Trauma-Informed Care Resources

Trauma-informed care is an organizational structure and treatment framework that involves understanding, recognizing, and responding to the effects of all types of trauma. Trauma informed care also emphasizes physical, psychological, and emotional safety for both consumers and providers, and helps survivors rebuild a sense of control and empowerment.

Ensuring that residents who have experienced trauma receive culturally competent, trauma-informed care is one of several new federal requirements which will go into effect when Phase 3 of the revised federal nursing home regulations are implemented November 28, 2019.

70% of adults have experienced some kind of traumatic event. Therefore, it is likely that a large majority of residents may be affected, and a best practice would be to approach all residents assuming they have experienced something in their life that may trigger a response.

Signs of trauma include, intrusive thoughts of an event that may occur out of the blue, nightmares, visual images of an event, loss of memory and concentration abilities, disorientation, confusion, or mood swings.

Recommendations for Implementing Trauma-Informed Care

• Admission: When speaking with residents and/or their representative about their life history ask if they experienced an event that would impact their care needs. 
• Resident driven decision-making: Ensure the care plan considers possible trauma for each resident (e.g., if not comfortable in the dark, ensure a night-light is available in the room). 
• Facility Environment: Train all staff to be sensitive to individuals (residents or staff) who are responding to a situation due to past trauma and understand how to support them. 
• Policies of the organization: Promote a culture based on beliefs about resilience, recovery, and healing from trauma (e.g., include language about being an organization that practices trauma-informed care in mission statements, staff handbooks, and policies and procedures).

Ombudsman Program Considerations and Advocacy Regarding Trauma-Informed Care

As resident advocates, the skills Ombudsmen use daily such as active listening, empowerment, and resident-centered advocacy serve as a solid foundation in working with all residents, including those that have experienced trauma. Ombudsmen can use those skills, their knowledge of federal and state requirements, and awareness of community resources to advocate for and share information about trauma-informed care.

• Consider events that may be traumatic to residents (e.g., transfer trauma after facility closure or discharge, their roommate dies, they experience or witness abuse, neglect or exploitation while in the facility) and check in with residents that may be impacted. 
• Connect residents with resources and advocate for services to support their needs (with resident permission). Ombudsman should be aware of local victim advocacy services. 
• Advocate for comprehensive care plans and individualized, resident-centered care, which involves understanding any past trauma a resident may have experienced. 
• Remind facilities of their responsibilities regarding federal and state requirements for person-centered, individualized care, including trauma-informed care. 
• Share information about trauma-informed care with facility staff, residents, family members, and the community. 
• Encourage the use of consistent assignment and other methods to ensure staff know the residents they are caring for and their needs.

Resources

Ombudsman program Reference Guide Trauma-Informed Care: Nursing Home Requirements and Ombudsman Program Advocacy

The purpose of this LTCOP Reference Guide is to introduce Ombudsman programs to trauma-informed care principles and related advocacy strategies and to outline nursing home responsibilities in accordance with the revised federal requirements.

Trauma-Informed Care: Nursing Home Responsibilities and Ombudsman Program Advocacy Webinar

This webinar discussed trauma-informed care, the new federal requirement, how trauma-informed care relates to resident-centered care, and what this means for Ombudsman program advocacy and communication. View the recording and PowerPoint slides here.

Trauma-Informed Care Issue Page

For additional information on trauma-informed care, visit the NORC issue page on trauma-informed care.