A new report that combines nursing home quality data with a survey of family members ranks the best and worst states for care and paints a picture of how Americans view nursing homes.

The website Care.com analyzed Medicare's nursing home ratings to identify the states with the best and worst overall nursing home quality ratings. Using Medicare's five-star nursing home rating system, Care.com found that Hawaii nursing homes had the highest overall average ratings (3.93), followed by the District of Columbia (3.89), Florida (3.75), and New Jersey (3.75).  The state with the lowest average rating was Texas (2.68), followed by Oklahoma (2.76), Louisiana (2.80), and Kentucky (2.98).

Care.com also surveyed 978 people who have family members in a nursing home to determine their impressions about nursing homes. The surveyors found that the family members visited their loved ones in a nursing home an average six times a month, and more than half of those surveyed felt that they did not visit enough. Those who thought they visited enough visited an average of nine times a month. In addition, a little over half felt somewhat to extremely guilty about their loved one being in a nursing home, while slightly less than one-quarter (23 percent) did not feel guilty at all. If the tables were turned, nearly half of the respondents said they would not want their families to send them to a nursing home.

While the survey indicates that the decision to admit a loved one to a nursing home was difficult, a majority (71.3 percent) of respondents felt satisfied with the care their loved ones were receiving. Only 18.1 percent said they were dissatisfied and about 10 percent were neutral. A little over half said that they would like to provide care at home if they could. The most common special request made on behalf of a loved one in a nursing home is for special food. Other common requests include extra attention and environmental accommodations (e.g., room temperature).

To read the full results of the survey, click here

If you are questioning the quality of your loved one's nursing home, you may be tempted to install a nanny-cam.

Can You Put a Surveillance Camera in a Nursing Home Room?

Technological advances have made it easier to stay connected with loved ones all the time. This has included the ability to install cameras in a loved one's nursing home room. These so-called "granny cams" or "nanny cams" have legal and privacy implications.

The benefit of putting a surveillance camera in a nursing home is the ability to monitor your family member's care. Families that suspect abuse or neglect can keep on eye caregivers. Being able to observe care from afar can give family members peace of mind that their loved one is being well taken care of. It can also serve as evidence if abuse is found. Even if there is no abuse, cameras can be helpful to observe if caregivers are using improper techniques that may injure a resident.

On the other hand, cameras raise privacy concerns for both residents (including roommates) and caregivers. Residents may not want to be monitored while they are in a vulnerable state, such as changing or bathing. If the recording device picks up audio, then even the resident's conversations may no longer be private.

All this aside, do nursing homes have to permit families to install cameras?  This varies depending on the facility. Some nursing homes may have language in their admission contracts banning cameras or imposing specific requirements for their use. However, concerns over elder abuse have led some states to pass laws allowing cameras in nursing homes. At least six states -- Illinois, Louisiana, New Mexico, Oklahoma, Texas, and Washington -- have passed laws permitting families to install a camera in a nursing home if the resident and the resident's roommate have agreed. Utah permits cameras in assisted living facilities. In other states, such as Florida, the law surrounding camera use is more vague.

What Does Florida Law Say About Cameras in Nursing Homes?

In Pompano Beach, Florida, ABC Local 10 News ran an investigative report that showed disturbing images retrieved by a family member who placed hidden cameras inside a nursing home resident's room to monitor their elderly loved one's care. The problem is that the Florida Health Care Association (which represents 550 of Florida's 680+ nursing homes; a powerful lobbying force - are against cameras, citing privacy issues). Currently, Florida law prohibits placing cameras inside a nursing home resident's room, even if the resident consents (with many nursing home residents having cognitive impairments, would most even have the power to consent at all?).

While the use of nanny or granny cams is illegal, many family members of residents choose to willfully break the law. In a risk benefit analysis - the safety and care of one's elderly mother or father may trump the potential adverse legal consequences.

However, understand the practical reality is that if elder abuse is found, I believe (my own personal opinion) that it is highly unlikely a state attorney would criminally prosecute. For example, I cannot imagine that the pompano beach family member who caught nursing home staff dousing his love one with mouthwash via his hidden video camera suffered any adverse consequence (other than the horror of seeing such willful and wanton mistreatment). That being said, there are most definitely risks. If you are considering installing a camera in a loved one's nursing home room, you should consult with your elder care lawyer first in order to fully understand the potential consequences involved.

For a fact sheet about nursing home surveillance from The National Consumer Voice for Quality Long-Term Care, click here.  

And keep in mind the Consumer Voice’s advice that cameras are “no substitute for personal involvement and monitoring.”

Florida Elder Abuse Resources