Keeping an eye on Grandma

Putting video cameras in nursing homes might curtail abuse. It might reassure relatives. But what about the privacy rights of the people who live there?

By THOMAS ZUCCO, Times Staff Writer
© St. Petersburg Times
published April 18, 2002

[Times art: Rossie Newson]

It looked like the perfect solution.

Install video cameras in nursing homes and assisted living facilities to cut down on incidents of abuse and neglect. If the staff knows they're being taped, the theory goes, they'll think twice about mistreating a resident.

Cameras cut down on crime in casinos, banks and department stores. Couldn't they stem abuse in nursing homes?

What's more, the residents would feel safer and their relatives would be reassured.

Most people would agree there is a need to keep an eye -- electronic or otherwise -- on the nursing home industry. In a July 2001 report on nursing homes nationwide, the House Committee on Government Reform drew this conclusion:

"Abuse of nursing home residents is a widespread and significant problem. In the last two years, nearly one out of every three nursing homes in the United States has been cited for violating federal standards established to prevent abuse. In over 1,600 of the nursing homes cited, the violations caused actual harm to residents or placed residents in immediate jeopardy of death or serious injury."

Electronic surveillance is already in widespread use. People are being watched in airports, football stadiums, banks, convenience stores and child care centers. There's even a saying floating around the Internet that sums up the sentiment:

"If you can, cam."

Finally, the so-called granny cams could help cut down on the number of lawsuits that drive up insurance costs and put a strain on the industry.

So cameras and nursing homes would seem to be a perfect match.

But that's hardly the case.

Ask those who work in or run a nursing home.

Or the people who live there.

Sitting in a chair by her bed, with yellowing photographs of her family tacked to the wall by her window, Isabel Maxwell, 93, talks about going to a public hearing on cameras in nursing homes last October at Stetson Law School. Maxwell, who is president of the resident's council at Egret Cove Center nursing home in St. Petersburg, spoke for 10 minutes.

"I asked them, 'How would you like someone to take a picture of every move you make?' " she said, her voice rising. "It's an invasion of privacy and dignity. And it costs money to install those things, money to maintain them, and I think if they brought them in, a lot of people (residents) would be intimidated and would withdraw into a shell.

"No . . . no one here (at Egret Cove) is in favor of it. And I've asked everyone."

To cam

The horror stories are everywhere.

"In one Florida nursing home, a staff person forced a call light from a resident's hand, placed it out of reach, and refused to comply with the resident's requests for assistance on numerous occasions. When the resident required a bed pan at night, the staff person did not provide it, forcing the resident to urinate in bed and wait until morning for their diaper to be changed." -- From a 2002 U.S. Senate report on nursing home abuse.

The General Accounting Office found recently that 30 percent of the nation's 17,000 nursing homes were cited in recent years for "deficiencies involving actual harm to residents or placing them at risk of death or serious injury."

A recent report from a task force of Florida health care officials and representatives from the Attorney General's Office found nearly 3,000 abuse and neglect allegations in nursing homes and assisted living facilities, or by home health care nurses, that were at least partly verified in the year that ended last July.

On March 18, two certified nursing assistants who worked at Oak Manor Nursing Home in Largo were charged in connection with injuries to an 89-year-old man. One was accused of choking the man and leaving him in a heap in a corner. The man suffered three broken ribs, bruises to his arms and chest and a cut on his head that required stitches.

As the stories piled up, so did interest in placing video cameras in nursing homes. Last year, Texas enacted legislation that could allow nursing home residents to install cameras on a voluntary basis. Several other states, including Maryland, Massachusetts and Florida, also tinkered with the idea.

But Florida, which has more than 71,000 people living in state-licensed nursing homes, a figure that is likely to grow as baby boomers age, did more than debate the issue. On March 20, the state Senate passed a bill to start a pilot program that would place surveillance cameras in rooms in two nursing homes for a year. Sen. Ginny Brown-Waite, R-Brooksville, sponsored the bill.

But two days after it passed the Senate, the bill died in the House Rules, Ethics and Elections Committee.

"No one there (on the House committee) was brave enough to take up the issue," Brown-Waite said. "There were some legal issues that still had to be worked out . . . such as the chain of custody for the tapes and whether liability insurance will increase as a result. I don't believe it would, but some insurance companies have told nursing homes that it would.

"I think there is a need, even in the best of nursing homes," she added. "If putting cameras in rooms gives family members peace of mind, it's more than worth it. But the very best care is given when family members are active participants in the caregiving. Cameras won't replace going to the nursing home and seeing for yourself what's going on."

Brown-Waite acknowledges there are flaws with surveillance cameras.

"In one nursing home in another state," she said, "the family had a camera in there and allowed abuse to take place for months until they (the family) had enough evidence to begin a lawsuit.

"I don't think families should be enriching their wealth while allowing Grandma to be continuously abused."

There is no state law that prohibits someone from putting a video camera in a nursing home room. But as Brown-Waite noted, nursing homes can (and sometimes do) include provisions in their admissions forms that restrict or ban camera use. "Or they could retaliate against a resident who installs a camera," Brown-Waite said.

As for the privacy issue, Brown-Waite's bill required the permission of the resident (or a legal representative) before a camera is installed, and since many rooms are semiprivate, the permission of anyone else who lives in the room.

"If the other people don't sign, the person who wants the camera would be moved to another room where the roommate wouldn't object," Brown-Waite said.

"I would hope this issue is taken up again in the next (legislative) session," she added. "And that families in Florida would have the right to put cameras in the rooms of a loved one."

That said, she still thinks the ultimate solution is care, not cameras.

"I've been told by so many people what a difference increased staffing makes," Brown-Waite said. "Cameras are never meant to replace extra staffing . . . just to complement it."

Most people on both sides of the issue say that a state law placing a camera in every nursing home room in Florida is unlikely. What most camera advocates want is the option to install a camera.

To them, the issue is choice.

"To me, the privacy issue is a red herring being thrown out by the nursing home industry," said Barbara Hengstebeck, director of the Coalition to Protect America's Elders, a Tallahassee-based advocacy group. "We'd like to see families have the option to pay for a camera and install it. Then they would be the only ones looking at images. It would be at the resident's request and based on the loved one's wishes.

"Log on to the Internet and check on Mom and Dad. They're not seeing anything they wouldn't see if they were visiting them in the room.

"And believe me, if you've ever visited a nursing home, you know there isn't much privacy anyway."

The coalition, which was one of the strongest backers of Brown-Waite's bill, gets most of its funding from Jim Wilkes, a Tampa trial lawyer who has won several multimillion-dollar verdicts against the nursing home industry.

The least-expensive cameras cost about $200. Then there is the cost of tapes and a VCR. If the camera is connected to a home computer, there is an Internet fee.

Hengstebeck acknowledged that at least half of all nursing home residents could not afford the cost of installing a camera and maintaining it.

"If a resident has no family, there's nobody to look at it anyway," she said. "And a resident who has no money can't benefit from this.

"But just because of that, it doesn't mean those who can and want (a camera in their room) shouldn't be allowed. Not every nursing home resident can afford to go to the beauty shop every week or have a TV in their room.

"If you make cameras mandatory, God only knows who's going to be watching it. That's absolutely an invasion of privacy. But is it an invasion to have a Web camera in my mother's room connected to my computer?

"'Again, this is just one tool. It's certainly not the answer to all the problems. To me, staffing is way more important."

Some camera advocates, such as Larry Beltz, a St. Petersburg attorney who specializes in nursing home abuse cases, think the state should put cameras in all nursing home rooms, so those who can't afford cameras can be protected.

"A lot of people in nursing homes don't have relatives to watch on the other end," Beltz said. "They have appointed guardians who have 30 to 40 patients they're taking care of. So private, individual cameras wouldn't affect most people. It would be only for those who could afford them.

"They (nursing homes) are hiding behind the privacy issue because they just don't want their activity to be seen," he said.

The same task force that found the 3,000 abuse and neglect allegations in Florida in one year also made a recommendation to the Legislature in January.

"The likely deterrent effect on resident abuse and neglect, together with the benefits to management, residents and their families and friends, suggest that voluntary use of cameras in nursing homes and resident rooms . . . would work well in Florida."

Or not to cam

The U.S. nursing home industry, which comprises about 17,000 facilities and nearly 1.5-million residents, is generally opposed to granny cams, largely on the grounds that they would invade the privacy of the residents.

But the industry argues that the issue is far more complex than that.

"Putting in cameras is a real seductively simple answer," said Ed Towey, a spokesman for the Florida Health Care Association, an organization that represents nursing homes and assisted living facilities. "But it's a terrible affront to the privacy and dignity of the residents and staff and anybody else who goes in that room.

"Most nursing home rooms are semiprivate. And you also have the rights of privacy for doctors who practice bedside and for clergy who practice bedside.

"It could also have a huge impact on a nursing home's ability to recruit and retain staff. And there's also the issue of liability insurance.

"What are you trying to do? Catch someone after the fact? Or improve conditions?"

Several nursing homes in Florida, including Southland Suites in Lake City, have installed cameras in common areas and near exits to monitor residents. At Southland, the cost of installing 10 cameras was about $20,000.

But Southland stopped short of putting cameras in residents' rooms because no residents requested them.

According to a report by the Florida Agency for Health Care Administration and the Office of the Attorney General, six employees at Southland resigned when the cameras were first installed. Since then, there has been no more voluntary staff turnover.

Like nearly everyone on both sides, Towey says the solution is more and better staffing.

"Every 7-Eleven has surveillance cameras, and they're robbed quite frequently," he said. "All the camera can do is watch. It can't protect anybody.

"Yes, they put cameras in banks and in airports. But they don't stick them in the airport or bank bathrooms, do they?

"And the videotape may or may not actually tell you what went on. What if you see someone on the staff taking something out of a desk drawer and walking away? They stole something, right? Wrong. What if Mrs. Jones, who's in the common area, needs her glasses to watch TV, and that's what the staffer was doing? It's not going to decide every dispute that arises."

Like the people who live there, most of the people who work in nursing homes are also against the installation of cameras.

"It's not a fear . . . it's more of an uneasy feeling of having cameras on you all the time," said Karen Oliver, a registered nurse who is assistant director of nursing at Bon Secours Maria Manor nursing home in St. Petersburg. "At this point, it's a wait and see attitude. It might be something people (in nursing) get used to."

But if there are surveillance cameras in banks to watch tellers, why can't there be cameras in nursing homes to watch the nurses?

"Our job here is different than a bank teller," said Oliver, who has been in nursing 30 years. "We're putting people on bed pans, giving people baths.

"There a big difference between changing money and changing a bed pan."

Also at issue is the bond among the nursing staff, the residents and the nursing home owners.

"You build a rapport with the residents," said Beverly Fuller, a licensed practical nurse who works at Menorah Manor in St. Petersburg. "You have some residents who don't have family, and they take you on as a family member. They'll introduce you as the sister they never had, or the daughter. They hug you and give you a kiss on the cheek. That could be misconstrued as something different on camera."

Fuller added that cameras could create a climate of suspicion and mistrust between residents and caregivers, a group that already has to contend with low wages, minimal benefits and sagging morale.

"Could I do my job if I was on camera?" she asked. "I would if I had to. But it wouldn't be the same. The staff would be more inclined to do everything A-B-C. There might not be that special human interaction.

"And that personal contact is more important than almost everything else."

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