Kristi Eldredge, RN, JD, CPHRM

Regulations may vary, and case law may be lacking, but senior living operators can take steps to reduce risk related to social media use by employees, according to Kristi Eldredge, RN, JD, CPHRM, senior patient safety consultant at medical liability insurance company MMIC.

Eldredge discussed social media best practices in long-term care Wednesday in an educational session at the American Health Care Association / National Center for Assisted Living’s 68th Annual Convention & Expo.

Inappropriate use of social media in the workplace isn’t new, she said in an interview with McKnight’s Senior Living, “but the pace of reporting has really picked up, and we don’t know why.” It could be that regulators are more vigilant, Eldredge said, or the problem could be getting worse as people increasingly access social media from smartphones.

Either way, she said, “it’s not a problem that’s going away. It’s a problem that’s increasing.”

Part of the reason is generational, Eldredge said.

“I hate to sound like my mother, but I think the generation that’s currently predominantly working in long-term care, they’re younger and they are used to instant gratification. They’re used to posting everything about their lives at any moment in time, and that’s their norm,” she said. “But when we’re dealing with a vulnerable population, we have to be careful about how we use social media.”

So clear policies and procedures are needed to help employees know what is acceptable — and to help protect employers, Eldredge said.

A company or community’s proactive social media risk program, she added, should identify who will be authorized to post and monitor online information using the corporate and individual community social media accounts. The policy also should define what kind of comments are acceptable for the authorized users to make as they represent the company or community.

“And make sure that you have, in that policy, a response plan if there’s an incident,” Eldredge said. “If you have a response plan in place, you’re going to know exactly what to do.”

Include how the company or community will communicate with residents, families, staff members and the media, she said. Know that the Office of the National Coordinator for Health Information Technology,  a division of the U.S. Department of Health and Human Services, has a HIPAA risk assessment tool on its website to help you determine whether a HIPAA breach occurred.

“On a more granular level, the social media policies and procedures really need to be tailored to each facility,” she said. “You have got to resist the urge to be overly broad. Those policies have to be readable and understandable. And I really encourage communities to involve both staff and residents, especially in assisted living, where you have a higher usage of social media by residents. Include definitions.”

Be sure to review the policies and procedures periodically. As to whether the rules are housed in an employee handbook or somewhere else, Eldredge said, “I don’t think it really matters where they live as long as employees know what they are.”

Educate employees about the policies and procedures as part of their orientation, and have them sign a document indicating that they have read and understand them.

“That way, it makes it easier for a community to show that they did their due diligence when educating their employees about proper social media use,” she said. “It makes it more defensible.”

The social media policy also should be part of employees’ annual skills checklist, as a refresher, Eldredge said.

“And your abuse training should also include the fact that demeaning or humiliating acts are also a form of resident abuse,” she said.

Although a company or community can’t control what residents post on social media, residents should be educated about rules affecting employees so they are certain what behavior is appropriate.

More tips from Eldredge:

  • It’s OK to prohibit employees from carrying their personal cellphones with them at work. “If they’re taking that phone from room to room to room without washing it, just like taking your hands from room to room to room, that’s an infection control issue,” Eldredge said, adding that this fact should be addressed in employee education efforts. “Number two is, if they use their personal cellphones for anything at work related to their job, everything on that phone becomes discoverable if there should be a claim in which they’re involved.” Also, she added, “I think it’s a terrible distraction in resident care areas. If there’s an emergency, people have breaks. They can get to their phones to check them. People have their employer’s work number, so if there’s a situation with their child, they can call the community. That’s my bias.”

  • Don’t ask employees for the log-in information for their personal social media accounts. “Here’s how I look at it from a risk standpoint,” Eldredge said. “So now you have your employees’ passwords. So that means you had better be going on very, very frequently to every one of their social media sites and monitoring them, because you set yourself up to have that knowledge, so you knew, or should have known, what was going on.”

  • Be careful about trying to prevent an employee from saying anything negative about work on social media. “The national labor law says you can’t do anything that impedes an employee’s rights to discuss working conditions or wages with fellow employees,” she said. “It’s kind of a tricky line. …I probably am always going to side on what’s going to reduce your risk of having a claim and make you more defensible, should you have one.”

  • Ensure that your professional liability insurance coverage includes protection related to incidents involving social media. “Many carriers provide that,” Eldredge said.


Wednesday at the AHCA/NCAL meeting also featured additional educational sessions; the election of new officers and board members for both AHCA and NCAL; a closing general session including the presentation of previously announced awards and a keynote speech by Mike Rayburn, an award-winning speaker, entertainer and guitar virtuoso; and a gala show and dinner headlined by Huey Lewis and the News.

Wednesday was the last day of the annual gathering.