Security cameras can offer facility operators peace of mind, provide a way to monitor vulnerable residents or customers, and help deter incidents of theft or abuse. But there's a lot to consider before installing a security system, or even upgrading or changing the placement of cameras already installed. This article breaks down some of the major considerations when buying a security system.

Your first step should be to ask what your organization aims to achieve by installing or making changes to a security camera system. Do you need to comply with a new security mandate from a parent organization? Do you hope to gain information to navigate a spike in claims of abuse or neglect, or deal with incidents of theft? What would your organization consider a successful result of your security camera strategy? This analysis will help your organization establish the wants and needs that will guide your decision. Then you can begin to explore the technical and ethical considerations around security cameras.

Right to Privacy/Consent to Monitoring

Respecting the privacy of the people you plan to monitor is one of the top legal and ethical considerations around installing security cameras.

HIPAA, the patient privacy act, often guides how health care organizations handle photographing and recording residents. Accreditation by the Joint Commission also requires that facilities get a resident’s consent to create or use any images of them beyond what’s required for their care. And photographing or recording a resident without written consent from them or an agreed-upon representative violates the resident’s right to privacy and confidentiality, according to a memorandum from the Centers for Medicare and Medicaid Services.

Some long-term care providers monitor building exits with cameras to ensure patients living with dementia don’t accidentally wander out of the facility. Make sure your organization understands the laws and regulations around privacy and cameras in any state where it operates. State laws on this issue are changing. About a dozen states have laws or regulations that permit long-term care facility residents or their families to put cameras in a resident’s room to monitor care. Similar measures are being weighed in many other states. The costs to install, maintain, and service an Internet camera hookup in a patient’s room are often passed on to families. Cameras in publicly accessible areas, such as parking lots and building entrances and exits, should be accompanied by prominent signs disclosing that video monitoring is taking place.

Security cameras raise issues for all types of workplaces around employee consent to monitoring. Any workplace images captured on film will inevitably include employees. Employees should know about the cameras, their locations, and their purpose. Cameras should not be placed in any location, such as a restroom or locker room, where there is a generally accepted expectation of privacy. Security cameras in stockrooms or supply closets may be used to keep track of supplies and deter theft. An organization’s right to videotape staff is strengthened if cameras are clearly visible and taping occurs in areas at the workplace where the staff can’t reasonably expect privacy. Organizations with unionized employees must consider whether the terms of union contracts allow camera monitoring. Employers that have unionized employees must negotiate with the union regarding the installation of cameras, according to the National Labor Relations Board.

An agency’s marketing claims may create commitments when it comes to security camera monitoring. If an agency touts “24-hour security” in marketing materials, officials need to observe surveillance monitors at all times and have a system to immediately contact security personnel or law enforcement if cameras reveal a security concern. In such situations, the security system should ideally have a backup power source in case of an outage. The organization will also need to decide whether to use backup tapes for recording and how long it will retain its recordings.

Use of surveillance technologies raises ethical concerns beyond consent to be monitored. Many camera systems use some level of artificial intelligence. Research has revealed many discriminatory effects of AI, and facial recognition software is often less accurate at identifying people of color than white people. Before you invest in or change a security system, consider the harm it could cause residents or community members. How can you minimize potential harm? How can you minimize unnecessary contact between members of vulnerable groups and police? Reach out to the community and local advocacy organizations for their input. What security measures at your facility would community members appreciate? Which ones could infringe on their rights or potentially place them in danger? Consider before an incident happens what your organization would and would not report to police, taking into account any regulations for your facility.

Technology Considerations

IP (Internet protocol) cameras boast much higher resolution than traditional analog systems. Costs of the systems have fallen as their uptake increased. With IP cameras, health care facilities can use their current Ethernet cables.

IP cameras come in several designs. “Bullet cameras” often don’t move or zoom in, so they are frequently used for one-directional monitoring. With “dome cameras,” observers can’t easily discern where they’re pointing. “Speed domes” spin rapidly and can capture a wide range of images. This type of camera includes PTZ (pan, tilt, zoom) models. PTZs are designed to capture images over a wide area. They can move and capture a variety of angles, and an operator can control them remotely or program them to scan an area.

Other camera technology aspects to evaluate include:

What resolution does your organization need?

Resolution, measured in pixels (or “megapixels,” millions of pixels), defines how much data a camera can capture. Resolution typically is listed by horizontal and vertical pixel dimensions. A camera that captures 1600 X 1200 pixels will produce an image that has a 1.92-million-pixel resolution. It would be called a 2.0-megapixel camera.

What lighting situations will cameras need to work in?

Wide dynamic range helps view areas with high-contrast lighting. Infrared LED lighting can allow IP cameras to capture viewable footage when there is low light or no light.

What conditions will your cameras need to stand up to?

If you will use cameras outside, you’ll need models that are weatherproof, indicated with an IP66 rating. Cameras that meet a vandalism resistance standard are known as IK10 rated.

Will you use network video recorders?

This technology can broadcast security camera feeds over the Internet and allow you to check them from any accessible device. Organizations with multiple buildings or locations often use this option.

Risk Tips

  • Know the laws and regulations around consent to monitoring and placement of cameras in all locations where your organization operates
  • Accompany cameras in publicly accessible areas with prominent signage letting viewers know that recording is taking place
  • Know your bargaining responsibilities around camera use if your organization has an employee union
  • Understand the security monitoring responsibilities created by any claim of “24-hour” or “24/7” security
  • Reach out to vulnerable populations and advocacy groups in your community for their input on how to minimize any harm that your organization’s use of cameras could cause
  • Understand how your organization will use cameras so you can best evaluate the technological options to deliver the security levels you promise to residents, employees, and customers


 “IP video cameras in assisted living communities,” McKnight Senior Living

“Video surveillance for elder care,”

“Cameras in long-term care: Monitoring, surveillance and risk management concerns,” Annals of Long-Term Care

“Alternatives to calling the police,” Unitarian Universalist Association Safe Congregations Handbook

Subscribe to our newsletter for timely content in your inbox