As rates of elder abuse rise worldwide, prevention strategies in long-term care facilities, especially nursing homes, are becoming a national conversation. The most common solution — signed into law by seven states — is installing security cameras in elderly patients’ rooms. But this strategy ignores the rights of those it’s seeking to protect, a recent survey asserts.
What is elder abuse? How common is it?
About 1 in 6 seniors experience abuse, the World Health Organization reports. As populations age — and Alzheimer’s disease and other forms of dementia, which make older adults more vulnerable, become more prevalent — that number is only expected to get worse.
The National Institute on Aging defines elder abuse as causing bodily harm, saying hurtful words, yelling, threats, neglect, abandonment, forced sexual acts or stealing. Almost 60 percent of elder abuse occurs at the hands of a family member, two-thirds of whom are the child or spouse of the victim. Roughly 1 in 14 incidents go unreported, according to the National Council on Aging.
Louisiana, Illinois, New Mexico, Oklahoma, Texas, Utah and Washington have enacted laws that allow family members to install cameras in residents’ rooms in nursing homes and assisted-living facilities — and 12 other states have put forward similar bills.
What did the study look at?
These legal provisions may seem like an important step to stem an epidemic, but security cameras introduce a host of other issues into the lives of elders and those who care for them. Addressing this dilemma, recent research, published in AJOB Empirical Bioethics and Elder Law Journal, titled “Cameras on beds: the ethics of surveillance in nursing home rooms,” explores how constant surveillance affects the way long-term care facilities function.
For an anonymous online survey distributed to nursing and assisted-living homes, managers and resident advocates at 273 facilities in 39 states answered questions about the advantages and disadvantages of security cameras in residents’ rooms. About three-quarters of respondents listed at least one disadvantage while about 56 percent noted at least one potential advantage. Overall, respondents were much more concerned by potential disadvantages, which arose 323 times, compared to 200 statements of advantages.
What did the study find?
The primary disadvantage cited was that constant surveillance sacrifices the privacy and dignity of residents, many of whom are unable to consent to being recorded because of their dementia. Not to mention, the privacy of the roommates of residents whose families elected to set up a security camera also becomes compromised.
“Most nursing home residents have a roommate,” explained article coauthor Clara Berridge, an assistant professor of social work at the University of Washington, in a statement. “Protecting their privacy when a camera is in the room would be very difficult in practice, especially if the camera picks up audio. 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.”
Advantages that respondents listed included the potential to deter abuse or to determine the truth in allegations of abuse or theft.
“While some noted the dual uses of determining truth in abuse or theft investigations and motivating staff to provide quality care, others wrote that cameras should only be used to aid investigations,” the authors wrote.
In addition to security cameras capturing residents’ most private moments, such as bathing and getting dressed, they present other drawbacks, according to the article’s authors. For example, 32 respondents said cameras can “demoralize, offend, stress and undue pressure, intimidate and show a lack of confidence in staff.” They can also take a way from the home-like environment of long-term facilities and impede care providers’ relationships with residents. Other respondents argued cameras make staff self-conscious which can lead to mistakes and even injuries. Hacking and improper use of the footage is also a possibility.
Overall, the authors concluded that security cameras are not the best solution elder abuse, even if relatives find them comforting.
How can nursing homes and other facilities prevent elder abuse?
Perhaps the biggest issue emerging from this research is the lack of resources devoted to ending elder abuse, especially compared to efforts to stop child abuse and intimate partner violence. Gerontologists have gone as far as to label elder abuse an “under-appreciated public health problem.”
Currently, there is no academic research on the efficacy of nursing home cameras in preventing or detect abuse in nursing homes, a huge impediment to minimizing elder abuse.
“In order to understand how camera use might affect the quality of life of nursing home residents who have dementia, we need research that addresses the ways that surveillance might affect residents’ privacy and dignity and might promote an overly technocratic, less relational culture of care,” the authors explained.
One proven strategy to improve care is to increase the number of staff members to residents and to provide additional training for staff, says Margaret Battersby Black, a partner in the Chicago law firm, Levin & Perconti, whose practice is focused on nursing home, wrongful death and medical malpractice suits.
“The biggest issue we see with [abuse- and neglect-related] injuries to the elderly in nursing homes … is staff not having the training resources or time to provide all care required,” Black explains. “This leads to shortcuts in direct care and oversight, which leads to things like falls, bed sores and worse.”
Like the research authors, Black thinks security cameras should be a secondary measure for keeping nursing home residents safe (even though she does ultimately support them).
“I wish nursing homes would take measures to prevent these from even being necessary,” Black says, “rather than making residents and their families choose between ensuring the safety of their loved ones and deterring wrongdoers on one hand and sacrificing privacy and loss of dignity on the other.”