Risky: Patients sent to family-care homes

Ruth Terrell was in bed by 8 on May 26, the night that she was fatally stabbed in her room at the Evans Forever Young family-care home in rural Alamance County.

Later that night, Alamance County deputies arrested Anthony Zichi, a 25-year-old psychiatric patient who lived in a room down the hall from her, and charged him with assault.

Terrell died June 11 at Alamance Regional Hospital, nine days after her 88th birthday. She had survived long enough to tell her family about the terror of the attack. According to the autopsy, she was stabbed four times in her neck and twice in her chest. Zichi is charged with murder in her death.

According to court records, Zichi, who had a history of mental illness and violence, had been placed by authorities in the small family-care home for the elderly.

Lawyers and police declined to discuss the case in detail, but said that they can't understand how a young man with Zichi's record was ever placed in a home with elderly women.

"One has to wonder what in the world is going on in our mental-health system at this point in time," said Robert Johnson, the district attorney of Alamance County.

Advocates for the elderly have complained for years that the state relies on facilities that were designed to look after old people to house younger adults with serious mental illness. But the state's mental-health reform program does little to expand housing for people with psychiatric disorders.

With few other alternatives, social workers routinely place such young adults as Zichi in family-care and adult-care homes that are licensed to care for the elderly.

According to figures provided by the N.C. Division of Facility Services, 4,055, or nearly 15 percent, of the residents of old-age homes are adults younger than 65 who suffer from mental illness.

"It's a ticking time bomb," said Allison Breedlove, the interim executive director of the Governor's Advocacy Council for Persons with Disabilities.

Antisocial personality disorder

Court records in Alamance County say that Zichi was placed in the Evans Forever Young home because of a diagnosis of antisocial personality disorder and a history of mental illness. It is not clear from the records what agency made the placement.

The Alamance County Department of Social Services, the owner of the home, and the mental-health authority for Alamance, Caswell and Rockingham counties all declined to discuss Zichi's placement. Zichi's attorney and family also declined to comment for this story.

Zichi's criminal record includes convictions for assault in Randolph County, where his parents live, and in Guilford County, where he lived in 2002 in another family-care home.

In 2004, Zichi was charged with assault with a deadly weapon with a revolver. According to court records, a counselor reported that while in jail in Alamance County he took his "psychotropic" medication and did well. Zichi pleaded guilty to the assault charge and an Alamance County judge put him on probation, on the condition that he take his medications.

"I think the sad thing is that the facilities, in order to fill their beds, are not always really screening the residents all that much to find out about any prior history," said Don Heermans, the regional ombudsman for long-term-care facilities in Alamance County.

"What we seem to be seeing is a number of people who are going from one facility to the next because they get in fights or assault another resident," Heermans said. "The next thing you know, they may pop up in another county."

State officials are aware of the risk of placing young adults with mental illness with old people in adult-care and family-care homes. North Carolina does provide some housing for people with mental illness, through a network of group homes for the mentally ill. But the 259 homes across the state have nowhere near enough beds for the psychiatric patients who need them.

Last year the General Assembly's Committee on Aging asked the state to convene a committee of advocates and representatives from the long-term-care industry to make recommendations for improving care for the mentally ill in adult-care homes. That report is due in January.

Lou Wilson, the executive director of the North Carolina Association, Long Term Care Facilities, said that reform of the state's mental-health system has made the situation in adult-care homes worse. "We do know that the hospitals are under a lot of pressure to get people moved," she said. "The one thing we are seeing more of is that facilities are telling me that all the information is not being disclosed on some of the persons, like aggressive behavior and criminal activities and that kind of thing."

Ruth Terrell moved to the Evans Forever Young home about 10 years ago. The brick rancher was nothing fancy, but Terrell would tell her son and daughter-in-law that she was comfortable there. She could keep her recliner on the sun porch, watch television and work crossword puzzles.

Terrell's son doesn't remember exactly when Zichi arrived at the Evans home. But he said that his mother complained about the young man she referred to as "that boy." Darrell Terrell said that his mother and Zichi would argue over the television. He remembers hearing about other arguments, but no one at the home ever told him about Zichi's history of mental illness or his criminal record, Terrell said.

Zichi is in custody of the Alamance County Detention Center and is charged with murder in Terrell's death, but so far psychiatrists in the forensic unit at Dorothea Dix Hospital have found that he is not competent to stand trial, according to court records. The hospital report is sealed. Johnson, the Alamance County district attorney, said he plans to ask for a competency hearing for Zichi.

According to court records, Zichi told the deputy who arrested him that he had "been seen at mental health this week because he was seeing rats."

According to officials at the National Alliance on Mental Illness, Zichi's placement in family-care homes points to some of the more damaging problems within the state's mental-health-care system. Patients who are released from state hospitals are often sent to nursing homes, adult-care homes or homeless shelters, where they receive little treatment or guidance, said Benjamin Staples, the executive director of the alliance's North Carolina office.

Typically, staff members in adult-care homes are not trained to handle such patients, he said.

The Zichi case "seems like the perfect storm of the failure of the mental-health system," he said. "If you have no trained supervisor, there's nobody to identify and recognize if someone's condition becomes problematic."

Terrell was conscious during the two weeks before her death and told her son and daughter-in-law about the attack."He just came in and jumped on top of her and just started stabbing away at her," Geraldine Terrell said.

She and her husband said they hold the state and the county partly responsible for their mother's death.

"The one I would like to know is the one who brought him over there," Geraldine Terrell said.