The use of surveillance technology in residential care facilities for people with dementia or intellectual disabilities is often promoted both as a solution to understaffing and as a means to increasing clients’ autonomy. But there are fears that such use might attenuate the care relationship.
To investigate how surveillance technology is actually being used by nurses and support staff in residential care facilities for people with dementia or intellectual disabilities, in order to explore the possible benefits and drawbacks of this technology in practice.
An ethnographic field study was carried out in two residential care facilities: a nursing home for people with dementia and a facility for people with intellectual disabilities. Data were collected through field observations and informal conversations as well as through formal interviews.
Five overarching themes on the use of surveillance technology emerged from the data: continuing to do rounds, alarm fatigue, keeping clients in close proximity, locking the doors, and forgetting to take certain devices off. Despite the presence of surveillance technology, participants still continued their rounds. Alarm fatigue sometimes led participants to turn devices off. Though the technology allowed wandering clients to be tracked more easily, participants often preferred keeping clients nearby, and preferably behind locked doors at night. At times participants forgot to remove less visible devices (such as electronic bracelets) when the original reason for use expired.
A more nuanced view of the benefits and drawbacks of surveillance technology is called for. Study participants tended to incorporate surveillance technology into existing care routines and to do so with some reluctance and reservation. They also tended to favor certain technologies, for example, making intensive use of certain devices (such as digital enhanced cordless telecommunications phones) while demonstrating ambivalence about others (such as the tagging and tracking systems). Client safety and physical proximity seemed to be dominant values, suggesting that the fear that surveillance technology will cause attenuation of the care relationship is unfounded. On the other hand, the values of client freedom and autonomy seemed less influential; participants often appeared unwilling to take risks with the technology. Care facilities wishing to implement surveillance technology should encourage ongoing dialogue on how staff members view and understand the concepts of autonomy and risk. A clear and well-formulated vision for the use of surveillance technology—one understood and supported by all stakeholders—seems imperative to successful implementation.
This ethnographic field study on the ethics of using surveillance technology in residential care facilities suggests that a more nuanced view of the benefits and drawbacks of this technology is needed.
Alistair R. Niemeijer is a lecturer at the University of Humanistic Studies in Utrecht, the Netherlands; and a researcher in the Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Centre (VUmc) in Amsterdam, the Netherlands, where Marja Depla is a senior researcher and Cees Hertogh is a professor and the department cochair. Brenda Frederiks is an assistant professor in the Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VUmc. Anneke L. Francke is a professor at the Nivel Institute in Utrecht. This research was supported in part by grants from the following: ActiZ, Fonds NutsOhra, Reserves Voormalige Vrijwillige Ziekenfondsverzekeringen's Heeren Loo, Stichting Dioraphte, Stichting Regionale Zorgverlening Zeeland, Vereniging Gehandicaptenzorg Nederland, and Vereniging Het Zonnehuis. Contact author: Alistair Roelf Niemeijer, email@example.com. The authors and planners have disclosed no potential conflicts of interest, financial or otherwise.