'There can be safety concerns.' Sympathy, caution from Cape Codders after Riviello death

Editor's note: This story has been updated July 1, 2024, to add a statement from Beth Israel Deaconess Hospital Plymouth.

Around 7 a.m. on June 18, as a heat wave settled over Massachusetts, Rodney Riviello put aside his coffee cup, got up from his customary chair in the Manomet home he shared with his wife, Julie, and headed out for a morning walk. He never returned home, and his disappearance launched a massive search by police, family, friends and concerned citizens from Cape Cod to New York.

Four days later, Riviello's body was found in a Plymouth marsh, his New York Yankees cap at his side and a discharge paper from Beth Israel Deaconess Hospital in Plymouth in his hand.

The loss has left his son, Provincetown Assistant Town Manager Dan Riviello, daughter Michelle Norris of Boxborough, and their mother asking questions and calling for measures to prevent similar tragedies from happening to other families.

Others on Cape Cod expressed sympathy, understanding, concern and caution following the news of Riviello's death.

"While we try to understand what happened, we want to recognize this nightmare could happen to anyone’s father or grandfather," the Riviello family said in a statement. "We hope sharing his story will shed light on gaps in hospital protocols for elderly patients with cognitive issues, and we’re asking for immediate safeguards that require a safe handoff to a family member or caregiver."

In a statement on July 1, the hospital noted the entire team at the Plymouth hospital "expresses its profound sympathy for the family of Mr. Riviello, and knows his loss has been deeply felt by his family, friends and the Plymouth community."

"Our commitment to patient privacy prevents us from sharing details of individual cases. Our policies require all patients to be carefully evaluated by our clinical team prior to being medically cleared for discharge, and we provide options and resources for transportation and any necessary follow up care," the hospital stated. "We review any situation where a patient’s outcome is not as anticipated. BID Plymouth’s clinicians and staff continuously provide the highest quality care and do so with a deep sense of compassion and connection.”

'There can be safety concerns'

Riviello's walk wasn't anything out of the ordinary, as the 69-year-old — a man who enjoyed the simple pleasures of reading his newspaper, having his coffee, watching game shows and spending time with family — routinely took a morning constitutional. But for people who are developing or living with diagnosed memory loss and dementia ordinary things can quickly become a crisis.

"What can happen for people living with cognitive loss is they can get confused, and there can be safety concerns," said Molly Perdue, co-founder and executive director of the Alzheimers Family Support Center of Cape Cod .

Over the last couple of years, Riviello had been showing some signs of memory loss and a decline in his critical thinking and problem-solving skills, though he was not yet formally diagnosed with dementia, according to his son.

A trip to the hospital after a fall

At some point during his walk on June 18, Riviello apparently fell, and two strangers stepped in to help, leading to an ambulance ride to the hospital at 275 Sandwich St. in Plymouth, about six miles from his home. There, he was treated for a broken nose and a hematoma from his fall. A CT scan also revealed he had cerebral small vessel disease, which can cause dementia, his family said.

About three hours after his arrival at the emergency room, Riviello was released. The hospital staff was working on getting him a cab or Lyft ride home when he wandered out of the building about 11:15 a.m. His family said none of them had received a phone call informing them about his hospital visit.

It remains unclear whether Riviello's release had anything to do with hospital protocols, a lack of staffing, or simply just not fully recognizing the extent of his cognitive impairment.

Dementia can be difficult to recognize

Perdue said dementia can be difficult to recognize, particularly if spending a short amount of time with a person with developing or full-on dementia.

"What's hard about dementia is people can seem with it. People can have moments of acute confusion, but they can then seem OK," she said. "It can be really hard unless you've got a little bit of training to realize there's something that's just not quite right."

Diseases that rob people of cognitive health can take time to manifest, taking up to 20 years for some, Perdue said. Age is the number one risk factor for cognitive loss.

Perdue is an advocate for helping communities become more dementia friendly, especially considering that the number of people with dementia is rising "not only on Cape Cod, but in the country." It's important to educate community members from grocery store clerks to bank tellers to emergency personnel about what to look for and ultimately "help everyone living with cognitive loss be a little safer in our communities," she said.

"People don't wear Red A's on their shirts," she said of individuals with cognitive loss.

Wandering, Perdue noted, "is one of many dementia behaviors that can be life threatening."

"My heart goes out to the family. It's so hard," Perdue said.

Assessing hospital processes for patients with cognitive loss

State Sen. Julian Cyr , D-Truro, said he, too, grieves for the Riviello family, and agrees with them that Riviello's story does bring up a subject that legislators may want to address.

"I certainly have questions as to how this happened and if there are protocols and policies that need to be put into place to ensure that patients with memory issues, dementia and Alzheimer's are not at risk when it comes to discharge," said Cyr, who serves as chairman of the Joint Committee on Public Health , and is also on the Joint Committee on Elder Affairs .

Sen. Susan Moran , D-Falmouth, whose district includes Plymouth, declined comment.

At Cape Cod Hospital-Cape Cod Healthcare , Chief Medical Officer William Agel said "Cape Cod Healthcare always takes the safety of our patients into consideration when determining the proper disposition of people in our care and we continually reassess our processes based on current thinking, medical science and our patients’ needs."

Celebrating a life

Even as they share Riviello's story in hopes of raising awareness and preventing similar tragedies, family members are celebrating his life.

"We will miss him endlessly, and we’re eternally grateful for what he gave us and everyone who knew him," they wrote in their statement. "Rodney was everyone’s favorite meat cutter in his hometown of Clyde, NY, and hundreds considered him a best friend because, if you were with him, you felt like the most important person in his day."

Riviello's influence has even been felt by those who did not personally know him.

In Provincetown, he made a difference through his son.

"I have worked closely with Dan since he arrived here in September of 2022," said Provincetown Town Manager Alex Morse. "I have seen up close and personal how deeply Dan loved and cared for his father, and it pains me and many others that he has to experience this magnitude of loss."

"Many of us in Provincetown didn't have the privilege of meeting Dan's father," Morse added, "but knowing and working with Dan gives us a sense of the kind of person he was, and we are better for it."

Riviello's family said he "was proud of his family and would be proud of us now, not just for the way we’ve gotten through the past week, but for the way we’ll move forward from this preventable tragedy working to make things better for those just like him," they wrote.

A celebration of life is planned on July 7 in Riviello's hometown of Clyde, New York. It would have been his 70th birthday.

Heather McCarron can be reached at hmccarron@capecodonline.com, or follow her on X @HMcCarron_CCT

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This article originally appeared on Cape Cod Times: 'There can be safety concerns.' Sympathy, caution from Cape Codders after Riviello death