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In recent years, facilities themselves have placed signs that cameras are in public areas like lobbies and dining halls."Notification encourages transparency and reaffirms shared expectations for quality care," said Joseph De Mattos, the president of the Health Facilities Association of Maryland, which represents long-term care and rehabilitation centers. Laura Mosqueda, a geriatrician in Irvine, Calif., has misgivings about cameras, but feels that with careful consent and notice, the practice can be put to good purpose."The documentation in nursing homes can be so poor that you can't tell what's going on and you don't know who to blame," she said.A year ago, the New York state attorney general's office, which has relied on hidden cameras in patient abuse and neglect cases for years, demonstrated its methods at a national training program for state investigators.In June, Mike De Wine, the Ohio state attorney general, announced that his office, with permission from families, had placed cameras in residents' rooms in an unspecified number of state facilities.

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"So if your family sees your naked behind, what's the big deal?

Another question is whether signs should be posted alerting staff members and visitors that monitoring is taking place.

Certainly, abuse has been exposed precisely because staff members did not know about hidden cameras.

De Wine has moved to shut down at least one facility, in Zanesville, where, he said, cameras caught actions like an aide's repeatedly leaving a stroke patient's food by his incapacitated side. Based on Racher's videos, one aide pleaded guilty to abuse and neglect. Similar scenes of abuse have been captured in New Jersey, New York, Pennsylvania, Texas and other states by relatives who placed cameras in potted plants and radios, webcams and i Phones.

The monitoring is often a last-ditch step by relatives who suspect abuse but feel that the authorities dismiss their complaints."Families are witnessing injuries and neglect of loved ones, and the only way to detect what's happening is to use hidden cameras," said Wes Bledsoe, the founder of A Perfect Cause, a group based in Oklahoma that tracks such cases around the country.

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