Federal health regulators have announced plans to crack down on nursing home emp

loyees who take demeaning photographs and videos of residents and post them on s
ocial media.
The move follows a series of ProPublica reports that have documented abuses in n
ursing homes and assisted living centers using social media platforms such as Sn
apchat, Facebook and Instagram. These include photos and videos of residents who
were naked, covered in feces or even deceased. They also include images of abus
e.
Maria Fabrizio for NPR
SHOTS - HEALTH NEWS
Social Media Abuse Of Nursing Home Residents Often Goes Unchecked
The Centers for Medicare and Medicaid Services, which oversees nursing homes, sa
id in a memo to state health departments on Friday that they should begin checki
ng to make sure that all nursing homes have policies prohibiting staff from taki
ng demeaning photographs of residents. The memo also calls on state officials to
quickly investigate such complaints and report offending workers to state licen
sing agencies for investigation and possible discipline. State health department
s help enforce nursing home rules for the federal government.
"Nursing homes must establish an environment that is as homelike as possible and
includes a culture and environment that treats each resident with respect and d
ignity," said the memo signed by David Wright, director of the CMS survey and ce
rtification group. "Treating a nursing home resident in any manner that does not
uphold a resident's sense of self-worth and individuality dehumanizes the resid
ent and creates an environment that perpetuates a disrespectful and/or potential
ly abusive attitude towards the resident(s)."
CMS said that nursing homes have a responsibility to protect residents' privacy,
to prohibit abuse, to provide training on how to prevent abuse and to investiga
te all allegations of abuse. If homes fail to do so, they can face citations, fi
nes and theoretically even termination from the Medicare program.
Also last week, Sen. Charles Grassley, R-Iowa and chairman of the Senate Judicia
ry Committee, called on other federal agencies to take action on the problem. He
sent letters to the Department of Justice and to the Office for Civil Rights wi
thin the Department of Health and Human Services asking whether "rules and prote
ctions are in place to prevent and punish these types of abuses." He also has se
nt letters to social media companies, calling on them to pay more attention to t
his. The Office for Civil Rights is working on its own guidance related to socia
l media but hasn't released it yet.
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a statement to ProPublica, Grassley praised the new CMS memo. "This guidance
welcome and necessary," he wrote. "Nursing homes are obligated under the law
keep their residents free from abuse. Exploitation on social media is a form
abuse, and the agency memo makes that clear. We need to prevent it, and we ne
to punish it when it happens."

ProPublica has identified 47 instances since 2012 in which workers at nursing ho

mes and assisted-living centers shared photos or videos of residents on social m
edia networks. This includes three discovered in recent weeks. At one Los Angele
s nursing home, an employee took video of a co-worker "passing gas" on the face
of a resident and posted it on Instagram, according to a May inspection report.
"An interview was conducted with Resident 1 and the resident stated that facilit
y employees pass gas in his face as often as every month," the report said. One
employee resigned and a police report was filed.
While some states have taken harsh steps against nursing homes at which social m

edia abuse occurs, other states have not. We reported last month that Iowa healt
h officials recently discovered it wasn't against state law for a nursing home w
orker to share a photo on Snapchat of a resident covered in feces because his ge
nitals weren't visible. Officials are trying to change the law when the Iowa Leg
islature reconvenes early next year.
The federal government memo sets uniform standards for how such abuse should be
written up by inspectors and the severity of sanctions that should be levied. In
the past, there was great variability.
Last month, the industry's trade group issued its own suggestions for dealing wi
th such situations, encouraging training and swift responses by these facilities
when allegations are brought to light. The group also is holding training event
s around the country. While many facilities ban the use or possession of cell ph
ones by employees when in resident areas, some have also found such rules imprac
tical to enforce.
Greg Crist, a spokesman for the American Health Care Association, the trade grou
p, said the CMS memo dovetails with the industry's effort to stop social media a
buse.
"The two words in that CMS directive that stand out most to me are 'privacy' and
'responsibility,' " Crist wrote in an email Monday. "That's why we have taken r
esponsibility and made a concerted, nationwide effort to educate and share best
practices with our centers not only on how to detect and root out this abuse, bu
t also proactive steps to ensure it doesn't happen in the first place.
"It's not an issue that is conquered overnight," he wrote, "but every day, we ge
t smarter about it."
Has your medical privacy been compromised? Help ProPublica investigate by fillin
g out a short questionnaire. You can also read other stories in our Policing Pat
ient Privacy series.