The residents at the Meadows of Oak Grove, a rest home in Durham, are a varied bunch. More than 80 percent are mentally ill, while others have dementia. The majority are old, but nearly a third of the residents are younger than 50.

A lot of people think that is a very dangerous mix.

Rest homes are typically thought of as the domain of older folks, many of them frail, some of them with some form of dementia. In North Carolina, though, rest homes are allowed to take in younger residents. Some of them have medical ailments that require someone to help take care of them.

But many of them are there because they suffer from mental illness -- and have nowhere else to go. There are almost 5,000 mentally ill residents in adult care homes in North Carolina, roughly a fifth of the 25,000 people who live in such homes, state figures show. Most of them are in homes that serve primarily low-income residents.

"It's generally a disservice to both groups," said Roger Manus, a Raleigh lawyer who is chairman of Friends of Residents in Long Term Care, a statewide advocacy group.

"The staff frequently is not trained and oriented to meet the needs of the persons with mental illness, so the persons with mental illness lose out," he said. "Sometimes, the older infirm individuals are afraid -- correctly or incorrectly -- of some of the younger persons with mental illness."

Alice Watkins, executive director of the Eastern North Carolina chapter of the Alzheimer's Association, said the needs of people with mental illness and those with dementia are very different.

"It's a potent combination," Watkins said.

Jerry Cooper, who runs a trade association for the more expensive adult care homes that cater primarily to residents who can pay their own way, said the homes he represents do not take younger residents.

"It's just very, very difficult to meet the needs of a varied population," said Cooper, executive director of the North Carolina Assisted Living Association.

As the state proceeds with plans to close state mental hospitals, more people with mental illness are likely to turn to rest homes because of a lack of community-based programs specifically for such people.

"We're thinking that the situation may get worse with taking people out of mental institutions and trying to place them in the community without a place designed for them to go," said Karen Gottovi, head of the state Division of Aging. "Yeah, this is an issue."

The Meadows of Oak Grove is part of a chain of 18 rest homes in North Carolina. The homes are managed by Careamerica, a company based in New Hanover County.

Almost a third of the residents in Careamerica's homes have some form of mental illness, according to reports the homes filed with the state. About a fourth of the residents suffer from dementia.

Ron Burrell, chief executive officer of Careamerica, said the two groups can be housed together if the staff is properly trained and there are appropriate activities for both groups.

"If it's managed, it can work," he said.

Burrell said homes must also be selective about whom they accept as residents. He said some rest home operators in North Carolina do not take proper precautions.

"If they have an empty bed and Dix calls and says 'I got a patient for you. They killed 12 people yesterday, but they need to be placed,' then a lot of the facilities will take them," Burrell said. "It's unfortunate. It hurts us as an industry. But they'll do it."

Lou Wilson, head of the state association that primarily represents adult care homes that serve residents who rely on public assistance, said state regulations for adult care homes are written almost exclusively for the care of an elderly population.

The state, for example, does not require the staff in rest homes to have particular training in the needs of the mentally ill.

"There has been no guidance from the state," Wilson said.

This summer the General Assembly called on the state Department of Health and Human Services to study the question of whether rest homes should be allowed to mix the two groups under the same roof.

"Most people would agree that mixing frail elderly people with much younger people with mental illness or developmental disabilities can be problematic," said Bob Fitzgerald, director of the state office that regulates rest homes.

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