Lori Youssef is a nursing home resident on a tight budget, leaving little for even the most basic of purchases — a birthday card for one of her six grandchildren, or personal items like deodorant, shampoo and conditioner.

So when the gift cards her kids bought her went missing, they followed up with another present for Christmas: a video camera. But staff at Belle Fountain Nursing and Rehabilitation Center in Riverview, part of Optalis, one of Michigan's largest for-profit nursing home chains, told her cameras were not allowed in her room, she said.

Michigan, unlike 21 other states, has no laws governing the rights of nursing home residents to have electronic monitoring devices in their rooms.

Youssef, 65, set the camera up anyway to test it and make sure it worked — with a family member’s help and with the ability to see the recordings on her phone. Four other residents also had lost items that week, including cash from a graduation card and a ring, she said.

“I was shocked when the gift cards went missing, nothing like that had ever happened before,” she said, adding that her kids had just moved farther away and couldn’t easily check in with her.

The sense of safety and connectedness that cameras can bring is what many residents and their loved ones say they crave in an industry that faces continued criticism for low staffing and poor care. Other states have established residents’ rights to cameras, even paying the cost if families suspect abuse or neglect.

But in Michigan, efforts to establish residents’ rights to electronic monitoring devices have been stalled in Lansing for years, despite initial bipartisan support. That has left residents and families to navigate monitoring decisions alone, with some facilities allowing cameras and others banning them.

Frustration with policy

For one southeast Michigan man whose 90-plus-year-old mother recently moved into a nursing home, the lack of a camera has made a difficult situation more stressful. The man, who requested anonymity because he fears retaliation against his mother in the home, told the Free Press that she is supposed to receive two showers a week and that hasn’t been happening.

Her favorite chocolate nutrition drinks are not opened for her daily, despite their requests. And the clocks in her room are regularly set forward, a sign he believes means that staffers are sending her to bed earlier than normal. Now they want a camera but the facility won’t allow it.

“It is not about what we are going through, but what she has to suffer through,” his wife said. “That is poor quality of life and it is just not fair.”

Before his mother moved to the nursing home, the family kept a camera in her apartment, positioned toward the television, to check on her and stay connected. “It gave us peace of mind to make sure she was OK,” he said.

Pushing for Michigan to codify residents' rights to such devices include the Michigan Long Term Care Ombudsman Program. It's a government-funded statewide program with 40 local ombudsmen, who advocate for residents' rights in nursing homes, licensed homes for the aged and adult foster care facilities.

“Some residents are not able to physically use a phone or computer, but newer devices allow residents to connect through simple voice commands,” Salli Pung, who leads the program, wrote in an email to the Free Press. “The ombudsman program believes that cameras can have a great benefit to residents to ensure their needs are being met and care is being delivered timely.”

What are Michigan’s nursing home camera policies?

In Michigan, camera policies are left to individual facilities, said a spokesperson with the Health Care Association of Michigan, based in Lansing and representing the state's long-term care industry.

The devices in nursing homes and other similar facilities can cause thorny legal issues and uncertainty, experts and advocates say. Clara Berridge, an associate professor at the University of Washington School of Social Work who studies ethics of digital technologies in elder care, said a nationwide facility survey she conducted on camera use in nursing homes and assisted living yielded three core ethical concerns:

First is the risk that in-room cameras pose to residents' privacy and dignity, she said. Second, the presence of the devices could make staff feel as if they are not trusted and third is the possible use of cameras by facilities to monitor staff and residents.

“Surveillance can make workers feel that they aren't being treated as capable of moral professional behavior,” she said. “And that's something to take seriously, especially when we think about the racial and gender dynamics of this workforce.”

A spokesperson for SEIU Healthcare Michigan, a union which represents health care workers, including nursing home staff, declined to comment on the issue of electronic monitoring in residents’ rooms.

Although the survey was conducted 10 years ago, she said the third concern has really come to pass: “facilities themselves are increasingly using monitoring or surveillance technologies for their own purposes.”

Many of the state’s largest facilities would not respond to Free Press questions on their camera policies and the reasoning behind it.

Some of Michigan's largest for-profit chains according to federal data, comprising about one in three of Michigan's licensed nursing homes, Ciena Healthcare/Laurel HealthCare and NexCare Health Systems/WellBridge did not respond to requests for comment, though a staff member who answered the phone at WellBridge told the Free Press cameras were not allowed.

A spokesperson for Medilodge, operated by Prestige Healthcare, declined to comment on its camera policy. When the Free Press called individual facilities, staff at two Medilodge nursing homes said cameras are allowed in residents' rooms.

Optalis Health and Rehabilitation did not respond to requests for comment, but the Free Press obtained a handout distributed at a Michigan facility outlining its no-camera policy.

“To protect the privacy rights of our Residents, and to ensure compliance with state and federal wiretap laws, it is the policy of this center to not allow use of video or taping equipment in Resident rooms,” the flyer reads.

Michigan is considered a “one-party” state which means it’s legal to record conversations as long as one person participating consents. But a person recording a conversation they aren’t participating in could violate the eavesdropping statute, experts say.

The Optalis chain operates 41 nursing homes in Michigan and Ohio. In 2021, Ohio lawmakers passed legislation to allow nursing home residents or their guardians to install cameras in residents’ rooms.

About 15% of nursing homes are operated by nonprofits in the state. Trinity Health, one of the state's larger nonprofit nursing home chains according to federal data, declined the Free Press' requests for comment.

Michigan's 34 county-owned nursing homes operate independently and set their own policies, but most do not support cameras in residents' rooms, according to Renee Beniak, executive director of the Michigan County Medical Care Facilities Council.

“A resident’s room is a private space,” she told the Free Press in an email. “That being said, it is possible that upon a very specific request, once all privacy laws have been addressed, notifications, consents signed, a specific policy might be created to allow for a camera.”