Her face filled the video screen in the congressional hearing room, a halo attached to her skull with metal pins to support her broken neck. In a videotape made from her hospital bed two days before her death, Helen Love was describing how the caregiver in her nursing home had beaten and tortured her after she had soiled her diaper.
Her roommate, Shirley, thought the nursing aide had silenced Love forever, but Love only pretended to be dead to survive. “I saw what you did to Helen, so you’ll have to kill me too,” Shirley said.
Instead, the 32-year-old man left the room. He would eventually spend one year in prison, thanks primarily to the persistence of Love’s sons and their lawyer.
Helen Love’s interview, shown four years after her death, was an emotional apex at the hearing of the U.S. Senate Special Committee on Aging, held three weeks ago. But the purpose of the gathering was for the U.S. government’s General Accounting Office to present the results of its 18-month study on nursing-home abuse.
Sadly, the report indicates that Helen Love’s horror is not unique. The GAO found that 30 percent of the nation’s 17,000 nursing homes were cited in recent years for “deficiencies involving actual harm to residents or placing them at risk of death or serious injury.”
The nursing-home industry agrees that it has a crisis and is eager for the government to intervene with legislation–and funding.
Proposed solutions include conducting criminal-background checks for all nursing-home workers and creating a national registry for workers cited for abuse, so they can’t simply move from state to state. But one suggestion mentioned at the hearing has the industry seeing red: the installation of video cameras in nursing homes to keep an eye on patient care.
“If my mother would have had a camera, it would have caught all of it,” said Bruce Love, Helen’s son, from his home in Mill Creek, Calif., after he returned from testifying before Sen. John Breaux’s (D-La.) committee.
“With the camera, you have no question of what went on. I have talked to people who have used cameras in the room, and they say that even the demeanor of the hired help was better when the camera was on.”
But John Gillan, a spokesman for the American Health Care Association, a trade group of for-profit nursing homes, said the cameras, nicknamed “granny cams,” infringe on privacy rights.
“If a family petitions to put in a camera in Mom’s room, it immediately sets up privacy issues with the family of the roommate, including private treatment by physicians, including toileting and bathing,” he said.
Sarah Andrews, research director of the Electronic Privacy Information Center, agreed. “In general, we’re opposed to routine surveillance,” she said.
“Just installing these cameras as a matter of course could be a violation of nurses’ rights to privacy in the workplace. However, if there is a problem with health care, that needs to be addressed. I would question how effective cameras would be in that respect. The money could be put toward increasing the training of nurses and proper human supervision,” she said.
But Beverly Moore, Illinois state director of the American Association of Retired Persons, said nursing homes don’t have the right to tell residents or their families that they can’t use video surveillance.
“It should be a resident’s choice, because it’s their home. Nursing homes should respect that,” Moore said.
Attracting quality workers
Gillan added, however, that the cameras also make it difficult to attract and retain quality workers in an industry buffeted by staff shortages and low pay.
“The nurses and the certified nursing assistants [CNAs] really resent cameras and the insinuation that they’re not doing their jobs professionally or properly,” he said.
Violette King of Godfrey, Ill., who founded the pro-video Nursing Home Monitors group in 1996 after her father was abused, said research shows that facilities using cameras have a lower rate of staff turnover than other nursing homes. Besides, she said, if the abusers quit, that’s OK.
“I have yet to meet anybody who works in a nursing home who’s against it,” she said. “Some staff who have something to hide will leave. You know what I say to that? Good riddance.”
In a statement, Charles Roadman, president of the nursing-home trade group, went a step further, charging that the cameras are a ruse designed for one purpose: bringing lawsuits against nursing homes. From that perspective, his organization has marshaled lobbying efforts to combat a growing number of states that are exploring the granny-cam option. Texas has the only law on the books specifically allowing granny cams, but a number of others, including California, Florida and Maryland, have been studying the issue.
Rights are clear
The American Association of Homes and Services for the Aging, the non-profit counterpart to the for-profit homes’ association, said there is not much to study because the video rights of residents and their families are self-evident.
Deborah Cloud, vice president of communications for the non-profit association, said the introduction of cameras is the symptom of a deeper problem.
“If residents or their families want to put cameras in their nursing home rooms, there’s really nothing to prevent them from doing so, providing their roommate or their roommate’s guardian gives consent,” Cloud said. “I think the bigger issue is one of trust and communication. It would be important for the nursing-home staff to explore why the resident or the family felt a need to install a camera and to take some action to address whatever the underlying concerns might be.”
Cloud also noted the factors that set the non-profits apart from the for-profit homes.
“Non-profit homes as a general rule do tend to staff a little bit higher and as a group tend to have fewer deficiencies on government inspection reports,” she said, “and they tend to spend more on direct patient care.”
Yet a few for-profit nursing homes, surprisingly, are leading the fight in favor of the cameras.
An absence of cameras
Cindy O’Steen and husband Mark have owned two nursing homes in Florida. In 1999, they sold their first home and moved to Lake City, about 60 miles west of Jacksonville, and bought Southland Suites. But Southland didn’t have cameras; their first home did. The O’Steens were having problems with staff and patients at the second home, and the only difference in their operating procedures was the absence of cameras.
So they installed an $18,000 camera system in Southland’s exterior and interior public areas. The home pays installments of $300 a month for it, Cindy O’Steen said. The cameras have both video and audio, and residents’ families can dial in via the Internet and interact with their loved ones.
Private conversations are available, too, and the O’Steens don’t control the tapes; an independent company does. For instance, O’Steen said, a daughter who is concerned about Mom’s eating habits can ask the outside company to download “lunch time” to her computer so she can see if her mother got an appropriate portion and whether she ate it.
“We couldn’t function without the cameras,” O’Steen said. “I wouldn’t want to attempt to.”
Although $18,000 may sound like a lot of money, according to O’Steen, the system paid for itself when their liability insurance plummeted from $57,000 a year to $10,000 after the cameras were installed.
“I can’t say that it’s specifically due to the cameras,” O’Steen said. “But our agent has told us that we’re paying the price of neglect for [other nursing homes] down the road. If all facilities had cameras, they’d be forced to do it the right way.”
Covering the cost
The cameras can be expensive for a facility, but there are ways to soften the blow. O’Steen suggested charging families a minimal fee for Internet access to defray costs. And although the GAO report focused on law enforcement involvement in abuse cases, study director Leslie Aronovitz said two of the 19 police departments her staff consulted already had the granny-cam technology and were willing to share.
“They said they would be willing to put in the equipment in conjunction with the nursing homes’ cooperation,” she said.
Jackie DuPont, who owns Irvine Cottages in Irvine, Calif., has been cooperating on the granny-cam front for years. She took part in a state pilot program in which cameras were installed in all the patient rooms in her six facilities. The program was supposed to end two years ago, but DuPont said the state still hasn’t made up its mind about cameras.
She has. She said she loves them. All her patients have Alzheimer’s disease, DuPont said, and those patients, who often are delusional, need cameras the most.
“If someone hit them or turned them too hard when they were changing them, they wouldn’t be able to tell me,” DuPont said. Similarly, delusional patients sometimes falsely accuse caregivers, saying they hid their dentures or even sexually abused them. The camera, DuPont said, shows who is telling the truth.
“The caregivers feel protected,” she said, noting that her staff has a much lower turnover rate than in the rest of the industry.
Monitoring performance
The success of DuPont’s program has brought her patients from as far away as Indiana and Florida. The families also can monitor care via the Internet.
“Most of those patients had been abused in the past,” DuPont said. “The cameras really bring great business. You would think other homes would see the marketing viability.”
So why do most nursing homes deplore the camera? “Because they have something to hide,” DuPont charged.
Martha Ballenot of Florissant, Mo., said she and her sisters don’t need a granny cam for their father. They trust the small Alzheimer’s facility where he lives, Ballenot said. But they didn’t trust a previous nursing home where Ballenot said her father was abused. That’s why Ballenot is going through the courts to pressure that facility to install cameras in the rooms even though her father is no longer there. Her father was the victim of an attack noted in another government report, issued last July 30 by U.S. Rep. Henry Waxman (D-Calif.). The report stated it this way: “Nursing home attendants used cigarettes to bribe a brain-damaged resident to attack another resident, then watched as the two residents fought each other.”
Said Ballenot: “They set him up in a human cockfight and then sat back and enjoyed it for their own amusement.”
The workers were never convicted on any charges, she said. Waxman said he hasn’t studied the granny-cam issue at length but is willing to listen.
Entitled to decent care
“I’ll look at any tool that will allow us to make sure that the care being given is the kind of decent care our seniors are entitled to,” he said.
But he charged that the Bush administration hasn’t shown sufficient interest in funding nursing-care reform.
“I am frustrated and I’m angry that the main reason we haven’t responded to this nursing-home crisis is we are told we don’t have the funds,” he said.
Yet in some cases, residents’ families bite the bullet and install cameras themselves. What do the cameras find? Usually, it’s poorly trained nursing-home workers providing subpar care with no malicious intent, said John Richard, an assistant district attorney in Fairbanks, Alaska.
Richard is a former ombudsman for Alaska, whose job was to investigate and resolve complaints of nursing-home residents. He vividly remembers a recent situation involving a resident whose daughter had placed a camera in his room.
“You wouldn’t expect to get any real serious abuse on camera, right?” Richard said. “Because, if it were me, I’m thinking I’d be straightening up my uniform, taking a deep breath, reviewing mentally what it is I had to do, do it as best I can and then get out of there.
Providing poor care
“Yet what was absolutely amazing is how much poor care we caught on the camera. These people obviously don’t know they’re providing poor care.
“For example, two staffers came in and put this guy on the toilet seat. You have to strap him to it. And they leave him there for at least 45 minutes. One of them goes to lunch. They forgot about him. It’s not exactly consistent with our notions of human dignity.”
For that infraction and others, the Anchorage assisted-living home was threatened with a ban on new patients.
Marty Margeson knows all about the events because the patient left unattended was her father, a former stockbroker and Ivy League Hall of Fame soccer player.
“He was in a lift apparatus for a potty chair, and he had no way to summon help because he can’t talk,” Margeson said.
She was reluctant to talk on the record because she said she fears retaliation against her father, but said she does not regret installing her own camera system, including a time-lapse VCR, at a cost of $1,200.
“I think the video camera is an excellent tool. I would recommend it to every family who has a resident suffering from dementia or who is handicapped and can’t speak for themselves. I can’t be there 24 hours a day, so it monitors my dad’s care.”
Who should pay?
Of course, $1,200 is a lot of money for many families, and that’s why Sen. Chuck Grassley (R-Iowa) thinks the nursing homes should pay for them. Grassley was the chairman of the Special Committee on Aging when the GAO report was commissioned.
“Putting the onus on family members would shift too much responsibility from the nursing-home owners and regulators,” he said. “Nursing homes accept billions of federal and state dollars to perform their job. They’re required by federal law to maintain nursing home residents’ quality of life. When the system fails nursing-home residents, then the system has to be fixed.
“I do understand that families are desperate sometimes. In those cases, if family members work out the placement of cameras with individual nursing homes, that’s fine. But on a national, systemic level, I don’t want the responsibility of maintaining good care to shift from the nursing home and regulators to family members.”
Margeson said she hopes the federal government will pass legislation giving nursing-home residents and their families the right to install cameras, but congressional staffers said the camera issue may be left to states to decide. That is why Violette King hopes to test the camera issue in court.
Ready to litigate
King’s Nursing Home Monitors group has teams of lawyers standing by across the country to litigate for granny-cam rights provided that a resident and the family agree to an overt camera placement.
(Many families, she said, would prefer hidden cameras because, although they suspect abuse, they are fearful their loved one will be threatened with eviction if they introduce a camera in plain sight.)
She is puzzled by the industry’s fear of cameras, because she believes the granny cam offers nursing homes “a win-win situation.”
“They’re going to save money with cameras,” she said. “You’re going to have less abuse, less cuts, less bruises, less incontinence and less bedsores. With that money, you can either put it in your pocket or hire more health-care aides. But by far the biggest gain is going to be full beds and less staff turnover.”
The CNA who abused King’s father was stripped of her certification in Illinois, but King said she recently ran into her at a shopping mall.
“She said she was now working at a children’s hospital in Missouri,” King said.
