ProPublica, the nonprofit investigative news organization, reports that it has identified 35 instances since 2012 in which workers at nursing homes and assisted-living centers have posted photos or videos of residents on social media. The residents were sometimes partially or completely naked.
At least 16 cases involved Snapchat, the social media site where photos appear for a few seconds and then disappear with no lasting record. Some of the cases have resulted in criminal charges. ProPublica says that 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.
Abuse and neglect in nursing homes and rehabilitation facilities is not new. Workers have been prosecuted for physically and sexually assaulting residents, for sedating residents with antipsychotic drugs, and for failing to provide basic care such as changing soiled bed sheets. But posting explicit, sometimes humiliating, photos is a new type of mistreatment, ProPublica says.
In February 2014, a nursing assistant at Prestige Post-Acute and Rehab Center in Centralia, Washington shared a Snapchat video with a coworker of a resident sitting on a bedside portable toilet with her pants below her knees. The following month, an assistant at Rosewood Care Center in St. Charles, Illinois, recorded another assistant slapping the face of a 97-year-old woman with dementia using a nylon strap. The woman could be heard crying out, “Don’t! Don’t!” as she was being struck. The employees could be heard laughing. Other postings include photos and videos of residents in the shower or partially naked as they dressed or undressed, according to ProPublica.
ProPublica identified such incidents by searching inspection reports, court cases and media reports, but the organization claims such incidents are underreported. Many of the victims have dementia and may not realize what has happened or their claims are dismissed because they are “confused.”
These inappropriate social media postings have come to light mostly through tips from other staff members or members of the community, ProPublica says.
ProPublica says 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. 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 Centers for Medicare and Medicaid Services, which regulates nursing homes, has cited individual facilities for deficiencies related to privacy. CMS will address the issue more directly when it revises definitions of “abuse,” “neglect,” “exploitation” and “sexual abuse” in updated regulations governing nursing homes.
“Nursing home residents must be free from abuse or exploitation,” CMS spokeswoman Lauren Shaham said. A Michigan attorney with experience in this area says health care organizations must pay attention to employees’ use of social media. They need to enforce their rules. “If there are no sanctions for misbehavior . . . staff members have no reason to actually respect the rule,” ProPublica quotes the attorney.