Cameras in nursing home rooms, additional supplies of protective gear recommended as legislative changes this year

Connecticut’s nursing homes, ravaged by coronavirus, should allow residents and their families to begin installing cameras in rooms, should broaden infection control training and practices, should increase their supply of personal protective gear and should continue aggressively testing staff members to catch non-symptomatic cases, members of an advisory group recommended Thursday.

The state’s nursing home oversight panel is devising suggestions for legislative reform in long-term care facilities, which have been hard-hit by the spread of COVID-19. As of Dec. 29, the most recent data available, 3,532 nursing home residents had died of coronavirus – representing 60% of Connecticut’s overall COVID-19 fatalities – and 12,473 residents had been infected.

Among the suggestions shared Thursday was a proposal to allow residents and their families to install cameras in resident rooms.

“We tell residents that these are their homes. They should be able to use any technology they see fit,” said Mairead Painter, the state’s long-term care ombudswoman and a member of the advisory group. “It should be directed by the resident; they should be able to turn things on and off. They should be able to have this accommodation to meet their highest level of quality of life.”

Proponents of allowing cameras in nursing homes have said the devices would not only permit families to keep an eye on their loved ones, they also would provide accountability. If a resident reports being neglected or mistreated and that claim is disputed by staff, a video feed could help provide clarity.

“It should be whatever tool best suits them, whether it be for visitation, socialization, recreation, or if they feel for their own reasons – as far as cameras go – safeguards and protections,” Painter said of allowing technology into the rooms, which could also include a virtual assistant device like Amazon’s Alexa. “I’m not sure why we feel we need to make those decisions for them, or to decide what protections they do and don’t need.”

At least eight states, including Illinois, Texas, and Washington, allow cameras in nursing home rooms.

The concept has been raised here as legislation in the past, including as recently as last year. A bill allowing residents to install electronic monitoring devices in their rooms was passed by the Aging Committee, but the regular session was suspended amid the pandemic.

In written testimony on last year’s bill, Matthew Barrett, president and CEO of the Connecticut Association of Health Care Facilities, which represents 145 nursing homes in the state, urged lawmakers to consider requiring additional notice and consent measures, such as mandating that staff sign a form acknowledging their awareness of the cameras, and to address security and privacy matters, such as ensuring the recording device is visible in the room and banning the posting of footage on social media.

Mag Morelli, president of LeadingAge Connecticut, which represents 37 nursing homes in Connecticut, echoed concerns about privacy during last year’s legislative session.

“The concept of implementing video monitoring of individual nursing home residents is a very complicated issue and balanced consideration must be given to the rights and interests of all those involved,” she said in written testimony. “Privacy rights are paramount in the discussion and should include consideration of the privacy of the resident, the resident’s roommate, other residents in the building, and visitors to the nursing home.”

Reached Thursday, Morelli said she was glad the issue of technology in nursing homes was up for discussion again this year. But when it comes to cameras in rooms, she reiterated her fears about privacy issues.

“When it comes to the cameras, we’ve always been very concerned and wanted to make sure that any [legislation] addressed notice, and consent of the resident and anyone else who might be captured by video or audio,” she said. “With technology these days, the breaches of privacy would be a real concern for us, and how do you contain that?”

Barrett said the pandemic has put into “sharp focus” the need to address technology in nursing homes, but he reiterated concerns about confidentiality and consent. Having employees on camera may also discourage some people from working in the facilities, he said.

“We do have an overarching concern that a technology approach that is negatively focused on surveillance of employees will make nursing home jobs much less attractive at a time when we have so much work to do to enhance the status of these caregivers and their profession,” Barrett said.

Members of the nursing home advisory group also listed several recommendations for reform in the area of infection control, including expanding qualifications for people who want to work as specialists in the field, making infection control jobs full-time positions in nursing homes, and mandating training in this area.

“We believe that the infection control specialist role in long-term care facilities should be a full-time role, that they could be given other assignments to complete, except during an outbreak, in which case they should be doing full-time infection control and prevention,” said Sen. Mary Daugherty Abrams, D-Meriden, who co-chairs one of the group’s subcommittees. “We also recommend that this position have a rotating schedule where once a month, they cover all shifts, so we make sure they’re seeing everything that’s happening in a 24-hour, seven-day-a-week timeframe in the facility.”

State officials noted they already are encouraging nursing homes to make infection control positions full-time. Gov. Ned Lamont recently announced he was directing an additional $31.2 million in aid to the cash-strapped facilities, but nursing homes that want a piece of the funding must agree to make their infection control specialist jobs full time.

Members of the advisory panel also suggested increasing the supply of personal protective equipment in nursing homes to three months’ worth, up from the one month’s worth, and requiring quarterly fittings for N95 masks, instead of annual fittings, to ensure the right sizes are available. If there is not “adequate” protective gear at the start of a shift, an employee should not have to work until it is provided, but they should still be paid, Abrams said.

Mandated COVID-19 testing for employees who work in nursing homes should continue, Abrams said, and possibly expand to residents. Workers currently are tested once a week. Residents are tested if an outbreak (one or more cases) is detected in a facility.

“We know in this pandemic how important the testing was and continues to be, and it should continue to be implemented,” Abrams said. “With this virus, you have asymptomatic contagion. We know that this testing is very important.”

Advisory group members also recommended that lawmakers consider an “essential caregivers” policy. The caregivers are family members or other people deemed critical to a resident’s well being. In states that have adopted such a policy, nursing homes have the discretion to allow these caregivers in regularly and in ways that differ from traditional visits, which require social distancing, the use of protective gear and meetings in common areas of the buildings.

Nursing home officials said they are open to the idea.

“The qualifications of the caregivers, an approval process, their role in the overall care plan, training, vaccination, testing, supervision, et cetera, are details that we look forward to providing input on as the concepts moves forward,” Barrett said.

The advisory group has not yet finalized its recommendations and will share additional suggestions for legislative changes next week. Connecticut’s regular session began on Wednesday and runs through June 9.