I was recently fortunate to be invited to attend a presentation at Parliament House in Adelaide by a UK company, Care Protect.

You can view their website here:  Care Protect Ltd

I have worked in aged care, and now work in health care services, and previously I have considered the growing calls for CCTV with a degree of suspicion. I believe that elderly people have the right to dignity and respect, and that includes privacy in their most intimate and vulnerable moments. Our privacy laws in South Australia currently allow for CCTV to be present in communal areas, and for vision but not sound to be recorded. However, providers control the footage and this can be highly problematic.

I have experienced the implementation of CCTV in a facility where I worked, and saw it being misused by management to “spy” on staff – counting trips to the toilets and reprimanding staff who were talking for “too long” by the viewers estimation – though they could not have truthfully known what the staff were talking about. I do not believe that the CCTV in that facility was installed with resident safety first and foremost in mind, I believe it was more of a “cover our butt” measure so that should someone be injured they could look to use footage to prove it wasn’t the fault of the home. I also don’t believe they properly informed residents and families about the installation, as many residents were concerned that cameras could see into their rooms and experienced some measurable distress as a consequence. Staff were extremely negative about the installation and felt it was impacting on their privacy also.

Where I currently work, we have a lot of CCTV cameras and they are equally used for patient and staff safety – at night staff can look at a screen to see who is at the door before opening it, and if we press a panic or emergency button all the cameras in the area will focus there automatically. We can also request that footage be reviewed should a patient abscond, so that we can provide a description to police who then perform welfare checks if required. I have never experienced a negative use of CCTV footage in my time in that workplace, and mostly i forget that it is there. I don’t feel negative about it at all, and see that it can be a useful tool for patient safety in common areas, as well as for staff and visitors.

When it comes to surveillance in private rooms, I certainly had a lot more hesitation and would previously have said that it was not something that I supported with any real conviction. My main objections were the right to privacy of residents, especially those with cognitive impairment that might be unaware they’re being filmed, the fact that providers would control footage and could pick and choose what they shared, and that some media really love to share sensational footage without full context, which could have dire consequences for staff who are accused of doing something wrong, but later cleared – the footage could still be out in the public domain for some time, and wide open to interpretation – much like some of the internet memes we all encounter on a daily basis.

The wonderful Noleen Hausler (featured image) spoke at our Adelaide rally about her brave decision to hide a camera in her father’s room, capturing terrible treatment of a vulnerable, defenseless elderly gentleman by a carer, who has since been convicted of aggravated assault. Noleen has spoken out about the legal threats she received from the provider instructing her to cease recording her loved one, instead of the expected immediate empathy and horror that their employee had acted in such a manner towards a resident. The employee resigned before the provider had considered terminating their employment, and the provider then went further and denied any record of previous complaints or concerns raised about care. This story shocked me, and made me start to reconsider some of my views on CCTV.

Noleen’s Story (warning: confronting)

As a nurse, I pride myself on providing excellent patient care, and always try my best to communicate with patients and their families, and educate them about the care I provide as a large part of my role. However, I know that sometimes things are not understood, or can be confusing due to cultural differences, or cognitive impairment. One of the things that impressed me most about the Care Protect presentation was that they discussed their reporting system which providers can use to identify gaps in care provision, and the real impact this has had on performance indicators. Better patient care should be everyone’s priority and this is one tool that could greatly aid that, if used correctly – and Care Protect certainly impressed me with their stated aims.

Some of the other points that stuck with me from the presentation:

Cameras are placed in communal rooms where sound is not recorded (due to the large amount of noise that would be difficult to isolate).

In private rooms, individuals can opt in or out of recordings. Sound and vision are recorded, but not sampled continuously. All footage is securely stored and can be retrieved if required, even outside of sampling times.

The footage is monitored remotely, and each area is sampled daily for a period of two hours – not always continuously, but for random times where care might be being provided, or when potential issues have been identified (eg: a resident who has experienced a number of falls overnight).

Staff who monitor footage are all healthcare professionals and have high security clearances. If they see an incident of concern, they will immediately contact the service provider and inform them. Should it be a reportable incident, such as an assault or injury, they would also contact and report to relevant authorities. Staff on duty will have iPhones on their person and will receive an alert as to where an incident has occurred so that they can attend swiftly.

If someone is injured in an incident, such as a fall, footage can be retrieved and the family would be invited to view it if they choose. The service provider does not control the footage, and cannot access it – it is retained and stored by Care Protect.

Cameras can be set up to start recording in “movement windows” eg: if a resident is in bed, the window can be placed beside the bed so if the resident gets up, the camera will automatically begin to record. This can be applied to any high risk area such as stairs.

A privacy window can be applied to the recording area – for example if there was a commode beside the bed, a black box (size and placement fully customisable) can be placed over the commode, so that the person can not be seen using the commode on the recording.

You can choose heat sensitive recording rather than standard vision also, so if someone had a camera in the bathroom you could not see clear details of them undressing or showering, but could still see that they were not lying on the floor injured.

Families can login with a unique PIN for a very short time if they wish to – around 3 minutes a day. This could be just to make sure their loved one is asleep and not distressed or unwell.

The cost is incredibly low – around $20 per person each week, and the service provider pays a set cost per bed. They receive daily reports of any flagged incidents and weekly, monthly and six monthly reports of collated statistics, details of flagged incidents and performance indicators for care provision.

I was extremely impressed and felt very positive after the presentation, having had all of my concerns addressed in a very satisfactory way. I could not find any negatives!

Those present included the Health and Wellbeing Minister Stephen Wade, Frank Pangallo MLC and Connie Bonaros MLC. Frank Pangallo spoke about Care Protect in Parliament at the next sitting and signaled keen interest in moving legislation to enable availability of the service for aged care homes in SA.

See the video here (14.22mins)

This is an exciting and important opportunity for service providers, residents and their families, and for staff. I hope to see it trialled soon, and look forwards to the results.

Thank you to the Care Protect staff who presented to us, and to Stewart Johnston for inviting me along.

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