The Dark Side of Social Media: Protecting your Residents’ Privacy—and Dignity (1/16)

By Emily Royalty-Bachelor, Staff Writer - January 18, 2016

The choice to move an elder or ailing relative into a long-term care facility isn’t an easy one; it can often be fraught with stress and heartache. Part of what makes the decision easier, however, is the knowledge that one’s relative is being placed in caring, competent, and compassionate hands. This is what LTC facilities are designed to be—providers of care, in every sense of the word.

But what happens when a facility employee chooses to violate the trust of the resident, the resident’s family, and the facility itself?

In the shadow of the social media revolution, a disturbing trend has begun to emerge of LTC employees posting and sharing degrading images of their residents on social media. In 2012, the National Council of State Boards of Nursing (NCSBN) conducted a survey of Boards of Nursing (BONs). Of the survey respondents, 63% reported having received complaints against nurses for inappropriate social media use, including the sharing of patient images and details. Since 2012, there have been at least 35 such cases specific to LTC facilities. ProPublica published an in-depth report detailing these incidents.

Some instances have shown residents in humiliating, compromising, or explicit situations. In 2012, a New Jersey nursing assistant took a photo of a resident’s genitals and forwarded the image to a friend; the friend uploaded the image to Facebook. In Indiana, former nursing assistant Taylor Waller pleaded guilty in September 2015 to one count of voyeurism after she sent a Snapchat showing a resident’s backside.

Other incidents have shown residents being physically abused or emotionally harassed. In 2014, a nursing home assistant recorded a video showing a fellow employee using a nylon strap to lightly slap the face of a woman with dementia, despite her audible pleas to stop. The employees could be heard laughing. And in 2012, former nurse’s aide Ericha Brown uploaded a video to Facebook showing off-screen staff members hurling insults at a resident as a hand pulled her hair. “The boss lady said that if you don’t wash the dishes, she will slap the black off you … and she called you a bitch,” one can be heard saying. Brown tagged her fellow employees in the post with the caption, “I miss these mornings.”

Because this trend is so recent, there’s no way to know yet whether it’s escalating. However, ProPublica identified 13 incidents between 2012 and 2013, and 22 between 2014 and 2015. Unfortunately, it’s difficult to get exact statistical data; many of these incidents most likely go unreported because many of the residents involved suffer from dementia.

It’s also possible that certain events go unnoticed because they’re shared via Snapchat, a social app that communicates privately between groups of friends and that displays images or videos for 6 to 10 seconds before permanently removing them from the recipient’s account.

Luckily, the vehicle of these breaches can also serve to better expose them. Most violations have been revealed not by facility administration but rather by fellow staff or community members who saw the images on social media and reported them.

The ramifications  

The time it takes to click “send” on a social post can be so negligible that facility staff members may not be taking the time to fully consider the ramifications of their actions. But the truth is that employees who engage in this behavior can bring on some serious repercussions.

Not only would such actions almost certainly be in violation of a facility’s policies but, depending on the nature of the incident, could be in violation of HIPAA and other federal and/or state laws.

Disciplinary actions can range anywhere from termination to suspended licensure to criminal charges and possibly jail time. Some cases have even been investigated by the FBI for HIPAA violations, and in the cases of explicit or indecent images, referred to the Sex Crime Unit.

After pleading guilty to voyeurism, Waller spent three days in jail, followed by probation. Brown was arrested and subsequently charged with willful violation of health laws.

Protecting your residents: Developing and monitoring a policy

Many facilities already have social media and cell phone policies in place, and administrators of those that don’t might assume that they don’t need to spell it out. After all, it seems like it would be common knowledge that taking and sharing images of residents is a serious violation of privacy and ethics.

Still, it’s important that the facility have an official policy written up and shared with the employees, even posted in visible locations as necessary. This serves to reinforce the policy and acts as a constant reminder of its importance. More importantly, it can serve as a guideline for staff members who might witness something improper but not know the proper protocol for reporting it.

It’s crucial to be proactive, even if your facility hasn’t yet experienced any such breaches. Here are some guidelines that facility leaders should consider when developing their policies.

What administrators can do:

1. Social media privacy training

Social media is a fairly recent phenomenon, and many organizations are still grappling with what it means to train their employees in proper social media use. Because social media is generally a casual instrument of communication, some users post without giving it a second thought, especially with apps like Snapchat where the images aren’t posted publicly.

Waller told ProPublica, “Everybody takes pictures of the residents all the time. I’m not the only one.”

It’s imperative that the point be made strongly and clearly that this is unacceptable behavior. Provide in-depth training on privacy, confidentiality, ethics, and HIPAA regulations.

2. Monitor the policy, but know the law

On public platforms like Facebook and Twitter, it’s fairly simple to keep an eye on what people are posting. However, you have to be careful not to violate an employee’s rights. It goes without saying that posting degrading images of residents crosses a line, but other posts, such as written gripes about work, could potentially be protected by the National Labor Relations Board. If you want to be certain, have a lawyer read over the policy before making it official.

3. Pull from your other policies and outside regulations

If your facility doesn’t already have a specific social media policy, you likely have confidentiality policies in place that you can use as a foundation. You can also pull from HIPAA, as well as other federal and state laws, to underscore the importance of maintaining these regulations. Be as specific as possible in outlining what constitutes a violation.

4. Address platforms and overarching policies

The scope of social media is constantly shifting and being updated. New platforms are introduced all the time, while other platforms become outdated and fall into disuse. Address guidelines specific to popular platforms, but also develop an umbrella policy to capture any upcoming changes in the social media landscape. On that note, be vigilant about keeping your policy current. A good rule of thumb is to review your policy every six months to ensure it’s up to date.

5. Be consistent

Once you have a specific policy in place, it’s important that you remain consistent in its application. Although instances will inevitably be dealt with on a case-by-case basis, administrators should stick to the rules outlined in their policies to ensure that staff members take it seriously and that all issues are dealt with using proper protocols.

What staff members can do:

1. Bring ideas up to administration

If your facility doesn’t already have a policy in place, or the policy lacks elements crucial to making it truly effective, be the catalyst to make sure your residents are protected. If you see holes in the policy, bring them up with your administrator. If there’s no policy at all, bring up some ideas on how to develop one.

2. Familiarize yourself with policy and regulation

If you don’t know whether your facility already has a policy, or what the details are, find out. But perhaps even more importantly, make sure you’re aware of state and federal regulations that dictate was is and isn’t acceptable social media behavior. Also, find out if your BON has specific policies. A 2012 NCSBN survey of BONs showed 17% have specific social media guidelines in place. When you know the rules, you’ll have a much easier time helping to maintain them.

3. Err on the side of caution

If you’re uncertain about whether to share a certain social media post, safe is better than sorry. After all, no social media post is worth risking your career over. Ask yourself, “Does this post violate any laws or regulations? Even if it doesn’t, is it a breach of ethics? Is it potentially embarrassing to my resident? If someone else shared this about my loved one or me, would I be okay with it?” If you’re uncertain, ask your administrator.

4. Report what you see

As a nurse, it’s part of your job description to make sure your residents are safe, protected, and cared for. Part of that responsibility is protecting them from unacceptable treatment they may be receiving from your colleagues. Not only that, but you may be held accountable if you’re aware of abusive behavior and don’t report it. Complaints to BONs have included not only direct actions resulting in breaches of privacy, but also failures to report others’ violations. Be an advocate for your residents. Report to your administrator any abuse, breach of privacy, or violation that you witness.

By taking these steps, you’re helping to preserve your residents’ dignity and allowing your facility to be the safe haven it’s meant to be.

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