From 2009 to 2011, 78-year-old Esther Piskor began to exhibit bruising and other injuries that concerned her son, Steve Piskor. Despite the unexplained injuries, she refused to discuss it and slipped into depression and silence. The answers that Steve received from the staff ranged from “a fall” to “bruising is normal for someone her age.” He made numerous attempts to report his concerns to the administrators of MetroHealth's Prentiss Center for Skilled Nursing Care on Scranton Road in Cleveland, however, they fell upon deaf ears.
He was not content with the answers he got from the staff nor the fact that new injuries would continue to appear, so he took matters into his own hands. During one visit, he placed a hidden camera in his mother’s room and what he saw shocked him beyond belief. In one of the videos, he saw one of his mother’s aids forcefully lift her from the wheelchair she was sitting in, toss her on the bed so hard that her legs struck the wall.
In another video, the same aid was seen yelling in her face, tossing the wheelchair and then hitting her on the head. The aid, Virgen Carabello, was arrested, convicted and sentenced to 10 and a half years in prison for the mistreatment and neglect of her patients.
Although Esther passed away in 2018, Steve continues to advocate for her and others in nursing care, pushing the state legislature in Ohio to pass a measure called “Esther’s Law” that would allow cameras to be installed in the rooms of nursing homes.
According to the Nursing Home Abuse Guide, there are over 3.2 million adults living in nursing homes and other long term care facilities in the U.S. Nearly 40 percent of all adults will a nursing home at some point during their lives, a number that is expected to increase as America ages. To be clear, most elders are well-cared for but even one case of abuse is too many.
But here are some facts that came out during Congressional hearings – for every case of abuse that is reported in a residential care setting, more than five cases go unreported. Another report found that an examination of nursing home records conducted over a two-year period showed that nearly 1 in 3 nursing homes were cited for violations that had the potential to cause harm and almost 10 percent of all nursing homes have violations that caused actual harm, serious injury or placed residents in jeopardy of death.
A survey of nursing home residents showed that up to 44 percent of nursing home residents reported that they had been abused at some time in residency and nearly all of those surveyed (95%) had seen another resident neglected.
A study conducted by the U.S. General Accountability Office revealed that state regulators are likely to miss signs of abuse. The GAO found that 70 percent of state surveys missed significant deficiencies and 15 percent missed notice of actual harm or immediate jeopardy of a nursing home resident.
Due to reports like these, legislatures in all 50 states have passed anti-elder-abuse laws but nursing home abuse continues to occur.
Physical Abuse is a condition or event that causes physical harm. Physical abuse may be intentional such as hitting or pinching or it may be due to neglect including overuse of restraints and lack of physical care.
Sexual Abuse is unwanted sexual attention or exploitation. This includes sexual attention given to a patient who is unable to express his or her wishes or is cognitively compromised such as the patient with dementia.
Psychological Abuse is not easily identified but can include yelling, criticizing, humiliating or otherwise shaming the patient. Patients who are experiencing psychological abuse may exhibit behavioral changes.
Financial Exploitation occurs a caregiver takes advantage of access to a patient's financial matters, steals or otherwise compromises the patient’s financial status. This could include direct theft, theft from banking accounts or applying for credit in the patient’s name.
Neglect is often unintentional and a result of inadequate staffing. Neglect occurs when a patient’s needs are not taken care of such as personal hygiene care or when the patient is not provided food, clothing or water. Neglect can contribute to a number of medical conditions such as bedsores, skin infections, malnutrition, and dehydration.
Resident to Resident Abuse occurs when one resident is allowed to abuse another. Resident to resident abuse may be physical, sexual or psychological. Nursing home patients should be protected from other residents.
Obviously, the abuse itself is serious on its own, but the outcomes of those abused are even more upsetting. Research shows that those who have been the victim of abuse have a 300 percent greater chance of dying within three years following the incident than those who did not suffer from abuse.
Given the numbers previously mentioned, it seems that putting cameras into residents' rooms at nursing homes would make sense. But, there are legal and ethical considerations making this debate a bit of a minefield.
Those who advocate for cameras state that the benefit of putting a surveillance camera in a nursing home is the ability to monitor your family member's care. Families that suspect abuse or neglect can keep on eye caregivers. Being able to observe care from afar can give family members peace of mind that their loved one is being well taken care of. It can also serve as evidence if abuse is found. Even if there is no abuse, cameras can be helpful to observe if caregivers are using improper techniques that may injure a resident.
However, some nursing home administrators state that the Health Insurance Portability and Accountability Act (HIPAA) prevented such use of cameras. HIPAA is a patient privacy law intended to prevent patient health records from falling into the wrong hands. Advocates for cameras disagree, stating that HIPAA is being used as a tool by nursing homes to make it harder for residents and their family members to get conclusive evidence that abuse has or is occurring.
HIPAA regulations do not 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 his family members. However, while HIPAA doesn’t prevent cameras, this does not necessarily mean nursing homes have to allow them.
Then comes another argument. There are care facilities that cite the Right to Dignity, Respect, and Privacy regulations that give nursing home residents the right to be treated with dignity and respect. Cameras, they say, would violate these rights. Again, advocates state that if a family and a resident want a camera, there is no violation of privacy.
"There are privacy concerns around this, and not just for the family and the resident," said Attorney Connelly. "Most residents have roommates, and if there is audio on the camera, visits with the roommate's family members and friends could be recorded as well as any discussions with their physician around confidential health issues."
To get around such a concern, camera advocates suggest that nursing home supervisors should be given authority to cover or turn off the cameras when just such a situation arises. But Clara Berridge, an assistant professor of social work at the University of Washington, who has researched and written on this subject, cites a flaw in this argument, “we found that the real-life constraints on opportunities to selectively move or cover a camera in a given situation are not acknowledged in the state laws. These are chronically understaffed settings.” Meaning that there could be a long wait for a nursing supervisor to shut off a camera because they are providing care to another resident, adding to an already stressful environment.
And, Attorney Connelly sees yet another problem, the issue of consent. "Even if the resident in question has the capacity to consent to monitoring, what about the roommate's ability to provide consent? And what if their family is against it? Imagine the dynamic that is set up in this situation."
But Ester’s Law attempts to address some of these concerns. According to lawmakers, Esther’s law will be modeled closely after the surveillance laws in Illinois, requiring:
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.) and;
The resident of the nursing home or their appointed power of attorney would be required to agree to a surveillance device being installed in their room.
"I see the merit in the arguments from both sides in this debate," said Connelly. "But if this technology can help, we should utilize it in accordance with privacy laws and the ethical considerations of both the resident and the staff. Remember, installing cameras would not only help verify allegations of abuse or neglect for the residents but also exonerate facility staff who might be wrongly accused."
Here's the bottom line, installing video cameras in residents' rooms brings up some important privacy concerns. It also raises questions about whether an elderly resident should give family members permission to monitor their care. Remember, these cameras are recording 24 hours a day, 7 days a week. Residents could be watched while they are getting dressed, undressed, bathing, and entertaining friends.
And as we have seen with social media, there are always those people willing to use tools of "good" for malicious purposes -- including editing the video that could allow interactions to be taken out of context or releasing compromising video clips for public consumption. We see this in society when interactions between citizens and police are recorded on cell phones and only select clips are released. These clips, taken out of context, do not tell the whole story and have been responsible for riots and even deaths.
And then throw in family squabbles such as will or probate issues and the content on these tapes could become public fodder for years as each side in the matter edits and releases their version of events. And who in the family becomes the gatekeeper of these tapes?
There is no doubt that something must be done to stop the abuse of residents in long term care, but before we react with emotion around the issue of cameras, it's important that we consider and address the potential for the abuse of video monitoring and develop an appropriate policy and procedure that allows this to work for all concerned.
And just one other note, in discussing this with a staff member at a long term care facility, she made a statement that rings so true, "Abuse in this setting is a horrible thing and those responsible should go to jail for a long time. But it seems we only hear about the things that go wrong in long term care. It would be just as nice to hear about all the things we are doing right." Indeed.
The author, Don Drake, oversees Connelly Law's Community Education Programming. He is a retired licensed clinician in the Commonwealth of Massachusetts with over three decades of experience working with older adults diagnosed with HIV/AIDS, substance abuse disorders, chronic homeless and mental illness. Prior to his retirement, he was the director of a unique treatment program for older adults with histories of mental illness, cognitive disabilities, and addiction at Shattuck Hospital in Boston. He was also a director at Steppingstone, Inc. in Fall River, Massachusetts where he was the clinical trainer, program and curriculum developer for the agency and oversaw treatment programming for older adults. He has over 40 years of human service and law enforcement experience and has worked as an administrator at programs in Boston, Hartford, Providence, and Philadelphia, helping to structure, hire and train staff in providing behavioral and addictions treatments for adolescents and adult clients. Drake also worked as a trainer for the Massachusetts Department of Public Health presenting training on QPR, a suicide prevention curriculum for the general public, the Massachusetts Council for Problem Gambling and the Crisis Prevention Institute, an international training organization that specializes in the safe management of disruptive and assaultive behaviors. He is also a retired professional wrestler who is in the New England Professional Wrestling Hall of Fame. Drake can be reached at Connelly Law Offices, Ltd. at firstname.lastname@example.org