I see elder abuse all the time, but today was the first time I saw a home health aide taken out of a home in handcuffs. I see elder abuse frequently, often, and in all its variations, but rarely do I have the circumstances to do anything about it. ARC left me a message about sending "the lady, her name is Fatima," a new home health aide from Tender Care, to the supermarket “to buy four things.” When Fatima came back with the groceries, ARC noticed the remaining balance on her food stamps debit card was reduced by more than the cost of those items.
I met ARC in about 2006 as the caregiver for her husband who was my patient. She negotiated all the tasks of her husband’s care well. She became my patient in 2013 and during our relationship she has remarked on not believing her own age. She has often shared the values imparted by her rural subsistence farmer-preacher grandfather about telling the truth and work ethic. ARC and I have had many conversations about "people stealing from my wallet," and "I am just a trusting person," "I don’t have anything, why do they take advantage of an old lady?" Around the time she turned 90, I posted a big hand-written sign on the mirror at her kitchen table with the single word VULNERABLE. I wanted her to be reminded of her predicament. One day she asked a physical therapist to add the meaning of vulnerable to the page, so I know she was thinking about it. On this same mirror she has a laminated sign with the phone numbers to report elder abuse to New York City Department of Aging and the business card of the officer at the 30th precinct who deals with all the vulnerable old people in her neighborhood. Her kitchen table mirror displays these three reminders intended to avoid another encounter with elder abuse. I have had many conversations with her about scams that might come in the mail asking for money, and people who call on the phone to invite themselves in to her home for valid or not so valid reasons. She had not been so savvy about acquiring the names, titles and agencies as long as these people were nice. My instructions to her start with the context of how much the world is a different place than when she came into it nearly 95 years ago. I always say “It’s not you, but you are unable to keep up with the way people conduct themselves these days.” I then tell her to call me or her niece if a stranger makes an offer or takes advantage.
Today, she pulled self-advocacy out of that innate vulnerability. Yes, she did the math and the cost of groceries purchased from her shopping list subtracted from the previous balance left today’s remaining balance on her food stamp debit card less than it should have been, so she called me. I suppose it would be fairly easy to get away with stealing a few bucks from the wallet of a senior while they aren't looking and blame it on their memory deficits. In fact it happens all the time, but to use a digital food stamps debit card to make a purchase that is ridiculously traceable. Fatima surely saw vulnerable, but not the certain cost to herself because every charge on the food stamps debit card records location, date and time. With both of them watching, I used the printed receipts for the month and sequentially subtracted next purchase from preceding balance to find the discrepancy. ARC was right ten or so dollars was not accounted for by receipts on the kitchen table. She knew exactly how to call the automated system that recites every deposit, purchase and refund on her food stamps debit card. I listened to it twice for date and amount. Indeed, in addition to the purchase for the groceries Fatima put in the refrigerator, today there was another separate purchase for $13.19 a few minutes later. Fatima said she had no other receipts and made no other purchases. Nope, she knew nothing about it even after I asked again, rephrased and repeated. She was the only person holding the food stamps debit card and the PIN when those purchases were made. When I called her employer in front of her, she pulled out a twenty dollar bill and threw it toward me on the table and said to take the money out of it, "do you have change?" and she said the same to ARC, “take it and just give me the change."
Fatima ultimately walked out in handcuffs, but that only happened after I left ARC’s apartment and her employer called and told her to make copies of the receipts. Apparently he didn’t trust my math. Jonathan who claims to be the boss at Tender Care accurately predicted that "maybe the groceries would be found in the apartment." While my elder abuse alarm was at full blast, Fatima’s employer was extremely certain that there were oh so many explanations and that the next step was to find a missing bag of groceries by searching in the apartment. At the time I thought his hypothesis, that I would find another bag containing $13.19 worth of groceries, was ridiculous because Fatima said she had no other receipt and ARC’s hand-written shopping list was clearly just four items. In retrospect, it seems that this home health agency had been through this before. In other words, when an unexplained charge on a food stamps debit card is discovered before end of shift of the employee doing the shopping, the resolution is: How considerate of her to pick up a few extra items and safely store them behind the sofa. All is well. It’s so lovely of her home visit geriatrician to help us find them.
The police were there when I returned to the apartment because I called them, so was a receipt for $13.19 and a bag containing banana cake mix, cake icing with sprinkles, a 5 lb. bag of flour, two peaches and two plums. Not only does ARC not bake because she can't stand in the kitchen and her hands are badly affected by arthritis, but neither does any other 95 year old. So, Jonathan was right the missing groceries were in the home, but they weren't items on ARC shopping list and they weren’t food she eats. Most importantly they materialized after a grocery bill didn't add up. The police gave Fatima every opportunity to do three things: just admit she bought groceries for herself with ARC's federal entitlement dollars; apologize; and return the items, but she wouldn't. Her story got more convoluted and contradictory. She said ARC called her while she was at the store and told her to buy items that she doesn’t eat. The home health aide insisted that the vulnerable old lady directed her because all home health aides know their job exists exactly because of vulnerability. Why two purchases? Why did the receipt and groceries appear after I called her employer? Why was there no record of the call on her phone? Oh, because ARC doesn’t actually have Fatima’s phone number and didn’t call her to make the second purchase that was denied when I first arrived. The story didn’t stick with five police officers sensitively seeking an honest admission, apology and grocery refund. Fatima left the home of a self-advocating old lady with a cost to herself of much more than $13.19. She left in handcuffs.