Tammy Terry remembers her mother as a woman who turned her love for animals into a successful dog-grooming business, a woman who never sat idle, who both worked on cars and sewed lingerie.
Terry prefers these memories to the other image that is etched indelibly in her mind: Her mom lying alone for four days in a dark storage room at Liberty Nursing and Rehabilitation Center.
Just days earlier, Terry's mother, who suffered from Alzheimer's Disease, had begged to come home. "I told my husband, 'I want her moved. I want her closer to me,'" said Terry, 45, of Gastonia.
She never got that wish. On Jan. 23, two days after Terry last saw her mom, 66-year-old Mary Hicks Cole went missing from Liberty. Four days later, Cole was found, dehydrated and sick with pneumonia, in a storage room on the same second floor where she was kept in an Alzheimer's unit.
Cole died a half-hour later at Presbyterian Hospital in Charlotte. The state would find that conditions at Liberty presented immediate jeopardy to residents' health and safety and would levy the heaviest possible fine -- $10,000 a day -- until the nursing home fixed the problems.
Now, nearly six months later, Terry is on a mission to see that her mother's death is paid for with more than a mere monetary offering. She's pursuing a civil suit, but what she wants most is for someone in charge to take criminal responsibility for her mother's death.
"It never should have happened," Terry said last week, breaking down in tears after listening to the 911 call made after staff found her mother.
Liberty director John Gryglewicz did not respond to messages left at his home and at the nursing facility. Neither did Mecklenburg County assistant district attorney Marsha Goodenow, whom Terry said was to receive the results of a police investigation this week.
Advocates for the elderly say Terry has picked a tough battle. Nursing home officials rarely go to jail for neglect even when it results in death. Advocates say that can be attributed partly to the unspoken belief that nursing homes are places where the old are warehoused to die. As Baby Boomers begin to hit old age, the magnitude of problems at nursing homes could worsen exponentially.
By the time Cole entered Liberty, Terry's struggles to find long-term care for her mom had taken on a pattern: Terry would finally find a decent home, but the home's staff would ask Terry to come get her mother after she made a few escape attempts. Terry felt the nurses did the best they could. Even when Terry would find her mom's socks unchanged and her ears uncleaned, she would not complain.
"You learn right fast that nurses don't like that," Terry said. "So unless it was something that I felt would be life-threatening, I made my mind up that I would not lodge a complaint -- that I would get those nurses to love me. And if they loved me, they would love my mama."
Wes Bledsoe, founder of the elderly- and disabled-care watchdog group A Perfect Cause, believes nursing home neglect is treated much less severely than neglect of children or even animals. Bledsoe, who became an advocate after his grandmother died in an Oklahoma nursing home, said the number of nursing home deaths caused by neglect or abuse is grossly underreported. Even when such actions are reported, he said, scarcely any reform results.
"Most D.A.s won't go after these people because they say, 'Who are we going to charge?' You have the administrator. You have the director of nursing. You have all these different nurses. Do we charge 10, 15 people? Since we can't do that, we don't charge anybody."
One example to the contrary is currently playing out in Pennsylvania. Martha Bell, an administrator of a Pittsburgh nursing home, awaits trial on charges including involuntary manslaughter in the death of an 88-year-old Alzheimer's patient who died after she was locked outdoors on a 40-degree night.
Bledsoe believes the most logical culprit is the owner of a facility. "They're the ones who set up this house of cards, and they're the ones who should be accountable," he said.
If owners knew they could be held criminally liable for what happens in their nursing homes, he said, "Don't you think they would show up at their facilities more?"
A 2002 study by the federal Department of Health and Human Services found that 90 percent of US nursing homes lacked the staff needed to provide adequate care. Another federal study, released in 2003, found that one in five nursing homes nationwide had "serious deficiencies that caused residents actual harm or placed them in immediate jeopardy."
With the oldest Baby Boomers turning 60 this year, more people will begin needing long-term care, said John Eller, adult services director for the Department of Social Services. The number of Mecklenburg County residents over 60 is expected to reach nearly 233,000 by 2030 -- more than tripling the current number -- while the child population isn't even expected to double.
Bledsoe said nursing home quality will be an even bigger issue. "If anything, I think it's getting worse, instead of better," Bledsoe said. "You've got a big ship that's moving full-speed ahead and it's going to take a long time, a lot of miles, for that ship to turn around. If you or I wait until our loved one, or we, are in this facility it's too late. There's just not enough advocates, there's just not enough people out there to protect these people."
As for Terry, her grief has gone through stages in the months since her mom's death. "At first, it was like, oh well, my mom doesn't have Alzheimer's [anymore], and I don't have to go through her not being able to walk and deciding not to put a feeding tube in," Terry said. "Then it settles down, and you realize, she lived in that room for four days. She had to lay there. She got to where she didn't get to walk, and she didn't get any food, and she wasn't getting any medicine."
Terry doesn't believe the staff was uncaring. "I could see the director was upset. Nobody there would intentionally have hurt her," she said. "But that was negligence, no matter what. You cannot lose somebody."
Terry poses this question over and over in her head: What if a child went missing from a daycare center? "You know that if it was a child, and it was a day care, there would have already been charges," she said. "When you think about a person in a nursing home, you think they went there to die. There's no value of life on old people."