Social Media: Potential for Abuse 

Centers for Medicare & Medicaid Services (CMS) published a memorandum addressing abusive uses of social media by nursing home staff with respect to unauthorized publications of residents being photographed or recorded. (See S&C: 16-33 NH on August 5, 2016)

What’s really going on here?  Do nursing home employees really believe that when they publish compromising and abusive photographs of our elders that only their “friends” can see the photos, not the entire World Wide Web?

Nine years ago, when resident abuse took to the Internet Waves of FaceBook, My Space and other social media on-line services, I asked the only expert I knew about confidentiality – my daughter Elayna.  I figured Elayna was an expert because, just 13 years of age at that time, she had astonished even the AT&T operators by registering twenty-eight thousand text messages during August. [Yes, 28,000!].

     Me:  “Elayna, when someone posts to Facebook, is it confidential?”

     Elayna: “C’mon Dad. No way! There’s a wall, and it’s seen by everyone; and ….”

That was all I needed to hear.

Back to today: I read court cases – over and over again – nursing home employees losing certifications and licenses, being assessed fines, and going to jail.  The humiliation; the loss of a hard-earned certification or license; the ability to earn a living and to feed one’s family; and the loss of freedom when going to jail. The consequences are horrendous and would seem to be sufficiently scary to motivate appropriate behavior.

Might these workers who abuse elders online with social media be ignorant as to the  potential consequences for themselves, let alone an elder, when photographing a  nude frontal with exposed genitals? On a toilet? While showering? There must be some other reasons, especially today after so much adverse publicity.

Might these workers just be evil? Too easy and inaccurate considering the high regard many of these workers enjoy prior to their online indiscretions.

Consider the other risks associated with social media and workers – workplace romances that may subsequently turn into sexual harassment through the use of social media technologies, such as YouTube, Facebook, LinkedIn, Twitter, text messaging, and other forms of digital communication.  “Bad workers”? Hardly.

How about workers surfing the Internet looking for pornography? Case after case of seemingly reasonably balanced workers caught pursuing personal interests during working hours and using company computers still won’t convince me that these workers are all “bad apples”.

We could go on and on (including my favorite as a healthcare attorney – breaching copyright laws.)

Perhaps we should look for the answer as to why a nursing home worker takes inappropriate and abusive photographs of an elder by looking more broadly at the online social media phenomenon.

Teenager sexting: the sending of equally explicit messages or images by cell phone. Huge challenge in our society today. Sending nude photographs of a minor can result in child pornography charges.  Simply possessing such photographs can result in a child pornography charge which could also lead to sexual offender registration.  Yet many teenagers still engage in sexting, despite these horrendous risks.

Our initial inquiry – why are nursing home workers abusing elders through photographs posted online with social media – may be stated another way: with so many reasons not to, why is the Internet filled with inappropriate material and behavior?

Numerous researchers (e.g.; see John Suler (2004) “The Online Disinhibition Effect”) have attributed inappropriate social media behavior to an “online disinhibition effect”, i.e., “a loosening or complete abandonment of social restrictions and inhibitions that would otherwise be present in normal face-to-face integration during interactions  with others on the Internet”. (Wikipedia)

For example, anonymity, which in the situation of a nursing home worker, may create a false sense that no-one will know who the worker is if he/she posts online an abusive photograph of an elder; or invisibility, in which the worker believes no-one can see him/her when posting online an inappropriate photograph; or a false sense of feeling above the law, of being able to “get away” with whatever the worker does, as if one’s own authority is supreme and thereby leads to disregarding the law.

When these factors come into play, some people’s negative behavior becomes amplified and they may behave differently in public than in private, with their negative traits amplified online. While we all “act out” once in awhile, perhaps those who “act out” online, clearly and sadly do not see the long term effects of doing so.

Social interactions – we all crave these.  Unlike traditional social media exchanges,  limited by time and space, online social media exchanges are available 24/7.  When one becomes satiated with available online social media exchanges, perhaps overcoming the satiation takes longer and requires greater intensity.  With greater intensity of online social media exchanges comes great risks.

What’s the solution?   We may be limited in positively impacting our nursing home workers’ basic motivations and needs; however, what is clear is that we must reinforce, over and over, through education, coaching and consequences, that our real world rules also apply to our online lives.

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