By Heather Campbell Pope
This is Part 2 of a blog series on men and dementia.
The Manitoba Court of Appeal recently sent a strong message about the importance of protecting and caring for society’s oldest-old.
In an October 2019 ruling, Justice leMaistre stated, “More Canadians than ever are living to the age of 85 and beyond. Society benefits from the wisdom and life experience of our elders. It is essential that we protect them and provide for their care, particularly as they experience physical and mental-health challenges associated with aging.”[i]
The case involved an adult son who pled guilty to criminal negligence causing the death of his 89-year-old mother. A judge had initially sentenced him to three months in jail; the appeal court increased the sentence to two years.[ii]
At the time of the offence, Ronald Siwicki was aged 62 and living with his mother, Elizabeth Siwicki. In November 2014, Mrs. Siwicki fell out of her bed and was unable to get up. Her son was unable to move her back into bed. For the next 26 days, she remained on the floor, where she died on December 17, 2014.
During the time she was on the floor, her son gave her water and the nutritional drink Boost. He did not reposition her or seek medical or other assistance.
Mrs. Siwicki died from complications due to bedsores and prolonged immobility. After her death, first responders found her body in a deplorable state on the hallway floor: “She was on a plastic sheet with a blanket over her. She was covered in feces and urine, her hair was matted and dirty and she had several gaping and infected bedsores on her leg and hip. The house was described as being in an appalling state: cluttered, dirty and smelling of urine and feces.”
According to the pathologist, Mrs. Siwicki would have been in significant pain until the nerves in her wounds died. The autopsy also showed evidence of dementia. Had she received appropriate care, her death would have been “completely preventable.”
Those who knew Mr. Siwicki described him as “immature, indecisive and passive,” and as someone who would never go against his mother’s wishes. He had never been financially independent and had lived with his parents all his life. Mrs. Siwicki was described as a strong, independent and stubborn matriarch.
The Crown appealed the three-month sentence, arguing in part that the judge overlooked substantial aggravating factors, including Mrs. Siwicki’s vulnerability and reliance on her son, as well as his failure to seek assistance for her, regardless of her wishes. The Court dismissed this ground of appeal, finding that the factors were addressed by the parties in their submissions and were squarely before the sentencing judge.
Prior to his mother’s fall, Mr. Siwicki maintained that he had tried to get her help, but she did not want medical intervention, nor did she want to go to the hospital. She was afraid she would die there. Mr. Siwicki raised the possibility of getting homecare, but she refused. Two of his friends offered to help, but she refused.
Mr. Siwicki installed a safety bar and chair in the shower, and when she could no longer wash herself, he washed her. He also arranged for a home visit, and his mother initially agreed to go to the hospital once-a-week, but then refused. Mr. Siwicki said the only response someone at the hospital gave him was that “sometimes this happens.” He also had his brother-in-law try to persuade his mother that she needed help, but she refused. One cold day, Mrs. Siwicki went outside inadequately dressed and he called 911 after he could not get her back inside the house; when paramedics arrived, she refused to go to the hospital.
When she fell out of bed and he could not lift her back, he gave her a pillow and blankets. When the blankets became soiled, he brought her fresh ones. He also gave her water and a nutritional drink; the autopsy suggested she was not dehydrated or malnourished.
Mr. Siwicki has since acknowledged that “his responsibility was to help his mother rather than follow her wishes.” However, the case raises broader societal questions about the highly libertarian perspective dominating the elder rights movement. It is worth asking whether society’s internalization of the “right to live at risk” message might be insidiously contributing to dire outcomes, and lenient jail sentences. As I argued in my master’s thesis on loneliness and the law, the rights pendulum has swung too far in favour of unfettered autonomy; we are letting vulnerable seniors like Mrs. Siwicki needlessly suffer.[iii]
Regarding the principles of deterrence and denunciation, the Court of Appeal found that the sentencing judge erred when she focused on Mr. Siwicki’s personal circumstances rather than the circumstances of the offence.
The appeal court also found that the judge erred in her proportionality analysis. In particular, she lost sight of the difference between failing to provide the necessaries of life and criminal negligence causing death, which is a more grievous crime and involves higher moral blameworthiness. These errors led to a demonstrably unfit sentence.
In sentencing Mr. Siwicki to two years in jail, the Court of Appeal emphasized the prolonged nature of his conduct, which lasted at least 26 days, and the fact that he “had an extensive network of friends, as well as his nephew, who offered him support after his mother’s death, yet he did not ask for help from anyone while she was still alive.”
While an extreme case, tragic deaths like Mrs. Siwicki’s raise several issues about family caregiving. As the sentencing judge noted, it is hard to understand how the relationship of devotion between Mr. Siwicki and his mother “could end with her dying in such profane circumstances.”
Mr. Siwicki had a duty to provide adequate care for his ailing mother; why did he fail to do so? His mother’s death was medically preventable, but was there adequate caregiver support and follow-up to help him navigate the difficult circumstances?
In a pre-sentence report, a psychiatrist found no evidence that Mr. Siwicki had a mental illness or a mood or anxiety disorder; however, he did demonstrate “dependent traits and a history of hoarding.” He was assessed as a very low risk to reoffend.
When an adult son commits elder abuse or neglect, the dominant narrative often frames it as a case of “the unsuccessful son in the basement.” However, as I suggested in Dementia Justice’s housing vulnerability report, this language may be unhelpful.[iv] Without condoning such conduct by adult sons, a preferred approach may be to modify the narrative to align it with the well-established understanding that in some cases the perpetrator may be experiencing his own mental health issues, including caregiver stress. Indeed, a counsellor who saw Mr. Siwicki while he was on bail described him “as being overwhelmed with the situation.”
Mr. Siwicki’s lawyer has stated that his client will be appealing to the Supreme Court of Canada.
Beyond the gender politics of dementia
[i] R v Siwicki, 2019 MBCA 104 at para 1.
[ii] R v Siwicki, 2018 MBQB 115.
[iii] Heather Campbell, Parens Patriae 2.0: Invoking the Superior Courts’ Protective Jurisdiction to Help Lonely Older Men Age-in-Place (University of Saskatchewan, College of Law, LLM Thesis, 2016) at 3.
[iv] Dementia Justice Society of Canada, Nowhere to Live: Housing Vulnerability of Criminal Defendants with Dementia (Ottawa: Dementia Justice Society of Canada, 2019) at 32-33.
By Heather Campbell Pope
This is Part 1 of a blog series on men and dementia.
Dementia can occur in both men and women, yet mainstream dementia culture frames it as a women’s disease. A few years ago, the Alzheimer Society of Canada launched a nationwide campaign that aimed to make the disorder “a women’s issue.” In the time since, there has been no similar focus on men. This is despite men being affected as patients and caregivers.
The breast cancer movement has faced a similar critique. Some critics of the pink ribbon campaign say that it has feminized the illness, reinforcing the misconception that breast cancer only happens to women.
This criticism has gained some support despite men accounting for less than one percent of all breast cancer cases. It is recognized that the stigma of being a man with a “women’s disease” can delay diagnosis, making survival less likely. As Beyoncé’s father, Mathew Knowles, recently said on Good Morning America after going public with his breast cancer diagnosis, “Men want to keep it hidden because we feel embarrassed. And there’s no reason for that.”
In contrast to breast cancer, the gender difference in dementia is less extreme, making its feminization even more misguided. While it is commonly reported that two-thirds of diagnosed dementia cases are women, the unspoken statistic is that one-third are men. Thirty-three percent is hardly negligible; at a minimum, the number challenges the feminist notion that dementia is a women’s disease.
Context also matters. For instance, the limited evidence suggests that the majority of people with dementia who come into conflict with the criminal justice system are men:
"Men like Second World War veteran Jack Furman, who at age 94 was charged with second degree murder after he allegedly attacked his care home roommate with a shelf; and 74-year-old Piara Singh Sandhu who was charged with two counts of second degree murder after he allegedly pried the metal base off a bedside table and bludgeoned his two roommates to death; and widower Peter Brooks, who at age 76 was convicted of second degree murder in the death of a fellow long-term care resident and sentenced to life in prison with no parole eligibility for 10 years."[i]
These men are our husbands, fathers and friends. Yet in part because they exist in smaller numbers, the women-centred dementia movement has kept them on the margins.
To further justify the focus on women, many dementia advocates also highlight the gender differences in caregiving. It is frequently said in campaigns and informational material that the majority of caregivers are women, particularly wives and daughters. There is little mention of the contributions by husbands, sons and other men in caring for their loved ones with dementia.
Mainstream dementia advocates also point out that women caregivers tend to experience more distress. However, this does not negate the fact that the consequences of caregiver stress in men can be severe. The problem is not exclusive to male caregivers, but unmanaged stress can lead to desperate acts.
While an extreme case involving an inexcusable crime, Michel Cadotte’s 2017 killing of his wife, who had Alzheimer’s disease, raises uncomfortable questions about caregiver stress. At sentencing, the Quebec judge said, “As citizens, we can only hope that the alarming cries of the difficulties caregivers face, as well as the problem of the growing number of people with Alzheimer’s disease, will have been heard.”
Last year, the federal government launched a new $20 million initiative to address dementia. Consistent with the Liberal Party’s feminist agenda, the Dementia Community Investment Fund prioritizes projects that target certain populations including women. Similarly, released in June 2019, Canada’s first national dementia strategy has a women-centred theme; there is little recognition of the impact dementia has on men as patients or caregivers.
During a federal election forum hosted by Dementia Advocacy Canada, moderator André Picard of The Globe and Mail asked Conservative Party candidate Lisa Raitt whether we need programs to specifically address dementia’s disproportionate effect on women. Ms. Raitt acknowledged the importance of doing so, but thoughtfully concluded, “It’s a human issue.” NDP candidate Stéphanie Mercier agreed and added: “In regard to support, it’s not just about women, it’s also about the husbands that it will happen to.”
To be sure, some dementia organizations are tackling men’s needs. For instance, the Alzheimer Society of Toronto has launched a woodworking program where males with the disease can socialize and collaborate on projects and small repairs.
While such local initiatives are encouraging, men with dementia need greater support across the country. This moral obligation exists independent of facts and figures; having men’s concerns meaningfully addressed should not be contingent upon reaching statistically significant numbers.
As Dementia Justice recommended in our housing vulnerability report, a first step could be the launch of a positive national campaign to raise awareness and reduce stigma about dementia’s impact on men——as patients, caregivers and, for a smaller number, criminal defendants who enter the justice system due to responsive behaviours.[ii]
It is time to move beyond the gender politics of dementia; otherwise, the current feminization of the disease will continue to push men’s needs to the margins——fuelling stigma, delaying diagnoses and discouraging requests for help.
Caregiver son 'overwhelmed' in elder neglect case
[i] Heather Campbell, “Killers with dementia: Canada’s overlooked criminal defendants” The Lawyer's Daily (6 March 2018).
[ii] Dementia Justice Society of Canada, Nowhere to Live: Housing Vulnerability of Criminal Defendants with Dementia (Ottawa: Dementia Justice Society of Canada, 2019) at 52.
By Heather Campbell Pope
“My recommendation is build more prisons, not more half way houses,” said one commenter. Another wrote, “How lame! The government didn’t create the problem, the criminal did! If they didn’t murder and sexually assault people they would not be in this situation. KARMA!” And a third concluded, “I really couldn’t care less if they ended up in a snow bank eating dog food.”
These statements are from the comment section of a recent CBC Out in the Open episode on aging ex-inmates living at Haley House, a 10-bedroom transition home in Peterborough, Ont., for elderly and palliative federal offenders on parole. Open for two years, the house is mainly funded by Correctional Service Canada and run by the non-profit Peterborough Reintegration Services.
The reactions are natural. It is difficult to have compassion for murderers and sex offenders.
The men inside Haley House have done bad things, some terrible. Forty-three years ago, current resident Cliff Strong was convicted of second-degree murder and sentenced to life in prison. He was paroled, but after sexually assaulting two girls, he was thrown back in jail. Today, at age 75, Strong has Parkinson’s disease, diabetes, swollen legs and a bad hip. He uses a motorized wheelchair.
Strong is part of the growing cohort of aging offenders. In 2011, Canada’s Correctional Investigator reported that over the past decade, the number of older federal offenders has increased by more than 50 percent. Today, 1 in 4 federal inmates are aged 50 or older. Some have committed heinous crimes, including our most serious offence, murder.
“Grace is something that we often don’t deserve, but which lends itself to us,” Strong told Out in the Open host Piya Chattopadhyay.
But such grace isn’t easy to find. Finding appropriate housing for those who have committed unforgiveable crimes is hard, especially when they have complex health conditions. Partly in response to this challenge, the Dementia Justice Society of Canada is researching the housing vulnerability of a specific group of criminal defendants: those with dementia. Our project, which is funded by The Law Foundation of British Columbia, aims to offer housing solutions that balance humanity with public safety.
Although rare, for some dementia patients, violence is an unfortunate by-product of the disease. These behaviours, combined with a criminal history, can leave elderly offenders suffering from dementia with nowhere to live. Some nursing homes have shown a reluctance to house offenders who’ve been involved with the criminal justice system—no matter the severity of their crime. Many shelters don’t have the capacity to care for an old, sick and mentally impaired man.
Homes such as Haley House are part of the solution. But there are few places like it. “[Haley House] is basically one of only two that I'm aware of [across Canada] that caters to this inmate population. And, to me, it represents the future of corrections,” said Ivan Zinger, Canada’s Correctional Investigator.
When another halfway house can no longer manage an elderly offender’s declining health, places like Haley House may be able to take him in. But when there’s no vacancies, the person may be sent back to prison, or end up on the street.
“There is no plan B,” said Jeff Morgan, a veteran police officer who works at Haley House. “They’ve earned the right to come out [of prison], yet society just wants to put them away somewhere.”
We must resist that impulse. It makes the world worse. In a free and liberal society like Canada, no human should be left in a ditch to eat dog food. Justice must be tempered with mercy.
Solutions like Haley House transcend the understandable outrage toward offenders who are released into the community. They do not mistake sentimentality for humanity.
By Heather Campbell
This article originally appeared in The Lawyer's Daily.
In October 2009, Ottawa nursing home resident Peter Lee allegedly smothered his bathroom-mate to death. Police believe that the 84-year-old, who had dementia due to Parkinson’s disease, suffocated the victim, who was asleep in bed, and then dragged the body toward the bathroom. Lee was charged with second degree murder.
In recent years, tragedies like this have captivated the public. Last month, a CBC Marketplace investigation reported on the “shocking rise” of abuse in Ontario long-term care homes. The episode begins with security camera footage of two elderly men having a physical confrontation in a nursing home hallway.
“One of these men will soon be dead,” says Marketplace host David Common. The video captures the aggressor punching and then shoving the 84-year-old victim, who falls to the floor. The attacker then smashes the man with a chair. Suffering a broken hip, the victim dies four days later.
Incidents like this are a double tragedy: one senior has lost their life, and another has become a killer. But after the headlines fade, we rarely hear about what happens to the aggressor. Like much coverage, the Marketplace investigation doesn’t mention it. With few exceptions, the killers’ stories remain untold. Yet these men are our husbands, fathers and friends.
Men like Second World War veteran Jack Furman, who at age 94 was charged with second degree murder after he allegedly attacked his care home roommate with a shelf; and 74-year-old Piara Singh Sandhu who was charged with two counts of second degree murder after he allegedly pried the metal base off a bedside table and bludgeoned his two roommates to death; and widower Peter Brooks, who at age 76 was convicted of second degree murder in the death of a fellow long-term care resident and sentenced to life in prison with no parole eligibility for 10 years.
These men are forgotten criminal defendants. Along with other killers with dementia, they are often left languishing in forensic hospitals and prisons, institutions that are generally ill-suited for someone with the disease.
Eight months after his bathroom-mate died, the court found Lee unfit to stand trial. He was sent to a secure forensic unit, where he was detained for over six years. Lee was stuck in a dilemma. Each year, the Ontario Review Board found him unfit to stand trial and concluded that his detention was necessary because he posed a significant threat to public safety. The board pointed to evidence that Lee was aggressive in hospital; for example, on one occasion, he pushed pizza into a nurse’s face.
Yet as the board acknowledged, many nursing home residents engage in similar behaviours as Lee. But the prospect of finding him a nursing home bed was “extremely limited.” At first, no home was willing to take him. Seven years after the slaying, two homes were prepared to house the 91-year-old, but their wait lists ranged from about eight to 10 years.
Most people with dementia will not commit a crime, let alone murder. However, nursing home violence may be on the rise. As Marketplace reported, resident-to-resident abuse in Ontario doubled in six years, from four per day in 2011 to about nine in 2016. Several factors are likely contributing to this increase, including under-staffing and increasing dementia rates among residents. Incident reporting systems have also improved, so some abuse that went unreported in the past is now being counted.
Another factor may be the well-intentioned reduction in anti-psychotic drug use, though the
evidence is unclear. On the one hand, the Canadian Foundation for Healthcare Improvement has found that taking residents off the drugs reduced abusive behaviour. On the other hand, Marketplace found that as anti-psychotic use went down, resident-to-resident abuse went up.
Deadly violence by people with dementia is an extreme outcome with no quick fix. Part of the solution is increasing the number of specialized beds for persons with aggressive behaviours. Earlier this month, Ontario made strides on this front, opening a new 20-bed unit for older adults with dementia who present complex behaviours in an acute care hospital.
It’s an admirable but likely unattainable goal. Prevention is the first line of defence for keeping persons with dementia out of the criminal justice system. But every incident cannot be reasonably eliminated.
Dementia is a condition whose symptoms can manifest as violence. Sometimes it can be fatal. The sad reality is that a small number of killers with dementia will enter a criminal justice system that is ill-equipped to manage their needs. To improve this situation, we cannot let these forgotten men fade from public memory. Their stories must be told.
By Heather Campbell
This article originally appeared in The Lawyer's Daily.
On the morning of Oct. 4, 2016, 85-year-old Fred van Zuiden stood alone before a justice of the peace in a Calgary courtroom. He was wearing a blue prison jumpsuit and appeared confused. He had no lawyer. Hours earlier, van Zuiden had allegedly murdered his wife of 56 years. Police had found her dead from blunt force trauma.
Audrey van Zuiden had been caring for her ailing husband at home; she did not want to place him in a care home. But at 80 years old, she was growing increasingly frail; at 5-foot-11, he remained a sturdy 180 pounds. As his dementia worsened, he often forgot that Audrey was his wife. Indeed, friends suspect that on the night of the killing, he had mistaken her for an intruder.
It was a cruel and unusual end to a decades-long love story. Described by friends as soulmates, the couple met in 1958, and went on to build Western Canada’s premier sailboat company. They also collaborated on van Zuiden’s book, a memoir that recounts his wartime memories as an 11-year-old Jewish boy who had to fend for himself during the German occupation of his native Holland. The book went on to be a bestseller, with proceeds helping to pay for a statue in the Netherlands that honoured those who helped hide Jewish Holocaust survivors.
Van Zuiden was eventually found unfit to stand trial. A psychiatrist testified that while in custody the elderly man had thought that corrections and medical staff were Nazis, or hiding in the war with him. The doctor also testified that he expected van Zuiden’s dementia to remain the same or get progressively worse.
Dementia is one of the greatest societal challenges of the 21st century. An estimated 50 million people worldwide are living with the condition. The global dementia population is expected to reach 131.5 million by 2050. In Canada, it is estimated that 564,000 people have dementia and that 25,000 new cases are diagnosed every year. If nothing changes, there could be nearly one million Canadians with the condition in 15 years. Among Indigenous populations specifically, dementia rates are reported to be 34 per cent higher than the non-Indigenous population.
People with dementia rarely come into conflict with the criminal law. But given these numbers, it is expected that more members of this vulnerable group will be present at all stages of the criminal justice system — from initial police contact in the community to fitness to stand trial assessments in the courts to aging inmates in correctional environments.
Yet this vulnerable population’s needs remain unmet. Indeed, in a recent canvass of dementia advocacy organizations, the Dementia Justice Society of Canada consistently heard that the criminal justice system is ill-equipped to manage people with dementia.
Once in the justice system, defendants with dementia can face several problems. A criminal charge can result in many collateral consequences. One fundamental post-charge challenge is securing safe and appropriate housing, whether in assisted living, a nursing home, or in the larger community. While there are many factors at play, the problem is exacerbated when care homes are reluctant, or outright refuse, to admit someone with a criminal history.
One year after being charged with second-degree murder, 86-year-old van Zuiden remained in a secure psychiatry facility. At first his friends could only see him by sitting on the opposite side of a glass pane; they had to use a phone to talk. Later he was permitted to have visitors in the dining room. He was eventually authorized by the Alberta Review Board to live in secure care home, but as of November 2017, he remained on the waiting list.
Van Zuiden is not alone. Across the country, criminal defendants with dementia suffer housing vulnerability. Yet there has been little co-ordinated action to remedy this state of affairs. Notably, in a review of provincial, national and international dementia strategies, Dementia Justice found that criminal justice is largely overlooked, and often not mentioned at all.
As such, Dementia Justice is working to strengthen the housing security of criminal defendants with dementia. The organization’s first major project, funded by The Law Foundation of British Columbia, will identify gaps in the provincial legal and policy framework that can lead to housing vulnerability. The final report, expected to be published by early next year, will also look for promising approaches in other Canadian jurisdictions and make recommendations for improving the housing security of this small but vulnerable population.
Dementia is not an inevitable part of aging. But it is something that many of us will get: one in 11 Canadians over age 65, and one in three over age 80, has the disease. It also afflicts about 16,000 Canadians under age 65. Few will clash with the criminal law, but when they do, we must ensure that the response of our justice and elder care systems is fair and humane.
By Heather Campbell
Nursing homes are communities, and like all social environments, there will be interpersonal conflict. Sometimes these clashes will be physical. In rare cases, they will be deadly.
Earlier this year, an Ontario man at St. Joseph’s Villa in Hamilton became the latest victim whose life came to such a heartbreaking end. While asleep in his bed, the 86-year-old was beaten by another resident, also in his 80s, who had dementia and a history of problematic behaviour. The victim was transferred to hospital, but according to his family, he never recovered. He passed away in April.
Staff witnessed the assault, but were unable to stop it. An investigation by the Ministry of Health and Long-Term Care found that the nursing home did not follow protocol and failed to ensure residents were protected from abuse.
Tragedies like this intensify calls for increased oversight, training and funding. To its credit, in its recent budget, the Ontario government announced a new dementia strategy and committed an additional $10 million to Behavioural Supports Ontario, a program created in 2011 to help care providers identify triggers that can lead to aggressive behaviours before they start. This is an important investment that will make long-term care safer for residents, staff and visitors.
But no reasonable amount of money, training or regulation can prevent every incident of aggression. This sad reality was driven home by a B.C. coroner’s investigation into the 2013 death of William May. The 85-year-old died after Jack Furman, his 94-year-old roommate who had severe dementia, attacked him with a shelf.
Immediately after the incident, Mr. Furman, who had been a member of a special forces team during World War II, appeared confused. Speaking angrily, he referred to “bunkers” and suggested that the nurse was “one of them.” The coroner investigated the death but made no recommendations.
This kind of violence often triggers a criminal justice response. Indeed, Mr. Furman was charged with second-degree murder and placed in an acute psychiatric facility as part of his bail. The Crown eventually stayed the charge, concluding that it was not in the public interest to prosecute the elderly accused given that he was likely unfit to stand trial. Mr. Furman died in palliative care two months later.
More recently, 76-year-old Peter Brooks was convicted of second-degree murder in the beating death of Jocelyn Dickson at a Scarborough care home. Mr. Brooks had moderate dementia, which resulted in disinhibition and poor impulse control. In January 2017, he was sentenced to life in prison with no parole eligibility for 10 years.
Most people with dementia will not commit a crime. However, as the population ages, we cannot ignore the increasing presence of dementia at all stages of the criminal justice system. Despite this growing problem, no government--at any level--has tackled the crime and dementia file.
To be sure, some good work is being done at the community level. For instance, the Guelph Police partnered with the local Alzheimer’s Society on an initiative to reduce the number of people with dementia who become involved with the criminal justice system.
But initiatives and investments in prevention will only get us so far. We must also ensure that when someone with dementia does fall on the wrong side of the law, the criminal justice system is prepared to manage their unique needs.
With its new strategy, Ontario is well-placed to be the first government to prioritize dementia as a criminal justice issue. No approach will solve every challenge, but through a coordinated effort with its federal counterpart, Ontario can set the groundwork for jurisdictions across the country to improve how the criminal justice system manages people affected by such a terrible disease. These vulnerable members of society deserve nothing less.