Cameras in Long-Term Care Rooms - Issues That Still Need to be Addressed
by Don Drake, Connelly Law Offices, Ltd. 4.17.24
"We have decided to update and reissue a previously shared blog on cameras in long-term care rooms, following the excellent guest blog by Kathleen Heren, Rhode Island's Long Term Care Ombudsman," states RJ Connelly III, certified elder law attorney and professional fiduciary. "Currently, only a small number of states have enacted laws allowing the installation of cameras in private rooms of senior living or assisted care facility residents. One of the issues here in Rhode Island centered around camera placement in shared rooms, which was addressed in an updated version of the proposed legislation. Other states have also addressed this, and these states have a legal framework defining who can grant consent in such circumstances. In today's blog, we will explore the importance of this issue and highlight other concerns that need to be addressed."
The Numbers
Research has shown that a sizable proportion of the elderly population residing in nursing homes experience some form of abuse or neglect. Approximately 10% of elderly nursing home residents are victims of abuse, with elderly women being at a higher risk than elderly men. However, the World Health Organization (WHO) suggests that the prevalence of nursing home abuse worldwide is even higher, at 15.7%.
In 2020, at the height of COVID and the mandatory lockdowns, the incidence of elder abuse increased significantly. The isolation of nursing home residents from their families played a significant role in the surge of such cases. According to a study, nursing home abuse rose sharply by 83.6% during this period, with one in every five nursing home residents experiencing some form of abuse. Experts estimate that up to 260,000 nursing home residents experience abuse or neglect annually, which is a worrisome trend.
Although the number cited is high, it is believed that nursing home abuse is underreported. Studies indicate that only one out of every twenty-four cases of abuse in nursing homes are reported, which is a cause of concern. Given the vulnerable nature of the elderly population, measures must be put in place to ensure that nursing home residents are treated with the respect and dignity they deserve. But are cameras the answer?
Washington Getting Involved
During recent Congressional hearings, it was revealed that the number of unreported cases of abuse in residential care settings is alarmingly high. For every case of abuse that is reported, there are more than five cases that go unreported. Furthermore, a recent report found that nearly one in three nursing homes were cited for violations that posed a serious risk of harm to residents over two years. Shockingly, almost ten percent of all nursing homes were found to have violations that caused actual harm, serious injury, or placed residents in jeopardy of death. These statistics are a cause for concern and highlight the need for greater oversight and regulation of residential care facilities to ensure the safety and well-being of our most vulnerable populations.
A study by the U.S. General Accountability Office has also raised concerns about state regulators' ability to identify and address instances of abuse. The report revealed that 70 percent of state surveys failed to identify significant deficiencies, while 15 percent failed to report actual harm or immediate jeopardy to nursing home residents. This lack of oversight and regulation is profoundly troubling and underscores the need for increased vigilance and accountability in the care of vulnerable individuals.
Despite the efforts to combat elder abuse in nursing homes, cases of abuse and neglect are still prevalent. The issue has prompted the enactment of anti-elder-abuse laws in all fifty states, yet the problem persists. Despite the regulations in place, reports of mistreatment, physical abuse, and financial exploitation continue to surface, raising concerns about the safety and well-being of elderly residents in care facilities. The lack of proper oversight and accountability, understaffing, and inadequate training of caregivers are among the factors contributing to this problem's persistence.
Identifying Abuse
Abuse in nursing homes is a serious issue and is identified as any intentional or unintentional harm caused by nursing home staff to their patients. This can include:
Physical Abuse
Physical abuse is a distressing condition or occurrence that inflicts physical harm or injury upon a person. This can be a result of intentional actions, such as hitting, pinching, or other forms of violence, or it can be due to neglect, including overuse of restraints, deprivation of physical care, or failure to provide basic needs such as food, water, or medical attention. The effects of physical abuse can be severe and long-lasting and can include physical pain, emotional distress, and even permanent disability or death.
Sexual Abuse
Sexual attention that is unwelcome or coerced and that involves any physical exploitation is considered sexual abuse. This type of abuse can occur in a variety of settings, including healthcare facilities. It can include patients who are unable to give consent or make decisions due to cognitive impairment, such as those with dementia.
Psychological Abuse
Psychological abuse is a form of mistreatment that is often difficult to pinpoint as it does not leave physical marks. This type of abuse can involve shouting, condemning, ridiculing, or using other methods to belittle and shame the victim. Psychological abuse can have a significant impact on the victim's mental and emotional well-being and may lead to changes in their behavior.
Financial Exploitation
Financial exploitation of patients by their caregivers is a serious concern. It involves situations where a caregiver who has access to the patient's financial affairs misuses that access to steal or compromise the patient's financial standing. This could take various forms, including outright theft, unauthorized withdrawals from bank accounts, or fraudulent applications for credit or loans in the patient's name. Such violations can have severe consequences for the patient, including financial ruin, loss of assets, and damage to their credit score.
Neglect
Neglect is a serious concern in the healthcare industry that can have devastating consequences for patients. Neglect typically occurs when there is a staff shortage to care for patients properly. This can lead to patients' needs being left unattended, such as lacking personal hygiene care or inadequate food, water, or clothing. When patients are neglected, it can result in a range of medical issues, including bedsores, skin infections, malnutrition, and dehydration.
Resident-to-Resident Abuse
Resident-to-resident abuse is an alarming phenomenon that happens when one resident becomes a perpetrator and subjects another resident to physical, sexual, or psychological harm. Implementing robust measures and protocols is essential to safeguard nursing home residents from such abuse. The well-being and safety of every resident must be the top priority of nursing home staff and management.
Outcomes of Abuse
Abuse is a serious issue that can have devastating outcomes for those who experience it. Shockingly, research indicates that victims of abuse have a 300 percent higher likelihood of dying within three years after the incident as compared to those who have not experienced abuse.
Given these alarming statistics, it seems reasonable to suggest that installing cameras in residents' rooms at nursing homes could be an effective solution. However, legal and ethical considerations make this debate complex and challenging.
Cameras as a Tool
Those who support the use of cameras argue that they provide a valuable tool for monitoring the care of family members. In cases where abuse or neglect is suspected, cameras can enable family members to keep a watchful eye on caregivers, providing peace of mind that their loved one is receiving appropriate care. Such footage from cameras can serve as evidence in cases of abuse. Even in the absence of abuse, cameras can help detect improper techniques that could potentially injure a resident.
The use of cameras in nursing homes has been a controversial topic for many years. While some nursing home administrators argue that the Health Insurance Portability and Accountability Act (HIPAA) prohibits the use of cameras, advocates for cameras claim that HIPAA is "just an excuse" to prevent residents and their families from obtaining concrete evidence of abuse.
"It is important to note that HIPAA regulations do not necessarily preclude the use of video cameras in a nursing home setting, as long as the camera is owned and installed by the nursing home patient and/or their family members," said Attorney Connelly. "Even so, nursing homes are not legally obligated to allow cameras on their premises."
Another argument against the use of cameras in nursing homes is that they violate the Right to Dignity, Respect, and Privacy regulations that are in place to protect nursing home residents. Some care facilities argue that cameras would infringe on these rights. Nevertheless, advocates for cameras contend that if a resident and their family wish to use a camera, there is no violation of privacy and that it can help protect the resident's rights.
Advocates of camera use suggest that nursing home supervisors should be able to cover or turn off the cameras in such situations. However, Clara Berridge, an assistant professor of social work at the University of Washington who has researched and written on this subject, points out a flaw in this argument.
She states that "the real-life constraints on opportunities to move or cover a camera in a given situation selectively are not acknowledged in the state laws. These are chronically understaffed settings." This means that a nursing supervisor could wait a long time to shut off a camera because they are providing care to another resident, which can increase stress levels in an already overstressed environment.
In many states, they are attempting to address these issues through the following recommendations:
No hidden cameras.
Signs on the door notifying of surveillance.
Consent allowing cameras to be shut off during certain times (bathing, doctor’s exams, etc.)
If the resident or their appointed power of attorney agreed, the family would install a surveillance device in the nursing home's room and be responsible for its maintenance and use.
In a shared room with a monitoring camera, the other resident has a legal right to refuse to stay in the same room and request to be relocated to a different room.
Social Media and Cameras
The oft-quoted assertion, "a lie is halfway round the world before the truth has got its boots on," is particularly relevant in the context of social media and the misuse of camera-generated videos. A Massachusetts Institute of Technology (MIT) study has revealed that a false story typically reaches 1,500 X (formerly Twitter) users within 10 hours, while true stories require at least 60 hours to reach that many users. Moreover, genuine stories seldom attain an audience of 1,000 users, while the top one percent of false stories succeed in reaching 100,000 users. The issue, however, is not technology per se but how it is employed.
"The ubiquitous utilization of social media has revealed that individuals can exploit seemingly benign tools for malicious purposes, particularly concerning video footage," stated Attorney Connelly. "The selective manipulation of videos, such as through the editing of interactions or the presentation of out-of-context clips as evidenced on social media platforms, has become increasingly prevalent. Such practices can create public perception nightmares for families and long-term care providers alike."
This practice has been particularly harmful when interactions between citizens and law enforcement are recorded on cell phones and only specific clips are shared with the public. In such cases, these clips often fail to convey the whole story and have been known to incite riots and even tragic deaths.
"Family disputes, such as those that arise from probate or will issues, have the potential to turn the content of videos generated within long-term care facilities into a source of public fodder for an extended period," said Attorney Connelly. "Given that family members on opposing sides of a matter may edit and release their version of events on social media, there is a significant risk that the representation of the truth will become distorted. Moreover, who would assume the gatekeeper role for such videos without a clear legal framework is unclear. This underscores the need for a comprehensive and unambiguous regulatory regime that considers the interests of all stakeholders involved."
A Final Word
During a recent conversation with a member of staff at a long-term care facility, the topic of abuse and the use of video monitoring within such settings was discussed. The staff member made a statement that resonated particularly strongly: "Abuse within this setting is an abhorrent act, and those responsible should receive severe punishment. However, we often only hear about the negative occurrences in long-term care facilities that destroy morale. It would be equally beneficial to acknowledge the positive work we are doing."
"This statement highlights the need for a balanced and nuanced approach to reporting on issues within long-term care facilities," Attorney Connelly said. "While it is crucial to address instances of abuse, it is equally important to acknowledge and celebrate the hard work and dedication of administrators and staff members who strive to provide high-quality care to residents. By highlighting these successes, we can better understand what is working and build upon it, thereby improving the quality of care for all individuals in long-term care while reducing the number of abuse incidents."
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