Nursing home workers across the US are posting embarrassing and dehumanising photos of elderly residents on social media networks such as Snapchat, violating their privacy, dignity and, sometimes, the law.
This story was co-published with the Washington Post.
ProPublica has identified 35 instances since 2012 in which workers at nursing homes and assisted-living centres have surreptitiously shared photos or videos of residents, some of whom were partially or completely naked. At least 16 cases involved Snapchat, a social media service in which photos appear for a few seconds and then disappear with no lasting record.
Some have led to criminal charges, including a case filed earlier this month in California against a nursing assistant. Most have not, even though posting patients' photos without their permission may violate the Health Insurance Portability and Accountability Act, the US federal patient privacy law that carries civil and criminal penalties.
The incidents illustrate the emerging threat that social media poses to patient privacy and, at the same time, its powerful potential for capturing transgressions that previously might have gone unrecorded. Abusive treatment is not new at nursing homes. Workers have been accused of sexually assaulting residents, sedating them with antipsychotic drugs and failing to change urine-soaked bed sheets. But the posting of explicit photos is a new type of mistreatment, one that sometimes leaves its own digital trail.
In February 2014, a nursing assistant at Prestige Post-Acute and Rehab Center in Centralia, Washingon, 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.
The following month, one nursing home assistant at Rosewood Care Center in St Charles, Illinois, recorded another using a nylon strap to lightly slap the face of a 97-year-old woman with dementia. On the video, the woman could be heard crying out, "Don't! Don't!" as she was being struck. The employees laughed.
And 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.
The woman's son told government inspectors that his mother, who had worked as a church secretary for 30 years, would have been mortified by the video. Days after the incident, the home changed hands and is now known as Price Road Health and Rehabilitation Center. Greystone Healthcare Management, its new owner, said it "provides extensive, on-going training, support and oversight to insure that we provide patient centered care." (The prior owner, Steve Hitchens, said the incident happened days before the home was sold and he does not recall details.)
In a statement, PrestigeCare said it fired the employee, alerted authorities and instituted new, stricter mobile phone and social media policies. "We take these situations very seriously and are thankful that our own internal procedures alerted us so promptly to the issue."
Rosewood Care Center did not respond to repeated requests for comment.
"Something hasn't happened now unless there's a selfie or Facebook posting about it," said Marian Ryan, the district attorney of Middlesex County, Massachusetts, whose office is pursuing elder abuse charges against two women who posted numerous videos of nursing home residents on Snapchat. "The use of social media is just pervasive across every aspect of society."
ProPublica identified incidents by searching government inspection reports, court cases and media reports. Ryan said she suspects such incidents are underreported, in part because many of the victims have dementia and do not realise what has happened.
Nursing homes rarely found problematic social media postings themselves. Records show that most came to light based on tips from other staffers or members of the community. Indeed, some of the Snapchat posts were not shared publicly but only with a select group of "friends", one of whom alerted home officials or authorities.
The US federal agency charged with enforcing the privacy law, the Office for Civil Rights in the Department of Health and Human Services, has not penalised any nursing homes for violations involving social media or issued any recommendations to health providers on the topic.
Deven McGraw, the office's deputy director for health information privacy, expressed outrage when told about the incidents. "If we don't have pending investigations on any of these cases 2026 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 US Centres for Medicare and Medicaid Services, which regulates nursing homes, has cited individual facilities for deficiencies related to privacy and is seeking to more explicitly address the issue as it writes new definitions of "abuse", "neglect", "exploitation" and "sexual abuse" in updated rules governing the homes.
"Nursing home residents must be free from abuse or exploitation," CMS spokeswoman Lauren Shaham said in an email.
While it is impossible to know whether these incidents are increasing, ProPublica's analysis identified 22 cases in the past two years, but only 13 in the two years before that. That could partly reflect the explosive growth of social media, and Snapchat in particular.
The incidents represent a tiny fraction of the content created by Snapchat's more than 100 million daily active users, who view more than 6 billion videos each day. Snapchat has a Safety Advisory Board to guide its policies and products.
"This type of behaviour is cruel and violates the Terms of Service promise Snapchatters make to respect other people's rights," the company said in a statement. "We believe that elderly people should be celebrated and cared for with respect and compassion. We have a dedicated Trust & Safety team that reviews abuse reports and takes action when they become aware of a violation, and we comply with valid legal requests from law enforcement."
Greg Crist, a spokesman for the American Health Care Association, the nursing home industry trade group, said in an email that unauthorised photos and videos of residents are "disturbing".
Some homes, he noted, particularly those in rural areas, do not use social media themselves so they may not realise that "many of their employees do, so they need to be vigilant and aware". The group hosts training sessions on social media and expects to hold more in the coming year.
Joe Small's great-grandmother, Annie Mae Martin, was videotaped without her permission at St Ann's Home, nursing home in Rochester, New York.
A former nurse's aide posted a video on Facebook in October 2012 showing a hand briefly tugging at the back of the woman's hair and recording unseen staffers taunting her with insults. "The boss lady said that if you don't wash the dishes, she will slap the black off you 2026 and she called you a bitch," one says. The aide, Ericha Brown, who worked at the home for less than a month in 2011, tagged other employees and added the caption: "I miss these mornings."
Brown was arrested and charged with three counts of willful violation of health laws; she pleaded guilty to one count. In a handwritten confession, she wrote, "I deeply regret my actions and will never do anything like this again." She did not return phone calls seeking comment.
Martin remained a resident of the home and died earlier this year at age 94.
"It was very distressing," said Small, who held Martin's power of attorney. "We are all going to get old one day and need assistance to help us in our day-to-day activities, and this is the way you have to be treated when you go into these establishments?"
Susan Murty, administrator of St Ann's Community, said the home began an investigation immediately after an employee discovered the posting and officials worked with authorities to determine its scope. "Most of the people who work in nursing homes are really wonderful people, and it's a shame that this is what people talk about. That's always our frustration."
New York Attorney General Eric Schneiderman's office prosecuted the case and also secured a guilty plea earlier this year in another case involving an aide at a nursing home in Erie County.
"We will not tolerate medical professionals who abuse and exploit the trust of nursing residents by broadcasting private and sensitive medical issues on social media," Schneiderman said through a spokesman.
Taylor Waller, a former nursing assistant in Indiana, pleaded guilty in September to one count of voyeurism for sharing a photo of a resident's back side and buttocks on Snapchat. She served three days in jail, she said, and is currently on probation.
In an interview, Waller acknowledged that she made a mistake but said she did not take the picture for malicious reasons and the resident didn't even know it happened. "They just blew everything out of proportion," she said. "It was just a picture of her butt. How many people take a picture of people's butts? I worked in health care for five years. Everybody takes pictures of the residents all the time. I'm not the only one."
Waller also said that people searching for nursing homes for relatives have bigger issues to worry about than privacy violations involving social media.
"There is so much abuse that goes on," she said. "Nursing homes are so short staffed. Every facility I worked in, every time I went in, residents would be soaked from head to toe in pee and they sat in it for hours. They were treated like animals. I understand taking pictures is bad but there are so many worse things that need to be taken care of, too."
At Gridley Healthcare and Wellness Centre in California, a nursing assistant reported a co-worker in April 2014 for using Snapchat to send pictures of residents who were "inappropriately exposed" or who appeared to be deceased. The assistant told state health inspectors that "she was absolutely disgusted by the lack of respect this showed for human life and for a person who had passed. It was amazing to her that a person could be so uncaring for a laugh."
Five workers ultimately pleaded guilty to state charges of elder abuse or failure to report elder abuse. The home's current administrator, Diana Haines, said she could not comment because she wasn't the administrator at the time and that the home changed operators this year. A representative of the home's operator at the time of the incident said in a statement to the Gridley Herald newspaper that the home was cooperating with authorities, took corrective action, and that its highest priority was to "ensure the best quality of care and treatment for [their] patients".
Many nursing homes ban the use of mobile phones on the job but have had trouble enforcing those rules.
This fall, an employee at LifeHOUSE Vista Healthcare Center near San Diego took video of a partially nude woman getting into the shower and shared it on Snapchat. A second employee is seen standing behind the resident laughing. Both were suspended, then fired. On December 9 the California Attorney General's Office charged one of the assistants with misdemeanour counts of elder abuse and invasion of privacy.
"Let's face it, if this were my mother, I would just be furious with this. I'd be inconsolable," said Tom Allen, a lawyer for the home. "There's no reason for anybody at LifeHOUSE to do or condone this type of thing."
Allen said social media poses many challenges for homes. "We're feeling our way through this. There's no ground rules here."
Some homes have allowed employees to keep working after warning them about using mobile phones on the job.
At Newaygo County Medical Care Facility in Michigan, a nursing assistant was written up twice for using her mobile phone at work, including once for taking pictures, before she was accused of taking a picture of Mindy Mench's grandmother-in-law, Janet Hartranft, on the toilet there in September 2013. Hartranft died in March 2014 at age 79.
The nursing assistant pleaded no contest to a charge of using a computer to commit a crime.
At the aide's sentencing hearing, Mench said she read a letter to the court asking the caregiver to explain her actions. "I just said, 'Why? Why did you take this picture?' " Mench recalled. "She never addressed anything that I said in my letter. She never even looked at me."
Mench, who had power of attorney for Hartranft, said she has two sisters who work in nursing homes and they couldn't explain it either.
"These people, our older generation, have served, whether they were a vet or not, they have served in our communities and in our society," Mench said. "Look what you're doing to them, look how you're treating them. It's taking advantage of the weak and it's sick."
In an interview, the woman who was convicted, Reida Osterman, denied taking or posting the video and said she believes another employee picked up her phone and did it. She said she pleaded no contest because "[she] was going through a very stressful time in [her] life, probably the worst time in [her] life ever".
"If I could answer to the family, I would, but I can't tell them why because I did not post no pictures of anybody," she said. "I know for a fact I would never ever ever do anything to hurt anyone."
Michigan lawyer Tatiana Melnik has written and spoken about the need for health care organisations to pay attention to their employees' use of social media. Facilities need to enforce their rules, not just have them, she said.
"If there are no sanctions for misbehavior because no one is actually watching what's happening," she said, "staff members have no reason to actually respect the rule."
Image: David Sleight/ProPublica