Elizabeth Newman
Elizabeth Newman

Sen. Tom Carper (D-DE) had never crossed my radar before this week, but he certainly has my attention now.

That’s because he sent a tough letter to Department of Health and Human Services asking what it’s doing about the rash of nursing home employees exploiting residents through social media stemming from a ProPublica report. (You can read some of the McKnight’s stories about these incidents here, here and here.)

Calling the investigation’s discovery of more than 35 incidents where photos or videos of naked residents were shared “unacceptable,” Carper asked for a variety of data on how HHS was tracking these incidents. Specifically, he wants to hammer home the potential violations of the Health Insurance Portability and Accountability Act.

“We all want our loved ones to receive the quality of care and attention they deserve from the professionals to whom we entrust their care. We also do not want their privacy and dignity to be put at risk because of poor oversight,” he wrote.

While I applaud his letter and the implication — that if HHS isn’t tracking these incidents in nursing homes or giving guidance on HIPAA, it sure should be — I also thought it was a good opportunity to once again discuss what providers can do to decrease this type of abuse.

So let’s take a step back, and do a stab at root cause analysis.

Let’s assume, as I do, that most people are basically good at heart. One aspect of these social media cases that tends to emerge, when the perpetrators’ statements are public, is that they thought the naked resident video was funny, or that they didn’t think anyone would see it. There was no grand conspiracy to make these images widely public. Basically, we are talking about non-evil people who are idiots.

One could counter that long-term care administrators are not in loco parentis, especially as these social abusers tend to be young, and we need to remember all 20-year-olds at least occasionally demonstrate a lack of judgement. The problem is when that snowballs from a private mistake — a bad decision with inventory, a harsh word to a resident’s family member or even a regulatory violation quickly addressed by an administrator — to one that is widely public. I suspect there are supervisors who don’t discuss social media etiquette and privacy in orientation or training because it doesn’t occur to them. Even if you are a 50-year-old director of nursing who has seen it all, it takes both technological awareness and a certain feat of imagination to envision this problem becoming as widespread as it is. A decade ago, in order to make inappropriate photos or documents public, you’d have to think through it, from snapping the digital image, uploading it to a blog, etc. Snapchat thrives on the idea of the fast and ephemeral.

While it could be seen as overreaching, I think there’s a certain responsibility to protect employees from themselves. The easiest answer — no smartphones at work — is as impossible to implement as it has been for schools to make students put away their phones. So in spite of my concerns around a Big Brother-type environment where facility networks lock out certain applications on company phones or for those on the company network, I’m inclined to believe it’s the best way forward. I interviewed Deb Woods of TheWorxHub by Dude Solutions last month for a story on a new product. It allows tech administrators to reassert control over their specific network, not only in blocking certain applications but in making phones’ cameras or microphones disabled when they enter the grounds.

Every facility and administrator will have to decide “how far they go” in managing patient privacy, but the option “puts technology in the hands of administrators,” she noted.

All of this can go too far, of course, and doesn’t help with those on other networks. Residents should have the right and be encouraged to use sites such as Facebook in order to stay connected, while marketing and sales departments also need broad access. But Carper’s letter shows that the government is paying attention, and nursing homes have to figure out this problem out before surveyors show up.

Elizabeth Newman is Senior Editor at McKnight’s. Follow her @TigerELN.