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Cameras Rate Low for Ensuring Nursing Home Care

By Jennifer Anderson

Privacy issues register concern among experts and survey respondents.

Relatives of nursing home residents want to know their loved ones are being treated kindly and doing well, but they do not necessarily want cameras installed, a new study finds.

"I did think cameras were going to rank more highly [among respondents]," says Gaby Loria, author of the study, "Consumer Perspectives on Nursing Home Surveillance."

A market research associate with Texas-based Software Advice, Loria says her research showed that while adult children want more information on nursing home residents' treatment, they would prefer methods that are less invasive, costly, and time consuming.

Loria says she pursued the report in response to what she described as "a fair amount of discussion" on the topic and what the report describes as "horrifying images" in the media of elder abuse caught on hidden cameras.

Data for the report came from a two-day online survey involving eight questions and 1,945 responses from adults in the United States who identified themselves as having a loved one in a nursing home. The report did not distinguish between private and public nursing homes, or between for-profit and nonprofit homes.

A 2012 fact sheet produced by the National Center on Elder Abuse and cited in Loria's study reported that more than 50% of nursing home staff admitted to mistreating older patients, either through physical violence, mental abuse, or neglect. 

Based on 2,000 interviews with nursing home residents, the same fact sheet reported that 44% of residents said they had been abused, and 95% said they had been neglected or had seen another resident neglected.

Laws to Protect Residents
In the report, Loria explains that Software Advice launched the study expecting that suspected abuse would be the most powerful motivating force for wanting to install a camera in a loved one's nursing home room. The company's data indicate, however, that the second most popular response—not receiving enough updates on an elder's condition—was almost as important.

"This stands to reason, as putting a loved one's care in someone else's hands can be a guilt-inducing, gut-wrenching process," the report states. Naturally, family members expect reassurance from nursing home staff that their loved one is receiving the highest quality care.

Several policy makers agree and are weighing in on the right to install surveillance cameras.  While no federal law prohibits or authorizes the use of cameras, more than a dozen states have attempted to pass legislation, and five have succeeded, according to the study.

Those states—New Mexico, Oklahoma, Texas, Washington, and Maryland—all have different requirements concerning surveillance cameras. As the study explains, Oklahoma allows cameras in resident rooms after a form notifying the facility has been filed. In Texas, it's up to the resident to pay for installation and maintenance, and the nursing home may require the camera to be placed in plain sight. In Maryland, the legislature enacted guidelines for facilities that voluntarily allow electronic monitoring.

Other Ways to Improve Care
Not all experts in elder care agree cameras offer the best choice for ensuring quality care in nursing homes.

"In most cases [cameras] would be a poor substitute for the real problems stated in the study: general mistrust and poor communication," says Lisa Gibbs, MD, chief of the Division of Geriatric Medicine and Gerontology and Ronald Reagan Endowed Chair in Geriatrics at the University of California, Irvine.

She adds that cameras would not help the most vulnerable residents—those with no family or advocates—and that often patients with disabilities are assisted in bathrooms and showers. "If cameras are placed there, or such that patients are exposed during bedding changes or wound checks, we must ethically consider whether resident/patients are being violated as an unintended consequence," Gibbs said.

To improve the care of older adults, she recommends improving staff-to-patient ratios as well as other less-invasive communication technologies that would keep family members informed without violating residents' privacy.

A majority of study respondents suggested that rather than camera installation, they would prefer other technologies such as video chatting, checking an online log of the resident's activity, texting staff to request updates or pictures, and regularly e-mailing the resident.

Gibbs notes that cameras could be effective for staff education in tasks such as proper resident handling and techniques for resident transfers or turning, or to protect staff against misplaced allegations.

No Substitute for Cameras
While Mike Moran, founder of Moran Elder Law in Santa Ana, California, agrees that cameras could protect staff from unfounded allegations, he also notes that elder abuse is widespread enough to support his successful, four-attorney firm dedicated solely to victims of physical abuse in nursing homes. He said his firm is one of approximately 30 in California alone.

"I wish they all provided great care and I wasn't as successful," Moran says. "The fact is there are enough bad nursing homes that we fill a void." He says he "absolutely" believes cameras should be installed, that cameras should be out in the open, and that there should be laws in place allowing for cameras. 

Regarding the other technologies cited in the report as preferred alternatives to cameras such as video chatting, online logs of the residents' activities, and staff updates via text messaging, he described staff updates as self-serving and not credible. He says only a camera would detail in real life what is actually taking place in the room.

Ensuring Quality Care
Ann Chartier, founder of Ontario, Canada-based Elder Pilot, an electronic navigation system for nursing home care, acknowledged there is no perfect answer to whether a camera should be installed in a nursing home resident's room.

"Cameras need to be looked at with thoughtful reflection, discussion, and understanding of the legalities to make sure we are ensuring residents' privacy and the privacy of others," she says.

Chartier noted that she found alarming the statistic in the report that 50% of nursing home staff admitted to mistreating older patients. "I was absolutely shocked, I must say, when I read that," she says. 

In Ontario, she explains, nursing homes are regulated under the Ministry of Health and Long-Term Care, with uniform standards of care. Prior to starting work in a nursing home, all employees are subject to a criminal reference check, including a vulnerable sector clearance.

The staff must provide a signed declaration if there have been any changes at any time after the screening has been conducted, and current employees may be subject to additional randomized criminal reference checks.

Chartier says she believes building a team and enforcing better care would be preferable to installing cameras.

Software Advice takes no stand one way or the other on installing cameras in nursing home residents' rooms but encourages nursing home staff members to do a better job of eliminating distrust and engaging families, helping to keep them in the loop regarding their loved ones' care.

— Jennifer Anderson is a freelance health and science writer based in Falls Church, Virginia.