Webcams in nursing home rooms can deter elder abuse, but are they ethical? | Opinions
Lisa, Mary Ann Papp’s daughter, was worried about her 75-year-old mother.
An infection in the foot appeared to go untreated, leading Lisa to fear that her mother’s nursing home was not providing proper care.
So Lisa did what any concerned child could do: bought a $ 199 webcam from Target and put it in her mother’s bedroom.
But she found that the nursing home staff kept pointing the camera away from Mary Ann’s bed or unplugging it. Eventually, Lisa bolted it to a piece of furniture and filed a formal complaint against the establishment.
In May 2017, the Minnesota Department of Health decided in favor of the Papp family: The nursing home had to allow a camera in Mary Ann’s bedroom.
A network of privacy concerns
Every year, the news area on nursing home staff physically or sexual assault the patients. Physics and cognitive vulnerabilities can do it difficult for residents to report abuse or that their reports be taken seriously.
Web-enabled digital cameras provide a solution. Evidence suggests that more and more people are putting cameras in a parent’s bedroom to detect and deter abuse, although the exact numbers are unknown as the practice is often done secretly. Seven states have passed laws allow families to follow the care of aging relatives.
The main one is confidentiality. The most intimate treatments are carried out in full view of the camera: wash, use a basin, change underwear. Sensitive conversations with visitors, from clergy to romantic partners, can also be recorded.
“Is this really what the resident would have liked to record about himself?” »Asked a respondent to our survey on webcams in retirement homes.
Recorded without permission
Consent is another tricky issue.
While state laws governing the use of the camera require patient consent, about half of nursing home residents in the United States have dementia, according to the Centers for Disease Control and Prevention. These residents are unlikely to be consulted about the installation of cameras, as they lack, or are perceived to lack, the capacity to consent.
In these cases, children often act as the parents’ legal representative to give consent on their behalf.
We have found that even when parents are able to consent, children may simply want to avoid conflict with a parent and find it easier to install an always-on camera without discussion.
Since the rooms in the retirement home are generally shared, the consent and confidentiality of roommates is also an ethical issue. Inevitably, the roommates’ conversations will be recorded, and they will be filmed as they pass through a camera’s field of view.
All of the states that allow in-room cameras require roommates or their legal representative to be notified surveillance and allowed to require the camera to be pointed away from their bed.
But this is not a guarantee of confidentiality. Dementia or unfamiliarity with technology can mean roommates can’t adjust cameras to protect their privacy. And because retirement homes and assisted living facilities in the United States are dangerously understaffed, their caretakers may not be available to offer technical assistance if needed.
Negative impacts on care
Webcams are a consumer response to America’s inadequate long-term care system.
Long-term care in the United States is poorly funded, mainly by Medicaid. Health Insurance covers the treble but not ongoing services and supports. Most Americans can’t afford the care they will do need as they get older.
As a result, nursing home staff who are trusted to perform this demanding and heavy work receive low wages – on average, do $ 27,470 per year. Turnover is particularly high among caregivers who provide the most practical, intimate care in American retirement homes.
For these staff, the same in-room cameras that allay family fears often produce anxiety.
Respondents to our survey of 273 nursing home and assisted-living staff in the United States said surveillance can create a culture of mistrust. The ubiquitous webcams give elderly care workers the impression that they are not seen as capable of professional and moral behavior.
“It’s like… having a supervisor or someone breathing over your shoulder at all times,” said a nursing home worker, adding that the cameras “take away employee confidence.” .
This, in turn, has a chilling effect on the relationship between patients and their caregivers.
“There are no benefits that outweigh the concerns and the kind of culture you create by doing this,” said one respondent.
Additionally, while media coverage of elder abuse tends to focus on abuse by nursing home staff, studies show that in almost 60% of incidents of elder abuse and neglect, the perpetrator is a family member.
The demoralizing effects of cameras in bedrooms, coupled with the ethical and privacy concerns they raise, indicate that webcams are not the solution to preventing abuse in elderly care facilities.
Rather, our work emphasizes the need to more investment from the US government.
With better wages and working conditions, nursing homes could attract more direct care staff who would stay longer and be more involved in their workplace. Nursing assistants could get to know the residents and better supervise them. Improved training on recognizing and reporting abuse would also promote accountability.
National efforts such as “cultural change”Movement – an attempt since the 1980s to make nursing homes more like home with more privacy and individual care – is already empowering staff and residents and improving the quality of care.
According to a 2014 study, in states where Medicaid rewarded culture change practices through “pay-for-performance” reimbursement policies, nursing homes were much more likely to employ these practices.
More public investment could expand these promising efforts, giving families real peace of mind about the safety of their older parents and ensuring Americans have quality care in old age.