Eye in the sky: SA to run CCTV pilot in aged care

The South Australian government has announced a trial of CCTV installations across at least five aged care facilities in the state over a 12-month period.

The government will invest $500,000 in the Australian-first trial. It will be administered by UK firm Care Protect, which runs its own facilities as well as provides CCTV monitoring in a number of homes in the UK. This will be its first foray into Australian facilities.

SA premier Steven Marshall said: “In the shadow of Oakden and the Commonwealth aged care royal commission, protecting South Australia’s most vulnerable is one of my government’s highest priorities.

“This CCTV pilot will strengthen the safeguards in place for our frail, older population, provide greater transparency than ever before, and hopefully give loved ones greater peace of mind that their loved ones are receiving quality care.”

How it works

Care Protect has been providing “smart technology camera systems” to aged care and mental health facilities in the UK, owning and operating four facilities itself, which is where the original CCTV technology was trialled over an 18-month period.

Scott Sterling, Care Protect’s business development director here in Australia, told Aged Care Insite that the UK was experiencing similar problems to the ones faced here, and this technology was born of the need for improvement.

“We’ve seen a lot of horrific things happening,” he said. “There were scandals all over the place, and a system like this can prevent that or at least bring it to attention very fast.”

Cameras are installed in communal areas, which then record continuously over 24 hours. Cameras are also installed in bedroom areas. In the UK, these cameras are only switched on with consent by the resident, next of kin, or when given under a ‘best interest assessment’ where the decision is made by a social worker.

Once the bedroom cameras are switched on, they lie dormant until triggered by changes in movement, sound or light. These cameras can also be set up to have “motion windows” so that if a resident falls out of bed in the night, for example, four seconds later the hub in Belfast is alerted and can then alert staff at the facility via smartphone.

The information recorded is immediately streamed to a secure offsite facility and “military grade” cloud server. The footage is reviewed by a team of healthcare professionals, independent of the facility, who are registered nurses or trained social workers.

They are also subject to background checks and are registered with the secured industry authority, giving them licence to view CCTV footage.

They will review recorded footage and categorise it by severity on a traffic light system – green for good, amber for okay and red for poor practice.

Families can also have access with consent via an app. They would be able to log in and see bedroom footage of three minutes in every two-hour window.

“The biggest reason we use this in the UK is from a quality assurance perspective,” said Sterling.

“We had a good rating [for our homes] in the UK from the regulator, the Care Quality Commission. But once we installed the cameras, we saw that we were providing sub-standard service.

“We were very quickly able to clear that up. Any client facility that we have, we spend two hours a day every single day retroactively reviewing footage of communal areas and bedroom settings, and compile a monthly report,” he said.

Care Protect also reserves the right to report misconduct to relevant regulators in the UK if it feels residents are being neglected or if its notifications of poor practice are ignored.

Potential barriers to change

One barrier to CCTV installation may be the perceived cost to providers; however, Care Protect works on a leasing model and covers all installation costs.

“There is no initial cost to the provider upfront. We pay for the entire installation, and we pay for all the kit. We operate on a leasing model and charge $20 per week per registered bed plus GST,” Sterling said.

“We also carry out a commissioning process. We go to the facility, meet all the residents and the families, and present to the residents and staff members, so everyone is on board.

“We provide the facilities with screens, so they can see what we see, and we also provide them with smartphones and tablets, so we can contact them whenever we see a severe event.”

Another potential problem is one of privacy and abuse of the CCTV footage.

“The footage cannot be exported from the technology we use,” said Sterling.

“If it’s downloaded onto the server to be reviewed, it cannot be exported to, say, a USB. The only way that footage can be transferred is to an FTP drop site to the actual facility itself.”

Footage and any data collected are legally protected and, in the UK at least, Care Protect cannot be compelled by a facility to delete footage.

Privacy is often mentioned as a key concern for those not keen on the idea of CCTV in aged care facilities and Care Protect has taken this on board.

“If a resident is using, for example, a bedside commode and doesn’t want to be seen on that, we can redact that area through a black window that will always remain there,” Sterling said, and these windows can be placed anywhere, and only the facility manager will know about this blackspot, which does not affect the motion sensors or fall protections.

“That was a game changer in the UK,” he said, as it gave residents some privacy while ensuring vigilance.

As for staff who may be wary of being filmed, Care Protect says the technology is for their safety as well. Sterling recalls an incident in the UK where initially the staff in Care Protect homes wanted to walk off the job over the introduction of CCTV.

“About four weeks after installation, there was a malfunction with one of the bed hoists and a patient was injured and taken to hospital,” he said.

“The resident actually blamed two staff members. But we were able to review the footage and see that the bed hoist was faulty, so the two staff members were vindicated.

“And now our staff say, 'We wouldn’t work anywhere without cameras now, because it really does protect us and residents'.”

However, Dr Bruce Baer Arnold, from the Faculty of Business, Government and Law at the University of Canberra, believes legal problems could arise.

“South Australia still doesn’t have an information privacy act. It has not recognised a tort [a legal cause of action allowing compensation] for serious invasions of privacy. Adoption of CCTV needs to be undertaken within a coherent legal framework,” he said.

“We have a large literature on the use of CCTV in schools and prisons … much of which suggests that some offenders simply shift the location of the abuse [i.e. they harm the victim out of sight of the camera; for example, in a hallway or a bathroom].

“Politicians and bureaucrats in search of a good news story or headline tend to think of CCTV and other technology as a silver bullet without taking a deep breath and asking whether it will be effective and whether there is a better way – for example, training, supervision and reporting [including best-practice whistleblowing by colleagues of offenders] – to deal with particular problems."

Looking forward

Now that the green light has been given to use the technology here in Australia, Care Protect can plan for the future.

“Initially, for the first facility up and running, the team from Belfast will review Australian footage,” Sterling said.

“However, now we have a projected cash flow from a 12-month commitment from SA Health, we can look at potentially opening a Care Protect hub in South Australia and employing healthcare professionals [Australian registered] to monitor and review client footage in Australia. They will be background-checked as standard, and hold relevant licences in accordance with local laws, to view CCTV.”

Minister for Aged Care Ken Wyatt believes this is a positive step in protecting elder Aussies.

“Covert filming by individuals has sadly exposed poor quality of care and malpractice in some aged care settings,” Wyatt said.

“The community has been asking for this, and today we deliver an initiative which will result in stronger protections for our elderly residents, reduced adverse incidents and improved standards of care.”

Stewart Johnston, whose mother was abused in the Oakden facility and is now a prominent aged care campaigner, is also glad these steps are being taken. He will serve on a steering committee overseeing the pilot as a consumer representative.

“This pilot will show a cutting-edge technology delivering an unparalleled safeguarding system to residents’ family and staff with dignity, privacy and choice. This is no spy camera,” he told Aged Care Insite.

“This pilot is a significant step forward not only for South Australia but the nation. The technology now exists where dignity and privacy don't need to be traded for safety.”

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