Skip to main content

The Limits of Camera Monitoring to Reduce Caregiver Abuse

Recording staff in nursing homes and special education classrooms may dodge the roots of the problem.
(Photo: ChameleonsEye/Shutterstock)

(Photo: ChameleonsEye/Shutterstock)

Last month, Illinois became the sixth state to allow nursing homes to install electronic recording equipment in private rooms, upon residents' request. Similar laws have passed in New Mexico, Oklahoma, Texas, Washington, and California, and are up for debate elsewhere, including Utah (where the state legislature struck down a similar bill before). Nursing homes aren't the only care environments bringing in cameras to monitor employee behavior. Last June, Texas became the first state to mandate electronic monitoring in special education classrooms upon parental request.

The cause behind monitoring is a no-brainer: Nursing home residents and children with disabilities are vulnerable to abuse in the environments where they spend most or all of their time. Each year brings dozens of reports nationwide of elder abuse and neglect: nursing home residents physically or verbally assaulted; left without oxygen support, clean linens, or simply someone to communicate their needs to. In San Diego County, one care worker is being investigated for allegedly sharing a video on Snapchat making fun of a resident getting into the shower. Support for the special education classroom law mounted after an NBC Dallas-Fort Worth investigation revealed that, in Plano, Texas, some elementary school students with autism had been forced into "calm rooms"—time-out rooms where children were sometimes illegally confined until they were deemed by their teachers to be behaving appropriately.

Recordings can be used to verify complaints of such abuse, and to clear caretakers of false accusations. The Texas classroom law makes clear that recordings can only be released to corroborate parental complaints, stemming, for example, from observation of unusual behavior in their children that suggests an incident may have happened at school. But even so, monitoring can lead caregiver environments into murky territory. Lawmakers and citizens usually raise concerns of privacy and cost—the Texas law, for example, allocated no additional funding for camera equipment that can total at least $3,500 per classroom, according to Janna Lilly, director of governmental relations for the Texas Council of Administrators of Special Education.

"Carers often feel like they're being blamed for so much, when often there are systemic issues."

But beyond those concerns, monitoring skips over a key factor in the quality of care: relationships between those vulnerable to abuse, their families, and caretakers. That's according to Gloria Puurveen, a Ph.D. student at the University of British Columbia who published research last year addressing the ethics of taping nursing home residents with dementia. Puurveen, who previously worked as a music therapist in a nursing home, found that temporary exposures to the camera can lead caregivers to provide "less organic," though not necessarily worse, care. She says future research should investigate possible ripple effects on care, like workers who are less comfortable in front of cameras withdrawing from certain duties, or some workers—perhaps without realizing it—giving more attention to residents with cameras in their rooms.

Monitoring also has the potential to create workplace tension. A 2014 study found that workplace monitoring decreased trust between employees and management, with a stronger effect among manual employees than non-manual ones. That's likely because manual workers are more often monitored by equipment they can see, such as a video camera installed in the corner of a room, according to Peter Holland, one of the study's authors and a professor at Monash University in Melbourne.

This "overt" monitoring is distinct from the hidden monitoring—like tracking Internet browsing and emails—common to work environments that rely on computer and other device use. Unsurprisingly, Holland says, out-in-the-open monitoring has a stronger negative impact on employees' work experience. These findings echo conclusions by a Data & Society Research Institute report that shows surveillance shifts workplace power dynamics in diverse ways, depending on relationships in the work environment and how surveillance is implemented.

One major strain on care center environments, Puurveen says, is understaffing, also a documented cause of negligence or abuse. "You need [nursing home] staff to be trained in fostering good communication skills, properly compensated—staff who feel empowered to give good care," she says. "Carers often feel like they're being blamed for so much, when so often there are systemic issues." Currently three states—California, Oregon, and Washington—require that residents receive a minimum of between two-and-a-half and three-and-a-half hours of direct care per day (the hours vary by state).

Special education, perennially labeled as being understaffed by the Texas Education Agency, faces this problem too—not only for teachers but also support staff, like speech pathologists and physical therapists, who often must be contracted across districts because of shortages, Lilly says. There's also the question of how staff receives their training. Lilly's organization, TCASE, backed a bill put forth last spring by Texas State Representative Mary Gonzalez to acknowledge children with cognitive disabilities in educators' required child abuse training, but the bill stalled before making it to a vote.

Legislators may be drawn to electronic monitoring as "a simple solution to a complex situation," which naturally has limitations, Holland says. Monitoring laws only address maltreatment that's detectable through recordings. Combatting abuse that falls outside those lines—for example, hurtful language or gestures not obvious from recordings—requires further cooperation between everyone in the monitored environment, he claims. "Inclusion is how you get people to buy into this approach."

The Texas Education Association has scheduled a stakeholder meeting for TCASE and other community groups this month, and promised to provide guidelines by April to help educators meet the looming mandate, according to Lilly. By this fall, the law demands that all classrooms with a majority of special needs students be ready to provide video and audio recording equipment upon parental requests, which have already started trickling in. Similarly, all six nursing home laws require consent from residents or their legal representatives; only California doesn't permit audio recordings alongside video. The nursing home laws are more vague as to when recorded footage can actually be viewed—if, for example, they can only be released in response to complaints from residents or their families.

Complaints might be reduced in the first place, Puurveen says, by a broader approach to abuse by caregivers. "You don't want to say, 'You can't install cameras to monitor this kind of stuff,' because this horrible stuff does happen," she says. "It just breaks your heart. But I have to wonder what else we could do."