Incidents of abuse are very much in the news in Australia. If it is not in juvenile detention centres it is in aged care. It seems institutional care suffers from examples of ‘bad eggs’ which of course when you are dealing with vulnerable individuals raises the ire of the community.
A recent incident of elder abuse in South Australia, where a family member took video of care staff in a nursing home and exposed abuse of their father highlights the issue of monitoring and/or surveillance in aged care.
As a nurse it has always caused me some concern that when a residents door is shut I can’t ‘keep an eye on what is happening’ and I can only imagine this concern is uppermost in the minds of family, especially if they harbour concerns, when contemplating or advocating for video surveillance.
24/7 Surveillance – is it the answer?
But do we need to have our ‘eyes’ on the game 24/7 or should we be more attuned to other signs of neglect, disrespect or abuse? In the SA example of Mr Hausler his family began to notice signs that caused them concern – “noticing he had bruising and bloodshot eyes from crying” and raised their concerns. Similar signs would also be apparent to care staff and they also might have seen or had reported instances of questionable care.
A comprehensive review of residents, their signs and symptoms and the views and input of their family should be sufficient to alert us, or identify when abuse might be occurring. If abuse is suspected there are then ways of intervening when care is being delivered to identify and rectify such care issues.
Closer staff supervision and monitoring of performance is another key way of keeping on top of the type of values and practice you want to see in your staff. First and foremost the culture and values must form the bedrock of our care delivery. We can’t rely on monitoring and the threat of punishment to bring about the standards of care we want for our elderly and vulnerable residents.
Granny Cam’s – ‘deter and detect’
In the US 12 States have considered legislation to allow the use of video surveillance in assisted living homes (note these are not nursing homes). This legislation allows the use of video footage in court proceedings and require the consent prior to installation/use (of resident, and advice of the facility). The legislation also protects the resident from negative treatment as a result of the use of surveillance equipment (ie, residency, tenancy etc). The recordings are the property of the family not the facility. There are also protections of such equipment from tampering or abuse.
Privacy is one argument against video surveillance in residents rooms. Residents receive intimate care and this may not be appropriate to share via video surveillance.
Alternatively some argue that the interest of protecting the vulnerable outweight that the right to privacy in the workplace for staff. This view allows that if the residents don’t object to a camera in their own room, then this should be allowed..
In a world where privacy is being redefined everyday especially as technology extends its reach and usefulness it is timely to have a debate about the use of surveillance in aged care. It is worth noting that surveillance need not only be by video – there is more an and more surveillance via monitoring, alarms, sensors and web-based technologies. There is often no debate about the increasing use of these but they also raise privacy concerns.
The UK Social Care Institute for Excellence (SCIE) produced a very useful literature review – title Electronic surveillance in health and social care settings: a brief review on this issue in 2014 which I would recommend you to read.
This review and others have highlighted some of the benefits of surveillance being
- providing evidence to review examples of poor practice and/or abuse
- allows remote monitoring of residents (if video is available to management) – this is often also seen as a potential long-term problem if used in preference to physical monitoring.
- Staff awareness of surveillance can have positive and negative impacts
While this is a complex issue it must be debated and supported by relevant legislation if residents, families, nursing home proprietors and staff are to be considered and protected in their use.
Some further reading on this issue
Where to from here
“Openness and participation are antidotes to surveillance and control”
This is a thorny issue and one which would benefit from debate. I’d love to read some of your thoughts on this issue, please feel free to leave a comment.
About the author – Helen Attrill, MBA
Hi, Just a bit about myself – I have over 26 years as a leader in the aged care and not for profit sector and have led the successful implementation of significant sector, profession and organisational change.
If you’re struggling with some aspect of change management or frustrated with your progress then maybe I can help please feel free to contact me by emailing me at firstname.lastname@example.org.
To find out more about my work visit Meet Helen page.