Proponents of the cameras, dubbed "granny cams," say their use in nursing homes could weed out abusive employees and document incidents of substandard care, while nursing-home owners term video surveillance an invasion of privacy that could actually decrease care by making it more difficult to attract and retain good staff.
The controversy has its roots not only in the march of technology, but also in the surge of Americans who are entering nursing homes.
About half of Americans currently 65 or older will be admitted to a nursing home at least once, writes Selket Nicole Cottle in an article in the Elder Law Journal, which is published by the University of Illinois College of Law.
This tide is only expected to rise as baby boomers approach their golden years.
At the same time, about 30 percent of the nation's 17,000 nursing homes have been sanctioned for deficiencies that put their residents at risk of harm. About one in 20 nursing home residents suffer from abuse, according to the Florida Agency of Health Care Administration, and this figure appears to understate the problem because many instances of physical and sexual abuse go unreported.
Although no law expressly prohibits the use of cameras in nursing homes, there are various practical barriers to their widespread use, including the strong opposition of the nursing-home industry.
About a dozen state legislatures have granny-cam legislation under consideration. Earlier this year, New Mexico joined Texas in allowing nursing home residents or their representatives to install monitoring cameras in their rooms.
Under the laws, a resident must let nursing-home operators know ahead of time of the placement of the camera. If the operator is not notified or if the equipment is not open and obvious in the room, the camera is considered covert surveillance and illegal.
Use of such cameras is a positive step in reducing the potential for elderly abuse, Cottle, an editor at the journal, concluded. In particular, Web cameras hold the greatest potential for restoring public confidence in nursing homes by giving family members access to "real time" or to recently stored footage.
Commercial outlets now sell Web-camera systems to the elderly at prices from $629 to $1,584, depending on the specifications of each camera, plus a $20 monthly fee to access the server and $10 a month for a data-only line to upload images.
"Certainly some families have the financial means to provide this quality of technological protection, however the majority of Americans do not," Cottle wrote. To be effective and properly regulated, granny-cam technology should therefore be mandated for all nursing facilities.
"Mandating the use of granny cameras in nursing homes will ensure that all nursing home residents are equally protected," she wrote.
While not trifling, the cost of installing equipment in a nursing home is on par with the cost of updating recreation, housekeeping or food services. And some of the cost would be defrayed by lower liability insurance premiums, according to Cottle.
What's more, surveillance equipment has advantages for operators by reducing unwarranted or frivolous litigation and minimizing their legal responsibility in cases of resident-on-resident abuse.
Cameras also could monitor many of the basics of resident care, such as drug administration and diaper changing. By linking the camera feed to the Internet, nursing homes could handle routine assignments more efficiently.
But because of understandable concerns over privacy, Cottle advocates placing the surveillance systems in the hands of independent companies, which would then monitor the equipment and be responsible for making the data available online.
"In this way, families can check on their loved ones and nursing homes can check on their residents, and everyone will sleep a little better at night knowing that the independent source is regulating and reviewing the tapes should any problems arise," Cottle wrote.
"This service, like the cost of the cameras or of the tapes, is an added institutional cost that the nursing home will incur. Nevertheless, it is likely the best option to preserve the integrity of the tapes and ensure that only families and authorized officials gain access to them."
Cottle's article is titled "Video Surveillance in Nursing Homes."