But she did not die. For 17 of those 32 years, Orduno has suffered from multiple myeloma, a cancer of the blood-plasma cells. "At first, they gave me eight months to live," she tells me. Her husband, she says, was counting the days.
Yet here she is. The disease has not killed her, though it leaves vast lumps beneath her skin. She bruises easily and terribly. Even now, her face is purple and swollen from a 3 a.m. bathroom tumble in the new apartment she shares with two pet rats and a plush pig. But eventually, that swelling will go away, and the angry color will soften.
Wounds to her soul will take longer to heal. Still, the process has begun, and that in itself is a marvel. Surely, says Delia Orduno, what has not killed her will only make her stronger. The 66-year-old now lives alone, but she is surrounded by friends, in downtown's Sentinel Plaza senior apartments. And every day is better than the day before.
For all those other years, she was trapped in her own tormented home. She had no money, and no place to go. "I was afraid to move out," she says. "I was afraid of everything, because I was afraid of him. He always told me, 'Oh, you are so stupid. You do nothing right.' He was mad because I was sick and didn't pass away. He said, 'You need to pass away. I want to live alone.'
"He was always like that. But with age, he's getting worse. For me, I was dying every day. If I didn't move out, I was going to die soon."
In April, when her 85-year-old mother was visiting from Mexico, they all took a shopping trip to Target. Apparently impatient, her husband drove off, stranding them at the store. So Orduno and her mother made their way home by bus. "Another time, he left us at another store," she says. "We paid a taxi $32 to get home."
For years, she suffered in silence, "because I had no place to go. I didn't tell anybody, because everybody thought he was a very nice person."
Among those she didn't tell were the cops. She'd seen what happened to her sister-in-law, who was in a similar situation.
"She would call the police, and they sent her to the shelter for two weeks, and then she'd come back," Orduno says. "Then, in three or four months, it was back to the same. I didn't want to go to the shelter. I wanted to move out. I don't want to see him ever again."
Then a friend told her about Robin Landers, supervisor of the Armory Park Senior Center. Soon, Landers had arranged a rent-subsidized apartment at Sentinel.
But even escape was an ordeal, as Orduno began secreting her belongings at a neighbor's home. The social workers told her to keep mum. "They said, 'Don't tell your husband you're moving out, because maybe he'll try to hurt you,'" she says.
All the while, her three sons refused to intervene. "They said, 'Whatever you want, Mom, we're for you,'" she recalls. "But they knew him, and they didn't want to confront him."
Today, Delia Orduno is among the fortunate. According to Generations, a journal of the American Society on Aging, a survey conducted in 2000 found that nearly 6 percent of seniors in the United States and Europe reported having been abused. Another study revealed that four-fifths of nursing-home employees had witnessed physical or psychological abuse of their clients, and two-fifths had committed such acts in the previous year.
Tragic as those numbers are, they seem only to be growing; in a similar study published eight years later, nearly 10 percent of respondents reported having been verbally abused; 3.5 percent said they had been financially exploited; and 0.2 percent reported physical abuse.
Among experts, it is widely believed that such incidents are profoundly underreported. A 2009 study by the Government Accountability Office concluded that 14 percent of noninstitutionalized older Americans had experienced some form of abuse in the previous year.
A 2010 report by the nonprofit Investor Protection Trust says that 20 percent of seniors have been the victims of financial scams. According to a 2011 study by the MetLife Mature Market Institute, the cost to elderly victims of financial exploitation tops $2.9 billion annually.
The most common thieves of property and wealth are family members, closely followed by professional caregivers and scam artists. Then there is the kind of domestic violence inflicted on Delia Orduno, which spans decades. Such situations bear ugly common threads: threats, isolation, manipulation and sometimes violence.
In Arizona, 75 percent of Adult Protective Services clients are age 60 and older, and 62 percent are women. Between July 2010 and June 2011, the agency fielded 6,889 reports of vulnerable-adult mistreatment. Among those, family members constitute 31 percent of the perpetrators; they were second only to reports of self-neglect as a cause for APS involvement.
Faustina Dannenfelser is the program administrator for APS. She says the economy has only made those numbers worse as people scramble for survival in less-than-honorable ways. "One of the things we've seen is that families will take their loved ones out of nursing homes and bring them home to live with the family. They do it pretty much for financial support, because the elderly person might have some resources—Social Security or disability or a pension of some sort."
But this move tends to be a rotten deal for the elderly person. "Once someone is in the nursing home, they're there because they need 24-hour care," Dannenfelser says. "The families don't really realize what that means until that person is at home, and they have to be feeding them and changing their diapers and helping transfer them to the bed."
While family members "may not be equipped to provide that level of care," she says, there is no legal way to stop them. "If that client in the nursing home still has the mental capacity to make a decision, they can leave whenever they want, whether they need the 24-hour care or not."
Here's where things get hinky: Is the elderly person competent to make his/her own decisions, or not? This question is key, because elder-abuse cases often hinge upon whether the victims are judged to be vulnerable. But if they are vulnerable, are they then competent enough to serve as reliable witnesses?
"The definition of impairment," Dannenfelser says, "is that the person has to have a physical or mental impairment that prevents them from protecting themselves. Once they reach that (criterion), whether they're in a private nursing home or assisted-living facility, then we can get involved.
"But if the client still has mental capacity, we can't do much. If a family member is involved, the client might be embarrassed to talk about it. If they say they still want that family member to live with them, we can't do anything. It's an ethical dilemma for our staff, because they have to walk out of a home they know is unsafe and unhealthy."
Financial rip-offs can be equally vexing—such as when relatives are given some money in exchange for care, but then begin soaking the elderly person for more. Who is to say when they've crossed the line?
Still more factors limit the ability to stop these crimes. "Perhaps the elderly person has had a stroke and can't effectively communicate," Dannenfelser says. "Or maybe they have lost their sight. In those cases, they can be taken advantage of financially and physically."
For all of these reasons, legions of battered and exploited seniors remain in the shadows, while APS stats mostly reflect the lucky ones. "This is just the tip of the iceberg in elder abuse," Dannenfelser says. "Statistics say that just one in every 14 cases is reported.
"We are not to the point in elder abuse that we are with domestic violence and child abuse. Hopefully, some day, we'll get there. But I think people have a hard time accepting that grandma is being slapped around by the grandchildren or the adult children. That's still something people are not very comfortable with. We get doors slammed in our faces all the time, and family members telling us they'll report us to the governor's office."
On the other hand, piercing that murk is far easier—and enormously more satisfying—when the perpetrator is a bottom-feeding scam artist. And the depths to which they'll sink is truly breathtaking.
"We had one case a few years ago," Dannenfelser says, "where the perpetrator was finding her victims by going to the funerals, where she would befriend the widow." After worming her way in, "she'd just take whatever she could."
Dannenfelser pauses. "There is a special place," she says, "for those kinds of people."
But the plotline swerved in a direction Rosa didn't expect: The clan was moving in because they couldn't afford their rent. And what happened next was dreadfully predictable.
"Rosa only lived two years after that," Delia explains, "because her daughter took away her Social Security checks, took away everything. She was sleeping in a small room. It was like the daughter owned the place. Rosa passed away in two years because she was afraid to get help. She was afraid of everything, like me. She kept saying, 'My poor daughter, my poor daughter.' After she passed away, her daughter lost the house."
But there are plenty of success stories, too. And they make it all worthwhile.
A grim sampling:
• Nov. 7, 2011: A 50-year-old health care worker named Glenda Walls-Tillis is sentenced to five years of probation and ordered to repay the $5,500 she stole from an elderly couple. According to authorities, Walls-Tillis penned three checks to herself totaling that amount from the couple's account. The two were 95 and 88. The caregiver told police she spent the money on housewares, including shower curtains and bedding.
The couple's daughter, Elisabeth Hurlbert, told the sentencing judge that her parents now live in fear and humiliation.
• Nov. 8, 2011: Ruthann Jacox dies at Tucson Medical Center, just weeks after her caregiver is charged with abusing a vulnerable adult. Jacox was a Navy vet and career nurse who was bedridden with multiple sclerosis. Five years earlier, she'd invited Lea Marie Hughes, now 37, and Hughes' boyfriend, Gilbert Pierre Peralta Jr., to live in her home, after which they proceeded to neglect her to stunning degrees while running amok with her credit card, according to authorities. Following a tip, police found the home rife with vomit, dog crap, maggots and rancid food. Jacox was infected with bedsores down to the bone, and her weight had plunged from 195 pounds to a mere 80 pounds.
In August, Hughes was convicted and sentenced to two years in prison. Peralta, 39, is expected to soon enter a plea agreement.
• May 14, 2012: Caregiver and serial predator Julie Lane, 46, is sentenced to more than 11 years in prison for forgery, theft and fraud. She was convicted of stealing nearly $30,000 from an 80-year-old woman. Lane told the woman's family she had been a registered nurse, had children fighting in Iraq, had been orphaned as a child, and had survived breast cancer. What Lane didn't mention was that she'd also been accused of ripping off a 90-year-old woman, for which she'd received a two-year sentence.
• July 2012: Health-care worker Jennifer Lopshire, 44, is arrested on suspicion of abuse of a vulnerable adult. In June, another caregiver informed police that Lopshire's client had a bruised and swollen mouth. Lopshire is expected to go to trial next May.
• Also in July, Shanna Harper, 36, is arrested on suspicion of fraud, theft and exploitation of a vulnerable adult. Police believe she and her boyfriend, 37-year-old Thomas Bonds, stole up to $320,000 from a former art dealer suffering from dementia. Both are expected to go to trial next April.
Then came budget cuts, and each agency fell back to working its own turf. But the commitment to these special cases appears to have persisted. At TPD, for instance, a current detail includes two detectives who investigate nothing but reports of elder abuse. They maintain a desk at the Arizona Attorney General's Office in Tucson, which has an agreement with the Pima County attorney to prosecute incidents of elder abuse.
Some things were lost when the task force was disbanded, says one of the TPD detectives, Kathy Kragnes, such as the superb ability to track suspect caregivers from one jurisdiction to another. Either way, the focus on elder abuse was enhanced, and today seems to be a pillar of police culture. To Kragnes, it's a personal calling. "I worked child sexual abuse for almost four years, and I've done elder abuse for about four years now," she says. "They are the true victims."
And so the reports rumble in. "The majority of our cases get reported to 911 or online reporting," she says. "Doctors and hospitals are also mandated to report suspected cases of abuse. But we can't investigate all the cases that get reported, because we just don't have the resources. That can be very frustrating."
So the police prioritize, with physical abuse landing atop the pile, and inter-family thievery settling somewhere in the middle.
But even when abuse seems obvious, molding it into a prosecutable case is another animal altogether. To even prod that beast, you first have to prove the victim is vulnerable. It's what you might call a legal term of art.
"So a grandmother may be fine," Kragnes says. "Then she falls and breaks a hip, and caregivers come into the home. Now she's a vulnerable adult, because if it wasn't for the fact of these caregivers coming into her home to provide services to her, they never would have had the means to exploit her." Therein lies a potential prosecution.
Det. Kragnes is also on the lookout for tell-tale patterns, such as the link between financial exploitation and abuse. "Most times, where there's one, there's the other," she says.
But even making that link doesn't necessarily make a case. Family members in particular are hard to prosecute. "It's never black and white," she says. "It becomes very convoluted. Looking at everything, often the likelihood of conviction just isn't there. It's not to say that something didn't happen. It's just that it would be very hard to prove it."
So they turn their focus to "professional" caregivers, far beyond the entanglement of family and friends, where things do tend toward the black and the white.
"Outside caregivers have to be a priority for us," Kragnes says. "Those are people who are actively making their money by going out and exploiting people. And they're not going to just exploit one person. They're going to exploit numerous people, versus the neighbor or a family member who, because of their relationship with this person, started helping them and then took advantage of them."
On good days, there's the bust that sticks—and it typically doesn't commence with a call from the victim. "It usually starts when a neighbor or someone else notices that something is amiss," Kragnes says. "Many times, these elderly people have either been brainwashed, or they're afraid of the person, or they don't want that care to go away. They're heavily reliant on these people."
An investigation ensues, and "we can see money has gone to another person, and there's no reasonable explanation for it," Kragnes says. "Usually, when we confront the (caregiver), we can get them to confess." Prosecutors "don't like to take these cases to trial if they don't have to, because it's very hard to put these older people on the stand."
Sometimes, other parts of the investigative machinery roar to life, such as the fraud unit within the state's Arizona Health Care Cost Containment System. The unit monitors retirement facilities and home-care organizations that handle AHCCCS clients—and tracks caregivers with a record of malfeasance, Kragnes says. "If they plead, then they go on a registry where they can't go to any legitimate business and try to do this work again, because they're basically flagged."
To bring cases together, Kragnes works closely with state prosecutors such as Assistant Attorney General Doug Clark. Clark, who is based in Tucson, calls elder abuse "one of most underreported crimes. Elders don't want admit being connected to it, particularly when a family member is involved."
It's also a particularly tough crime to prosecute, he says, "because we have to prove that they are a 'vulnerable adult.' It's often charged that way. On the flip side of that, we also have to prove that the person who stole was in a position of confidence."
Most rip-offs "are crimes of opportunity," Clark says. "Who's going to steal your money? Family members are at the top of the list."
Then come the sharks who may be morally challenged, but don't quite break the law. They include the door-to-door marketer who sold a 91-year-old man $23,000 worth of steaks and pork chops—and a couple of freezers to keep them in. "That becomes a consumer issue," Clark, says "but I wish we could flip it to criminal issue."
Still, Clark's team can't be faulted for lack of aggressiveness. The office supports the long-running Taskforce Against Senior Abuse, which focuses on financial exploitation of seniors, and works closely with Det. Kragnes and TPD officers to catch scam artists who prey on the elderly.
Another assist comes with toughened state laws. Clark says they make it easier to prosecute those who were in a position of trust with someone while taking their money. One change states that "anything you take from a vulnerable adult—such as having them sign their car over to you—without adequate consideration of them gives rise to an inference that you intended to deprive them of that property," he says. "It helps the state be one step closer to proving their case."
And there are successes to savor, such as catching a "gardener" stealing from a woman in Tucson's upscale El Encanto neighborhood, after she invited him to live in her home. "We're still not sure how much she lost," Clark says, "but it was probably more than $300,000. Her house was full of animal feces, and there were steel security doors between different parts of the house. Even when I was pursuing the case and prosecuting him, she still thought he was the best thing since sliced bread. She did not want him prosecuted."
Clark says the defense attorney tried to convince him that he would lose at trial. "But just the pictures of the house alone—all the jury would have to see is that, and they'd be like, 'Oh, man, that guy's guilty,'" Clark says.
The case was settled with a plea agreement that put the defendant on probation and—at Clark's insistence—sentenced him to weekends in jail for the next three years.
State prosecutors also assist a team that reviews suspicious deaths. The Pima County Death Analysis Review Team, or DART, involves everyone from detectives and lawyers to social workers, and the process starts when police call with a hunch that something's amiss. From that point, "we review all of the facts surrounding the deaths that might otherwise slip through the cracks," Clark says.
But sometimes, the call comes too late. "(Perhaps) the medical examiner did not do an autopsy because they were not asked to do an autopsy, and there was no reason for them to do it, and there has already been a disposition of the body," Clark says.
Then there's that red flag that turns out simply to be sad. "We reviewed one case where, on its face, it really looked like it was going to go somewhere," Clark says. "The woman was 54 or 58 pounds when she passed. That was like somebody who's been starved to death. Right off, when you get somebody that's under 60 pounds when they pass, that raises a lot of alarms. Then the rest of the story comes out, and she and her son ultimately were hoarders, and they lived an exceedingly unusual lifestyle. There wasn't anything he did that led to her failure to thrive. It was simply the way that they lived together."
With all those predators lurking, agencies such as the PCOA must intensely screen all of its volunteers, Grabel says. "We're always on the lookout for people seeking to have access to the elderly," who can be exploited in countless ways that aren't even necessarily illegal. For instance, Grabel describes one fine fellow who sold a 25-year subscription to Sports Illustrated to a 90-year-old man.
Or maybe the culprit is a landscaper who's billing for more time than he's actually working. "It's fraud," Grabel says. "But the victim doesn't even understand they've been victimized. It's almost like a homicide case in which the victim is not available to help you with the prosecution."
But property and money aren't the only things stolen. The other theft is simple peace of mind. According to Grabel, life expectancy for a senior who has been victimized shrinks dramatically.
"I had an elderly, distant cousin who lived in Tucson and got involved in a water-purification scam," he says. "They sold him a $7,000 water-purification system that he didn't need. He passed away within a year, and his family believes a good part of the reason was because he felt that loss of control. He'd been a successful businessman, and just let himself get hooked."
Physical and verbal abuse of the elderly can also take a terrible toll. That damage is a major focus for folks at Jewish Family and Children's Services of Southern Arizona. The JFCS is the lead agency with the Community Counseling Coalition for the Elderly, and expert in addressing the special needs of traumatized seniors.
That trauma often includes domestic violence, which grows entrenched over the years. "As we get older, it can become even more complicated," says Shoshana Elkins, the agency's vice president for programs and services. "You get so enmeshed in experiences that are really hard to get out of. Isolation and depression are also very common, especially when you don't have the resources or have limited mobility. Your world just becomes smaller."
It's also tough for outsiders to help. "You can be in a domestic-violence situation as an adult, and you don't have to report that," she says. "Vulnerability is really the key."
"When Delia finally got in touch with me, I was able to share the news that she got an apartment in Sentinel Plaza," Landers continues. "The only thing she had was a bed, so we got her a sofa, table and chairs, dresser, bookcase and more, through a grant that the Armory Park Foundation gave to purchase furniture at Habitat for Humanity.
"She is a strong, courageous and very positive person with a big heart. With all that she has been through, it has not tainted her love of life or humanity."
To Delia Orduno, that all rings painfully familiar.
For her, liberation day came in September. She'd been moving boxes to the neighbor's house. When it came time to bring her things to Sentinel Plaza, her husband helped. He acted so kind, so loving, she says, "because my neighbors were there; my friends were there. Too many people were watching. He tried to be nice."
The scars, however, were not so easily left behind. "He always told me, 'I know you're crazy, and I'm going to put you in the crazy house,'" she says.
Years of that barrage have taken a toll. "I'm always afraid, afraid of everything," she says, "afraid to go out. Because I didn't drive a car, I never went out by myself."
Now friends are helping her use the bus and get to medical appointments. She plans to get counseling, too. "My doctor tells me I need to go," she says, "but I haven't gone yet."
Yet Delia knows she is among the fortunate. "People think we stay because we want to," she tells me. "But I know too many people who are the same as I was. The man puts the foot on the woman, and the woman doesn't do anything. Because like me, they are afraid. They think no one will believe them."
But they now believe Delia Orduno, in her bright new apartment with her pet rats and stuffed pig. She smiles ever so slightly. "Right now," she says, "I feel very strong, very healthy—and free."