Friends and neighbors of Barbara Lewis-Brown were stunned at the reports of her slow and gruesome death, all raising the same unanswered question: How could anyone have let this happen? 

The elderly woman died last week from infected bedsores and neglect after Baton Rouge police found her lying in her own feces, her flesh beginning to merge with the couch. Two of her granddaughters were arrested.

Chasity Lewis, 36, identified herself as her grandmother's primary caregiver and admitted to police that she "could have done better," according to her arrest report. Lewis and her cousin Carlnessa Butler, 22, were booked into East Baton Rouge Parish Prison on counts of manslaughter and cruelty to the infirm. 

The tragic case sheds light on what happens when elderly people — a vulnerable segment of the population that often relies on surviving relatives for care — find themselves lacking the necessary support to end their lives with some semblance of comfort and dignity.

Arrest reports for Lewis and Butler reveal new details about the horrific scene and the relationship between the cousins. Both were aware of their grandmother's condition as it changed from bad to worse, leading to what medical experts described as an agonizing death. 

Baton Rouge police said the case is still under investigation, and detectives are looking to determine whether any other relatives were aware of what was happening. Additional arrests are possible.

Lewis-Brown, 77, was found suffering from bedsores with maggots living inside them, according to police. Her apartment was "in deplorable condition."

When investigators later searched the home, they found the sofa "covered in roach feces, human feces (and) cigarette butts." A nearby bedside commode was "filled with old human waste" and had flies swarming around it, according to the arrest reports.

There were dishes in the kitchen sink and no food in the refrigerator. Lewis-Brown was 103 pounds when she died. Police said malnutrition and dehydration also contributed to her death.

Butler told police she was responsible for bringing her grandmother food, and the last time she went to the apartment was about one week earlier. She claimed to have been paying her grandmother's rent and cable bill, but said that Lewis was the primary caregiver. So after recently noticing a foul smell emanating from her grandmother, Butler told Lewis about it.

Lewis told police her grandmother "had medical problems and lost a lot of weight because she was refusing to eat" and said she "stopped being active approximately three months prior and stayed on the sofa."

Police said the 911 call alerting authorities to Lewis-Brown's condition came from one of the granddaughters. But the caller then stopped communicating with authorities and refused to answer additional questions. Both Lewis and Butler are now being held on $300,000 bail, according to online jail records. They appear not to have hired attorneys. 

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Lewis had been living with her grandmother since 2016, according to her arrest report. It's unclear whether Butler was also living there in recent months. But both women received mail at that address, according to police and the mail carrier assigned to that route. 

Lewis-Brown had a two-bedroom unit at the Provincial apartment complex on North Foster Drive, which residents described as quiet and for the most part well-maintained. They said the complex performs annual equipment inspections, which would suggest that someone had entered the apartment at some point within the last 12 months. The leasing office declined to comment.

Ms. Barbara

Lewis-Brown spent decades working for the Louisiana Workforce Commission — probably at least 30 years, according to one of her former co-workers.

Tinisha Parker Stevens, who started working there in 2005, said Lewis-Brown helped show her the ropes, becoming a mentor and friend.

"She was like a grandmother to all of us," Stevens said. "We all are devastated ... and still trying to grasp how did this happen. ... I feel like I can't wrap my mind around it. It's almost like a bad dream."

She described Lewis-Brown as someone with a big heart and infectious smile, always "full of life" and ready to offer "a word of encouragement."

"She would always brighten your day," Stevens said. "You would never have known if she was (feeling) down because she was always the life of the party."

Lewis-Brown retired about five years ago, and the two stayed in contact for a while afterward before losing touch.

Stevens said she was even more shocked when she heard about the arrests of Lewis and Butler because both women had close relationships with their grandmother — who even helped raise Butler from the time she was a child.

Lewis had three children of her own, including one son who died several years ago. She spent her life working full time and raising her family, Stevens said.

Stevens also noted that Lewis-Brown was not a petite person, probably about 5 foot 8. So the thought of her shrinking to 103 pounds is frightening.

"Dear Jesus, how could anyone let this happen?" she said. "I'm running through scenarios in my mind, (thinking) what could possibly make them do this. ... Ms. Barbara would have done anything for anybody. That's what makes it even harder to understand."

Cause of death

Bedsores occur when someone is unable move for long periods of time. But they're preventable in almost all cases, said Jean Cefalu, a nurse practitioner and adjunct assistant professor of clinical nursing at the LSU medical school in New Orleans who specializes in geriatrics and wound care.

She said pressure wounds develop from the inside out, unlike a blister that starts with skin irritation. First the bone compresses muscle tissue, causing it to lose circulation and eventually die. That's what creates the open sore, which often become infected if left untreated.

The infection can spread throughout the body and enter the bloodstream, causing organ failure and death. Preliminary autopsy results show that Lewis-Brown died from "complications of infected deep pressure ulcers with superimposed fecal contamination," according to East Baton Rouge Coroner Dr. Beau Clark.

"Most people have never seen an advanced pressure sore — how horrific they look and how painful they are," said Jonathan Rosenfeld, a Chicago attorney who specializes in elder neglect cases but is not involved with the Lewis-Brown case. "There's an odor associated with it where the person can actually smell their own flesh rotting. So it's an incredibly dehumanizing injury."

Elder neglect

Cases of elder neglect are not uncommon, though the vast majority are much less severe and often resolved before resulting in serious injury or death.

The Louisiana Governor's Office of Elderly Affairs opened 5,860 investigations during the 2017 fiscal year in response to reports of possible abuse or neglect, according to agency data. Investigators found that caregiver neglect was the primary problem in 1,785 of those cases.

Nationwide about one in 10 elderly people experiences some kind of abuse or neglect, whether physical, psychological, sexual or financial, according to recent studies. Researchers estimate many more cases are never reported.

Experts said severe cases like Lewis-Brown's raise awareness about the dire consequences of allowing neglect to spiral out of control. She isn't the first person to have suffered under such circumstances in East Baton Rouge Parish.

Bessie Looney, 82, also died from infected bedsores in 2014. Authorities found her dead in a wheelchair, unclothed and surrounded by feces, trash and flies. The woman's daughter and granddaughter were charged with manslaughter and obstruction of justice.

Joleslie Looney, 57, was convicted and sentenced this spring to 40 years in prison — the maximum sentence for manslaughter. Her daughter Lauren Looney, 21, pleaded guilty to negligent homicide and was sentenced to five years.

And in February 2017, a paraplegic woman was transported to the hospital on her mattress and bedframe because the sores on her back were so severe that paramedics couldn't extract her from her bed.

She claimed to have refused help from her uncle and grandmother, her main caregivers. But both relatives were arrested on counts of cruelty to persons with infirmities because they knew the woman was unable to care for herself and failed to get professional help.

Getting help

Karen Roberto, a professor of gerontology at Virginia Tech who has studied the psychology of elder abuse, said it's important to note that the vast majority of caregivers are not abusive. But she said caring for an aging relative can be psychologically challenging, particularly if that person is suffering from dementia.

Sometimes the caregiver will be dependent on the elderly person for financial support or housing, she said. Other times the caregivers get in over their heads and just don't realize the extent of their responsibilities.

"Caregiver burnout and caregiver stress is a factor. However it is not an excuse," said Ebony Phillips, director of the Governor's Office of Elderly Affairs. "If there's a situation where someone becomes overwhelmed, you cannot just walk by (the elderly person) lying on the sofa, not eating and not drinking and clearly suffering — you have to do something."

Experts emphasize the availability of services for people who need help providing care. Funding is often available through Medicare and state agencies can step in when needed and act on behalf of the elderly.

"If you don't know, ask — ask for help and don't wait until it's too late, because at that point the senior is in jeopardy and you are too," said Baton Rouge Council on Aging CEO Tasha Clark-Amar. "That's a responsibility that you have to take seriously because situations like this can always be avoided."

Follow Lea Skene on Twitter, @lea_skene.