Posted on May 12, 2025

By Tina Lowry, CQL Quality Enhancement Specialist and Katherine Dunbar, CQL Vice President of Services and Systems Excellence

With innovative technology impacting nearly every part of life, the use of cameras and other surveillance equipment in support services is raising ethical questions. Are they actually promoting safety and independence or are they undermining rights? 

CQL | The Council on Quality Leadership promotes the use of enabling technology and remote supports that allow people to achieve personally defined outcomes, such as increased independence, the promotion of dignity and opportunity, lower reliance on in-person support, and improved access to their communities.

In this Capstone, we address the rights issues surrounding camera/CCTV use for surveillance. We also detail the importance of due process when reviewing the utilization of cameras/CCTV in people’s homes. Then, someone receiving services describes the impact of remote supports on their life. Finally, we share some considerations and questions to address before using cameras/CCTV, along with some additional resources that can support you as you look into remote supports.

CCTV, Surveillance, And Privacy

Historically, CCTV was implemented for public surveillance, to deter criminal activity, and for a measure of control over situations. However, CQL has found minimal peer reviewed research to support the theory that cameras/CCTV prevents or deters abuse, neglect, mistreatment, or exploitation in settings that support people, such as group homes. According to The Surveillance Technology Practice Guide, developed by the NDIS Quality and Safeguards Commission, on ethical and best practice considerations for surveillance technology: 

“Is surveillance technology effective against abuse and neglect? The abuse of people with disability, particularly those with intellectual and developmental disabilities has been recognized for decades (Horner-Johnson & Drum, 2006). However, there is limited evidence to support the use of CCTV to prevent abuse and neglect. (Hayward, 2017; Berridge, et al., 2019). For example, in the first study to review the literature on the use of CCTV for people with disabilities, Hayward (2017) found no evidence that surveillance technology reliably protects people with disabilities from abuse and neglect in their homes. In contrast, CCTV might be an indicator of possible abuse, when its use is influenced by unethical practices such as staff convenience” NDIS Quality and Safeguards Commission (2022). Surveillance Technology Practice Guide (2022). Penrith, Australia: NDIS Quality and Safeguards Commission.

While household cameras were initially introduced for home security or to monitor caregiving, such as with nanny cams, their purpose and capabilities have evolved significantly with advancing technology. As cameras become more accessible and integrated into daily life, ensuring they are used to support rather than surveil requires thoughtful navigation. Clear organizational systems and ethical guidelines are essential to distinguish supportive use from intrusive oversight.

It’s also critical to understand that the expectation of privacy is significantly higher in private homes than in public spaces. In public settings, such as streets or commercial areas, people generally accept a lower degree of privacy due to the nature of shared space. In contrast, the home is widely regarded, both legally and ethically, as a sanctuary where people are entitled to control their environment and interactions. This expectation of privacy is especially strong in personal bedrooms, bathrooms, and areas where intimate or vulnerable activities occur.

The use of visual or audio recording devices in the home may violate state eavesdropping or wiretapping laws, particularly when people are unaware that they are being recorded. Even when there are situations of guardianship, the person receiving supports must acknowledge and provide approval for the use of the camera. Beyond legality, inappropriate or unchecked use of cameras – especially in homes where people receive support – can infringe on fundamental rights, including:

• The right to privacy
• Freedom of association (e.g., choice of visitors and relationships)
• Freedom of speech (within one’s personal space)
• Freedom of movement (without feeling monitored or restricted)

Responsible camera use in homes, particularly in caregiving contexts, requires a careful balance between promoting safety and respecting the dignity, autonomy, and rights of the people who live there. Organizational policies, person-centered planning, and informed consent processes are essential tools in upholding that balance.

HCBS Guidelines And Due Process

Under the Home and Community-Based Services (HCBS) Settings Rule, any use of cameras as a restriction must be fully justified in accordance with the requirements outlined in §441.530. This includes identifying a particular, individualized assessed need and documenting the positive interventions and supports that were attempted before implementing the restriction.

A particular, individualized assessed need must be identified for each individual person living in a home using cameras and cannot be justified based on only one person’s need. There must be clear evidence that less intrusive methods were tried and found to be ineffective. The use of cameras must be directly proportionate to the assessed need, with ongoing data collection to evaluate the effectiveness of the support.

During due process, if the use of the camera support is not working and there is no evidence to continue this restrictive measure, it should be discontinued. Additionally, the restriction must be time-limited, subject to regular review, and include the written informed consent of the person receiving support. There must also be assurance that the intervention will not cause harm.

These safeguards are rooted in the need for due process, which ensures that everyone is treated fairly, has the right and chance to participate in decisions that affect them, and is protected from arbitrary or unjust and blanket restrictions and obstacles. Due process in disability support settings means people must have access to clear information, the opportunity to consent or object, opportunities to be heard, and mechanisms for appeal or reassessment. 

The Human Rights Committee (HRC) plays a vital role in upholding due process by serving as an impartial body that reviews restrictive interventions, evaluates whether the proposed action is the least restrictive alternative, and ensures that the person’s rights and voice are central to the decision-making process. To support due process, HRCs should include diverse representation (including advocates and people with lived experience), offer accessible explanations of proposed restrictions, encourage and support people impacted by the restriction to attend or participate in their reviews, and document all deliberations transparently.

The HRC should confirm that any use of cameras is tied to individually defined outcomes, not generalized goals like “safety,” and that there is a clear plan to reduce or eliminate the restriction over time. Importantly, committees must take into account the psychological and emotional impact of surveillance, ensuring that interventions promote dignity, autonomy, and well-being at every step.

Supporting People With Cameras

Cameras, when used ethically and with informed consent, can play a valuable role in supporting people to live more independently in their own homes. As part of remote monitoring systems, two-way cameras can reduce the need for constant in-person staff presence while still ensuring that help is available when needed. This model promotes autonomy and privacy, helping people build confidence in managing daily tasks like cooking, cleaning, and organizing routines. Rather than functioning as tools of constant oversight, cameras can support on-demand assistance, allowing remote staff to check in only when requested, by a person receiving supports. This approach minimizes the feeling of ‘being watched’ and reinforces a person’s control over their environment and who they let into it. 

With informed consent, recorded footage may be used constructively to support skill-building and goal tracking, such as reviewing progress in daily living tasks alongside a coach or staff member. Empowering people to control when cameras are active, and who can access the footage, enhances autonomy and fosters digital literacy. Accessible controls, such as voice assistants or simplified interfaces ensure that the technology supports people in their goals and dreams versus creating greater learning gaps. 

Cameras can also be used as part of personalized safety plans, such as detecting inactivity or falls, for people with medical or mobility challenges, offering a less intrusive alternative to full-time supervision. Finally, in emergencies, remote monitoring can help responders locate and assist people quickly without compromising their daily privacy. 

When implemented through a rights-based, person-centered approach, cameras can help people live fuller, more self-directed lives within their own homes and communities.

In Practice: Cameras As A Remote Support

One person receiving support at Envision Unlimited, a provider organization in Illinois, shared her experiences with living in a remote support environment that utilizes cameras and assistive technology. After obtaining her consent for the interview and to share her perspective, this is what Michelle had to say:

Comparing her current experience to living in a 24/7 community integrated living arrangement (CILA), she shared that she especially enjoys the increased freedom and flexibility:

“I like where I’m at. I have my own bedroom. I’m cooking for myself. I do laundry. I get to call for my own rides. I get to come and go as I please for holidays.”

When asked about the presence of cameras in the home, she confirmed:

“Yes, in the living room. They only come on when the staff leave at night.”

Her response showed an understanding of how the cameras function and a level of comfort with them. 

“That’s fine. I’ll ask what time staff come in and leave so I know. But when the cameras are on, we can be there by ourselves.”

She was also involved in a Human Rights Committee (HRC) review related to the use of cameras in her home:

“I was there and heard the list. They asked if I had questions.”

Although she initially didn’t want to attend the meeting, she was supported and encouraged to participate:

“I didn’t want to go to the meeting, but Tawanda encouraged me to go. I was there.”

When asked what she would improve, she mentioned medication timing as she still needs support in this area and the state is still working on procedures for remote support:

“I can’t go without my meds, so they have to come to give my meds. I can’t leave during med time because they have to put my meds into the computer.”

Finally, she offered a heartfelt endorsement of remote support:

“I’m going to the women’s conference in May. I get to stay in a hotel with my family. I would recommend remote support because you get to come and go. I get to do things by myself.”

Considerations Before Installing Or Using Cameras/CCTV

Intent & Scope

• What is the purpose of camera use? Is it truly to support the person, or primarily for surveillance or risk avoidance?
• What is the actual effect on the person’s quality of life, independence, and sense of security?
• Are cameras being universally implemented on an organizational level, or on an identified, individualized, assessed need?

Location & Placement

• Are cameras located only in common areas (kitchen, hallways, living room)?

Consistency & Context

• How do cameras impact those living in the home?
• Are cameras present in every home or setting? If not, what criteria determine their use?
• What data or evidence supports the need for cameras in this particular case?
• How does camera use affect staff morale, trust, and daily interactions?

Transparency & Access

• Who can view live or recorded footage?
  • How is that access determined?
  • Under what circumstances can the footage be viewed?
• Where can the footage be accessed?
• Are people aware of who has access to the footage? If not, why?
• Is there informed consent from the person receiving services and, when appropriate, legal representatives?
• What happens when a person does not give consent? How are their rights still being respected?

Technical & Policy Considerations

• How is footage stored, secured, maintained, and deleted by the organization providing the technology?
  • What safeguards ensure confidentiality?
  • Is there a retention schedule and destruction protocol?
• Are there policies and procedures that:
  • Clearly define who can access footage and for what purpose?
  • Specify how breaches will be addressed?
  • Are monitored regularly for compliance and accountability?

Control & Accessibility

• Who controls the camera? Can the person receiving support turn it on/off?
• Are camera functions accessible based on the person’s needs? (e.g., physical, cognitive)
• Are people supported in exercising their rights related to technology and surveillance? 

Training & Rights Education

• Are people receiving services educated on their rights related to privacy and surveillance?
• Are staff trained in rights promotion, privacy laws, ethical use of surveillance, and the emotional impacts of being watched?
• Are there safe mechanisms for people to express concerns or challenge surveillance?

An Ethical Path Forward

As we navigate the intersection of care, technology, and rights, it becomes clear that surveillance in support settings is not a simple matter of safety versus privacy. Rather it is a nuanced ethical terrain that demands diligence, empathy, and a steadfast commitment to human dignity. Cameras and other monitoring tools should never substitute for meaningful relationships, quality support, or a culture of accountability.

When used intentionally, with written informed consent, transparency, and a focus on individually defined outcomes, technology empowers people to live more freely and safely. But when imposed without due process, informed consent, or ethical safeguards, the risks are a silent intrusion. Ultimately, the question is not just whether we are watching over people, but whether we are truly watching out for them by honoring their rights, their voices, and their vision for a life of their own choosing.

Additional Resources

• The Surveillance Technology Practice Guide (NDIS)
• Remote Supports For People With Disabilities (CQL)
• Expanding the Use of Remote Supports for People with IDD (ANCOR)
• Electronic Monitoring: Cost Saving Technology or Potential Ethical Dilemma? (CQL)
• Remote Supports In Action (Ohio DODD)
• Remote Supports for People with IDD in HCBS (CQL)
• Video: Elizabeth Finds More Independence with Technology (Ohio DODD)
• The Rights of People With Cognitive Disabilities to Technology and Information Access (Coleman Institute)
• How Remote Support Technology Can Alleviate the Caregiver Shortage (Marquette Benefits and Social Welfare Law Review)
• The Arguments Against Camera And Closed-Circuit Television Surveillance In The Homes Of People With Disabilities To Protect From Abuse And Neglect (Brent A. Hayward)