Trauma-Informed Care

Implementing Trauma-Informed Care in Nursing Homes

What is Trauma-Informed Care?

According to Harvard Health Publishing, a division of the Harvard Medical School, trauma-informed care is defined as “healthcare practices that promote a culture of safety, empowerment, and healing.” In simple terms, this healthcare delivery model takes into account a patient’s past traumas, then provides supportive care to maintain a patient’s dignity. 

Some residents may have a clear history of trauma, while others may have experienced past trauma but do not recall it or understand it. Trauma survivors can include:

  • Military or law enforcement veterans
  • Survivors of natural disasters
  • Survivors of traumatic events like terrorism or violence
  • Sexual, physical, and emotional abuse survivors
  • Holocaust survivors
  • Residents who have lost loved ones or have come from failed relationships in their pasts

Why is Trauma-Informed Care Important?

For most people, anxiety about certain medical visits is relatively standard. For those who have experienced trauma, however, a visit by a caregiver or to a medical facility may be terrifying. Some medical procedures are invasive or painful. Still others require answering sensitive questions. Nursing home care may cause embarrassment or discomfort on an emotional level. Facility residents may be asked to remove clothing for examinations and treatments, or even when getting assistance with dressing or bathing. In each of these cases, past traumas – physical, sexual, or mental – can cause severe reactions, putting the health and safety of residents and their caregivers at risk.

Trauma-informed care is essential, then, because this model comes with the understanding that every resident may have experienced some form of trauma, and those residents may not even be aware of past traumas and their effects. Adopting healthcare practices that reduce anxiety, avoidance, or loss of control can create a protective, supportive environment, helping to keep residents and caregivers safe from harm.

Components of Trauma-Informed Care in Nursing Homes

The Substance Abuse and Mental Health Services Administration (SAMHSA) has prepared a guide for healthcare professionals, including nursing home and long-term care facility caregivers and managers. The guide, entitled SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach, was published in 2014 as part of the agency’s Trauma and Justice Strategic Initiative. It contains six key elements:

  1. Safety – understanding and promoting a safety-oriented culture across operations.
  2. Trustworthiness and Transparency – building and maintaining trust between stakeholders by decision-making practices that are transparent. 
  3. Peer Support – Creating a supportive environment for residents and staff.
  4. Collaboration and Mutuality – partnering with others to lessen power imbalances between residents, staff, and facility managers; in other words, to level the playing field so that everyone feels a part of decision-making processes equally.  
  5. Empowerment – providing the tools and support to foster goal setting, shared decision-making, and advocacy for resident rights. 
  6. Demographic/Historical Issues – developing ways to move beyond stereotypes and biases based on race, orientation, sex, religion, and location and to recognize individuals by being responsive to their unique needs. 

The purpose of the SAMHSA guide and its key elements is to provide nursing homes with a basic framework to modify, update, or add operational practices. The ultimate goal of trauma-informed care is to avoid unintentionally harming a resident or aggravating the symptoms of a past trauma while providing a more stable and secure environment for residents and staff members.

Taking the Next Step in Trauma-Informed Care

Now that we understand what trauma-informed care is and the major components of such a care delivery model, the natural question is “how can my facility adopt this care plan to protect residents and staff?”

Because trauma-informed care is an emerging model, there is a wide range of resources to help facilities adopt strategies designed to provide safety, empowerment, and healing. The SAMHSA guide noted above is a good beginning point for facility managers and caregiving staff; additional resources can be found on the Scholars Strategy Network

The first part of trauma-informed care implementation is to share the core principles with all stakeholders. Hosting regular meetings to discuss concepts and solutions with residents, staff, family members, and support personnel can create a foundation for the facility to grow upon.

Training in trauma-informed care is available for caregivers; investing in this training can have a high return on investment as it ultimately creates a safer, more inclusive environment for staff and the facility’s residents. Allowing staff members to share their own ideas, insights, and concerns is an important part of the move towards trauma-informed care. Simply encouraging staff members to think about the ways that existing treatment and care practices address potential traumas or resident anxieties can pinpoint areas in need of improvement. As trauma-informed care gains recognition as a compassionate and safety-oriented care delivery model, new training opportunities and resources will become available. This set of care practices can reduce nursing home liabilities while creating a safer living experience for residents. 

About Caitlin Morgan

Caitlin Morgan specializes in insuring assisted living facilities and nursing homes and can assist you in providing insurance and risk management services for this niche market. Give us a call to learn more about our programs at 877.226.1027.