In an effort to prevent abuse of the elderly, Maryland lawmakers will take a fourth look at a bill that sets guidelines for nursing homes to set up cameras in residents' rooms.

The legislation, dubbed Vera's Law, was introduced for three years by Democratic former state Delegate Sue Hecht, who lost a bid for the state Senate in November. It's named for her mother.

Now Democratic state Delegate Marilyn Goldwater has taken up the cause, but the nursing home industry says it may do more harm than good.

Nursing homes are already struggling to retain health care professionals to provide daily bedside care and don't want to cast a pall on the profession. The shortage of nurses and nursing assistants has prompted critics to charge that the bill could further discourage people from entering the field.

"The single most important factor in providing quality care to residents is the nursing staff. This bill sends the message that our staff is suspect and untrustworthy in providing care," said Mark Woodard, vice president of government relations for Health Facilities Association of Maryland, which represents 150 licensed nursing homes in the state.

The intent of the bill is to work with the nursing staff, not against it, proponents say.

"There are a lot of good nursing homes, we're not here to degrade nursing homes, but to protect the patient," said Goldwater, who is a registered nurse.

This year's version of Vera's Law provides strict specifications for the use of electronic monitoring, aimed at addressing opponents' questions.

Cameras would not be mandated. They are to be installed at the request of a resident or the resident's family, and at their expense.

Furthermore, the resident must obtain written consent from a roommate before installing the monitor to prevent any privacy infringement. In addition, a notice must be posted on the door indicating that electronic monitoring is being used.

Such a camera might have helped Hecht's late mother, Vera.

Hecht's mother resided in a Fredrick, Md. nursing home, which Hecht had researched and found to be "well-respected." During a midday visit, Hecht found her mom in the bathroom "with a nurse's aide standing over her, yelling and cursing at my mother," she recounted.

"It is the right of residents and families to have monitors if they choose," said Hecht. "If you're doing your job right, monitors shouldn't matter."

In past years, opponents have suggested a compromise that included the creation of a pilot program, where the state would develop guidelines for cameras to be used in specific nursing homes and then track their progress.

"This compromise has been suggested in the last two years, but has never taken place," said Hecht.

The House Environmental Matters Committee turned down the bill last year.

The Department of Health and Mental Hygiene and Carol Benner, director of the Office of Health Care Quality, assured the committee that the department would "carry out the [pilot] project as quickly as possible," as long as nursing homes complied.

The department cannot compel the homes to participate, and so far there is no pilot project.

"We have been working with private nursing homes, but don't have one yet," Benner said.

Neither Benner's office nor the Department of Aging has taken an official position on the measure.

The strict guidelines provided in this year's bill may finally soften past opponents.

"Should Maryland pass legislation that allows cameras in nursing homes, then informed consent of all parties is the key," said HCR Manor Care, the nation's leading owner and operator of long-term care centers. It has 13 skilled nursing and nine assisted living facilities in Maryland.

"We are willing to explore any avenue in order to get the best possible care for patients," that could include cameras, especially if they're voluntary, said Larry Rubin, spokesman for the local Service Employees International Union, which represents health care workers in Baltimore and Washington D.C.

Texas is the only state to have passed a similar law.

The U.S. General Accounting Office released a study in March 2002 that was very critical of nursing homes and their care of patients. Another report is due in the next couple of months.