Should You Use Surveillance to Monitor an Elderly Parent?

The psychology and ethics of clandestine home protection

Posted Aug 24, 2019

One of the most difficult decisions adult children have to make is how to care for an elderly relative that is at the point of needing assistance.  Many older individuals who are suffering from mental or physical (or both) challenges prefer to continue living alone, and do not want full-time caretakers.  Their children want to keep an eye on them, particularly if they are fall risks, have dementia, or otherwise require observation to ensure their safety.  Psychologically and ethically, however, how can they?

The Ethics of Eavesdropping

The primary concern facing family members who are facing this dilemma is the well being of the family member who will be monitored.  How do they feel about it?  How do you bring it up?  And are there circumstances where the desire to maintain their safety should override their will?

Many children with aging parents decide to begin by discussing a broad range of options.  Perhaps a parent would consent to a camera in the kitchen, or in the living room, as opposed to in the bedroom or God forbid the bathroom.  There is also the option of adding audio, which can be a good way for a child to check in on his or her parent initiating two-way communication, as long as it is installed in an area that would avoid picking up private phone calls.  Sensor monitor cameras offer a compromise position, only recording when motion is detected in a certain area of the home, such as near the front door, if a parent is prone to becoming confused and walking outside in the middle of the night for example, or in certain rooms, such as the kitchen, where a lack of detected movement could be cause for alarm.

The rationale for checking in on elderly, homebound relatives is understandable.  But how do the individuals to be monitored feel about it?  Research has some answers.  

Living on Video 

A study by Bert Bonroy et al (2009) examined the utility of video cameras to capture facial expressions of discomfort of bedridden demented elderly individuals.[i]  Because patients with late-stage dementia lose the ability for verbal communication, reading facial expressions can help caregivers keep them comfortable by monitoring signs of discomfort. Using a Digital Discomfort Labeling Tool, they found that nurses were able to recognize a higher level of discomfort than they would have without the tool in one out of six patients.     

On the other end of the spectrum, studies have examined the impact of consensual video calling as part of elderly homecare.  Antonia Arnaert and Lucas Delesie (2007) studied the impact of video-telephone nursing care on elderly homebound individuals.[ii]  Studying 71 such persons, with a mean age of 72 years old, they identified groups of study participants that showed significant improvement in functioning, mentally, physically, and emotionally, following telecare nursing.  They note that their findings indicate the value of telecare as an alternative care model that can be integrated into existing home care services.

Regarding consistent video home monitoring, some elderly people who know they are at risk of falling are receptive to the idea.  Sophie Turgeon Londei et al. (2009) explored the receptivity of elderly participants with a history of falls to having an intelligent videomonitoring system (IVS) installed in their home.[iii] They found that most participants were favorable to IVS, half said they would use it, with the others expressing reluctance to use it unless their health worsened or they had to live alone.  

But what type of video monitoring is appropriate for someone with early-stage dementia, or who is cognitively sound but physically frail?  Is it ever appropriate to secretly monitor such individuals without their express consent? 

Weighing Options Over Time

Many children would not install secret recording equipment in a parent´s home without their knowledge, viewing such surveillance as spying.  A better option in this scenario is to respectfully bring up the subject of home monitoring, as well as the rationale, over time.   

Many older individuals who are physically frail or beginning to notice early signs of dementia warm up to the idea of some level of monitoring over time, if it means continuing to live independently.  The goal is to balance safety, security, and quality of life.  Because research indicates different levels of receptivity depending on the type of monitoring being used, permitting older individuals to have a voice in the discussion allows them to maintain their dignity, as well as their safety.  

References

[i]Bonroy, Bert, Pieter Schiepers, Greet Leysens, Dragana Miljkovic, Maartje Wils, Lieven De Maesschalck, Stijn Quanten, et al. "Acquiring a dataset of labeled video images showing discomfort in demented elderly." Telemedicine and e-Health 15, no. 4 (2009): 370+. Gale Academic Onefile.

[ii]Arnaert, Antonia, and Lucas Delesie. “Effectiveness of Video-Telephone Nursing Care for the Homebound Elderly,” Canadian Journal of Nursing Research Archive 39, no. 1 (2007):20-36.

[iii]Londei, Sophie Turgeon, Jacqueline Rousseau, Francine Ducharme, Alain St-Arnaud, Jean Meunier, Jocelyne Saint-Arnaud, and Francine Giroux. “An Intelligent Videomonitoring System for Fall Detection at Home: Perceptions of Elderly People.” Journal of Telemedicine and Telecare 15, no. 8 (December 2009): 383–90.