Integrating Trauma Informed Care

Hello everyone,

As you know, a new regulation by the Centers for Medicare & Medicaid Services (CMS) about trauma informed care will go into effect on November 28th of this year, requiring skilled nursing facilities that receive federal funding to “ensure that residents who are trauma survivors receive culturally competent, trauma-informed care” with the goal of eliminating or mitigating “triggers that may cause re-traumatization of the resident.” Easier said than done, right?

While you and most of your staff are likely familiar with the term “post-traumatic stress disorder” (PTSD), we tend to associate it mainly with military veterans who have served during wartime. But there are many other traumatic events that occur over the course of a person’s life that can also lead to PTSD, such as the death of family members, natural disasters, abuse and abandonment. Some research shows that the incidence of PTSD is higher in residents of long term care communities than in the general population. In addition, a person who had not previously shown signs of PTSD can begin to show signs later in life.

Educating staff about how to identify possible past traumas and develop effective strategies to address behaviors related to these past traumas is critical and will be an ongoing effort. This is where we can all learn from each other by sharing creative, successful interventions for the variety of possible traumas that our residents may have experienced.

Attached is a document with a variety of resources to learn about trauma informed care, and below is a link to a brief article about the topic:

Below is a case study you can use to teach staff how to identify possible past traumas and develop effective interventions to address the behaviors related to those traumas:

82 year-old widowed female admitted to the nursing home. Medical history is notable for dementia, probable Alzheimer’s disease, depression, HTN, osteoarthritis of the left knee, and renal insufficiency. She lived in an assisted living facility for the past 3 years, but she needed more supervision due to wandering. She tends to wander more in the evening and at times will try to walk off of the unit with visitors. The resident is a retired RN who worked in long term care facilities. She loves dogs. Upon her admission, she was screened for past trauma with information from the resident and her daughter. She has no history of physical, verbal or sexual abuse. She is not a military veteran, and was not exposed to violence or trauma in her job.

The staff notice that the resident has periods of anxiety and fearfulness whenever there is a thunderstorm or if hurricane warnings appear on television. She won’t stay in activities if it is raining outside and instead walks around asking staff to direct her to the “basement door.” The nursing assistant mentions this change in behavior during storms to her daughter, and her daughter indicates that her mother’s house was destroyed by a tornado when she was 50 years old. “I don’t know why she is upset about this now. She really hasn’t brought this up in a long time, but I know that it bothered her for a few years after the tree fell on the house. She never liked to be near windows during a storm though.”

For staff: What interventions can you try to decrease the resident’s fear and anxiety during storms?

Here are some of our ideas:

1. Keep the resident away from large windows or pull the blinds during storms.
2. Move her away from the television or turn off the TV when there are frequent storm warnings.
3. Bring the resident into an interior room if she still seems upset.
4. Distract her with activities (i.e. holding her stuffed dog, helping to clean the dining room)

Do you have an example of an intervention you have used with a resident who had behaviors related to a past trauma? Let us know!

Have a great week!

Trauma Informed Care Resources

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