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Cameras in Care Facilities: Balancing Safety and Privacy in Eldercare
Concerns about the well-being of elderly loved ones in assisted living and nursing homes are driving a surge in the use of surveillance cameras. Fueled by personal experiences and legislative momentum, the debate around monitoring devices in care facilities is intensifying, raising critical questions about resident safety, privacy, and the quality of long-term care. This article explores the growing trend of cameras in eldercare settings, examining the motivations behind their adoption, the legal landscape, and the ongoing discussions surrounding their impact.
A Family’s Discovery Sparks Change
Jean H. Peters and her siblings chose an assisted-living facility in Edina, Minnesota, for their mother in 2011. Initially, the location appeared ideal. “But then you begin to discover the reality,” Ms. Peters recounted.
Their mother, Jackie Hourigan, an 82-year-old widow with emerging memory issues, was frequently found still in bed when her children visited in late morning.
“Her personal hygiene was neglected, her clothing soiled,” explained Ms. Peters, 69, a retired nurse practitioner from Bloomington, Minnesota. “She was deprived of hydration and not assisted for meals.” Consequently, her weight dropped to a frail 94 pounds.
Alarmingly, Ms. Peters and her siblings also “observed unexplained bruises” on their mother’s arm. Their complaints to facility administrators – conveyed in person, via telephone, and through email – were met with “numerous justifications.”
Hidden Cameras Reveal Neglect
Determined to uncover the truth, Ms. Peters purchased a discreet camera. She and her sisters secretly installed it in their mother’s room, apprehensive about potential repercussions from the care facility if discovered.
Monitoring remotely through a smartphone application, the family witnessed firsthand Ms. Hourigan spending extended periods unkempt. They also observed and recorded an aide verbally reprimanding her and handling her roughly during dressing.
They further witnessed another aide rouse her for breakfast and then leave the room, despite Ms. Hourigan’s inability to independently open the heavy apartment door to access the dining area. “It was devastating to confirm our suspicions,” Ms. Peters stated.
In 2016, following a police report, a legal action, and her mother’s passing, Ms. Peters co-founded Elder Voice Advocates. This organization advocated for state legislation permitting cameras in residents’ rooms within both nursing homes and assisted-living facilities. Minnesota enacted the law in 2019.
Legislative Push for Cameras Gains Momentum
Despite ongoing debate, the use of cameras in care environments is becoming increasingly prevalent. By 2020, eight states, in addition to Minnesota, had passed legislation authorizing them, according to the National Consumer Voice for Quality Long-Term Care. These states include Illinois, Kansas, Louisiana, Missouri, New Mexico, Oklahoma, Texas, and Washington.
The legislative drive has accelerated subsequently, with nine additional states enacting similar laws: Connecticut, North Dakota, South Dakota, Nevada, Ohio, Rhode Island, Utah, Virginia, and Wyoming. Legislation is currently under consideration in several other states.
California and Maryland have implemented guidelines, rather than formal laws. State governments in New Jersey and Wisconsin offer cameras to families who have concerns about the safety of their relatives.
However, some proposed bills have been unsuccessful, most recently in Arizona. In March, for the second consecutive year, a camera bill received overwhelming approval in the House of Representatives but did not proceed to a vote in the State Senate.
State Representative Quang Nguyen, the Republican primary sponsor of the bill who intends to reintroduce it, stated, “My inclination is to believe special interests have something to do with it.” He cited opposition from industry groups, including LeadingAge (which represents nonprofit aging services providers in Arizona), as a contributing factor in the bill’s failure.
The American Health Care Association, whose members are primarily for-profit long-term care providers, does not have a national stance on cameras. However, its local affiliate also opposed the Arizona bill.
Debate and Concerns
“Those legislators who vote against these measures should be publicly held accountable and told, ‘You are indifferent to the well-being of the elderly,’” asserted Mr. Nguyen.
While some camera laws are limited to nursing homes, most also encompass assisted-living facilities. The majority mandate documented consent from the resident (and roommates, if applicable). Some regulations require signage informing staff and visitors that monitoring may be occurring.
These laws commonly prohibit tampering with cameras or penalizing residents for their use. They often address “protocols regarding access to recordings and their admissibility in legal proceedings,” noted Lori Smetanka, executive director of the National Consumer Voice.
The extent to which facilities adhere to these laws remains uncertain. Several family members interviewed for this article reported being initially informed by administrators that cameras were not permitted, yet the issue was not subsequently raised, and the cameras remained in place.
Ms. Smetanka suggests that the heightened legislative activity is partially attributable to the Covid-19 pandemic, during which families were barred from facilities for extended periods. “People desire direct observation of their loved ones’ care,” she explained.
Technology and Evolving Perceptions
Technological advancements have likely played a role, as individuals have become more accustomed to video communication and virtual assistant technologies. Cameras have become pervasive – in public areas, workplaces, law enforcement vehicles, and personal devices.
Initially, the impetus for cameras stemmed from anxieties about resident safety. Kari Shaw’s family, for example, had previously experienced theft of her mother’s prescribed pain medication by a trusted home care nurse.
Consequently, when Ms. Shaw, residing in San Diego, and her sisters relocated their mother to assisted living in Maple Grove, Minnesota, they promptly installed a motion-activated camera in her apartment.
Their mother, 91, has significant physical limitations and relies on a wheelchair. “Why wait until an incident occurs?” Ms. Shaw questioned.
Eilon Caspi, a gerontologist and elder mistreatment researcher, emphasized that “individuals with dementia are particularly vulnerable” and “may lack the capacity to report or accurately recall incidents.”
Cameras for Connection and Contact
More recently, families are utilizing cameras primarily to maintain communication. Anne Swardson, who divides her time between Virginia and France, employs an Echo Show for video calls with her 96-year-old mother in memory care in Fort Collins, Colorado. “She cannot operate buttons, but the screen activates automatically,” Ms. Swardson explained.
Art Siegel and his siblings faced challenges in communicating with their 101-year-old mother in assisted living in Florida; her mobile phone frequently lost power due to forgotten charging. “It was concerning,” said Mr. Siegel, who lives in San Francisco and resorted to contacting the facility staff for welfare checks.
Now, with a traditional telephone positioned near her preferred chair and a camera focused on the chair, they are able to ascertain when she is available for calls.
Do Cameras Improve Care Quality?
As the discussion surrounding cameras persists, a fundamental question endures: Do they enhance the standard of care? “There is no research foundation to support these legislative efforts,” stated Clara Berridge, a gerontologist at the University of Washington specializing in technology in elder care.
“Do cameras effectively prevent abuse and neglect? Do they motivate facilities to revise policies or improve practices?” she inquired.
Privacy and Staff Concerns
Both proponents and detractors of cameras express apprehension regarding residents’ privacy and dignity in environments where personal care is provided.
Lisa Sanders, a spokeswoman for LeadingAge, stated, “Consider also the necessity of ensuring privacy during interactions related to spiritual, legal, financial, or other sensitive matters.”
Although cameras can be deactivated, relying on residents or overstretched staff to consistently do so may be impractical.
Furthermore, Dr. Berridge suggests that surveillance may create an environment where staff members are treated as “presumed offenders.” She noted instances of facilities installing cameras in all resident rooms: “Everyone lives under observation. Is this the desirable future for our elders and ourselves?”
The Need for Comprehensive Solutions
Ultimately, experts contend that even when cameras identify issues, they are not a replacement for systemic improvements in care. Effective solutions require enhanced family involvement, improved staffing levels, better training, diligent facility oversight, and more proactive federal and state regulation.
“I view cameras as indicative of a deeper problem, not a resolution in themselves,” Dr. Berridge concluded. “They offer a superficial fix that can divert attention from the more complex challenge of delivering high-quality long-term care.”