When Steve Piskor put a hidden camera in his mother's Cleveland nursing home 10 years ago, he got proof of what he suspected: His 78-year-old mother, who was living with Alzheimer's disease, was being abused by the staff.

"There was actually nothing that stopped me from putting [a camera] in and there was no law that actually lets you put it in, so I did it and I said whatever happens, happens," he said. 

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Ultimately, two nurse assistants pleaded guilty to the abuse in 2011. At the same time, Piskor began his campaign to raise awareness around nursing home abuse, founding Elderly Nursing Home Abuse Advocates, and set his sights on the state legislature, hoping to make it easier for other loved ones to monitor potential abuse. 

Now, more than a decade later, his goal is being realized, with a new state law — Esther's Law — that goes into effect March 23. It allows residents and families to place cameras in nursing home rooms. Esther Piskor died in 2018 at the age of 85.

Ohio is joining a handful of other states, including Illinois, Kansas, Louisiana, Minnesota, New Mexico, Oklahoma, Texas, Washington, that allow for cameras in nursing homes. 

"The pandemic really woke everybody up to, you know, 'Hey, we've got problems in nursing homes and with our elderly,'" Piskor said.

"I would've pursued for another 10 years if I would have had to," he added. 

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The law requires that long-term care facilities allow residents or their guardian or attorney to install a monitoring device — be it a video camera or audio recorder or both — in a patient's room. 

Facilities may require forms to be filled out to use a camera, and consent is needed for residents who live with other residents. In cases where a roommate does not consent, the law says that the facility needs to make reasonable accommodations, such as moving the resident to another room with someone who does consent, or putting conditions on what is recorded, whether that be limiting sound or only having the camera on the resident. 

Under the law, facilities may require signage indicating that recording is in place. They may not discriminate against residents who wish to install a camera. 

The law does not apply to assisted living facilities, which do not fall under the state's definition of long-term care facilities as they are not skilled nursing settings, but individual facilities may have their own policies around recording. 

Patty Phillips, a nurse aide who works at multiple nursing homes in Massillon through an agency, said she thinks the law is a win-win. 

"I have worked with a few people who I feel like have no business working in this industry with the elderly," she said. "I feel like the cameras and everything would be a good way to protect the elderly from those people."

As a nurse aide, she said she is confident in the care she provides and doesn't mind being observed. In fact, she said that as someone who works with residents in memory care, the cameras are also a good way to protect nursing home employees. 

Still, privacy and dignity are concerns. Phillips said that residents are often in vulnerable positions during the care process, and while staff members do what they can to protect individual dignity, she understands why a resident may not want a camera on them.  

Susan Wallace, chief policy officer at Leading Age Ohio, a trade association for nonprofit nursing homes, said her organization is encouraging all their member facilities to implement a form for camera use so that all privacy concerns can be worked out ahead of installation. 

"We are hopeful that by this being a request that you make and it's a process and you have a discussion with the facility, we're hoping that we can really make sure that we're understanding the goals, the reasons for monitoring so that we're able to be proactive and preserve that [caregiving] relationship to the best of our ability," Wallace said. 

Her organization has been involved with Esther's Law throughout the legislative process, and Wallace said they feel as though the final version of the law ultimately protects residents rights. Leading Age produced their own toolkit for member organizations, including a sample form, to make implementation easier. 

Peter Van Runkle, executive director of the Ohio Health Care Association, said his organization also created a toolkit for nursing homes, and in particular they are encouraging that nursing homes place signage on resident rooms where a camera is in use to ensure that no one inadvertently has their privacy violated. 

"It's a careful balance the legislature achieved between the family's desire to know what's going on and a resident's right to privacy," Van Runkle said. 

Paula Mueller, the founder of Cleveland-based Elderly Advocates, is cautiously optimistic about Esther's Law.

She's concerned about the ambiguity in the law: forms for camera use are not required, but rather up to the facility's discretion, and Mueller is worried that without standardization, or in the cases where no form is used at all, families could accidentally find themselves violating privacy rights. 

"If [nursing homes] embrace the cameras now, I think they would have more control over it," Mueller said. "But if they don't, with technology so quickly evolving, people are just going to do stuff, and maybe protections won't be there."

Mueller's organization is planning to do the best it can to advise residents and loved ones on camera usage. She said that, as funds allow, it also would like to help sponsor cameras for those who want them and may not be able to afford them. 

Residents or guardians are responsible for paying for their own monitoring devices under the law. Sam McCoy, senior vice president of elder rights for Direction Home Akron Canton, said facilities are responsible for only providing electricity, and the costs of cameras he believes will limit the number of people who opt to exercise their new right.

Indoor cameras can range in price depending on what features are desired: Wyze's cameras and Amazon's Blink camera start at $35, while devices from Ring or Google Nest are typically more expensive, upwards of $60 or $100. 

McCoy advises that for residents or guardians interested in setting up an electronic device, they should consider whether they want it to be able broadcast livestream video or just record and store information to the device. 

Piskor said that residents should consider also setting up their own individual Wi-Fi hotspots for broadcast cameras, so as not to rely on a nursing home internet connection. 

A dozen Stark-area nursing homes did not respond to requests for comment for this story. Any resident or guardian who meets resistance to the law should contact an Ohio long-term care ombudsman at 800-282-1206. 

Sam Zern can be reached at szern@cantonrep.com or 330-580-8322. You can also find her on Twitter at @sam_zern.