u201cShe could barely function,\u201d her son David says. (David Tingley)<\/p>\n A psychiatrist consulting with the hospital endorsed doubling the Zyprexa to the starter dose recommended by Eli Lilly, and the Tingleys consented, according to medical records.<\/p>\n For five days, there were no incidents at Vista Grande, according to her medical records. But the family alleged in court filings that Tingley was being excessively sedated. They instructed that the Zyprexa be cut back to its initial level, according to her medical records.<\/p>\n \u201cShe could barely function,\u201d David said in the interview.<\/p>\n The sons said they were especially disturbed to learn she was being given both Ativan and Zyprexa after they had approved Zyprexa as a replacement drug.<\/p>\n Reports from emergency room crews and the hospital made the sons doubt their mother was as aggressive as Vista Grande described, they said. Those records show that throughout the ER trips, Henry Ford employees and ambulance workers generally found Tingley cooperative and polite.<\/p>\n A nurse said Tingley allowed her to braid her hair and blew her kisses when she left. \u201cJust the sweetest patient and very loving,\u201d another ER worker wrote in the medical records. A physician noted the discrepancy from what Vista Grande was reporting, writing in her record: \u201cHer behavior on what I am witnessing is completely contrary to what they are indicating.\u201d<\/p>\n In a legal filing, Vista Grande attributed Tingley\u2019s calm to medication and the \u201cfamilial love and attention\u201d her sons gave her at the emergency room.<\/p>\n \u201cThe next time Ms. Tingley decompensated, the cycle predictably resumed,\u201d Vista Grande said in the filing.<\/p>\n Vista Grande reported that aggressive behaviors resumed and continued sending Tingley to the hospital. On the last trip, Jennifer Wheeler, then-director of Vista Grande\u2019s memory care unit, told ambulance workers that Marjorie would not be accepted back, according to EMS notes. \u201cShe is a danger to other residents and a danger to my staff,\u201d Wheeler said.<\/p>\n Tingley stayed in the hospital until she was moved to another memory care facility in Jackson. She died<\/a> on Jan. 26, 2025, less than two weeks later.<\/p>\n Her sons asserted in their lawsuit that the frequent trips back and forth to the hospital hastened their mother\u2019s demise.<\/p>\n \u201cThey weren\u2019t really caring about my mom,\u201d Mark said. \u201cIf they were, they would know that all this back-and-forth to the hospital was no good for her.\u201d<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/em><\/p>\n This article<\/a> first appeared on KFF Health News<\/a> and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License<\/a>.<\/p>","protected":false},"excerpt":{"rendered":" In December 2024, Marjorie Tingley\u2019s adult sons received an urgent email from the dementia care unit at Vista Grande Villa, a Michigan senior living community. They were told that their 85-year-old mother was a major safety threat. On at least 10 days the previous month, Tingley had hit, kicked, or elbowed aides when they were…<\/p>\n","protected":false},"author":0,"featured_media":15806,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-15805","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-articles"],"_links":{"self":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/15805"}],"collection":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=15805"}],"version-history":[{"count":0,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/15805\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/media\/15806"}],"wp:attachment":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=15805"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=15805"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=15805"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}