Last December, the state of New Jersey made waves in the elder care industry by announcing its “Safe Care Cam” program, allowing relatives to rent surveillance cameras from the state.
Initially intended for use in private houses to monitor home health and care aides, the program abruptly expanded this spring to include skilled nursing facilities, residences for people with developmental disabilities and other institutional care settings — raising serious questions about privacy and liability. But a few months later, industry groups in the Garden State say they’re satisfied with the protections that come with the program.
A shocking start
State attorney general Christopher Porrino’s office announced its decision to approve the use of the care cameras in institutional settings through a press release on May 9, taking the industry by surprise.
“Without any notice, or pre-meeting, the AG came out and expanded the camera loan program, and the Department of Health and trade associations were scrambling to find out what was behind it and if a change in policy and procedure occurred,” said Jon Dolan, president and CEO of the Health Care Association of New Jersey (HCANJ).
While the New Jersey legislature had previously tried to codify the use of video cameras in care facilities — including a 2014 proposal to allow residents to set up surveillance systems in their rooms — such efforts eventually failed, Dolan said, leaving state law “silent” on the issue.
Porrino framed the expansion as a necessary step to protect vulnerable seniors in residential care facilities.
“We’re not only enhancing oversight of caregivers, we’re advancing New Jersey’s role as a leader in the nation’s efforts to prevent patient abuse,” Porrino said in the statement.
Other states, including Illinois, Utah, and Texas, allow the installation of “granny cams” in nursing home or assisted living facilities, and other states have floated similar proposals in recent years.
Privacy concerns
Though he emphasized that the safety of seniors is paramount for HCANJ — a trade group that represents long-term care operators in the state — Dolan also expressed deep concerns about the privacy issues that could arise when placing government-sponsored hidden cameras in health care facilities.
“If Grandma’s going to end up on Snapchat or Instagram … how are we going to account for the privacy issues?” Dolan said, raising the specter of camera users posting sensitive video of other residents — not the ones they intended to monitor — on social media.
Dolan cited the case of Dani Mathers, a model who received three years’ probation after surreptitiously taking a picture of a nude fellow patron in a gym locker room and sharing it with friends on Snapchat. He offered a host of other hypothetical scenarios that could arise from the use of care cameras in medical facilities, from feuding family members using footage of visits as evidence in probate proceedings — to prove who cared more — to users inadvertently hearing staff discuss plans to form a union, a violation of labor laws.
“Imagine what they could do to our seniors — talk about abuse or misuse,” Dolan said. “This is not the way to approach a clinical care or residential care situation.”
The HCANJ and LeadingAge New Jersey, a group that represents non-profit long-term care providers, worked with the attorney general’s office and the state Department of Health to express their concerns, prompting the release of updated guidance regarding the use of the cameras.
Certain restrictions apply
In order to receive one of the cameras, New Jersey residents must now supply documentation proving that they’re a legal representative or proxy for the resident in question, and receive a warning that they must take all possible steps to avoid recording roommates or other residents.
State representatives must also ask whether or not the representative sought other methods to address their suspicions of abuse or sub-standard care before resorting to the camera program, such as contacting an administrator or the facility’s director of nursing. And, most critically, they are told that they remain liable for any violations of the resident’s admissions agreement — many of which prohibit filming residents or staff.
These changes have largely assuaged Dolan and Theresa Edelstein, regulatory consultant for LeadingAge New Jersey. Her organization suggested several of the ideas later adopted by the state, including the more careful vetting of camera borrowers and the encouragement of other means of conflict resolution.
In a world where most people carry powerful smartphone cameras around in their pockets, Edelstein even sees the benefits of having a government-sponsored surveillance program with rules and oversight.
“It’s better to do it this way, and have it known, than to have somebody buy their own camera, put it in a stuffed animal, and have it the room and no one knows it’s there. And there’s been no vetting done,” Edelstein told Skilled Nursing News. “I think you have to be realistic that in this day and age, some people are taking it upon themselves anyway.”
Many providers in the state have gone back to revise their admissions agreements to address the program, Edelstein said, and she framed the program as a way to forge tighter relationships between operators, regulators, and residents.
“We have not heard from facilities that there has been any kind of a run to put cameras in their facilities by family members or others,” she said. “I think if we can continue to partner with the attorney general’s office on this, and all be working toward establishing working relationships between facilities and families, we will all be better.”
Written by Alex Spanko
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