The 47-year-old allegedly shot seven elderly patients and a nurse at the Pinelake Health and Rehabilitation Center on March 29, 2009.
Residents Tessie Garner, 75; Lillian Dunn, 89; Jesse Musser, 88; Bessie Hedrick, 78; John Goldston, 78; Margaret Johnson, 89; Louise DeKler, 98; and nurse Jerry Avant, 39; all died.
Stewart was eventually stopped by Carthage police officer Justin Garner who was wounded by shotgun pellets in the leg during an exchange of gunfire. Garner shot Stewart in the chest.
Prosecutors say Stewart came to the nursing home looking for his estranged wife Wanda Luck. She managed to hide in a bathroom in a locked area for Alzheimer's patients and was not injured in the attack.
Prosecutors plan to seek the death penalty if Stewart is convicted.
Stewart's defense asked that the trial be moved out of Moore County because of intense pre-trial publicity. Instead, Moore County Superior Court Judge James Webb ordered that the jury be picked from Stanly County. Jurors will be bused in every day from Albemarle, which is about 60 miles west of Carthage.
Moore County chief prosecutor Maureen Krueger stepped down from the case earlier this year because she defended Stewart's mother in 2004 when she was charged with threatening her son's life.
Stewart's attorneys said Krueger's past relationship with the defendant's mother gave her access to information that could unfairly be used against their client.
Assistant prosecutor Peter Strickland replaced Krueger on the case with help from another assistant.
Stewart's defense claims he has mental issues. According to search warrants released soon after the shooting, Stewart claimed he didn't remember the attack. He allegedly told a nurse he had taken six "nerve pills" and did not remember anything else.
Officer Garner left the Carthage police force in 2010 to train to be a member of the North Carolina Highway Patrol.
Two years after the attack, the incident is still a raw scar for many in Carthage. Most residents either lost family members, or know families that did. Some who spoke with ABC11 said they don't understand how someone could target the most vulnerable - elderly loved ones who had no way to defend themselves.