Cameras on beds: The ethics of surveillance in nursing home rooms

Abstract

Surveillance cameras are increasingly being deployed in nursing homes and assisted living facilities, with insufficient attention to what is ethically fraught about this way of assuaging concerns about abuse and other personnel challenges. With seven state laws now regulating camera monitoring and more on the way, it is urgent for us to consider the ethical implications of how we use technology to keep older adults safe. Drawing on findings from the first facility survey on this topic, we address three ethical issues: the risk that in-room cameras pose to residents’ privacy and dignity, the risk of undermining care workers’ sense of being fiduciaries for residents, and the probable extension of camera use by facilities to monitor staff and residents. We argue that with an aging population, intensifying strain on the care workforce, and ease of access to Web-connected cameras, this is a critical moment to address these ethical challenges.

Keywords:

• Aging
• decision making
• confidentiality
• nursing
• privacy
• law

Notes

1 The U.S. government defines nursing home in the following way: “Nursing home is a term that includes both skilled nursing facilities and nursing facilities. Nursing homes primarily engage in providing residents skilled nursing care and related services for residents who require medical or nursing care and rehabilitation services for the rehabilitation of injured, disabled, or sick individuals” (Medicare.gov Nursing Home Compare Glossary: https://www/medicare.gov/NursingHomeCompare/Resources/Glossary.html).

The philosophy of the assisted living facility centers on enabling residents to age in place in a home-like environment and is often operationally defined as “one that provides or arranges at least the following: 24-hour staff, housekeeping, at least two meals a day; and help with at least two activities of daily living (ADLs)” (Hawes, Phillips, and Rose 2000, 2).

2 A minority of nursing home rooms are single-occupancy. A survey of a single state found that 39% were private rooms (Shippee, Henning-Smith, Kane, and Lewis 2015), and another study established that 29% of residents live in single-occupancy rooms (Kane et al. 2004). Approximately three-quarters of assisted living facility units are single-occupancy (Hawes et al. 2003).

Additional information

Funding

The authors gratefully acknowledge the Borchard Foundation Center on Law and Aging for its support of this research and the Agency for Health Research and Quality, National Research Service Award (T32 HS-000011), for its support of the first author.