One resident was found with maggots crawling out of his leg. An elderly woman with dementia scuffled with an aide who was supposed to be taking care of her. A man was killed after being stabbed by another resident in a drunken brawl.

Troy Stephens simply disappeared. Two fishermen found his body nearly a week later in a lake a mile from the Garner rest home where he lived.

The incidents occurred in different rest homes in North Carolina. As far as state regulators are concerned, most of them were isolated events having little to do with one another.

There is a common thread, though, one that state officials say they must ignore. Those incidents and others all happened in homes managed by Careamerica, a company in New Hanover County. Those homes were paid more than $17 million in taxpayer money last year to take care of people who could not afford to pay for their own care.

The company operates 18 homes in North Carolina, serving primarily low-income, rural families. Two of the company's homes are in the Triangle: The Meadows of Garner and The Meadows of Oak Grove in Durham.

Over the past three years, state and county reports on the homes document numerous incidents of violence, neglect and filth in homes run by Careamerica.

A relative of a resident in a home run by Careamerica in Pink Hill wrote to state officials that she had seen vomit on the floor that had been there so long that bugs were swarming in it.

She described the home as "the most inhumane, unsanitized area I have ever seen" and said, "There are pets that live better than these elderly folks live."

A 1999 law calls for the state to deny a license to homes that are part of chains with persistent problems. State officials say the law does not apply to Careamerica's homes because the homes are licensed under different names.

State officials have said the General Assembly needs to revisit the law to close that loophole, which has prevented action against other chains, including Third Street Management, based in Hickory.

"This is an issue and a concern of the department, and we are going to need to have more legal analysis done about what we can do in defining affiliates," said Bob Fitzgerald, director of the state office that regulates rest homes. "But the way the law is currently written, we are advised ... that they are not affiliates."

The leaders

Ronald Burrell and Michael Elliott are the men behind Careamerica. Elliott, of Myrtle Beach, S.C., handles the finances. Burrell, the chief executive officer, is responsible for operations, acquisitions and dealing with state and county regulators.

Burrell, 48, has a long history in the long-term-care industry. Until recently, most of his work had been with nursing homes, which are licensed to provide medical care. Rest homes, or adult care homes, are designed primarily to serve people who need help with such day-to-day activities as bathing, feeding and dressing.

About five years ago, Burrell was offered the chance to run a rest home in Lenoir County. The company has expanded quickly; Burrell and Elliott now run one of the biggest rest-home operations in the state, with more than 1,400 beds throughout Eastern North Carolina.

Such rapid growth has not come without difficulty. Burrell said many of the homes he took over had long histories of problems with care.

Echoing the complaints of many both in and out of the rest-home industry, Burrell said the state does not provide enough money for operators to provide the level of care required by state regulations. The General Assembly sets the rate paid to homes for residents on public assistance -- currently $1,066 a month. Medicaid also reimburses homes for personal care, which includes assistance for bathing, feeding and dressing.

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