In a long-overdue move toward accountability, the Centers for Medicare & Medicaid Services (CMS) is ramping up requirements for nursing homes to disclose detailed ownership information, a step experts say could lead to more targeted audits and enforcement actions against facilities that deliver substandard care. The rule requires skilled nursing facilities (SNFs) to submit comprehensive ownership data through the Medicare Provider Enrollment, Chain, and Ownership System (PECOS). Starting January 1, 2026, providers must identify not just direct owners but also influential business associates and related parties, with this information feeding into public tools like Care Compare by summer 2026. For readers of the Aging-in-Place Planning and Elderlaw Blog, this development is a double-edged sword: It holds promise for weeding out problematic operators, but its actual impact on quality and consumer choice remains uncertain amid implementation hurdles and historical enforcement gaps. We've addressed the topics of ownership and for-profit/non-profit many times, but there is no more effective planning than proactive prevention. In the worst cases, we offer readers tips, tricks, strategies, and tools to evaluate risk factors such as ownership and select the 'best' of available care options. This article introduces the new rule's key elements, evaluates whether it's a meaningful reform or mere window dressing, and offers strategies for seniors and families to leverage it while steering toward the safer shores of aging in place.The Rule in a Nutshell: What CMS Is Requiring and Why Now
The CMS ownership transparency rule, finalized in late 2024 after years of delays, requires nursing homes participating in Medicare or Medicaid to update their enrollment forms (CMS-855A) with granular details on ownership structures. This includes:
- Direct and Indirect Owners: Anyone with a 5% or more ownership stake, including private equity firms or REITs.
- Related Parties and Associates: Managers, board members, and entities with financial influence, even if not formal owners.
- Revalidation Process: Facilities must resubmit data off-cycle, with the first wave due January 1, 2026, and ongoing updates every 30 days for changes.
The goal? Shine a light on opaque chains that operate hundreds of homes, where ownership complexity has shielded poor performance. CMS will integrate this data into Care Compare, allowing consumers to see links between owners and quality ratings. The rule stems from post-COVID scrutiny, in which OIG audits revealed that 24% of facilities failed staffing standards amid ownership shifts.Meaningful Reform or Window Dressing? A Critical Look
On paper, the rule is a win for transparency. Even if the federal government gridlocks or slows the pace of reform to a standstill, states appear to be stepping in "just in case," considering bills and regulations that force transparent ownership, with Maine and Oregon leading the way.
But critically, it's window dressing without teeth: Implementation delays (from August 2024 to January 2026) and vague "influential associate" definitions burden providers without guaranteeing action. For seniors considering facilities, it may flag risks, but it's unlikely to prevent falls or ensure sufficient staffing levels. Besides, the industry's history is a pattern of short-term improvement after regulators shine a light on a facility's substandard quality, followed soon afterwards by a return to the same substandard quality that first caught regulators' attention. Ultimately, it's meaningful for informed choice but insufficient for systemic change, reinforcing why aging in place outshines institutional care.Conclusion: Transparency as a Tool, Not a Panacea
CMS's ownership rule is a step toward light in dark corners, but families deserve more. While this article has provided a thorough overview of the developments and strategies, it is by no means comprehensive. The landscape evolves rapidly. Readers must remain vigilant. By combining awareness with proactive planning, families can safeguard independence and thrive as they age in place. For support, consult a professional. Your security depends on proactive engagement.
In the quiet corners of social media, where staff from nursing homes once shared "funny" moments with colleagues, a darker reality lurks: photos of residents with taped pig snouts, videos of aides spraying cleaning chemicals on a resident's private areas, and clips of dementia patients encouraged to vape. These aren't isolated pranks; they're part of a persistent pattern of demeaning, humiliating abuse, revealed in a 346-page report titled “Snapped and Exposed: Social Media Abuse in America’s Nursing Homes.” *Warning: the depictions can be graphic and heartbreaking* Compiled by elder mistreatment expert Eilon Caspi and funded by Colorado's Long-Term Care Ombudsman Program, the report is based on 100 state investigations from 2017 to 2025 across 30 states compiled from ProPublica's Nursing Home Inspect database. The report documents over 200 such incidents, affecting 147 residents, 88% of whom suffer cognitive impairments.
For readers of the Aging-in-Place Planning and Elderlaw Blog, this isn't just a scandal; it's a stark indictment of institutional care's dehumanizing risks, where privacy violations, retaliation against whistleblowers, and eroded empathy turn caregivers into objectifiers. As we've explored in such articles as: proactive tools like advanced directives, supported decision-making (SDM), caregiver agreements, and trusts can prevent such betrayals by prioritizing home-based dignity over facility dependence. This article unpacks the report's findings, the human cost of objectification, and why aging in place, bolstered by legal safeguards, remains the safer, more humane path.A Decade of Digital Cruelty: The Report's Alarming Findings
Caspi's report builds on ProPublica's landmark 2015 exposé, which first spotlighted staff sharing explicit resident photos on Snapchat, prompting a 2016 CMS memo asserting such abuse was unlawful (federal law prohibits causing mental/psychological harm). In 2016, the National Council of State Boards of Nursing (NCSBN) also published "A Nurse's Guide to the Use of Social Media" (2018, updated 2023), a concise, 12-page resource aimed at nurses, stressing that social media breaches can destroy trust and careers. It warns against posting identifiable patient info (even without names), as details like diagnoses or locations can reveal identities. Examples include sharing "hilarious" patient stories or photos. Consequences are stark: license revocation, lawsuits, and jail for HIPAA violations. Best practices, says the Guide, include strict privacy settings, no patient mentions, and reporting breaches, framed as ethical duties to maintain "dignity and respect" in nurse-patient relationships. Yet, a decade later, violations persist: Over 200 posts from 132 perpetrators (73% certified nursing assistants, or CNAs), including nudity, feces smears, and forced "performances" like singing with taped faces. Victims were overwhelmingly frail, 48% with moderate to severe cognitive impairment, making them easy targets for amusement.
The report's data paints a grim picture: These incidents occurred in less than 1% of the nation's 15,000 nursing homes, but underreporting is staggering, with dementia obscuring complaints, and implicit and explicit threats of retaliation and/or intimidation preventing others. Staff often dismissed harm, and facilities fail to investigate, despite CMS mandates. Caspi notes, "This form of abuse is deeply concerning, it is underrecognized, and understudied," calling for stronger enforcement and training.
Caspi recently conducted a Webinar entitled "Abuse Posted on Social Media in Nursing Homes: A Hidden Danger to Older Adults," hosted by the Long Term Care Community Coalition, and published a series of tips on preventing social media abuse by staff in a guest column for McKnight’s last year. The Human Cost: Privacy Violations, Retaliation, and the Erosion of EmpathyThe privacy angle is devastating: Residents, stripped of consent, become unwitting stars in viral mockery, their vulnerabilities (incontinence, confusion) weaponized for likes. One case featured a CNA spraying cleaner on a man's genitals in a lift, captioned "Hygiene time!," a violation not just of HIPAA but of basic humanity. Retaliation looms large: As ProPublica found in 2015, whistleblowers were labeled "troublemakers," deterring accountability. Staff who report or complain face firing or shaming, fostering a culture of silence. Imagine what that culture visits upon patients, weak, vulnerable, needy, and utterly reliant on their abusers.
But the deeper wound is objectification, where residents become "props" for "content" rather than people. Objectification is, by definition, dehumanizing. If all people merit dignity, the vulnerable aged deserve it more. This loss of empathy signals disinterested care: When aides see a 90-year-old with dementia as a "funny meme" instead of a person with stories and fears, and a family who are left no alternative but to trust those to whom responsibility, by definition, is given, quality of care plummets, and misery is widely spread.
The report shows that 73% of perpetrators were CNAs, who are systemically underpaid and overworked, suggesting that burnout breeds callousness. Caspi warns of "dismissive attitudes" downplaying humiliation, leading to unchecked neglect. In a system where facilities routinely fail to meet staffing standards, this empathy erosion manifests as delayed responses or ignored needs, turning "care" into cruelty.
To victims and their families, though, it's more than cruel. It’s a profound betrayal of trust, that strikes harder than the same act by a janitor or kitchen worker. Why? Because CNAs aren’t peripheral staff; they’re the frontline guardians of dignity, trained, licensed, and entrusted with the most intimate care.
The CNA’s Unique Role: Intimacy, Training, and Licensure
CNAs are the hands-on heart of long-term care, spending 70-80% of their direct resident time on bathing, feeding, toileting, and mobility, tasks that demand trust, intimacy, and vulnerability. Unlike janitors (focused on environment) or food workers (meal delivery), CNAs are licensed healthcare professionals with:- State-Mandated Training: 75-180 hours covering ethics, infection control, and resident rights (e.g., dignity, privacy, abuse prevention), and reporting requirements, all per CMS requirements.
- Certification Exams: Passing the National Nurse Aide Assessment Program (NNAAP) or similar exam, including a skills evaluation, typically hands-on demonstration of 5 randomly selected tasks (e.g., handwashing, taking vital signs, transferring a resident).
- Ongoing Education: Annual in-services on HIPAA, rules, and regulations.
This isn’t janitorial or cafeteria work, it’s therapeutic. A CNA’s touch can heal or harm; their words can comfort or crush. To a victim and the victim's family, when a CNA turns to abuse, it’s not a "bad apple" in a low-skill job; it’s a trained protector turning predator, weaponizing intimacy. Residents and their families depend on them for survival, making betrayal visceral. Nursing homes decry resident cameras for "privacy" while employees expose them online, a hypocrisy that underscores the power imbalance. Families denied oversight can't protect loved ones from this digital abuse, amplifying the case for home-based alternatives where privacy is under your control.The Bigger Picture: A Symptom of Institutional Care's Flaws
Persistence reflects systemic rot: low wages, high turnover, and profit-driven models that erode empathy, objectifying residents as "units" rather than humans. Private equity-owned facilities prioritize costs over training, fostering environments where abuse thrives. The victims, mostly cognitively impaired, highlight vulnerability: Without voice, they suffer in silence, their dignity commodified for a laugh.
For aging in place, this is a clarion call: Home care, with vetted supporters via SDM agreements, restores humanity. Family and friends know your quirks, but don't exploit your embarrassing moments. Aging in Place planning protects your autonomy, keeps you in your home or community, and foregoes facilities where empathy fades.Solutions: Reclaiming Dignity Through Proactive PlanningEmpower yourself:- Legal Shields: Include in directives: "Prohibit any recording or sharing of my image without consent; violation triggers trust penalties."
- SDM for Oversight: Nominate supporters to monitor care, reporting violations via state ombudsmen (1-888-678-7277).
- Prioritize Home: Use an aging-in-place trust, or incorporate aging-in-place planning in both advance directives and SDM. Fund private care agreements with family, as in our "SDM-Driven Supplemental Advanced Directive," keeping dignity intact.
- Advocate for Reform: Support Caspi's call for mandatory training and enforcement—contact your senator.
Conclusion: Dignity Denied, Independence DemandedA decade after ProPublica's wake-up call, social media abuse persists, a symptom of institutional care's empathy deficit. For seniors, it's a reminder: Facilities objectify; homes humanize. While this article has provided a thorough examination of the report and its implications, it is by no means comprehensive. The landscape of elder abuse evolves rapidly, influenced by regulatory changes and cultural shifts. Readers must remain vigilant, consulting sources such as ProPublica, AARP, and local elder law attorneys to evaluate their situations and identify risks. By combining awareness with tools such as SDM agreements and trusts, seniors and families can better safeguard independence and thrive as they age in place. For ongoing support, consult a professional and stay informed—your security depends on proactive engagement.
