More adults are coming under the legal authority of guardians. Many adults who are declared incompetent by a court have a relative who takes over guardianship. But for those who don't, the state takes over that role.
The North Carolina Department of Health and Human Services said in an e-mail that there were about 3,000 adults with public guardians in 2007. That number is expected to double by about 2017.
Corye Dunn is Policy Director for the advocacy group Disability Rights North Carolina. She says one factor is that elderly people are living longer. But there's also a new demographic.
"The big change in the system has really been about younger adults with disabilities, people with serious mental illness or with intellectual or developmental disabilities, who need support earlier in life," says Dunn.
Disability Rights N.C. filed a legal complaint that led to a 2012 settlement and the de-institutionalization of adults with serious mental illness.
In 2011, North Carolina also switched its behavioral health care model from case management-focused mental health authorities to a managed-care model for Medicaid recipients. These non-profit organizations refer mental health patients to providers, but they do not coordinate care.
Now, if county Departments of Social Services are unable to find guardians for these patients, it becomes their responsibility to make sure these people's needs are met.
Bob Wallace is the Adult Services Program Manager at Durham County Social Services. He says his office has about 80 adults wards, a 5-10 percent increase from a few years ago.
Wallace says his staff was used to helping elderly people with dementia. But now social workers are serving more young adults with mental illness.
"The wards are just simply different. They're younger, they're mentally ill, they're more challenging, they're in the community more," Wallace said. "There aren't sufficient places for people with mental illness to either go or perhaps not always getting services in the community. We're not mental health experts."
The Guilford County Department of Social Services is now the legal guardian of 250 adult wards.
That's a big increase, says Cheryl Millmore, who supervises the Adult Foster Care and Protective Services Unit at Guilford DSS. Millmore echoes Wallace's sentiment that his is new territory for social workers there.
"We try and help them be equipped to deal with that. It is a new realm for us, relatively new. We try and find training and they try and find training that's gonna help them better handle that population."
NC DHHS did not respond to a request for comment on the availability of services in communities.