Snapped and Exposed: Social Media Abuse in America’s Nursing Homes
What happens when nursing home abuse is captured and shared on social media? Social media can expose mistreatment that might otherwise go unseen, but it also raises serious questions about resident privacy, dignity, and safety. In this week’s episode, nursing home abuse lawyer Rob Schenk welcomes Dr. Eilon Caspi to discuss social media abuse in America’s nursing homes and what families and advocates should know.
Intro
Schenk:
Phones are supposed to help us stay connected. In nursing homes, they can sometimes become tools for humiliation. I’m attorney Rob Schenk, this is the Justice for Residents podcast, and this week I’m talking to Dr. Eilon Caspi, whose research is focused on protecting vulnerable residents from mistreatment and abuse, specifically via the phone and social media.
Stick around.
Welcome back, folks. Today, we welcome back to the show Dr. Eilon Caspi. He was a guest on our show way back in 2019, where we were talking about resident-on-resident incidents. And recently, he has published a 350-page report on social media abuse in nursing homes, and that is called Snapped and Exposed: Social Media Abuse in America’s Nursing Homes.
And we’re gonna have a link to that in the show notes, and I really highly advise everybody to check that out. There’s some really interesting information contained in that, some things that I didn’t even consider when evaluating these types of cases. Without further ado, let’s get into it, the meat and potatoes.
Guest Intro
Schenk:
Dr. Eilon Caspi has been working in the aging field for 32 years, starting as a nurse aide in a nursing home where his grandfather lived. Since then, he worked as a social worker, educator, author, dementia behavior consultant, applied researcher, and data-driven elder care advocate. Throughout the past 18 years, he has led several research studies on various forms of elder mistreatment in long-term care and care homes.
He is the author of the first and only book on the prevention of injurious, in- injuries and deadly resident-to-resident incidents in the context of dementia. He is the owner and director of Dementia Behavior Consulting, LLC, based in West Hartford, Connecticut, and the founding member of Elder Voice Advocates Minnesota.
Professionals interested in discussing abuse prevention and dementia care can connect through the LinkedIn group focused on these long-term care issues.
How Do You View Social Media Abuse in Long-Term Care Homes?
Schenk:
Dr. Caspi is the recipient of the 2025 Janet Wells Public Policy Leadership Award from the National Consumer Voice for Quality Long-Term Care, and we’re so happy to have him back on the show. Dr. Caspi, how do you view social media abuse in long-term care homes?
Dr. Caspi:
Thank you for inviting me to speak about this issue today.
A little bit of context in about a decade ago, ProPublica published a review of sixty-five incidents from nursing homes and assisted livings. They were brief descriptions. It led to a strong reaction from lawmakers. CMS put out a memo to all state survey agencies about it, and the industry admitted that all nursing home companies struggle in addressing it.
Now, when we say social media abuse we mostly refer to situations where employees take unauthorized photos and videos of residents, often with demeaning and abusive content, and then they post them on social media. Okay? I wanna quickly share a few examples of incidents that have occurred in nursing homes.
The first one happened in in Oklahoma. Two CNAs video recorded themselves taunting a woman with dementia as they were holding her hands down and gave her wet willies wet– that is wetting a finger with saliva and inserting it into her ear, and it was shared on Snapchat. In New York, a video showed a CNA pulling a wig off of a woman’s head, a woman with Alzheimer’s disease, and slapping her on the head with it.
Recent findings highlight serious concerns on the impact of preventive health measures in elderly populations, including the misuse of social media involving nursing home residents.
In Illinois, a CNA was shown on video jiggling the loose skin and tissue on the back of an arm of a woman with severe cognitive impairment. The caption on the video read, “Don’t leave your family members with her. She plays with their skin.” And in Oregon, a person with dementia and schizophrenia repeatedly asked to make funeral plans for a deceased relative.
Two CNAs recorded a phone call with the person in which they pretended to be a funeral home staff and discussed funeral plans. While laughing, they made comments such as, “We have cardboard coffins,” and, “We are on so and so street.” These are just some examples. Now, four main issues that stand out to me as I reviewed over 100 incidents of this form of abuse.
The first one, even before taking the photo and posting it, how would it make me feel if someone would provide me with personal care, say a shower or assisting me with the toilet, and they would pull out their phone and hold it while providing care? We know that it causes anxiety among residents. Staff may become distracted when using their phones while providing care.
I’m already aware of severe injuries when the staff member attends to their phone and not to the person. The person falls, and one woman broke her hip. And then, of course, there’s privacy violations. Then there’s deme- the demeaning and abusive acts themselves. And then there’s re-victimization when it’s posted and viewed by others.
Emerging research provides additional insight on the impact of preventive health measures in elderly populations, particularly when protecting vulnerable residents from mistreatment.
In some cases, posts remain accessible on social media for days, weeks, months, and years, as we will see in a minute. Now, the severity of these incidents varies, okay? It’s anywhere from unauthorized videos showing a resident tying his staff shoes, shoelaces, or assisting a person with eating or socializing and dancing All the way to cruel and very harmful verbal, physical, and sexual abuse.
Some of it is criminal. Now, many of the victims live with dementia, and are… many of whom are defenseless. I’ll talk about the CMS Reasonable Person concept in a minute. There is a need to raise stakeholders’ awareness and strengthen federal and state oversight and enforcement. As I will describe in a few minutes, lawsuits can play a role in holding perpetrators and neglectful care homes accountable.
As importantly, the lawmakers must hold these wealthy social media companies accountable for not having meaningful safeguards in place for early detection, removal of content, referral to law enforcement, et cetera. I should point out again that these incidents also take place in the assisted living sector particularly in assisted living with dementia care sector.
So we can pause here, or I can share some of the findings from my report, whatever works for you.
What Did the Snapped and Exposed Report Find About Social Media Abuse?
Schenk:
No, I would love to, I would love to get you to talk about your report and wh- where you’ve come to with respect to what you’ve described.
Dr. Caspi:
Okay. So my report is called Snapped and Exposed: Social Media Abuse in America’s Nursing Homes.
Okay. It was funded by the Colorado Long-Term Care Ombudsman Program. The data consisted of 100 state investigation reports from 100 nursing homes in 30 states. So I’ve identified 147 victims. 88% of them live with some level of cognitive impairment. Dozens of them had moderate to severe cognitive impairment.
In terms of the perpetrators, I’ve identified 132 primary perpetrators. There were also secondary perpetrators. And nearly three-quarters of them, of the primary perpetrators, excuse me, were CNAs, but there were also nurses and other professionals. There was a total of 209 items that were posted on social media.
Over two-thirds were videos. About a quarter were photos. Interestingly nearly a third of those videos and photos included a caption with a demeaning content meant to humiliate, to further humiliate and make fu- make fun of the victim. Most commonly, these items were posted on Snapchat, followed by Facebook.
Interestingly, it’s consistent with what the ear- earlier review by ProPublica found a decade ago. But it’s also, it was also on TikTok, on Instagram and other social media platforms. I was curious about the location. Where does it happen? The most of those incidents occurred inside bedrooms, but also in bathrooms, shower rooms, but essentially in all parts of the public spaces of the nursing home.
In terms of day of the week while there’s limitations with these data, a preliminary trend indicated that it happened disproportionately on Fridays. And also incidents took place on weekends as often as they took place on weekdays, and we both know what could be the reasons for that as well. So this was kind of the background, setting the stage, answering your first question about this relatively for- relatively new form of elder abuse in long-term care homes.
Families can learn more on the impact of preventive health measures in elderly populations, including concerns about inappropriate images and social media activity involving residents.
Question of the Week
Schenk:
All right, folks, I interrupt this interview for the Nursing Home Regulation Question of the Week. Difficulty level this week, folks, is medium-hard. If you get this right, you can go to the 15 items or less aisle at the grocery store with any number of items that you see fit. You tell them that I said so
Under 42 CFR 43.20i, which of the following nursing home documents must be certified under penalty of perjury? Is it A, comprehensive care plan; B, baseline care plan; or C, comprehensive assessment
And that answer is C, the comprehensive assessment via the resident assessment instrument must be verified under penalty of perjury by at least a registered nurse
What Effect Does This Have on Residents and Families?
Schenk:
How many of the victims in your, in, in your report, in your experience, in your research, are cognitively aware of the dignity violation of you being posted online? Some of our clients, some of our residents are not able to be aware of something like that.
Of those that are, what do you see as the results? How does that typically affect that person?
Dr. Caspi:
Yeah. So I’m gonna talk now about how it affects victims in their own words, then I’m gonna move to how families perceive the impact on their relatives, particularly people in the more advanced stage of dementia.
Then I’m gonna share how state surveyors perceive the impact on residents, and then I’m gonna share the impact on families. So the first one harm on residents in their own words. There was a broad range of negative consequences of these incidents. Embarrassment, feeling violated, humiliated, feeling anxious about it, fearful, sadness, crying, depression, feeling upset, anger, and a broken trust Now, families’ perceptions, that is how they thought their relatives with dementia would have felt if they were aware of the incidents.
So those family members said that their loved one would have been, if they would have known about it, they would feel embarrassed, feeling demeaned, appalled, mortified, and devastated. One family member said the relative would be beside self. Now, in terms of surveyors, state surveyors’ perceptions of resident harm, again, a lot of what I describe now, but beyond that, they spoke about dignity violations, shame, degradation, dehumanization.
Long-term care providers can also review recommendations on the impact of preventive health measures in elderly populations to better understand social media risks in nursing homes.
For example, one state surveyor said, “Being treated as an inanimate object, having no emotions or feelings.” You asked also about the impact on family members. There was limited data on that but still, what I was able to capture I think is meaningful. Family members expressed disappointment. They were very upset, angry.
One of them said they were absolutely livid. One person who could not believe what one, one person could not believe what happened to his brother. His brother lived with cerebral palsy and cognitive impairment in a Minnesota nursing home, and he the person was aggressively thrown by an aide into his bed, and then the aide threw the shoes on his bare chest, then posted the video on Snapchat.
Now, my colleague attorney Susie Shiller, in a TV segment about this recent incident said, “It’s just inhumane, and it just shows a lack of connection with basic human life.”
Families concerned about mistreatment should first understand the definition of elder abuse and the behaviors that may qualify as abuse.
Can Social Media Abuse Re-Victimize Nursing Home Residents Years Later?
Schenk:
I think that there’s something to be said about a abusive incident, a slap, an in a spoken indignity But there’s just something different about when that indignity, when that that, that violation to human rights or respect can live forever on the internet. It’s just a different, it’s a different beast.
Dr. Caspi:
Yeah. It’s kind of a good segue to the misconceptions. I can give an example just because you brought it up now. One of the misconceptions is that employees… or misperceptions, is that employees are not being aware that the photo or video that they took is still online months, a year, or years after it was originally posted.
So I wanna give an example of that. Three aides encouraged two women with dementia to fight with each other in a- an assisted living in North Carolina. They called it Fight Club. That was the… in the title of the newspaper article. That happened around 2019. A few months ago, that is over six years later, the story has gained renewed interest on social media as the video has started doing more rounds on the often poorly moderated platform, X.
Some concerned citizens have since asked the public to stop sharing the videos, as it takes the family back to the difficult time in their lives. So who knows how many people watched this video over six years’ period of time. And when New York Times article, New York Times reporter asking me, “So how prevalent it is?”
We’re not tracking it centrally. CMS doesn’t track those specific, spec- this specific form of elder abuse, so we don’t know. And even the National Ombudsman Reporting System doesn’t centrally track it nationwide in their complaint codes. So it’s invisible, so we’re guessing. We’re just guessing at this point, and it’s invisible, so we’re not taking action and meaningful action to address it.
Understanding the most common form of elder abuse can help families recognize problems before they become more serious.
What Should Nursing Homes Do to Prevent Social Media Abuse?
Schenk:
We see the problem on paper. We see the problem in real life. I would imagine, in your opinion, the current oversight, the current regs perhaps aren’t enough. What do you think should happen to minimize or mitigate or eliminate these incidents?
Dr. Caspi:
So I think it starts from the top. That is owners, administrators, director of nursing they are the ones who should set the expectations.
So everything starts with education, and education. Here’s an example of something that my colleague, Chris Sanberg, executive director of Elder Voice Advocates in Minnesota, said about this form of elder abuse, and I think it touches directly upon what I just said. And then I share…
I’ll share a few more ideas about what to do about it. This type of horrific degre- degradation is becoming commonplace, and is often a direct reflection of upper management blatant disregard for the well-being of the residents. Well-trained staff with clear expectations for compassionate care from management would discourage this sort of abuse.
If something does not seem right, learn how to tell if your loved one is being neglected or abused.
Now, of course, education is not enough. You need to have stronger, You need to do public awareness campaigns. You need to do stronger oversight by CMS, but also assisted living, as I mentioned. You have to have stronger enforcement. You also have to pass l- state laws, if it’s not federal law.
State laws require annual in, annual in-service training for staff to to require them to know about this issue and the risks, and the risk for their own employment and careers and their lives. We also must have lawmakers wake up and hold those wealthy social media companies accountable because their safeguards on older adults and people living with dementia in long-term care homes are weak.
And and I have not seen a meaningful legal action against one of those giants to start putting more meaningful safeguards in place. But I think it, it starts with awareness and it starts from the top, if that makes sense.
Families should familiarize themselves with the signs of nursing home abuse so suspicious injuries or behavioral changes are not overlooked.
Schenk:
Do you find that there is public sentiment that agrees with you?
In other words, I feel like sometimes society might be behind with respect to what they think of this. It’s… Some people might be like I would rather them put my picture up online than beat me or slap me or yell at me.” You know what I mean? That might be a, that might be a particular jury panel that thinks that, right?
What have you seen in terms of is there outrage for this i, in the general public, or indifference or?
Dr. Caspi:
I think there’s a lack of awareness, and I think that some residents and families cope with it in isolation. That’s why I put the report with 100 cases.
That’s why my editorial in the journal, in JAMDA the Journal of the American Medical Director Association is about to be published soon, basically a wake-up call for all stakeholders to pay attention to this.
I’ve been trying to engage lawmakers in Connecticut, in New York, and other states, and so far without success. So your platform and other platforms that I’m speaking on, and the National Conference of the Consumer Voice, I’m trying to raise awareness to this. I don’t think anybody would agree to have their pictures and videos taken in such compromised situations, and then also being posted on those social media platforms to make fun of the person and to further humiliate them.
I think there should be an outcry, but I’m afraid there’s lack of awareness until a family meets this situation and they’re shocked.
Early intervention starts with knowing how to recognize signs of nursing home abuse and documenting concerning behavior.
Schenk:
I think that it’s growing up, the analogy was made to me that in the 1940s and 1950s and 1960s in the US, drunk driving was seen as an accident, something that you do sometimes.
You sometimes you have to do it, right? It… There wasn’t a… There wasn’t an aspect of moral turpitude. There wasn’t an aspect of this is this is immoral and wrong to get behind the wheel of a car and drunk and drive. Of course, now you’re a villain if you do that, rightfully. And for me, at least in my anecdotal experience, I just feel I don’t know maybe it’s a, a new generation where privacy. Yeah is not that big of a deal.
Dr. Caspi:
Yeah.
Schenk:
That the… and so the… You’re right. I think that in the same way that now drunk driving is viewed as terrible, there needs to be a level of awareness in our country about essentially visually abusing our most vulnerable people.
Dr. Caspi:
Certainly. And there’s a lot of people in this country are addicted to their phones, myself included.
And when you look at the age group of people who work in nursing home and the age group of Snapchat users, for example, there’s a substantial overlap, okay? And there’s this urge to share, “Oh, this was so funny, I have to share it with my boyfriend, with my mom, with my colleagues, with the public.” And if you go on TikTok now and search for nursing home abuse, you will be shocked to see some of the things that are on there.
Or maybe you’re not because that’s your line of work, right? But the public would be terrified the stuff that is out there right now as we speak. But you asked about what to do, and I also want to talk about misconceptions, and I think another way to deal with it is through lawsuits. So I don’t know if you wanna talk about…
want me to talk about misconceptions first or about some of the lawsuits that came out recently.
Broader concerns about dignity and mistreatment of older adults are discussed in Human Rights Watch and Seniors – Episode 110.
What Are Some Staff Misconceptions When It Comes to Social Media Abuse Incidents?
Schenk:
Let’s do some… let’s do the misconceptions.
Dr. Caspi:
Okay. In my report, I identify 21 mistaken beliefs held by perpetrators, managers, and other employees. I’m gonna give obviously, in the interest of time, only a few key examples.
First of all, keeping an unauthorized photo or video on your phone, even without sharing or posting it, is a violation. Another one is the employee would say, “I s- but I set it to automatically disappear.” But the receiver takes a screenshot or video records it, and then it has a life of its own.
Also, even when the perpetrator deletes it from their devices, it may still be on the server and discoverable in court. Another one is, “It was only her leg.” Not to mention that there was feces on the leg. Or, “But you can’t see her face.” It’s still a violation as described in the CMS 2016 memo. Here is a brief story from a nursing home in Ohio, okay?
You have a video showing an African American woman with CVA, cerebral vascular disease, seated on the toilet with feces running down her leg. All this is public information. A cartoon character image was placed by the perpetrator over the woman’s face and upper torso. The woman was wearing rainbow tie-dyed Croc shoes.
Abuse and safety concerns can also arise between residents, as explored in Resident-to-Resident Incidents – Episode 106.
The caption, “Bruh, now I’m pissed and ready to F go.” The brother identified his sister’s rainbow Croc shoes, but even if he didn’t, it’s still a violation. Or another one is, “He was asleep, so he’s not aware.” Nope. You must apply the reasonable expectation of privacy rule. “She has dementia. She doesn’t understand and won’t remember it anyway.”
You need to apply CMS reasonable person concept, which is defined as what degree of actual or potential harm would one expect a reasonable person in a similar situation to suffer as a result of the non-compliance? And we talked about employees not being aware that the photo or video’s online for months or years.
Another one is not knowing that the few seconds video could end your employment, risk your career, livelihood, and throw your entire family life into chaos. In an extreme case, a recent case, an aide posted degrading photos of residents in Oklahoma nursing home and received a 12-year prison sentence.
The aides’ video showed degrading content, including mocking residents and showing them on the toilet and nude, and then posted them on Snapchat 66 times. A total of 15 victims. So this person received a 12-year prison sentence. There’s other misconception, but these could be read in my report. And I’m happy to talk about, just to give examples of the lawsuit, which is one more tool in the toolbox in terms of holding perpetrators and poor-performing and neglectful providers accountable.
Families interested in monitoring a loved one’s care can learn about privacy, safety, and surveillance issues in Nanny Cams in Georgia Nursing Homes.
How Can Lawsuits Help Address Social Media Abuse in Nursing Homes?
Schenk:
Yeah, please go ahead.
Dr. Caspi:
Okay. So in Illinois, all these happened in nursing homes. 91-year-old Margaret Collins lived with dementia. In 2018, she was taunted by two aides with an hospital gown. They knew that she hates hospital gown. In fact, they put it on the caption, “Margaret hates gowns.” While she was in her bed, she was trying to get it away from herself.
The aides video recorded and posted it on Snapchat. Attorney Margaret Black told me that the case was settled quickly. When you record your own abuse of a resident, you just provided the proof of the case. The lawsuit sought out $1 million in damages. I do not know the amount settled. Many times, as you know well, families sign a clause prohibiting them from disclosing or speaking even about the case Annie Jones lived with severe cognitive impairment in a Tennessee nursing home.
In 2019, Annie was assisted by a CNA with bathing in a shower room. The CNA received a video call from her incarcerated boyfriend. So what does she do? She takes her phone, puts it on a shelf to continue and speak with him while she’s helping bathe the woman. During the call, one employee called Ms.
Jones by her first name while the CNAs undressed her. Ms. Jones’ nude body was visible to the CNA’s incarcerated boyfriend during the video call. A person in the prison was monitoring the call. He was the one who was so alarmed by it, he notified law enforcement. Attorney Hannah Garrett is handling this case on behalf of the family.
Schenk:
And shout out to Hannah Garrett in Tennessee.
Dr. Caspi:
There you go. She’s awesome, and she taught me a lot also about using AI in her work and in my work, so I’m very grateful for her. In Ernest Tosh, s- recent seminar in Denver. Several residents in California, that’s the last example of a lawsuit were victims in a third case.
San Francisco was ordered to pay $2.2 million settlement to the victims. In this case, six nurses took nude and other photos of residents and drugged that is medica- overmedicated them and physically assaulted others. For example, a CNA and a nurse took photos and videos of resident and shared them through their personal cell phone text messages without consent.
That’s another, another misconception. “Oh, I just shared it with my colleagues.” No, that’s a violation. You can’t do that. Examples of photos that were shared, were taken and shared, residents buttocks an open wound, being agitated to shout sexual obscenities, and even being kicked by the staff to the back, causing the person to jerk off.
There were also demeaning photos that I won’t even go into them. Katherine Stuebner is the attorney who represented the family- the families in this case. I just wanted to share that we’re starting to see lawsuits coming out to address this issue, and I think it’s very important that your colleagues will continue to do that.
So to send a signal to the nursing home and assisted living sector that these types of abuses and neglectful practices of care homes should not be tolerated
Schenk:
Very well said. Dr. Caspi, we really appreciate you coming back onto the podcast after so many years of an absence to share your knowledge with us.
Dr. Caspi:
Yeah I greatly appreciate being here. I love your podcast. I’m sharing it regularly. You have it’s a goldmine, a lot of gems. Everybody can, I know it’s for, you said it was for elder abuse attorneys, for nurses, and for ombudsmen. So I think it’s way broader than elder abuse attorneys. So I greatly appreciate the hard work you and your colleagues put to creating those podcasts.
I know it’s a lot of work.
Schenk:
Folks, I hope that you found this episode educational. New episodes of the Nursing Home Abuse Podcast come out every single Monday for now. If you have an idea for a topic that you would like for me to discuss, please let me know. If you have an idea for a guest that you’d like for me to talk to, please let me know that as well.
And with that, folks, we’ll see you next time
Thanks for tuning in to the Justice for Residents podcast. Nothing said on this podcast, either by the host or the guest, should be construed as legal or medical advice, nor is intended to create an attorney-client relationship between the listener and either the host or any guest. New episodes are published every Monday and are available on all your favorite podcast apps, as well as on YouTube and our website, justiceforresidents.com.
Again, that’s justiceforresidents.com. The Justice for Residents podcast is hosted by Rob Schenk, a trial lawyer representing victims of nursing home abuse neglect throughout the state of Georgia. We’ll see you next Monday.