What would you do?
After caring for a patient in her niece's home for several weeks, the nurse noticed the camera on the laptop was following her, including while she helped the patient to dress. The patient became upset when the nurse asked about it. The patient reported that she knew it was there but hated it, stating her niece "watches the whole place" and wouldn't turn it off.
What now? Are you uncomfortable? Do you talk to the niece? The patient is at risk for falling, but what about her privacy or choice? How do you share this with the team?
Nanny cams, home security, smart TVs, smart refrigerators, laptops, and a variety of other smart devices are camera-enabled. As a nation, we love our technology. According to the commercials, these devices let us tuck our children into bed from hotels, look in our refrigerators from the supermarket, watch who enters the front door, and tell the delivery person where to leave our boxes while sitting in the office. Home security systems are internet-enabled and hidden in any number of clocks, radios, and other nondescript home decor. Our homes are increasingly recorded, monitored, connected, and visible outside the physical walls. What does this mean to home healthcare providers?
In hospitals, cameras in public spaces are routine. Some specialty units, like intensive care and newborn nursery, have been utilizing cameras for monitoring and safety for many years. Legal, professional, and ethical standards about these cameras continuously evolve. Issues of individual privacy, organizational security, patient safety, professional duties to protect, to do no harm, to honor patient choice and legal issues of workplace privacy, accountability, and malpractice are regularly reevaluated (Lahey, 2014). These conversations are often the topic of ethics committees, which purposefully include various professional perspectives, ethics experts, patient advocates, and legal experts. In this manner, questions of when, how, and with what technology cameras are used are discussed in hospitals. But what about in private homes?
When professional caregivers enter individual homes, control over the environment belongs to the resident, who may or may not be the patient. The responsibility and decision-making capacity for the environment are clearly different. This is the core of why people want to have care at home. It is their space. The healthcare professional becomes the guest, not the host. Home-based professionals learn to adapt to a variety of life styles, cultures, and spaces. But have we considered the addition of cameras in these spaces? Should we? Home-based care agencies rarely have ethics committees with the depth and availability of hospitals. Even if they did, could they reasonably weigh in on the use of private cameras in private homes?
The questions are almost endless. Who is in control of the camera? Does the patient know it is there? What is within view? Can intimate acts of bathing or hygiene be watched? Is the camera recording, or live streaming, or hackable? Does it include audio? What is the range? Is it self-adjusting? Motion activated? Who has rights? What if the homeowner is not the patient, or even the patient's family? Is the camera intended to improve safety or a tool for abuse? Does the professional entering the home have any rights?
Hidden cameras are legal on private property in all states, but laws regarding cameras in private "places" within private property vary. Laws for audio recording are even more complex. The legal use of the material from these cameras is murky. The International Nanny Association strongly recommends that employers disclose the use of cameras in writing and encourage nannies to document the use in signed agreements (2018). The Joint Commission (2018) encourages hospitals to publicly post notices that cameras are in use. Workplace law governs use in offices. In intensive care units, procedures often include informing patients, and stopping or blocking the camera when intimate care is being provided. How do these standards translate in to the home?
These questions are real. Frontline caregivers are encountering cameras in homes. Slowly, stories are being shared within and across agencies. Universally, surprise is a part of the story. These encounters are a surprise to agency leaders, frontline caregivers and unfortunately, sometimes even a surprise to the patients. We seem to be unprepared to respond to cameras directly in the homes. State laws, organizational standards, and patient and family preferences all need to be balanced. Navigating this issue will rely on open, direct communication with a variety of stakeholders. Surprise in patient care is never a good thing. Have you talked about it?
Healthy Habits Can Lengthen Life
American don't live as long as people in most other high-income countries. Heart disease and cancer are two of the most common preventable chronic diseases in the United States. An unhealthy lifestyle increases your risk for these and other chronic diseases that can lead to an early death. To explore the effects of healthy habits on Americans' health and lifespan, a team of scientists led by Frank Hu at the Harvard T.H. Chan School of Public Health analyzed data from more than 78,000 women and 44,000 men who participated in two nationwide surveys: the Nurses' Health Study (NHS) and the Health Professionals Follow-up Study (HPFS).
The five factors included maintaining a healthy eating pattern (getting the daily recommended amounts of vegetables, fruit, nuts, whole grains, polyunsaturated fatty acids, and omega-3 fatty acids and limiting red and processed meats, beverages with added sugar, trans fat, and sodium); not smoking; getting at least 3.5 hours of moderate to vigorous physical activity each week; drinking only moderate amounts of alcohol (one drink or less per day for women or two drinks or less per day for men); and maintaining a normal weight (body mass index between 18.5 and 24.9). The researchers also collected information about the participants' medical history, such as heart disease, cancer, and diabetes, as well as when they died.
At age 50, women who didn't adopt any of the five healthy habits were estimated to live on average until they were 79 years old and men until they were 75.5 years. In contrast, women who adopted all five healthy lifestyle habits lived 93.1 years and men lived 87.6 years. Independently, each of the five healthy lifestyle factors significantly lowered the risk of total death, death from cancer, and death from heart disease.
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