Reports show the man placed a pillow over her face in their Sullivan Street apartment, possibly as she was snoring.
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Neighbors said they had concerns before this that 92-year-old Veronica Ivins was being abused and they even contacted adult protective services over their concerns.
Ivins lived in the apartment building most of her life.
Disturbing screams and noises echoed from the fourth-floor apartment every couple of weeks, according to neighbors.
An eerie phone call just before 7 a.m. Thursday quickly brought police to the building where they discovered Ivins suffocated on her bed.
Investigators said her roommate, 47-year-old Enrique Leyva, allegedly confessed to placing a pillow over her face.
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Leyva had been living with and caring for Ivins for several years.
The suspect allegedly called police and told detectives, "I killed my roommate."
The woman was pronounced dead at New York-Presbyterian Hospital.
Leyva is being charged with murder.