02/20/2014 11:01 am ET Updated Apr 22, 2014

The Utility and Ethics of 'Granny Cams'

I was recently interviewed by the New York Times on the use of "granny cams" to detect elder abuse in nursing homes. The piece was prompted by several cases in which family members of nursing home residents placed video cameras in the rooms of their loved ones and recorded the goings-on there, unbeknownst to the staff. Caught on tape were some horrific episodes, including a staff member stuffing a rubber glove into the mouth of a helpless resident. As someone who has devoted his career to studying elder abuse and protecting the rights and dignity of older people, I nearly passed out.

So, should "granny cams" be installed widely in American nursing homes? I have spent thousands of hours providing medical care in nursing homes as a geriatrician. From this vantage point, I think we need to give the use of cameras some serious thought before plunging headfirst down this new surveillance rabbit hole.

The rights and safety of residents should be of paramount concern here, and the positive potential of video cameras to protect the safety of residents has obvious appeal. But what about the privacy rights of patients in this setting? The nursing home residents that stand to benefit the most from hidden surveillance are also those most likely to lack the capacity to consent to being recorded 24/7 due to diseases like Alzheimer's. Would you consent to be recorded continuously while being bathed, toileted, and more? If you were recorded, would you trust that these videos would remain private? In the digital age, ensuring privacy has practically become a Sisyphean task; we don't know where these videos will wind up.

There should certainly be zero tolerance for elder abuse in nursing homes -- I have participated as an expert in the civil and criminal prosecution of errant heath care workers -- but do employees have any rights here? Who among us would want to be recorded -- continuously and secretly -- in our daily employment? I also worry about how such evidence might be interpreted by lay observers. Any family caregiver who has tried to lovingly care for an agitated parent or spouse with Alzheimer's Disease will tell you that resistive behaviors are common, and interactions in trying moments could be misconstrued when taken out of context. The most meticulous and kind caregiver attempting to feed or bath an agitated patient will, from time to time, be greeted with shouts, assaults, and struggle that can be maddening.

The Times article also interviewed my friend and colleague from UC Irvine, Dr. Laura Mosqueda, whose perspective was compelling. If this is going to happen, it should be done with everyone's consent and knowledge -- employee, family member, and patient -- whenever possible. I think this notion is spot on. Video cameras have become a part of our daily lives, and this is going to happen whether we approve or not. As more states look to implement laws related to cameras in nursing homes, it seems prudent to develop standards around how and when these devices should be employed.