In Nursing Homes, Eyes That Never Turn Away
Should you be able to place a video camera in your parent’s room at a nursing home?
Cindy King votes yes. Her mother suffered a major stroke, and when Ms. King could no longer care for her at home, she started looking for a decent facility.
“I did a lot of research,” she told me in an interview. “I was under no illusion that there was a perfect place.”
The home she chose in 2011 was a short distance from her house in Chicago, so she could visit two to three times a week. She made a point of coming on days when her mother, who no longer spoke much, was given a shower. “It gave me a chance to look at her body,” said Ms. King, alert for bedsores or bruises.
So it came as a shock last year when her mother, taken to an emergency room because of unusual blood test results, began to talk, haltingly, about a “mean” aide who had elbowed her in the chest.
“I hadn’t heard her speak so much in over a year,” said Ms. King, 43. Apparently prompted by the sight of a police officer who happened to be in the E.R., her mother described the aide but didn’t know her name or exactly when the assault had happened. But, she said, “I fought back.”
Ms. King fought nausea.
She decided to buy an inexpensive video camera and install it in the room where her mother lives alone, without a roommate. “She is less and less vocal, less and less alert,” Ms. King said of her mother, who’s 72. “How can I protect her?”
But the bylaws of the nursing home (which, fearing retaliation, Ms. King declines to name) prohibited cameras, saying they violated federal privacy laws under the Health Insurance Portability and Accountability Act. That’s untrue if the families themselves own the cameras and the recordings, several legal sources told me, but invoking Hipaa has become a standard response from some health care providers.
Ms. King thinks nursing home residents should be able to give their families permission to monitor their care.
The Illinois attorney general, Lisa Madigan, whom Ms. King buttonholed at a luncheon this summer and who’d been hearing similar complaints from other constituents, agrees. Her office has begun drafting legislation that would allow residents and their families to put cameras in their rooms in the state’s 1,200-plus nursing homes. The families would own and install the cameras; facility administrators would not have access to them.
Ms. Madigan, a Democrat, hopes the bill will be introduced in January; she believes it will pass and be signed by the governor next year, to take effect in 2016.
In Illinois, cameras in residents’ rooms aren’t illegal, but nursing homes can ban them. But outside, “cameras are everywhere,” Ms. Madigan noted. “You drop off your dog in a kennel, and you can watch on your computer. And the one place you can’t have one is where your frail, fragile loved one is? That doesn’t make sense.”
To protect residents’ privacy, they or their health care proxies will have to request the camera; roommates would also have to consent. Intimate acts — bathing, dressing — take place in nursing home rooms, after all. The law would also require some sort of posted notification telling visitors and staff that they may be recorded.
Wouldn’t that warn off possible abusers? That’s the point.
“We’re happy with prevention,” Ms. Madigan said. “When people know they’re being watched, most will behave properly. For too long, there’s been nobody watching.” And if cameras don’t deter abuse, the recordings will be admissible in court.
Family members might also document inactivity: staff failing to turn a bed-bound patient every two hours to prevent bedsores, for instance. Ms. King, whose mother is losing weight and has trouble eating, wonders whether the staff is taking enough time to hand-feed her.
Four other states — Texas, Oklahoma, New Mexico and Washington — have laws or regulations explicitly permitting cameras in nursing home rooms. Maryland’s guidelines allow facilities to agree or prohibit them.
Such surveillance raises complex questions, including the rights of staff members, as Jan Hoffman reported in Science Times last year. I’m interested in your responses: Would you consider a camera in your relative’s room, or in your own? If you work in a nursing home, are you O.K. with being recorded?
You could argue that cameras represent a failure, of sorts. Are they really the best way to protect vulnerable nursing home residents? Shouldn’t a well-trained, attentive staff with responsible administrators — the people on the scene, entrusted with their care — be able to stop abuse?
But nursing homes remain chronically understaffed, and Ms. King wants a camera. With three children still at home, “I stretch myself as much as I can, but some weeks I can’t be there three days.”
Advocates at the National Consumer Voice for Quality Long-Term Care support such laws — cautiously. They could be particularly valuable when residents have dementia or are otherwise unable to report mistreatment, said Robyn Grant, director of public policy and advocacy.
But cameras are no panacea, she warned. Not all abuse takes place in residents’ rooms. And unless family members monitor hours of video, recording an incident isn’t the same as knowing about it.
“I think there’s a place for them,” Ms. Grant said. “But no one should think of cameras as a substitute for being there, communicating with the staff, monitoring, seeing things with your own eyes.”