Ohio's Push for Cameras in Assisted Living: A Step Toward Transparency, But Is It Enough?

In a state where elder abuse affects 1 in 10 adults over 60, and only 1 in 5 cases is reported, according to the Ohio Department of Aging, any tool that empowers families to monitor care is a welcome development. Ohio is now considering legislation to extend "granny cam" rights to assisted living communities, allowing residents and their loved ones to install cameras in private rooms to deter or document abuse. S.B. No. 154, introduced by Sen. Catherine D. Ingram, would build on Ohio's existing "Esther's Law," adopted in 2022 for nursing homes,  mandating that assisted living facilities accommodate such devices without compromising patient privacy. As reported by McKnight's Senior Living, the measure aims to close a gap affecting 60% of Ohio's senior living market, where assisted living residents lack similar protections. For readers of the Aging-in-Place- Planning and Elderlaw Blog, this initiative is a timely step. Yet it raises questions: Does it go far enough to prevent the "invisible crimes" lurking in understaffed facilities, or is it a band-aid on a system that needs an overhaul? 
As we've delved into in our article on "Esther's Law: Ohio's Granny Cam for Nursing Homes" and "The Limits of Nursing Home Cameras: Addressing Unseen Risks in Institutional Care," cameras are a tool, not a panacea, essential for transparency but insufficient without complementary reforms. This piece dives into the bill's details, its potential impact, and why it underscores the case for home-based alternatives.The Bill: A Bid to Extend 'Granny Cam' Rights to Assisted LivingThe proposed legislation would amend Ohio Revised Code § 3721 to require assisted living facilities (also called Residential Care Facilities or RCFs) to permit electronic monitoring devices in resident rooms, provided:

• The resident or their representative pays for installation, maintenance, and removal.
• Cameras are positioned to avoid capturing common areas or other residents without consent.

Facilities can't retaliate against residents (e.g., by issuing eviction threats) and must provide reasonable accommodations to residents.

The proposed extension would cap installation and maintenance costs to ensure affordability. Communities could charge up to $50 for device installation and a $2 monthly fee for internet access. The bill also would provide greater flexibility in camera options and who can access footage.

This push mirrors a national trend: 16 states (e.g., Connecticut, Minnesota, Texas) already mandate assisted living camera accommodations, with Rhode Island's law taking effect January 2026.
If the law is not approved and submitted to the governor by December 2026, it will need to be reintroduced in the following session. 
A Critical Look: Progress or Partial Fix?
On the surface, the bill is a victory for transparency.  Families could install cameras to monitor interactions, potentially deterring overt abuse. It addresses a key flaw in assisted living's lighter regulation compared to nursing homes, a gap that Esther's Law has helped address. Yet, a deeper dive reveals hurdles and limitations:

• Privacy and Practical Hurdles: Organizations like LeadingAge Ohio argue cameras invade privacy or create liability (e.g., capturing other residents), potentially leading to lawsuits or refusals. The bill requires consent but doesn't mandate facility cameras or dignity training.
• Not a Cure-All: As we noted in "The Limits of Nursing Home Cameras: Addressing Unseen Risks in Institutional Care," cameras catch overt abuse but miss subtler neglect, like understaffing or emotional isolation. With understaffing being ubiquitous, cameras alone won't fix systemic rot.
• Enforcement Gaps: No penalties for non-compliance beyond civil suits, and assisted living's voluntary reporting (vs. mandatory for nursing homes) means violations could slip through.

Overall, it's progress.  Extending Esther's Law could boost reporting 10-15% (similar to other states), but without broader reforms like mandatory staffing cameras, which empower but don't prevent the abuse of substandard care, seems like a pyrrhic victory for residents and their families; true reform demands a cultural shift toward quality care outcomes and autonomy.
What It Means for Seniors and Families: A Window to Watch, or a Door to Home?
For Ohio seniors, the bill means potential oversight of care, potentially reducing overt abuse. Families gain leverage in captured cases; cameras could document neglect, aiding lawsuits or APS reports. Yet, it reinforces institutional reliance, where cameras band-aid a system in crisis. The real takeaway? Use this as a prompt to prioritize home: With 80% of seniors preferring aging in place, cameras highlight why.  Home preserves privacy and control, without the "acuity mismatch" and risks of assisted living.  Better a door to your home than a window to a more dangerous and less safe alternativeStrategies: From Watching to Walking Away

• Advocate for Passage: Contact Rep. Brent (614-466-4891) or Sen. Craig (614-466-5087) to push for more vigorous enforcement.

• If Enacted, Use Wisely: Install cameras with consent; review footage routinely with family.

• Legal Shields: Add to advance directives which prioritize home care: "Utilize cameras in facilities, and avoid institutions where they are not permitted or are discouraged. 

• Home as Haven: Stay at home using family caregivers and in-home aides funded by HCBS waivers, Medicare supplemental insurance, or Medicare Advantage Plans. 

• Evaluate and Compare Facilities: See our article "Choosing a Nursing Home or Skilled Nursing Facility: Navigating the Long-Term Care Crisis," for tips, tricks, tools, and strategies.

Conclusion: Cameras as a Step, Home as the Goal

Ohio's bill is a flicker of progress, but cameras alone can't fix a flawed system. While this article has provided a thorough analysis of the initiative and its implications, it is by no means comprehensive. The landscape evolves rapidly. Readers must remain vigilant. By combining awareness with proactive planning, families can safeguard independence and thrive as they age in place. For support, consult a professional. Your security depends on proactive engagement.

 

Rising Malpractice Claims in Assisted Living: A Stark Incentive for Robust Aging-in-Place Planning

A recent report from the Nurses Services Organization and CNA Financial Corp. reveals a troubling 32% increase in malpractice claims against assisted living nurses from 2018 to 2023, with claims frequency rising to 0.71 per 100 beds and average severity reaching $284,000. Common allegations include falls (28%), pressure injuries (17%), and wrongful death (15%).  A majority of nurse professional liability claims involved treatment/care allegations (56.2%). The second most frequent category of allegations involved patients’ rights/abuse/professional conduct claims (18.2%). These trends, highlighted in McKnight's Senior Living article on October 2, 2025, underscore systemic vulnerabilities in institutional care settings, where understaffing and complex health needs heighten the risk of neglect and errors. Among the drivers of these claims is "increasing resident acuity," specifically  "acuity mismatches." 
Acuity and Acuity Mismatch
In healthcare, acuity refers to the severity or complexity of a resident's health needs, encompassing physical, cognitive, and emotional conditions. An acuity mismatch occurs when a resident's care needs exceed the capabilities, resources, or staffing levels of the assisted living facility in which they reside. In the context of the CNA report, acuity mismatches arise when facilities accept or retain residents with complex conditions, such as advanced dementia, severe mobility limitations, or chronic illnesses requiring intensive medical oversight, without adequate staff training, numbers, or infrastructure to provide appropriate care. 
A resident with significant cognitive impairment, for example, might require one-on-one supervision to prevent falls or wandering.  An understaffed assisted living facility, however, may lack the personnel or specialized training to meet these needs. This mismatch can lead to neglect, errors, or inadequate monitoring, resulting in incidents like falls,  pressure injuries, or even wrongful death.  These outcomes comprised the vast majority of claims in the study. 
How Acuity Mismatches Drive Malpractice Claims
Acuity mismatches contribute significantly to malpractice claims because they create conditions where care failures are more likely:

• Inadequate Staffing: Facilities often operate with low staff-to-resident ratios, unable to meet high-acuity needs. For instance, a resident requiring frequent repositioning to prevent pressure sores may be neglected if staff are stretched thin, leading to costly claims averaging $284,000.

• Lack of Specialized Training: Nurses may lack expertise in managing advanced dementia or complex medical conditions, increasing risks of errors like improper medication administration or failure to recognize warning signs.

• Facility Misalignment: Assisted living communities are designed for residents needing moderate support, not intensive medical care. Unfortunately, care needs change.  Accepting or retaining high-acuity residents without transferring them to better-oriented assisted living facilities or skilled nursing facilities can result in injury and claims.

• Regulatory Gaps: While states like Missouri have tightened oversight with 2025 laws mandating better staffing and reporting, enforcement varies, and many facilities struggle to comply.  Facilities failing to comply with standards and regulations may leave residents with less capable staff that might be necessary to meet individual and collective needs, heightening malpractice risks.

These mismatches directly fuel claims, as families pursue legal action when loved ones suffer harm due to preventable oversights. The 32% rise in claims frequency reflects how acuity mismatches, combined with other institutional challenges, like staffing or training deficits, create a perfect storm of liability in assisted living settings.
For readers of the Aging-in-Place Planning and Elder Law Blog, this surge serves as a powerful incentive to prioritize home-based strategies that minimize exposure to such hazards inherent in institutional care. As discussed in our "Rethinking Elder Abuse Strategies: How Prophylactic Planning Can Safeguard Autonomy and Aging in Place," proactive tools such as trusts and powers of attorney can help avoid institutional pitfalls altogether. This article examines the report's findings and offers practical guidance for leveraging aging-in-place planning to mitigate these risks.The CNA Report: Escalating Risks in Assisted LivingThe study, analyzing claims data from its Aging Services program, attributes the rise to chronic staffing shortages, exacerbated by post-pandemic turnover, and to residents with higher care needs, such as those with dementia or mobility issues. Falls remain the top claim, often linked to inadequate supervision, while pressure injuries highlight gaps in routine care. Wrongful death claims, though less frequent, carry the highest severity, resulting in significant payouts due to allegations of negligence. Industry leaders like Argentum note that these trends reflect broader challenges, including regulatory pressures and workforce deficits, which could lead to higher insurance premiums and operational costs for facilities.
For consumers, this means that assisted living, once viewed as a safe middle ground between independent living and nursing homes, now carries growing liabilities and risks. The report recommends enhanced training, improved risk assessment, and technology integration (e.g., fall-detection systems) to curb claims.  Still, these fixes don't eliminate the inherent risks and uncertainties of institutional environments.Why the Findings Incentivize Aging-in-Place PlanningThe rising number of malpractice claims is a wake-up call: institutional care, despite regulations, remains prone to human error and systemic flaws that can result in harm and legal battles. These risks are not unique to nursing homes. Aging in place offers a compelling alternative, allowing seniors to control their environment and care, reducing risks like those highlighted in the CNA report. By planning ahead, you can avoid the emotional, physical, psychological,  legal, and financial toll of facility-based mishaps, preserving autonomy.
Key incentives from the report:

• Reduced Exposure to Neglect: Home settings minimize risks through targeted modifications like grab bars or smart sensors, unlike understaffed facilities.
• Customized Care: Family or vetted caregivers can provide personalized attention without the acuity mismatches driving claims.
• Financial Savings: Avoiding high-severity incidents cuts potential medical and legal costs, redirecting funds to home supports.

Practical Strategies: Building a Resilient Aging-in-Place PlanTo harness this incentive, integrate elder law tools into your planning strategy. Establish trusts, advance directives with supported decision making  (SDM), dementia, aging in place, and guardianship directives.  Consider powers of attorney with safeguards. Include health care powers of attorney to outline home-based preferences and prevent forced institutionalization.
Invest in aging-in-place planning technology, medical devices, and security devices and monitors to secure home caregiving. These steps not only mitigate malpractice risk and dangers but also align with the CNA's call for better preparation in senior care.
While this article has provided a thoughtful examination of the rising malpractice claims in assisted living and their role as an incentive for aging-in-place planning, it is by no means comprehensive. The landscape of care risks evolves rapidly, influenced by staffing trends, regulatory changes, and individual circumstances that no single resource can fully capture. Readers, therefore, must remain vigilant, continuously educating themselves through reliable sources like CNA reports, AARP, local elder law attorneys, and this Blog, while regularly evaluating their personal situations to identify potential risks. By combining awareness with tools such as legal safeguards, caregiver screening, and home modifications, seniors and their families can better safeguard independence and thrive as they age in place. For ongoing support, consult a professional and stay informed.  Your security depends on proactive engagement.