'Reform' puts mentally ill in homes for elderly

State hospitals are being phased out faster than local care options are being developed

The number of people with mental illness in North Carolina rest homes has grown by 15 percent -- to more than 6,200 -- since 2002. Family members, doctors, lawmakers and residents themselves call the mix troublesome and, at worst, deadly.

Adult-care homes are designed and staffed to meet the needs of frail elderly people. Advocates for the mentally ill say it is challenging enough to serve this core population without adding adults who have schizophrenia, bipolar disorder and other kinds of mental illness.

But for lack of other options, some adult-care homes have become dumping grounds for mentally ill adults.

"That [dumping ground] characterization is a crude way of saying that we don't have that range of alternatives, and no one disagrees with that," said Carmen Hooker Odom, secretary of the state Department of Health and Human Services. "We haven't seen the necessary commitment of resources, locally or nationally."

Most everyone with a stake in North Carolina's elder care and mental health systems -- including parents with mentally ill adult children, industry leaders, regulators and academics -- agrees that blending the two groups can be dangerous.

Rest home files, criminal records and state agency reports reveal problems when younger adults with mental illness are mixed in homes with older people.

* Between August and November 2006, three female residents of a Louisburg rest home reported they were raped -- two of them, ages 63 and 80, by the same 20-year-old male resident with mental illness. In another case, a staff member is suspected of raping a 33-year-old woman with mental illness. The incidents remain under investigation.

* In December 2005, a 71-year-old former cocaine user died a few weeks after setting fire to a living room at a Robeson County rest home. Employees had left him alone in a chair, his feet and chest bound in response to his agitated behavior. He suffered from smoke inhalation before rescuers could cut him free from the restraints.

* In 2003 and 2004, adult-care residents younger than 60 who had mental health problems generated more than 380 instances of criminal activities and violent, threatening or inappropriate sexual acts, a statewide ombudsman reported in 2005.

"To place somebody who is 32, with bipolar disorder, in a room with someone who's 86, who's just had a hip replacement, that's not the best setting for either of those folks," said John Tote, executive director of the state Mental Health Association.

Needs neglected

Such incidents focus attention on older people living side-by-side with those discharged from mental hospitals. But those with mental illness can also suffer when they do not get the kind of treatment their conditions require.

Jimmy Meadows, 60, has lived at an Angier rest home for 21 years. Diagnosed with bipolar disorder, the poetry-writing college graduate shares a room with a 23-year-old man recently discharged from a state mental hospital.

Meadows worries that when he feels "hairy," or at the manic end of his disorder, he could become aggressive toward other residents.

"I worry that I will," he said. "I can't fight good."

Advocates say people such as Meadows need an environment specifically tailored to people with mental illness. That means more privacy, structured daily activities and better monitoring of his illness.

At rest homes, state guidelines require a staffing ratio of one caregiver for every 20 patients during day shifts, and one caregiver per 30 residents at night. At Dorothea Dix Hospital, a state-run institution in Raleigh, the most recent records show a staff-to-patient ratio of about 1-to-4.