There’s been a resurgence in legislation on electronic monitoring devices in nursing homes, with 17 states actively figuring out the right balance between privacy for residents and their safety amid continued workforce pressures. One thing is clear between operators and state associations: such laws must put resident choice and autonomy first.

Legal expert Bradley Arant Health Care Attorney Chris Puri shared examples from five states, including Ohio and Oklahoma, which he said were considered “best in class” when it came to nursing home surveillance. He said that as the legislative push expands, states will be eyeing their example closely.

Kimberly Green, CEO of Oklahoma-based Sage Integrated Health, said the resurgence in resident monitoring legislation has been spurred in part by the pandemic.

“When families could not walk through our doors for months, or a year, cameras became a lifeline,” said Green. “People got used to being able to see their mom or dad on a screen, and that expectation did not go away when visitation reopened. It became a tool for them to stay in touch and for the families to feel more engaged and safe.”

Green added that in 2020, about nine states had laws allowing cameras in resident rooms, with Rhode Island’s law just going into effect last month and Florida, New York and Pennsylvania having bills moving along this legislative session.

“I expect more states to follow until it is the norm across the country,” said Green. “The pandemic changed what families expect from long-term care. They want access, they want transparency and they are not going to settle for less so we better buckle up and learn the regulations, develop clear policies and procedures and train our staff. It is here to stay.”

Oklahoma’s resident room monitoring laws were ahead of the curve, Green said. These laws were implemented in 2013 and expanded in 2020 to offer a strong, consistent framework including roommate rights, conspicuous signage and anti-retaliation, along with device placement and security rules.

Oklahoma set the standard, Puri said.

“Oklahoma’s provisions are frequently cited in multistate policy comparisons for their clarity and balance between dignity and privacy, and resident safety,” said Puri.

In Ohio’s case, the resident’s choice has played an important role.

Policymakers and families continue to look for ways to enhance transparency and resident safety through a renewed interest in such monitoring in Ohio, Ohio Health Care Association CEO Scott Wiley told Skilled Nursing News. States that don’t already have monitoring laws are re-examining their existing framework. The trend reflects an important ongoing conversation about how technology can support trust and accountability in long-term care, Wiley added.

“Here in Ohio, our providers have long been committed to accountability and high-quality care,” Wiley said. “We believe it’s essential that discussions around electronic monitoring remain centered on resident rights –— ensuring that any monitoring is driven by the resident’s choice and aligned with their dignity, privacy and autonomy.”

Ohio’s initiatives on electronic monitoring also draw from Illinois’ example.

Ohio’s Esther’s Law passed in 2022 is considered a newer, comprehensive enactment with a lot of Illinois components: cameras are authorized in nursing home rooms with resident and roommate consent, signage, anti-retaliation and temper prohibitions.

“Because [Ohio’s legislation] is recent, it reflects lessons learned from earlier states and has quickly become a reference point,” said Puri.

OHCA engaged with lawmakers and state agencies during implementation to align the law with real-world care environments, added Wiley. Throughout the process, the association stressed that electronic monitoring needs to be a resident-driven decision and that providers shouldn’t bear the responsibility of installing, operating or managing the monitoring devices or the recordings they produce.

“We continue to uphold that principle today. While other states have looked to Ohio’s framework for guidance, OHCA has not taken a position supporting expansions of electronic monitoring requirements into other settings,” said Wiley.

Instead, OHCA has engaged constructively to ensure resident privacy is protected and the legislative framework avoids unintended legal, HIPAA-related or operational consequences, Wiley said.

Figuring out the right balance of privacy and safety

Striking a balance between safety and privacy begins with a simple but essential premise, Wiley said: resident autonomy is first, always. “Safety and privacy are not competing priorities – both must be upheld simultaneously,” Wiley said.

Green added that the conversation gets nuanced when discussing a balance between privacy and security.

“Some people don’t want a camera watching them get dressed or have a private conversation with their doctor. That is very valid,” said Green. “But others — especially families who live far away or can’t visit often — want that window into daily life. That is a conversation within the family that needs to happen and we can help guide that if requested.”

Green echoed Wiley’s number one rule: the balance comes from making it the resident’s choice. “You can honor both if you let the resident decide what works for them,” she said.

But on the other hand, not every clip tells a clean story, Green noted. A family member might see something that looks like it might not be a good situation but is actually a proper two-person transfer with a resident who is combative.

“That cuts both ways. Families might see something alarming that has a reasonable explanation, or they might miss something that happened just outside the frame. Context matters, and cameras do not always provide it,” said Green.

As an owner and operator, Green said she understands liability concerns. No one wants to end up in court, but at the same time it makes sense why families want this option.

“They are handing us their mother, their father, their spouse, and asking us to take care of them when they simply cannot be there. That’s a big ask. If a camera helps a family feel like they are still part of that care, I am not going to try to fight it and talk them out of it,” said Green.

Snapshot at other ‘best in class’ monitoring laws

While Ohio is more recent, Illinois was one of the first to get monitoring legislation on the books. Authorized Electronic Monitoring in Long-Term Care Facilities Act is considered a model for other states.

“It offers explicit statutory authorization, standardized consent forms, roommate consent and accommodation rules, clear signage and notice requirements, anti‑retaliation provisions and procedures for disabling during personal care upon request,” Puri said.

State law offers options to restrict audio and penalties tied to obstruction or tampering of monitoring equipment; Illinois law also laws out cost allocation and complaint pathways for situations concerning resident monitoring.

Texas, meanwhile, offers another template statute with clear resident and roommate consent for monitoring, Puri said. Monitoring must be done with mandated notices and door placards, anti-retaliation protections, detailed placement and privacy parameters, limits on covert use and an enforcement structure.

“Operational guidance for facilities is well developed and familiar to regulators and providers,” added Puri.

Residents in New Mexico are offered clear opt-in consent, Puri noted, along with roommate consent and accommodations should monitoring be refused. The state also has procedures for muting and covering cameras during personal care.

Statute and implementing guidance is “practical for operators,” he said.