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A case for cameras -- augmenting the view of small assisted living

Should video monitoring be required in small assisted living homes?  In recent Senate testimony, ALFA president Rick Grimes sounded a bit defensive about the regulatory oversight of assisted living facilities (ALFs) in Florida (aka 'group homes' in other states). Let's back up: Even when multiple residents died of abuse and neglect and inspections revealed multiple violations, the Agency for Health Care Administration didn’t close these troubled small homes down. Says Mr. Grimes: regulation in all fifty states (aka 50 different sets of regulations) is plenty adequate, and by the way, each state’s seniors are ‘different’ -- the Florida deaths were due to ‘management’ issues.

So where can YOU go these days where there are no cameras?  In smaller assisted living/group homes (6 – 20 residents in a modified private home), no one besides the manager/administrator is or can be watching the goings-on. Yet YOUR day-to-day life is heavily watched: your bank’s ATMs, entrances to apartment buildings, grocery and department stores, shopping malls, maybe even security cameras in Mr. Grimes’ own house.  All are watching visitors and customers in the event that they present any kind of risk to the owner/manager’s premises. In large and luxurious assisted living communities, cameras are typical – the front desk and security staff can see hallways from multiple views in all directions. These organizations do this voluntarily, of course, to reduce risk and boost safety of residents and staff.

No nationwide regulation exists that mandates a security camera.  Yet every state has a Florida situation where frail and/or demented seniors within small care settings are neglected -- and that neglect makes the news. My take is that Mr. Grimes is wrong – management is clearly not enough, either in the care of the disabled or the care of the elderly. At the very least, for assisted living homes that have been cited with violations and still not closed down, state and federal agencies should require cameras with audio to be installed in common areas – precisely to put fear of being monitored onto the premises. Cost of the technology should be born by the administrator or owner cited in the violations as part of enabling them to stay in business. Then inspectors should require a backup plan for moving residents, like a hurricane evacuation plan, if ‘violations’ such as abuse and neglect persist.

Assisted living today has an older and frailer clientele. The economy has kept seniors at home longer: today’s Assisted Living resident has an average age of 86, stays for an average of 28 months, is likely to have dementia as a member of the 85+ population, not to mention other disabilities, mobility limitations, behavior issues, and wound care requirements that may develop over time. The cliché persists that Assisted Living residents want to stay put as long as they can, that seniors fear a nursing home ‘worse than death.’ But when a woman dies in assisted living because too-tight restraints killed her, when lack of oversight does result in death or immobilization from drugs, than this is the ‘worse’ that could make heavily regulated nursing homes -- some with newer and creative designs, more staff training and certification requirements -- look pretty good.

In the meantime, in the state which is in the process of dismantling volunteer ombudsman programs, where the Miami Herald continues its multi-part investigations into abuse and neglect, where regulations of assisted living change rarely, let's put more of a lens on day-to-day life of frail elderly who cannot speak up for themselves.


Recently, I had a discussion with a group of geriatric care managers about camera usage. We talked about "nanny cams" and live surveillance cameras. The feeling was mixed amongst the group, but everyone pretty much agreed that cameras put everyone on best behavior. The memory care facility we toured had cameras in every residential room (which could be turned off on request of the residents.) They are inexpensive and easy to deploy. And, if they save a life, deployment seems to be a no brainer.

Many years ago, when kids were first being introduced to the Internet, a teacher friend told the kids that the blinking light in the ceiling mounted fire alarm was a camera. It kept most of the kids behaving well.

There should be adequate patient rights for nursing homes in all 50 states. A few years back my mother went to a nursing home temporarily after she fractured her femur while recovering from a hip replacement. I lived out of state and while she was recuperating I talked to her daily and then started noticing a lot of coughing and wheezing. She would get out of breath when getting out of bed. I suspected pneumonia or a blood clot and kept calling for the nursing home doctor to see her. Day after day went by with excuse after excuse for not seeing my mother. I left messages with the doctor's office to no avail, finally had to fly into town and demand that she have an immediate xray - turned out she had blood clots in her leg and her lungs and had to be admitted to a hospital.

Nursing homes shouldn't be allowed to neglect the medical needs of their patients, and they shouldn't be self-regulating. We need strong patient's rights and oversight to protect the vulnerable people in nursing homes. A camera in this instance wouldn't have done much good, but I am sure they can be valuable in cases of abuse and should probably be located in some areas of a nursing home, assisted living facility and group homes.


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