When Social Media Meets Non-Compliance in Nursing Homes


Sugar Land, Texas, is home to Silverado Senior Living, a nursing home that is ground zero for a conflict between a family and a health care provider accused of abusing and imprisoning a resident. The most recent battle, allegedly led the provider to revoke the visitation rights of three children and their spouses in order to prohibit them from visiting their 93 year old mother who is a resident of Silverado. According to a Southeast Texas Record report, the conflict allegedly stems from two legal proceedings, a family dispute, and social media posting that Silverado, allegedly demanded that the children take down. Whatever the true root of the conflict, if true, the allegations embedded in two different legal proceedings suggest Silverado Senior Living may face serious trouble both from the resident, her children, and potentially the federal health care programs.

Civil Rights

According to a recent civil rights complaint, filed in a federal court in Texas by Mackey Glen Peterson, Don Leslie Peterson, and Lonny Peterson, the children of the resident, Ruby Peterson, Silverado banned the children from visiting their mother because of posts the children made on social media about the conditions of their mother’s confinement. The Southeast Texas Record reported that the nursing home allegedly banned the children and their spouses from visiting their mother because of the “posting of exploitive and invasive materials which also violate the privacy rights of other Silverado residents.” According to the complaint, Silverado agreed to reinstate their visitation rights if they removed all the posts, pictures, and videos. The suit alleges that the brothers’ First, Fifth, and Fourteenth Amendment rights were violated by the social-media ban and seeks recovery for the violations and the resulting fear of arrest the children allegedly suffered as a result of Silverado’s actions.

Silverado’s Motivation

Did Silverado Senior Living shut its doors on the children of a resident because of some inadequacy the children were exposing through social media? Was Silverado concerned that awareness would effects its conditions of participation? Or was Silverado really protecting the privacy of its residents, as it claimed? The allegations in a state court filing related to a protracted probate court battle between the Peterson children, if they turn out to be true, suggest something on the nefarious side. Allegations in the guardianship proceedings of false imprisonment, conspiracy, assault and battery, intentional infliction of emotional distress, and involuntary drugging by Silverado staff indicate that the nursing home may have been attempting to shield itself from scrutiny when it allegedly took steps to restrict the speech of its resident’s children.

Guardianship Complaint

The Harris county probate court battle, filed on behalf of Ruby Peterson, sheds additional light on the real nature of the conflict by diving deeper into the cause of the children’s outrage. The legal contest pits Carol Ann Manley and David Peterson, Ruby’s son and daughter, against the authors of the civil rights complaint, Ruby’s other sons and the siblings of Carol and David. The state court complaint, boldly alleges that through a conspiracy between Carol Ann Manley, David Peterson, and Silverado, Ruby is being held at Silverado Senior Living against her will and being abused while she is there.

Chemical Restraint

The most serious allegations in the lawsuit are the claims by Ruby’s sons that Silverado personnel are abusing Ruby through involuntarily chemical restraint. The sons allege that they have seen Silverado staff “spike” Ruby’s vitamin drink by putting as many as 11 different medications in her drink without her awareness. The complaint alleges that Ruby was drugged against her will three times a day and woken in the night for additional drugs. The sons’ allege that the restraint leaves their mother incoherent, confused, and slumped over her wheelchair.

In addition to being unethical, due to the Omnibus Budget Reconciliation Act (OBRA) of 1987 (P.L. 100-203) and the Nursing Home Bill of Rights that it created, chemical restraints are illegal. Under, 42 C.F.R. 483, the regulations that set out the conditions of participation for skilled nursing facilities (SNFs), a nursing home like Silverado is apprised of a direct mandate not to use medication to involuntarily restrain its patients. Specifically, 42 C.F.R 483.13 states that “the resident has the right to be free from any physical or chemical restraints imposed for purposes of discipline or convenience, and not required to treat the resident’s medical symptoms.”

Thus, in addition to opening itself to liability with Ruby Peterson and her family, if the allegations are true, Silverado has potentially exposed itself to the myriad administrative sanctions that accompany violations of a Medicare provider’s conditions of participation. Is it possible that Ruby’s children turned to social media as a means to expose the alleged unlawful actions of Silverado?

Ethics and Profit

If the allegations are grounded in fact and Silverado did have something to hide, a question remains: why would a nursing home drug its own residents? One theory, presented by the California Advocates for Nursing Home Reform (CANHR), suggests that due to understaffing and costs, nursing homes engage in involuntary chemical restraint as a means to control behavior in a simpler and more cost effective manner than legal and traditional forms of behavior modification. According to a story in the Examiner, “some experts estimate that 50-75% of nursing home and assisted living patients are being improperly and/or illegally chemically restrained with these highly dangerous drugs.” The cause, allegedly, is that corporations charged with caring for the elderly are putting costs above ethical considerations. An AARP article suggests that the phenomenon is happening at an alarming rate as a result of physician kickbacks and practices that keep patients’ families in the dark.

What is Really Going On?

Whether there really is a connection between the alleged involuntary chemical restraint and the social media posting is a fact that remains to be seen. Silverado may very well have been attempting to protect legitimate patient interests. The nursing home may have been reasonably acting to stop an inappropriate practice. The allegations could be without merit. However, the abuse allegations, if they turn out to be true, suggest another scenario. If the story is as the Peterson children have told it, Silverado may have had its mind on Medicare billing privileges and its conditions of participation when it took the alleged steps to quiet the speech of Ruby Peterson’s children.