If you have a loved one in a long-term care facility, beware of a new kind of shooting that can hurt the old and vulnerable. The weapon? Smart-phone cameras that nursing home employees can point at residents—while they are naked, on the toilet, in the shower, having sex, or acting out in embarrassing ways, often as a result of dementia.

The problem has escalated to the point that the federal government has announced a crackdown. In an unprecedented memo to state survey and credentialing agencies, the Centers for Medicare & Medicaid Services (CMS) recently directed state inspection teams to begin enforcing federal privacy regulations to protect patients from social media abuses. The memo cites a growing number of troubling media reports as the impetus for taking action.

In its memo, dated Aug. 5, 2016, CMS orders state inspectors to review nursing home policies and procedures related to social media abuses beginning in September, and continuing until all skilled nursing homes have been inspected. The memo points out that staff training alone is not enough, and that compliance must include plans for implementing daily practices that protect residents’ privacy. The memo defines “staff” as employees, consultants, contractors, volunteers, and others who provide care services to residents.


The abuse is not limited to nursing homes

While social media abuses are especially prevalent in nursing homes, incidents are proliferating throughout healthcare.

A 2014 survey by the National Council of State Boards of Nursing (NCSBN) revealed that 48% of responding Boards of Nursing (33 in number) face challenges with social media. Several boards in the survey reported images of wounds or procedures being shared across social media.

NCSBN has called for greater awareness and vigilance to stop this kind of activity. In a published guide on uses of social media, NCSBN reminds nurses and others of the blanket responsibility to safeguard any and all patient information, and to limit disclosures only to members of a health care team who need to know for the purpose of providing care to an individual.

In a case reported by USA Today, for example, a New York nurse took photos of an unconscious patient’s penis and shared them with co-workers. The nurse initially faced a felony charge but agreed to give up her nursing license as part of a plea bargain.


Egregious examples

ProPublica and the Washington Post have been especially out front in reporting on abuses in nursing homes.

In December 2015, reports co-published by the two news organizations revealed startling social media abuses within long-term care facilities. Initial findings documented 37 incidents since 2012, exposing nursing home workers across the country for posting embarrassing photos of elderly residents on social media. In some cases, residents were partially or completely naked. At least 16 cases involved Snapchat, a social media platform where photos appear a few seconds, and then disappear.

Details of the incidents came from government reports, court cases, and stories in the media.

Here is an excerpt from one report on the ProPublica website:

“In February 2014, a nursing assistant at Prestige Post-Acute and Rehab Center in Centralia, Wash., sent a co-worker a Snapchat video of a resident sitting on a bedside portable toilet with her pants below her knees while laughing and singing.”

“This February at Autumn Care Center in Newark, Ohio, a nursing assistant recorded a video of residents lying in bed as they were coached to say, ‘I’m in love with the coco,’ the lyrics of a gangster rap song (‘coco’ is slang for cocaine). Across a female resident’s chest was a banner that read, ‘Got these hoes trained.’ It was shared on Snapchat.”

In the latter case, the woman’s son told federal investigators that his mother had worked as a church secretary for 30 years and would have been mortified.

In some cases, employees have faced criminal charges.

Meanwhile, in July, the U.S. Office for Civil Rights announced that federal audits have moved into “high gear” under the Health Information Portability and Accountability Act (HIPAA). The federal audits are in addition to the inspections that state survey teams have now been ordered to conduct.


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