Early this year, an inexplicable blister developed on the heel of Mary Ann Papp’s foot — the size of a baseball and a shade of purplish red.

It appeared to be a serious infection, but Papp’s daughter, Lisa Papp-Richards, said the Bemidji nursing home where her 75-year-old mother lived was unable to provide a clear explanation. Papp-Richards said she grew more concerned after she discovered what she thought was a puddle of urine on the floor beneath her mother’s wheelchair.

So Papp-Richards, 49, a day-care worker and mother of two young children, did what a growing number of Minnesota families are doing: She installed a surveillance camera in her mother’s room to monitor her daily care.

To her surprise, staff at Neilson Place objected — even covering the camera with a towel on some occasions or unplugging it. Eventually the family filed a complaint with the Minnesota Department of Health, and even though the home said it tried to resolve the dispute, the agency last week issued a far-reaching ruling in favor of the family.

The maltreatment finding is significant because it is considered the first of its kind to affirm, in clear language, the right of a Minnesota senior home resident to use a camera in a private room without fear of harassment. It also comes at a time when state health regulators have publicly acknowledged they are failing to keep pace with a dramatic, sevenfold increase in maltreatment complaints since 2010.

With state health inspectors overwhelmed by maltreatment complaints, the tiny cameras have become an important tool for families who suspect abuse or neglect but feel nursing home authorities dismiss their concerns.

Yet the cameras — small enough to fit inside a potted plant or a stuffed doll — have become a major point of controversy. Relatives who install the devices at times face intimidation by nursing home staff, and conflicting guidance on whether such surveillance is even legal without the facility’s consent. State law is murky on the matter, even as hidden camera footage has become increasingly useful for law enforcement officers and regulators investigating allegations of criminal abuse.

Bolted to the TV

The Papp family never imagined that the $199 camera, bought at a local Target store, would cause trouble. But the reaction from the nursing home, which is owned by the Sanford Health medical system, was swift.

Within days, the elderly woman was being pressured to remove the device from her room, according to the state’s investigative report. Without warning, investigators said, staff would unplug it or point the lens away from Papp’s bed. At one point, Neilson Place staff seized the device from Papp’s room, prompting the family to call the Bemidji police and report a theft.

When attempts to negotiate a solution failed, Papp’s son-in-law, a construction worker, built a wooden box for the camera and bolted it to Papp’s television cabinet. Even then, a facility supervisor in early May asked Papp to sign a statement saying that “photographic, video and/or audio monitoring” was not permitted in the facility when personal care was taking place. Papp refused to sign the document.

“All through this ordeal, I kept asking myself, ‘What are they so afraid of?’ ” Papp-Richards said. “It was clear they were trying to scare my mom.”

A spokeswoman for Sanford Health, a large health system based in the Dakotas that owns 16 long-term care facilities in Minnesota, said it took immediate action to resolve the complaint with the Department of Health, but declined to provide specifics on any corrective actions taken. The spokeswoman did not respond to specific allegations about care and questions about whether Neilson Place would now allow cameras in residents’ rooms.

After a lengthy inquiry, state health investigators found that Neilson Place staff members were directed by administration to ask Papp about turning off the camera every time they provided care. If she said no, staff members were instructed to tell her she would need to be moved to another room. The facility kept questioning Papp about the camera even after she made it clear the device made her “feel safe” and she did not want it removed. Staff also treated Papp differently after the camera was installed, by going into her room less often and not engaging in conversations with her, state investigators found.

“This is the kind of bullying behavior you might expect on a school playground, but not in a skilled nursing home,” said Suzanne Scheller, a Champlin attorney who handles elder abuse and neglect cases and represents the Papp family. “It’s inappropriate in this setting, period.”

‘Powerful message’

With thousands of elder abuse cases going uninvestigated by the state, a growing number of Minnesotans are turning to surveillance equipment as their one line of defense against maltreatment.

“It’s really sad that this individual sustained constant communication with staff about a camera,” said Cheryl Hennen, Minnesota’s long-term care ombudsman, who investigates complaints in senior care facilities. “But this [case] is hopeful because it sends a nice, powerful message to the public that it’s OK to put a camera in a room.”

As for Mary Ann Papp, she remains adamant about her rights, but said she has grown “mentally fatigued” by her battle with the nursing home. Most days, when her daughter drops in with a homemade meal and takes her on trips outside in her wheelchair, Papp said she can forget about the camera and the concerns that led the family to install it in the first place. The leg with the festering blister has since been amputated.

“I took care of myself for years and years, and I’m going to keep fighting this battle until they allow it,” Papp said. At that moment, a nursing home aide appeared in her room, and Papp fell silent.


Twitter: @chrisserres