

(1.29.25) "In today's blog entry, I would like to follow up on Kathy Heren's post from Monday, presenting my perspective on the upcoming Electronic Monitoring Law, which is set to take effect on January 30," stated professional fiduciary and certified elder law Attorney RJ Connelly III. "As Kathy stated, this legislation allows residents of nursing homes and assisted living facilities in Rhode Island to engage in authorized electronic monitoring within their designated rooms or private living units and signifies a significant transformation in the approach care facilities are expected to follow concerning the safety and privacy of residents."
Under this legislation, an “electronic monitoring device” is defined as any photo, video, and/or audio surveillance equipment fixed in place and capable of broadcasting or recording activities and sounds occurring in the resident's designated space. This definition encompasses a wide array of technologies, including security cameras, audio recording devices, and other monitoring systems that can assure family members concerning the well-being of their loved ones.
"While implementing such technology appears to be a viable approach for enhancing health and safety oversight for residents, considerable opposition still exists to the widespread adoption of monitoring devices," stated Attorney Connelly. "Fewer than twenty states permit the use of cameras in long-term care facilities, with Rhode Island soon being one of them. Opponents contend that electronic surveillance may infringe upon the privacy and dignity of residents, potentially fostering an atmosphere of mistrust within these facilities. Today, we aim to examine the advantages and disadvantages of video monitoring, recognizing that there are no perfect solutions to the challenges we seek to address."
The Scope of the Problem
The issue of nursing home abuse has reached concerning levels in this country, representing a widespread problem that transcends mere statistical data. Recent findings from Nursing Home Abuse Justice indicate that there are approximately five million cases of elder abuse each year, revealing a concerning reality where nearly 10% of individuals aged over sixty report experiences of abuse. This statistic underscores a significant vulnerability within this demographic, as older adults, particularly those who are frail or suffer from cognitive impairments, encounter substantially increased risks of both abuse and neglect.

Abuse within nursing homes manifests in various forms, ranging from overt and violent acts to more insidious and subtle behaviors. Physical abuse may be inflicted directly by negligent or malicious staff members or even by fellow residents. Further, there are countless situations where negligence results in avoidable physical injuries.
A particularly alarming issue in nursing home settings is the prevalence of falls, with statistics indicating an alarming average of 1.5 falls per resident each year. Many experts suggest that many of these incidents can be attributed to staff members who are either inattentive or overwhelmed by their workloads. These factors create an environment where vulnerable residents are at heightened risk of injury.
For families of nursing home residents, being present is vital to address signs of abuse or neglect quickly. However, modern family dynamics often make this difficult, with many loved ones living far apart and missing important changes in behavior or physical signs of abuse. Video technology offers a way to bridge this distance, yet opinions vary on the effectiveness of surveillance cameras. Families must balance the benefits of virtual observation with concerns about privacy and the emotional impact of monitoring their loved ones.
The Arguments
Proponents of surveillance cameras argue passionately for their implementation within nursing homes, highlighting a significant advantage: the ability to monitor the care provided to loved ones. Families who harbor suspicions of abuse or neglect can discreetly observe the actions of caregivers, offering an added layer of security and assurance. The mere presence of a camera can grant family members a sense of calm as they gain firsthand insight into the daily routines and treatment their elders receive. Moreover, in the unfortunate event that abuse is detected, video can serve as crucial evidence, shedding light on the situation. Even when no outright abuse occurs, these cameras can reveal improper techniques or negligence that may inadvertently harm residents.

However, some nursing home administrators raise concerns regarding the implications of the Health Insurance Portability and Accountability Act (HIPAA), a law designed to safeguard patient privacy and protect sensitive health information from unauthorized access. They argue that HIPAA restrictions impede the use of surveillance technology in these facilities. Advocates for camera usage counter that nursing homes often leverage HIPAA to obscure potential abuse, complicating the process for families seeking definitive proof of mistreatment.
"Contrary to the assertions made by some nursing home officials, HIPAA does not categorically ban the installation of video cameras in nursing home settings, provided that the cameras are owned and installed by the residents or their families," said Attorney Connelly. "Nevertheless, despite the legal allowances under HIPAA, this does not compel nursing homes to permit their usage."
The debate deepens with the introduction of another critical argument: several care facilities invoke the Right to Dignity, Respect, and Privacy regulations. These regulations assert that nursing home residents deserve to be treated with dignity and respect. Opponents of camera surveillance claim that such monitoring infringes upon these fundamental rights. Yet, advocates contend that if both a resident and their family members consent to the presence of a camera, their autonomy should be respected, and the notion of privacy should not obstruct their right to ensure safety and accountability in care.

"There are other privacy concerns regarding the use of cameras in nursing homes, extending beyond the immediate effects on the family and the resident," said Attorney Connelly. "Most residents live with roommates, which means that if the cameras are equipped with audio capabilities, any visits from their roommate's family members and friends could be inadvertently recorded, along with sensitive discussions between residents and their physicians pertaining to confidential health issues."
States that allow cameras in rooms attempt to address the issue of patient confidentiality by allowing the transmission of sound and images to be disrupted during specified events and times. This leads to another challenge that could be monumental in some cases -- who will be responsible for activating or deactivating cameras during these identified situations?
Attorney Connelly points out, “If the responsibility is assigned to the floor supervisor, we may encounter significant difficulties. Like many human services facilities, nursing homes frequently face chronic understaffing issues. If a supervisor becomes preoccupied with another resident or an emergency occurs, this could result in delays that increase stress for staff, residents, and their families. These issues will likely need to be navigated as this new legislation is implemented, and exercising patience will be imperative.”
Other Concerns
"The emergence of social media has unveiled a disconcerting trend in which individuals distort platforms like YouTube and Facebook, designed for uplifting and positive interactions, to promote their malicious agendas," stated Attorney Connelly. "This exploitation frequently involves deliberately manipulating video content, where only selective clips are presented. As a result, the essential broader context is obscured, leading to misinterpretations that can ignite feelings of anger and distrust among viewers who are oblivious to the complete story."

Additionally, familial conflicts, such as those concerning wills or probate matters, could lead to the public release of content from these recordings, which either party may manipulate in a dispute. This situation begs the question -- who within the family would assume responsibility for the management and accessibility of these tapes?
This will be an evolving challenge, necessitating carefully developing a thorough policy and procedural framework. Such a framework must thoughtfully consider the diverse concerns and interests of all stakeholders involved—ranging from residents and their families to dedicated caregivers striving to provide quality support and facility management focused on operational excellence. Each group's voice will play a vital role in shaping a solution that fosters collaboration and understanding among all parties.
The Bottom Line
"In the ongoing dialogue surrounding the implementation of surveillance technology in long-term care facilities, there will be a need to find a harmonious balance between the promising benefits and the potential drawbacks," said Attorney Connelly. "If this technology can truly help improve care, we should embrace it while respecting privacy laws and the sensitivities of both residents and staff. Installing cameras could play a vital role in verifying claims of abuse or neglect, and equally important, they can help protect staff members from being unjustly accused."
"While it is essential to condemn any acts of abuse and to pursue justice for victims relentlessly, we must also take time to acknowledge and celebrate the tireless dedication of the vast majority of staff and administrators in these facilities," Attorney Connelly continued. "These individuals demonstrate an unwavering commitment to providing compassionate, high-quality care. Having spent considerable time in these facilities throughout Southern New England, I have witnessed firsthand their efforts to cultivate nurturing and safe environments for all residents, consistently prioritizing their well-being and dignity above all else."

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