According to a survey of older adults, 61% preferred to remain in their homes, even if they live alone. Home care agencies are increasingly admitting patients who have caregivers who live at a distance (Famakinwa, 2019). Video cameras should be considered when the patient has caregivers who do not live with the patient or are away from the home for work or other obligations. Simple video cameras cost as little as $50 and are easy to install, and provide a means of monitoring a loved one from a distance via connection to any home network. The most common goals of care that can be supported by home cameras relate to safety and fall detection. Each year in the United States, about 3 million older adults are treated in emergency departments because of falls (Centers for Disease control and Prevention, 2017). Cameras don't prevent falls, but they can alert viewers to a fall so the patient can receive prompt help.
Camera placement should be focused on where the patient ambulates the most, such as in and out of the bathroom, the kitchen, bedroom, and living room. If the patient goes to their mailbox, a camera can also be pointed from the door to the mailbox. Cameras can also be placed on the floor-the least-invasive location-to detect falls. Most importantly, the plan specifies who will be called when a fall or other safety issue is detected on a camera.
The ethical principles of autonomy and informed consent are foundational when using cameras in the home. Patients, of course, have a right to not consent. Truthfulness cannot be compromised, no matter what the potential benefit may be to the patient. The patient should determine who will have access to the camera feed and provide those individuals with the username and password. When the patient does not have mental capacity to give consent, the primary caregiver or healthcare proxy gives consent and participates in developing the support plan. The number of cameras and locations should be known to all parties. If a user is no longer in the support system, the camera password can be changed. If there are no local relatives, it is very helpful to identify a neighbor who can respond quickly if the patient falls or calls for help. It is not necessary for the neighbor to have access to the feed, just someone who can be asked to check on the patient quickly and call for emergency help if necessary. Extending the ethical principle of honesty, visitors and caregivers should know there are cameras in the home and how they are being used. Let them know their conversations are not private.
When recommending or selecting a model, brand names increase the chance that the camera firmware will be regularly updated by the manufacturer. Several websites with camera information are available in Table 1. There are two camera types; one is stationary, and the other can rotate around the room. Check social media ratings and instructional videos by the camera manufacturer in order to learn more about the features. Cameras should be rated for indoor use and meant for surveillance, not security. In addition to the camera, a smartphone or computer will be needed to download the application. One can also insert a mini memory card and record, either time lapse or continuously, and review the recordings later.
In our experience, the easiest method is to install a camera that will rotate to show all areas in a large room where the patient spends time. Cameras that rotate can be supplemented with stationary cameras that are focused on the floor or other locations. If the patient will be hearing audio from the camera, help them practice what to do when a person speaks to them and reminds them to take medication or complete another activity.
Baby monitors are a good first-level camera monitor. This type of camera usually has good night vision, which is an important feature of any camera. The disadvantage is that the camera images may not be unloadable to the web so that others can assist in monitoring the client. The second area of concern is the security of the camera. The internal "firmware" needs to be updated regularly, making it less likely to be hacked. Popular baby monitors are made by Motorola, Phillips, and Nanit. Older mobile phones can also be adapted as a stationary camera. A resource for how to use old mobile phones is in Table 1.
Indoor cameras made for viewing an area within a home are the next level of monitoring. Users of "smart home" products usually have cameras as part of an integrated system. Laptop or desktop computers can be used to transmit video via Facebook, Instagram, or any other social media platform that has the advantage of two-way communication. However, in practice, the laptops tend to give the narrowest view and are difficult to adjust, especially if a family member is using the laptops for other purposes.
Once the camera is set up, help the family create some very basic ground rules for using the cameras. For example, who will have access to the camera feed. The most important part of the plan is to establish a system for what action will be taken when the viewer needs to notify the primary caregiver that an issue has occurred. When there are multiple caregivers, use a calendar to keep things organized.
NIH: Stay Safe in the Hospital
* Bring a friend or family member with you to serve as an advocate.
* Know the members of your care team. Learn who's overseeing your care.
* Make sure your care providers and visitors wash their hands or use hand sanitizer.
* Know the signs and symptoms of infection.
* Ask your health care team questions and voice any concerns.
* Protect yourself by getting vaccinated against flu.
* Keep a written record about tests, medications, and the providers who visit you to help prevent mistakes.
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