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It seems that the patented New York no-eye-contact attitude is being carried over to nursing homes, resulting in worsening conditions for the state’s most vulnerable citizens: the elderly. Nursing home abuse is a problem all over the U.S., but New York is notably lackluster in addressing the issue despite being the state with the most number of nursing home residents in the country.

According to advocacy groups, the state funds provided to the agency running the required long term care ombudsman program in New York is less than one-fifteenth that of California, which has fewer nursing home residents. As a result, the capacity of the agency to monitor the performance and standards of care in long-term care facilities for the elderly in New York is severely compromised. This has significant consequences for the well-being of those who are unable or afraid to report nursing home abuse.

Some family members of residents who suspect some type of abuse have taken to installing hidden cameras in the room. These so-called granny cams have been instrumental in bringing to justice staff members that were recorded being abusive or neglectful. However, legal and civil rights issues have prevented legislation from passing that would make video monitoring a requirement in nursing homes despite the growing abuse and neglect problems in New York as well as the rest of the country.

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Septic Shock is one of the most devastating and unnecessary conditions that residents of nursing homes can experience. Sepsis is a condition that can cause extremely low blood pressure which, in turn, inhibits blood from circulating properly. Residents at nursing homes are often more likely to develop conditions like sepsis since their immune systems are more easily compromised. Patients are considered to be in septic shock when, after being treated with antibiotics and intravenous fluids, their condition doesn’t improve. The outcome of septic shock can have fatal consequences, such as organ failure. Additionally, the mortality rate for septic shock is 25%-50%.

Some symptoms of sepsis are chills, high heart rate, fever, or hypothermia. Residents of nursing facilities can develop sepsis when their caretakers aren’t attentive to their needs. Sepsis can develop from something as small as a bed sore. If the patient is bed-ridden and the caretaker doesn’t shift the resident’s body weight enough, the constant stagnant weight will cause sores to develop on the affected skin. Infection can develop from bed sores that aren’t tended to. Caretakers that neglect to move patients around are likely to neglect patients with bed sores, and thus the patient could develop a case of sepsis.

Fortunately, ailments like bed sores and sepsis are easily avoided if the caretakers are vigilant. Constant care nursing homes have a difficult time staffing a crew of certified and well-trained nurses. Because of this, nursing homes usually resort to hiring less educated candidates that aren’t equipped to handle the arduous task of caring for multiple high-needs patients. When nursing homes don’t hire qualified people the consequences are devastating for the residents, families, and employers alike. Many advocacy groups and legal practices try to keep nursing facilities accountable for damages experienced by residents. Until nursing homes can figure out a way to attract and keep qualified caretakers, they will find themselves under legal and moral scrutiny.

Nursing home “care” may border on abuse in some states, according to a report released last month by advocacy group Families for Better Care. The Florida-based group graded states on several criteria including average employee hours per resident per day, care staff to resident ratio, and health inspection score. Hawaii, Alaska, and Maine received the highest scores, but the report declared nursing homes in Texas, Georgia, and Louisiana inadequate.

Nursing home staff are responsible for providing excellent care for their elderly residents. However, nursing homes across the country continue to fail to provide even adequate care. Nursing home residents who are not receiving proper care can suffer injuries from falls, bedsores, malnutrition, and physical and emotional abuse.

Laws passed in several states last year allowed the use of hidden cameras in nursing home rooms, which have improved the standard of care according to inspectors. Last year in Oklahoma, a state that received an “F” rating from Families for Better Care, a video camera caught a nurse forcefully shoving food into a 96-year-old woman’s mouth. Similar scenes of abuse have been captured by cameras in other homes.

One of the most substantial barriers to providing effective care is the lack of well-trained nursing home staff. According to July’s report, a paltry seven states provided residents with more than one hour of professional care each day, and a vast majority of states gave residents less than three hours of direct daily care. Brian Lee, the executive director of Families for Better Care, called nationwide nursing care “slipshod” and blamed it for “thousands of painful or deadly blunders.”

“It’s beyond time that states take a hard look at their nursing home care and figure out what’s working so residents receive safer, more affordable care,” Lee said.