As a result of an abuse citation at a Lexington nursing home where employees used cell phones to inappropriately photograph residents, state officials are asking Kentucky facilities to prevent such cell-phone use in the future.
The Inspector General's Office of the Cabinet for Health and Family Services made the request after an April investigation found that Bluegrass Care and Rehabilitation Center staff members attached sexually explicit lyrics to photos of residents and sent them as text messages to other employees.
"We did not think things would get so far out of hand," an employee who sent photos to 10 others told state investigators. "We were just having fun. Everybody was on the cell phone 24-7."
The Herald-Leader received additional documents in the case this week under the Kentucky Open Records Act. They show that employees recorded patients screaming or asking to go to the bathroom and then played a guessing game to see which resident was involved.
Some of the patients were not fully clothed when they were photographed.
In interviews with state investigators, employees gave details of a number of disturbing incidents involving seven residents. Neither the residents nor the employees were identified in the reports.
In one of them, investigated in March and April, a staff member took a cell-phone photo of a resident who had dementia and was obese entering the bathroom. The photo showed the resident's exposed back, legs and incontinence brief, which appeared to be wet.
The staff member attached the lyrics of a sexually suggestive song called Stanky Leggs to the photo and sent it to a nursing assistant, the assistant told investigators.
Sherry Culp, executive director of the Bluegrass Nursing Home Ombudsman Agency, said that the employees' behavior reflected the worst in how disabled and elderly people can be treated.
"It relays that they think of that resident as less than human," Culp said. "It looks like a form of bullying to me."
Officials at Signature Healthcare, the Florida-based company that owns Bluegrass Care, said that 10,000 employees in their company nationwide have been re-educated on their policy regarding the use of cell phones on the premises.
Any employee with a cell phone in a resident area is subject to immediate termination, said Signature spokeswoman Erica Staley. All of the employees involved in the incidents have been fired, she said.
Photos and ring tones
In another incident at Bluegrass Care, a nursing assistant told state investigators that she took a photo with her cell phone of a resident in a wheelchair with one thumb pointing up in an OK sign. She forwarded it to another employee, who added a recording from the television show Family Guy with the words, "Giggity, giggity. Let's have sex."
When state investigators told the resident about that incident, the "resident's eyes grew wide," according to state records.
"I don't know why anyone would want to do anything like that or even think about doing something like that," the resident told them.
In another case, nursing assistants exchanged a cell-phone photo of a resident lying in bed, buttocks partially exposed. The resident was outraged upon learning about it and told investigators about wanting to file a lawsuit.
A staff member also recorded a resident with Alzheimer's disease talking about having to use the bathroom, saying, "I gotta do do."
The staff member used it as a ring tone and played it for at least 15 people standing around a nurse's station.
A licensed practical nurse who heard it said no one "acted like it was a big deal."
The LPN told investigators that she had worked at the facility since July 2008 and no one there enforced the policy or seemed concerned about the use of cell phones in resident care areas.
The Office of Inspector General criticized the nursing home administration for not investigating allegations earlier.
Problems in other states
There are no laws or regulations in Kentucky regarding cell-phone use by staff in long-term care facilities. Any action taken because of the IG's request would be voluntary.
Even though Bluegrass Care had a policy against cell phones in patient areas, a registered nurse at the facility told investigators that the cell-phone use on weekend night shifts "was out of control."
One member of the administrative staff is quoted as saying she thought all the residents needed to know about what happened, but "did not want to put ideas into the residents' heads," according to state records.
Relatives of the residents said they were not told about the lyrics added to the photographs.
The problem has cropped up in other places in the United States in the last few weeks.
An Oklahoma nursing home employee was arrested in March after he used his cell phone to videotape himself being abusive to residents.
Also in April, two workers at a Pigeon Forge, Tenn., nursing home owned by the same company as Bluegrass were fired for inappropriately using their cell phones.
"The incidents that took place at both locations were coincidental and we have absolutely no knowledge of or reason to believe that any photos were shared between the locations," Staley said Friday.
Tim Veno, CEO of the Kentucky Association of Homes and Services for the Aging, said that none of his 150 members had been cited by the state for using their cell phones improperly. But he said he had asked members to review current cell-phone policies or implement new ones as the IG's office directed.