This story by Jordan Rau appeared on KFF Health News on September 30, 2026. We are sharing it in two parts.
In December 2024, Marjorie Tingley’s 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 in the previous month, Tingley had hit, kicked, or elbowed aides when they were trying to help her change her briefs, get dressed, bathe, or go to the bathroom, according to Vista Grande behavior logs. Vista Grande wanted permission to sedate her.
Into the new year, Tingley’s 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’s and similar diseases.
More than 5 million Medicare beneficiaries 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 estimated.
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.
As the Tingleys alternately acquiesced to and resisted Vista Grande’s 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.
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.
“I want her out of here,” a flustered administrator told an ambulance crew, one entry shows.
Tingley died at another facility in January 2025. The cause was plaque buildup in her brain, a hallmark of Alzheimer’s, a degenerative brain disease and the most common type of dementia.
“They just wanted to have her drugged up,” David Tingley, one of her five sons, said about Vista Grande in an interview. “It’s a lot easier to take care of someone who’s just out of it.”
Her sons’ 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’s disagreements about Tingley’s care. Vista Grande and its director have denied the allegations. Their attorneys and the director did not respond to requests for comment.
In a legal filing, Vista Grande called the drugs recommended to the Tingleys “routine medication” and said it sent their mother to the hospital “because of her family’s refusal to allow Ms. Tingley to be treated on site.”
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.
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.
Dangers of Aggression
Diseases that cause dementia damage the parts of the brain that regulate impulse control and perception. Impaired people can become aggressive because of fear — especially when they no longer recognize their caregivers — or because they have no other way to communicate that they are in pain, are hungry, or have some other need.
Altercations between agitated people with dementia and other residents or workers charged with caring for them are disturbingly common 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 than for any other type of abuse, neglect, or exploitation.
Those dangers are particularly true in the more than 6,000 assisted living facilities 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.
The long-term care industry’s reliance on tranquilizing medications has been a concern of Congress for half a century. A 1975 Senate report stated that “an ugly pattern of prescription drug misuse, with harsh consequences to patients, exists in many nursing homes of the United States.”
A National Campaign
In 2012, the Centers for Medicare & Medicaid Services launched its Partnership to Improve Dementia Care 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 nursing home residents in 2025. An inspector general report released in March identified “alarming instances of inappropriate use of antipsychotic drugs.”
Nationally, nearly half of the 1 million people in assisted living facilities have Alzheimer’s or other diseases and conditions that cause dementia. Unlike nursing homes, assisted living facilities don’t 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.
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 for 13% of the time they lived there. Other researchers looking at prescribing trends through 2017 concluded the federal campaign “did not appear to affect antipsychotic prescribing” in these residents.
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, “for some patients, these behaviors are so severe that medications will be required.”
Read Part Two… tomorrow…
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