The Rise of the 'Granny State' in America's Nursing Homes
WHY YOU SHOULD CARE
Surveillance might seem an easy solution to elderly abuse, but it’s more complicated than family members realize.
By Nick Fouriezos
It’s easy to decry the nanny state. But what about the granny state?
More and more states are passing laws and introducing regulations requiring nursing homes to let relatives set up webcams in the private rooms of elderly family members. Until 2014, only three states — Texas, New Mexico and Washington — had laws on such cameras in assisted living facilities. But over the past five years, five more states — Illinois, Louisiana, Utah, Oklahoma and Virginia — have introduced statutes.
Maryland allows these so-called granny cams but doesn’t require nursing homes to agree to relatives’ requests for them. The Florida and Minnesota legislatures are debating bills that will allow family members to demand that assisted living facilities set up webcams in the rooms of elderly relatives. The governments of New Jersey and Wisconsin are loaning out cameras to nursing homes.
These efforts center around rising fears of elder abuse, with more than a million elderly Americans living in nursing homes and a host of news reports emerging around nursing home staff physically or sexually assaulting those under their care. These worries are expected to grow as America ages — the U.S. population above the age of 65 is predicted to double from 49 million in 2016 to 98 million in 2060. But the wave of laws and regulations is also spawning an intensifying debate on the unintended consequences of such cameras.
They [the elderly] also care about their identity, sense of self, autonomy … a romantic relationship they don’t want their children to know about.
Clara Berridge, University of Washington
Do webcams, for instance, risk violating the privacy and diminishing the dignity of older patients, many of whom are dealing with disabilities that come with age? Some don’t have the ability to legally give consent to the intrusion on their privacy (roughly half of U.S. nursing home patients suffer from dementia, according to the Alzheimer’s Association). What’s more, they aren’t the only ones being recorded: So too are caregivers, many of whom don’t want Big Brother peering over their shoulders.
“The family member is more concerned about safety, while older adults have more varied personalities,” says Clara Berridge, an assistant professor at the University of Washington’s School of Social Work who studies elder care issues. “They also care about their identity, sense of self, autonomy… or perhaps a romantic relationship they don’t want their children to know about.”
The concerns of family members are understandable. In Utah, a 30-year-old nursing assistant was sentenced to a year in jail last October for repeatedly assaulting elderly residents at the facility where he worked. In 2015, another nursing assistant was convicted of raping an elderly resident at a Minneapolis assisted living center.
The limited research available on the impact of introducing webcams into nursing homes suggests that balancing safety concerns with those about privacy is difficult. Berridge and her research partner, Karen Levy, an assistant professor of information science at Cornell University, led a survey of caregivers earlier this year on the ethics around such webcams in nursing homes.
The reality, they found, was that the webcams would mostly capture activities like bathing, using a bedpan or changing underwear. “Is this really what the resident would want to have recorded about themselves?” asked one respondent. Another worried that the feeling of being watched would make an already stressful job even harder: “There are no advantages that outweigh the concerns and the kind of culture you create by doing this.”
The ramifications could be wide-ranging, in ways the proponents of the laws may not fully intend. One of the most surprising discoveries of the survey, Berridge says, is that 11 percent of nursing homes said they were choosing to install the cameras. Webcams that were being forced on facilities by concerned relatives are now being adopted as a means of bringing overhead down, and to avoid legal complications later. It could be tempting for nursing homes to slowly start replacing human monitoring of patients with cameras.
“Somebody can set up a baby monitor, but that doesn’t take the place of human interaction,” says Julie Schoen, deputy director of the National Center on Elder Abuse at the University of Southern California. Adds Berridge: “It’s a danger that they are going to just remove people and increase the tech and that could have negative consequences for the residents.” For instance, people with dementia benefit from touch and contact. It could also soon become the case that not just relatives but caregivers too are infringing on patients’ consent. “You’re not going to have the option to say no. It’s going to be, ‘If you want to live here, you’re going to be surveilled,’” Berridge says.
Those cautioning against the spread of granny cams recognize elderly abuse as an issue America needs to face. “Elder abuse is one of those really messy topics that people want to think doesn’t happen in their family or their neighborhood. But we all know it’s going on wherever,” Schoen says.
Webcams could also connect lonely elders with the outside world. More than half of nursing home residents don’t have people who regularly visit or check in on them. While some older people would need help working the webcam, having access to digital communication could connect them with friends, family or even far-away strangers … with the goal of helping address their loneliness.
But granny cameras get particularly dicey when you consider that not all people in nursing homes have private rooms — some have roommates, or significant others. Instead of cameras, some states are adopting other measures. In Georgia, state lawmakers this year passed a law requiring tougher background checks for caretakers and mandating a state register that tracks elder abuse. Meanwhile, the U.S. Congress last year passed a measure that allows banks to report suspected financial fraud against the elderly to law enforcement, without fear of being sued.
“We’re an aging society. Surveillance has its place, and there are places where it can be effective,” Schoen says. “But is it the be-all, end-all? Certainly not.”