An In-Depth Look at Using Cameras to Monitor Professional Caregivers

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In this age of ever-evolving technological capabilities, people are more connected than ever before. New breakthroughs and novel takes on existing technologies have allowed us to side-step many of the implications of distance and time and feel more secure. Many of these advancements have proven useful in surprising settings, such as elder care. But as our abilities expand, questions arise regarding privacy, dignity and misuse.

A hotly debated example is the use of cameras and other recording devices to monitor the care that vulnerable elders receive in their own homes and in long-term care settings. Safety and quality care are top concerns for seniors who live alone and especially for those who rely on hired help to maintain their health and independence. Most people have heard cautionary tales about negligent care providers, causing families and seniors alike to be apprehensive about hiring in-home care or entertaining a move to a senior living facility. These concerns are well-intentioned, as caregivers only want the best for those they love.

But, it is impossible for one person to provide around-the-clock care and supervision. As seniors’ needs increase and caregivers struggle with burn out, there are few solutions out there that do not involve bringing in outside help from “strangers.” To feel more comfortable with this arrangement, many caregivers have applied a technique used to monitor childcare workers (nanny cams) and applied it to elder care, resulting in so-called “granny cams.”

Trust is a fundamental part of any relationship, especially those between seniors, their family members and professional caregivers. Establishing trust takes time, but most care providers and receivers do not have the luxury of getting to know one another well before their relationship begins. Can installing cameras help to strengthen or undermine the trust a family places in professional caregivers and long-term care facilities? Is this technology beneficial or intrusive when it comes to monitoring the care an aging loved one receives? This complex issue has many legal and ethical implications, and they are worth exploring before making a decision for or against video surveillance.

Potential Benefits of Installing Cameras

There are a few reasons I can see that could lend strength to the argument for using cameras to observe interactions between seniors and caregivers.

The obvious advantage is a family’s ability to monitor the care a loved one receives, even if they cannot be present. This can help provide peace of mind and a higher level of involvement to family members near and far. Any kind of abuse, neglect, theft or other misbehavior would be recorded. Not only would this alert a senior’s family to wrongdoing, but it would also serve as concrete evidence as grounds for rebuke, termination or even the filing of criminal charges. In a more idealistic scenario, the family would also be able to observe the wonderful care and compassion that many staff members provide, which is an important step in establishing a trusting relationship.

If home care aides or long-term care staff are aware of the cameras, it could also reduce the likelihood of a loved one’s mistreatment, much in the same way signs alert the public to the presence of surveillance systems, guard dogs or home security systems to deter crime.

While the goal of using cameras is usually to provide peace of mind to families and added protection for seniors, surveillance can also protect the professionals who are providing hands-on care. If an accident does occur, video can quickly eliminate any suspicions that an aide or staff member is at fault. This is actually very important, especially for seniors who are prone to falls or bruising. Even the most gentle and attentive caregivers, whether family members or hired professionals, have had falls and injuries occur on their watch. The ability to confirm that a mishap was, in fact, an accident could help prevent unnecessary drama and even the departure of an excellent, well-meaning caregiver.

Potential Drawbacks of Installing Cameras

In some cases, cameras can help to kickstart the development of trust between staff and families, but in others, the presence of cameras may undermine this initiative from the get-go. Each person has their own ideas and opinions regarding trust and privacy, but the understanding is usually that one must give trust and respect in order to receive these things in return. Some professional caregivers may fully understand and agree with a family’s decision to opt for heightened supervision, while others may resent entering a work environment where they are automatically met with distrust and suspicion.

Genuine friendship between caregivers and care receivers care could be inhibited by cameras as well. Quality care providers make an effort to get to know their clients and residents. Learning about their backgrounds, their family members, their hobbies and their careers is an important part of promoting comfort and trust. Smiling and joking when appropriate and physical gestures like holding hands or giving hugs are important methods for diffusing tension, embarrassment and discomfort in elder care. Constant supervision could change that dynamic.

There would be an awareness on the part of the caregiver that conversations or gestures could be taken out of context and misinterpreted by people monitoring the situation. They might also be consciously or subconsciously concerned about performing their duties “by the book,” so that anyone watching can’t criticize their work. Cameras may ultimately deter aides and staff from forming friendships with clients and getting creative with how they provide care as well as set expectations of strict professionalism and efficiency in their work. Some caregivers may handle this better than others, but for many, the camera could cause them to forgo even positive interactions for fear of misunderstandings.

While some caregivers are uncomfortable with the idea of being filmed, this concept doesn’t just apply to them. For many elders who require assistance with activities of daily living, privacy and dignity are already in short supply. Accepting help with incontinence care and bathing is humiliating enough without the process being recorded on camera and reviewed. I know that my mother would have balked at the idea of being constantly monitored in her nursing home room. It would have deprived her of her last bit of dignity and solitude.

Yes, some elders may be indifferent to the notion and prefer the added security that can come with such monitoring. But, I feel it is important to involve competent elders when making this decision and to carefully weigh their dignity with their vulnerability. Whether or not an elder is aware of the camera(s), most would probably not appreciate their intimate care being monitored by family members or anyone else.

Potential reliance on video footage could be problematic for families in a few ways as well. For one, I feel that cameras should be utilized as a source of reassurance rather than a substitute for physical involvement in a loved one’s care. The ease with which family members can access a live camera feed may prevent them from enjoying and making the most of their respite time as well. Furthermore, constant monitoring can make it tempting to nitpick any and all aspects of a caregiver’s performance. Being under constant scrutiny is exhausting for employees, and it can actually cause their work to suffer because they are nervous and uncomfortable in their environment.

Control is a difficult thing to give up, especially when the wellbeing of someone you love is potentially at stake. But, to actually take advantage of respite time and allow our elders to receive the care they need, we must learn to back off some and trust the care decisions we have made. Balance is difficult to achieve, it’s true, but it is vital in all aspects of caregiving.

Follow State and Federal Laws for Recording Audio and Video

Aside from the personal and professional implications of using video recording to monitor seniors and their caregivers, there are also important legal aspects to consider. When it comes to recording video of other people, whether in your home, in a loved one’s home or in a long-term care facility, it is important to research privacy and consent laws for your state. If your loved one resides in a long-term care facility, it’s crucial to look over their contract to see if cameras are permitted in the facility. Similar precautions apply for in-home caregivers’ employment contracts.

If you wish to record audio footage as well, the laws are even more complicated. There are federal laws protecting conversations in which participants have a reasonable expectation to privacy. One loop-hole to this law is obtaining prior consent of one party to a conversation. For example, if you are participating in said conversation (not just listening in), you can be the one party to provide consent and authorize a “secret” recording. However, some states have strengthened consent requirements for audio recordings and all parties to a conversation must provide consent. This means that in “all-party” states there is no such thing as both secret and legal audiovisual recording without certain legal exemptions like a police warrant.

The legal concepts of privacy and consent and how they vary in different states and settings is far too complex to address here in detail. The best guidance is to avoid being deceitful or infringing on anyone’s rights. When in doubt, obtain the consent of everyone who may be recorded (written or recorded proof of consent can’t hurt) or consult an attorney before using cameras with or without audio capabilities. Breaking these laws can bring hefty fines and even jail time. If you do manage to record negligence or elder abuse, illegally obtained footage may not be admissible as evidence.

Deciding Whether to Install Video Cameras

Deciding to use cameras to monitor a loved one’s care is a very personal decision. I believe it is important to balance an elder’s safety, privacy, dignity, and the law in this matter. Seniors are certainly the vulnerable party in elder care arrangements, but it is important to remember that their professional caregivers have rights, too.

There is only so much research and investigation that family caregivers can perform when it comes to selecting where a loved one receives care and who provides it. Most importantly, seniors’ advocates should do their due diligence when making care decisions. While cameras may help, knowing that you have done your best in vetting and selecting an in-home caregiver or a senior living facility and continuing to be personally involved in managing your loved one’s care will provide the most peace of mind.

Carol Bradley Bursack

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Over the span of two decades, author, columnist, consultant and speaker Carol Bradley Bursack cared for a neighbor and six elderly family members. Her experiences inspired her to pen, "Minding Our Elders: Caregivers Share Their Personal Stories," a portable support group book for caregivers.

Minding Our Elders

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27 Comments

We have been in the two most prominent nursing facilities in the Dallas Texas area. Now, Dallas County Ombudsman office actually advised me to look at Tarrant Count Facilities. I stayed with my Father EVERY Night. If for one second anyone thinks these places are what they are Curbside Appealed to look like please take a deeper look! His finger was broken, his head was bashed into the bed, he was dropped, bruised and literally left in his Wheelchair for hours in his room with no-one coming to check. So I was the Monitor, with such an influx of immigrants coming into our nation and so many of them are shown that the Medical Field is where the money is, these bigger places recruit them and send them to finishing school and a 1 week program, and then put them in charge of our loved ones. Your loved ones base caregiver is the least paid at the Facility. Turn-over rates are high as when the people see what's actually going on they decide to further their own education. They all run 10-15 patients to one Aide. Alot of the Aides don't speak good English. Now granted there are a lot of good Aides. But the best ones have gone into Private Duty Care as they can't tolerate the compassion levels at the facility's. I have SEEN a lot over the last two years spending the night and listening and talking to the people at the forefront of our Elder care. I have Nanny Cams set up now in their home. It allows me to know exactly what goes on with his care. I watch the CNA's so I can see how compassionate they are with him when he goes into Sundowners, I watch them to make sure they keep our schedule and do what I ask. And I have caught several who passed back-ground checks and passed thru a probation period only to leave him dirty or wet and do as they please. So I highly recommend the use of them. But use the ones that are not connected to the Internet if your concerns or of privacy....you can look at them yourself and erase what you don't want....
i think anything to increase safety is a great thing
My one and only concern is my Loved ones safety. Even in a Acute Care Hospital being taken to have a Cat Scan mine has been hurt. If I had not been with him at one such Cat Scan he would have been hit in the temple with a floating 4 way plug hanging from the ceiling...So Body Camś Nanny Cams, What-ever cams. Need to watch the people handling your loved one period.