The nonprofit investigative news organization ProPublica has identified 35 instances since 2012 in which workers at nursing homes and assisted-living centers have posted photos or videos of residents, sometimes partially or completely naked, on social media.
At least 16 cases involved Snapchat, a service where photos appear for a few seconds and then disappear with no lasting record. Some of the cases have resulted in criminal charges, including a case recently filed in California against a nursing assistant. Posting patients’ photos without their permission may violate the Health Insurance Portability and Accountability Act (HIPAA), the federal patient privacy law that carries civil and criminal penalties, ProPublica reports.
Abusive treatment of nursing home residents is not new. Workers have been accused of physical and sexual assaults on residents, of sedating residents with antipsychotic drugs, and failing to provide care such as changing urine-soaked bed sheets. Posting explicit photos is a new type of mistreatment, ProPublica says, and the activity sometimes leaves a digital trail.
In February 2014, a nursing assistant at Prestige Post-Acute and Rehab Center in Centralia, Washington sent a coworker a Snapchat video of a resident sitting on a bedside portable toilet with her pants below her knees while laughing and singing. The following month, a nursing home assistant at Rosewood Care Center in St. Charles, Illinois, recorded another assistant using a nylon strap to slap the face of a 97-year-old woman with dementia. The woman was crying, “Don’t! Don’t!” as she was being struck and the employees could be heard laughing. Other postings include photos and videos of residents on the toilet or in the shower, ProPublica reports.
ProPublica identified incidents by searching government inspection reports, court cases and media reports, but the organization claims such incidents are underreported, in part because many of the victims have dementia and do not realize what has happened to them.
Inappropriate social media postings have come to light mostly through tips from other staffers or members of the community, ProPublica says.
The federal agency charged with enforcing the privacy law, the Office for Civil Rights in the Department of Health and Human Services, has not penalized any nursing homes for violations involving social media or issued any recommendations to health providers on the topic, according to ProPublica. Deven McGraw, the deputy director for health information privacy, expressed outrage about the incidents. “If we don’t have pending investigations on any of these cases … they would be candidates for further inquiry from our end,” she said, adding that the office also should issue guidance on social media and the privacy law.
The U.S. Centers for Medicare and Medicaid Services, which regulates nursing homes, has cited individual facilities for deficiencies related to privacy and will more explicitly address the issue when it updates definitions of “abuse,” “neglect,” “exploitation” and “sexual abuse” in revised regulations governing nursing homes.
“Nursing home residents must be free from abuse or exploitation,” CMS spokeswoman Lauren Shaham said, according to ProPublica. A Michigan attorney involved in this area says health care organizations must pay attention to employees’ use of social media. “If there are no sanctions for misbehavior . . . staff members have no reason to actually respect the rule,” ProPublica quotes the attorney.