In a move that would give new meaning to Missouri’s nickname of the “Show Me State,” a lawmaker there is sponsoring three bills that would require long-term care facilities to honor resident requests to install electronic monitoring equipment in their rooms. The fate of the legislation remains uncertain, however, as none of the bills has been assigned to a committee.

Rep. Andrew McDaniel, a Republican, is sponsoring H.B. 1652, which would allow video and audio devices in resident rooms in residential care, assisted living, intermediate care and skilled nursing facilities. A resident or his or her representative would need to approve of (and could decline) the monitoring, and approval also would be required of any roommates who would be affected by the recording.

Unlike a similar bill under consideration by the Senate in Utah, which applies solely to assisted living communities, Missouri’s Authorized Electronic Monitoring in Long-Term Care Facilities Act would allow equipment to be connected to the Internet, to enable remote access by family members and legal representatives. Another difference between the Utah and Missouri legislation is that the Missouri bill would require facilities to post signs at all entrances alerting visitors if one or more resident rooms is electronically monitored. The Missouri bill also would require facilities to post signs outside all rooms that are being monitored. The Utah bill states that facilities can require residents to post signs outside of their rooms.

A second bill in Missouri, H.B. 1654, is intentionally less detailed than H.B. 1652, according to McDaniel’s legislative aide, John LaVanchy. If the bill makes it to a House committee, members could address their concerns via amendments, he said. As written, the bill would apply to the same types of facilities as those covered by H.B. 1652, so only one or the other, if either, would be passed into law.

A third bill, H.B. 1655, would permit residents of homes for veterans to install electronic monitoring equipment in their rooms.

LaVanchy told McKnight’s Senior Living that McDaniel sponsored the bills to address senior living resident and family concerns about potential abuse and neglect. “It’s unfortunate that the very facilities, many times, that are entrusted with these people don’t seem to be doing an adequate job a lot of times,” he said, later adding: “We wanted to go ahead and give people the option [of installing monitoring equipment] because, essentially, that’s their home and their residence. You have the right to security within your own residence.”

None of the bills has entered the committee process in the state House of Representatives. A similar bill last year made it to the Health Committee, where it faced concerns related to privacy and the potential for “frivolous lawsuits” related to the provision of care, LaVanchy said. The bill stalled in the committee, but afterward, McDaniel’s staff met with officials from the Missouri Department of Health and Senior Services to find ways to address concerns while offering residents and their families the sense of safety that cameras can provide, he said.

This year’s version of the bill would permit a resident or facility to turn off or block a recording device under certain conditions. “We don’t want to take anyone’s privacy away,” LaVanchy explained.

Brian Lee, executive director of the national advocacy group Families for Better Care, told McKnight’s Senior Living that “extensive thought has gone into privacy” with regard to the Missouri legislation. Contrary to LaVanchy’s and Lee’s assessments, however, Nikki Strong, executive vice president of government affairs and member services for the Missouri Health Care Association, told McKnight’s Senior Living that the bill-related concerns of last year’s Health Committee remain. MHCA worries, for instance, about the chilling effect the installation of such equipment could have on workforce development, already a challenge in senior living, she said.

“It’s difficult enough getting staffing now in the state of Missouri, adequate staff that we need to care for people,” Strong said. “If we can’t get quality staff because staff are concerned about coming in or going in and caring for a resident, I would argue that a camera could actually deter the quality of the care that a resident could receive in a facility.”

Legislators and others must be careful not to use monitoring devices as a “quality crutch,” Lee said. The installation of such devices in other states, he added, hasn’t been shown to result in better care.

“I’m a proponent of cameras — don’t get me wrong,” Lee said. “I think they’re an important part of this equation, but I think a lot of people put all their eggs in this one basket like this is going to fix these problems. No, it’s just one more piece to try to get us to better care.” Pre-employment background checks and training after hire, two steps favored by Argentum, as well as sufficient staffing, are other pieces of the puzzle, he said.

Another of MHCA’s concerns related to the legislation, Strong said, is that liability issues may remain related to residents whose poor eyesight or dementia might prevent them from seeing or understanding a sign alerting them to the presence of a monitoring device. “Is it going to be up to the facility to … keep friends out of their friend’s room?” she said.

Currently, Strong said, facilities are free to permit residents to have monitoring devices in their rooms, and MHCA believes that the decision should remain with the facilities. An alternative to the bills, she said, is educating staff, residents and families about existing elder abuse laws in the state as well as the current ability to report a community via a hotline, which prompts a state investigation.

“On the surface, it [cameras] seems like a good idea: ‘Hey, let’s put a camera in a room, and let’s see everything that goes on,’ ” Strong said, “but I think that there’s just so much more negativity that could come out of it rather than good.”

Strong believes that at least one of the bills is likely to make it to a state House committee, she said, where it will be “extremely vetted again this year.”

The Missouri Assisted Living Association did not respond to a request for comment by McKnight’s Senior Living.

Five states — Illinois, New Mexico, Oklahoma, Texas and Washington — currently have laws requiring nursing homes to grant resident requests to use surveillance equipment in resident living areas, according to Argentum. The legislation under consideration in Utah, if it passes, could be only the second law to apply to device requests initiated by assisted living community residents or their representatives. Texas’ 2001 law was amended in 2003 to apply to assisted living communities, too. Missouri’s bills apply to both settings.