The Ethics of Camera Surveillance in Nursing Home Rooms: Findings from a Stakeholder Survey

Background and Purpose:

We examine an ethically unsettling response to concerns about abuse in nursing homes and assisted living facilities: in-room surveillance cameras. This use of cameras by family members has become so prevalent that six states have passed laws that explicitly permit private individuals to use cameras in residents’ rooms, and at least a dozen others have had bills proposed. With this policy movement, there is surprisingly limited academic research on this phenomenon and on stakeholders’ views of it. Absent prevalence data, we began with a survey of actual use of cameras known to facilities and their related policies as a first step toward understanding the scope of this issue. We present new findings from the survey and we address two ethical issues they raise as part of the larger question: How can we use technology to keep residents safe without disrespecting and potentially dehumanizing both the residents and the care staff?

Methods:

Data are presented from the first survey on nursing home and assisted living facility policies on cameras in resident rooms. The survey included two open-ended questions on perceived risks and benefits of camera use and was distributed electronically to members of the American Health Care Association and National Center for Assisted Living. 273 participants responded from 39 states and Washington, D.C.. Descriptive analysis of the quantitative data were conducted in Qualtrics and qualitative responses were analyzed using an open coding process and categorized by theme.

Results:

Thirty percent report that their nursing home and/or assisted living community allows family members to install cameras in resident rooms. Nearly one in five (18.7%) report knowledge of at least one camera in use. Respondents were more critical of the practice than in favor of it, with a total of 323 statements of negative effects and 200 comments about benefits. The majority (172) wrote that the privacy of residents would be inappropriately invaded and the next most commonly raised issue was the beneficial use of cameras as a tool to determine truth in abuse or theft allocations (67). Other prominent themes include: cameras threaten resident dignity, demoralize staff, and cameras could keep staff vigilant.  

Conclusions and Implications:

The finding that in-room cameras are a significant trend suggests that we need to engage more seriously with the ethical dimensions of this practice and conduct empirical research on stakeholders’ perspectives and outcomes. These findings from a survey conducted with one stakeholder group raise two critical ethical questions: First, how do in-room cameras affect the privacy and dignity of the residents? Second, what might being under surveillance do to care workers’ sense of being fiduciaries for the residents? That is, what are the consequences of treating people as if they have no capacity, or are untrusted, to have a professional ethical bond to a resident? With an aging population, intensifying strain on the care workforce, and accessibility of web-connected cameras, social work researchers and policymakers must delineate the ethical problems this growing practice responds to and presents.