At 2 a.m. on a November morning, Shirley Breitman began to scream for help from the bed of her assisted-living facility in St. Louis Park.
Her pained cries were streamed live to the smartphones of Breitman's two adult children — Richard in Minneapolis and Laurie in Los Angeles — through an internet-connected camera placed in her bedroom. Within minutes, Richard was on the phone with the facility's nursing staff, asking them to check on their 98-year-old mother, who has advanced dementia and was experiencing an adverse reaction to new medication.
"Once you install one of these cameras, you can't imagine living without it," said Breitman, an attorney. "It gives you peace of mind knowing that another set of eyes is on our mother."
In recent years, a raft of new video surveillance technology has made it possible for families to monitor the daily movements and care of their aging relatives with remarkable clarity and precision. Yet Minnesota law has long been silent on whether people actually had the right to install such equipment in residents' rooms at care facilities, an omission that sowed confusion and conflicts between families and senior homes.
Now, after years of legal wrangling, state law is finally clear: Minnesotans have the right to use electronic monitoring devices in most senior care facilities, provided they notify the facility and obtain consent from residents being monitored. Effective this month, nursing homes and assisted-living facilities across the state are required to inform residents of their right to use the cameras.
The small, internet-enabled cameras can bring peace of mind to families who suspect abuse of a loved one, or who simply want to keep better tabs on their care. The remote monitoring systems, which can be purchased online for less than $200, have become increasingly sophisticated. People can now receive automatic alerts to their smartphones when someone enters a loved one's room, or when there is unusual activity or sound.
Breitman said the streaming videos are so vivid that, on a recent morning, he could see the type of food aides left for his mother as well as the quality of the bandages on her injured wrist. "It's stunningly good," Breitman said as he watched the video feed.
But not all seniors want to live under round-the-clock surveillance. Last year, elder care advocates, industry representatives and state health officials struggled to work out a compromise between invasion of privacy and fears of resident abuse. The result is a complicated set of new reporting requirements and some confusion over how the new law will be implemented. Some advocates worry that the bevy of new rules will discourage the very surveillance it was designed to protect and that some people may be subject to retaliation for using the devices.
Modeled after legislation in Illinois, Minnesota's law requires that families obtain the resident's consent to the use of a camera and notify the facility of their plans. If a resident occupies a shared room, the roommate must also provide consent. In cases where senior residents are too frail or cognitively impaired to give consent, relatives must fill out a 9-page form with a written statement from a medical professional.
The prior notification requirements also have advocates worried about possible retaliation. In the past, families who suspected abuse or neglect of a loved one could put hidden cameras in their loved one's room without ever telling facility staff. In many cases, families would take this step as a last resort, when attempts to work out problems with facility staff had failed, advocates noted.
Now, however, residents or family members who install a surveillance camera without first notifying the facility and completing the required consent forms are violating state law. The new law does allow for an exception: If a resident or family member fears retaliation, they can install the device for two weeks without notifying the facility, provided they submit a special form to the Office of the Ombudsman of Long-Term Care.
Jean Peters, president of Elder Voice Family Advocates, a nonprofit that advocates for safe and quality care in long-term care facilities, said the new law and its bevy of new rules are "unnecessarily punitive" and leave families vulnerable to retaliation.
"All people want to do is monitor the care of their loved ones, to make sure they are getting what they are paying for," Peters said. "These reporting requirements will have a chilling effect on families."
Sean Burke, public policy director at the Minnesota Elder Justice Center, which helped craft the regulations, acknowledged that some families may find the new paperwork overly burdensome. But, he said, the state had to respect the privacy rights of seniors, including those who may be incapable of understanding that they are being filmed.
"With this new technology, it's literally like 'The Truman Show,' " Burke said. "You are putting [your loved one's] entire life on film, potentially, including their most intimate cares. That is an awesome power."
Staff tampered with camera
Allegations of abuse in senior homes are notoriously hard to prove, and hidden cameras are one of the few ways that families can corroborate claims by elderly relatives. Increasingly, the footage is also being used by law enforcement officials and state health regulators, in some cases to bring criminal charges.
Across Minnesota, many seniors and their relatives are learning about the technology for the first time. Care Providers of Minnesota, a long-term care industry trade group, is urging its member facilities to include information about the new law in admissions packets for new residents.
"Eventually, everyone should be educated," said Patti Cullen, president and chief executive of Care Providers.
Lisa Papp-Richards is among the first to take advantage of the new law. Three years ago, she tried to install a camera in the Bemidji nursing home where her 77-year-old mother lived after she noticed a sudden decline in her health without any clear explanation. Soon, however, facility staff began tampering with the camera — even placing a towel over it — and eventually seized the camera without her consent. The family filed a police report alleging theft.
Last week, emboldened by the new law, Papp-Richards reinstalled the camera in the same place, high atop a wooden cabinet, with a clear view of her mother's room. Already, she is checking the video stream on her smartphone four to five times a day, and she's noticed an improvement in her mother's mental well-being. Her mother, she said, has become "more relaxed" knowing that her daughter is keeping a closer watch on her care. On the video feed, Papp-Richards could see staff joking and interacting well with her mother, which helped assuage worries that her mother was being left alone.
"At my mother's age, things can change in an instant, so it's vitally important to be able to react immediately," Papp-Richards said. "The cameras are a reassuring, last line of defense."