When an older adult enters a care facility, they – along with their families – can face an ethical dilemma: how to ensure safety without compromising dignity and privacy. The growing trend of installing surveillance cameras in elder care settings – now legally permitted in roughly 20 states – forces us to confront fundamental questions about autonomy, vulnerability, and the nature of care itself.
As a recent New York Times article discusses, the camera debate centers on two essential but sometimes competing values: protection and privacy.
On one side, the duty to protect vulnerable adults from potential neglect or abuse seems clear. Older adults, particularly those with cognitive impairments, may be unable to advocate for themselves or even report mistreatment. Cameras provide an objective witness when concerns arise. For many families, the peace of mind that comes from being able to verify care quality feels like a moral imperative, especially given documented cases where cameras have exposed serious neglect.
On the other side is the equally important right to privacy and dignity. Long term care inherently involves intimate activities – bathing, toileting, dressing – that most adults would prefer to keep private. The presence of a camera during these moments can feel deeply intrusive. Furthermore, constant surveillance fundamentally alters the living environment, potentially making a resident’s room feel less like a home and more like an institution.
The heart of this ethical dilemma involves the tension between respecting autonomy and ensuring protection. When an older adult has full cognitive capacity, the choice about camera installation should prioritize their preferences. But what about those with dementia or other cognitive impairments?
Some ethicists argue that we should consider what the person would have wanted when they were fully capable – a concept known as “precedent autonomy.” Others suggest that when vulnerability is high, protection may sometimes need to take precedence over privacy concerns. Neither approach offers easy answers, especially when family members disagree about the right course of action.
Surveillance fundamentally alters the dynamic between caregivers and residents. At its best, caregiving is built on trust, empathy, and human connection. When cameras are introduced, the relationship risks shifting to one of surveillance and compliance.
Care workers – often underpaid, overworked, and undervalued – may experience cameras as a statement of distrust, positioning them as potential perpetrators rather than partners in care. This can create defensive behaviors, reduce job satisfaction, and potentially accelerate staff turnover in an industry already facing critical staffing shortages.
Some ethicists argue that this surveillance approach reflects our societal failure to address the structural problems in elder care: inadequate staffing ratios, insufficient training, low wages, and weak regulatory oversight. By focusing on monitoring individual behaviors rather than improving systemic conditions, cameras may provide an illusion of safety while leaving the root causes of poor care unaddressed.
The ethical complexity deepens when considering who has the right to authorize camera installation. Most state laws require the resident’s consent, but this becomes problematic when cognitive impairment is present. Should family members have the authority to install cameras when their loved one cannot meaningfully consent? What if the elder would have strongly objected to such surveillance when they had capacity?
Even more challenging: what about roommates who may be recorded incidentally? Their privacy concerns are equally valid, yet they may feel pressured to consent to avoid conflict. These questions highlight how cameras can create a cascade of ethical dilemmas that extend beyond the initial concern about monitoring care quality.
Alternatives and Proactive Approaches for Concerned Families
For families concerned about the quality of care, cameras represent just one option in a broader toolkit. Consider these alternatives and complementary approaches:
- Establish a care partnership: Build relationships with multiple staff members at different levels. Learn their names, acknowledge their work, and express appreciation when appropriate. This relationship-building can lead to better communication and care.
- Increase your presence: Vary the timing of your visits to get a more complete picture of care quality. If distance is an issue, enlist local friends or relatives to visit, or consider hiring a professional patient advocate.
- Document concerns systematically: Keep detailed records of any issues, including dates, times, staff members involved, and any physical evidence like photos of injuries or unsanitary conditions.
- Understand the complaint process: Familiarize yourself with the facility’s grievance procedure, but also know how to file complaints with:
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- Your state’s Long-Term Care Ombudsman (find yours at theconsumervoice.org)
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- The state licensing agency that oversees care facilities
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- Adult Protective Services in cases of suspected abuse or neglect
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5. Explore technological alternatives: Consider less intrusive options like:
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- Call systems that log staff response times
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- Wearable devices that track vital signs or falls
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- Scheduled video check-ins rather than continuous monitoring
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Resources for Families
If you’re concerned about a loved one’s care, these resources can help:
- National Long-Term Care Ombudsman Resource Center: Advocates for residents in long-term care facilities (ltcombudsman.org)
- Justice in Aging: Legal advocacy organization focused on fighting senior poverty and ensuring access to benefits (justiceinaging.org)
- AARP Caregiving Resource Center: Offers tools and support for family caregivers (aarp.org/caregiving)
- The Consumer Voice: The leading national advocacy organization for quality long-term care (theconsumervoice.org)
The Broader Ethical Imperative
While each family must navigate its own path through these difficult decisions, we share a collective responsibility to address the systemic issues that make cameras seem necessary in the first place. As gerontologist Dr. Clara Berridge notes, “Cameras are a symptom, not a solution.” The fundamental ethical question may not be whether to install cameras, but rather: How do we create a care system where safety and dignity naturally coexist, where neither residents nor families feel compelled to choose between these essential values?
Perhaps by confronting these deeper questions, we can move toward elder care that truly honors the whole person – their safety needs, their privacy rights, and their inherent dignity. Only then will cameras become what they ought to be: not a desperate measure, but simply one option among many for maintaining connection in a care system we can genuinely trust.
Written by Ann Laatsch, J.D., NCALL Justice System Coordinator