State laws designed to protect nursing home residents from abuse often fail to address the growing risk of explicit social media posts by healthcare workers, a new report finds.

Released by ProPublica and NPR on Thursday, the report is a follow up to a story published last December that identified nearly three dozen incidents where explicit content of long-term care residents was shared on social media.

Nine additional events have since been discovered, including an incident at an Iowa-based care facility where a nursing assistant shared an image on Snapchat of a resident with his pants around his ankles. Captioned “shit galore,” the photo showed the resident’s hand and legs covered in feces.

Under the current Iowa law that protects seniors against abuse, which has not been updated since 2008, images shared on social media must contain a resident’s genitals to fall under “sexual exploitation.” Because the nurse’s photo did not include the restricted content the state was unable discipline her or file charges.

“What we have is a very disgusting and humiliating situation,”said David Werning, a spokesman for the Iowa Department of Inspections and Appeals. “But it does not meet the definition of sexual exploitation, and I think that was a surprise to everybody.”

Employees also have avoided criminal charges in other states in similar incidents.

The incidents prompted Sen. Charles Grassley (R-IA) to write letters to the executives at Facebook, Instagram and Snapchat, questioning what measures were in place to prevent nursing home employees from posting exploitative content about residents on their platforms.

In responses to Grassley, Facebook, Instagram and Snapchat executives said the companies had policies in place to remove abusive content from their platforms and that all users had the capability to report inappropriate content.

The report says no long-term care facilities have been penalized by the U.S. Department of Health and Human Services for violating the federal patient privacy laws.