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.