Why Trauma-Informed Care Matters: A Compassionate Approach to Better Care
Imagine walking into a place that is supposed to be your safe haven, yet something as simple as a sound, a touch, or even a routine procedure triggers deep-seated distress. For many residents in skilled nursing facilities and assisted living communities, this is a daily reality. By adopting trauma-informed care, we can transform caregiving environments into spaces of healing, safety, and trust.
In 2016, the Centers for Medicare and Medicaid Services (CMS) revised their conditions of participation for nursing homes. As part of their regulatory updates, CMS emphasized the importance of trauma-informed care, stating, “Trauma survivors, including veterans, survivors of large-scale natural and human-caused disasters, Holocaust survivors, and survivors of abuse, are among those who may be residents of long-term care facilities. For these individuals, the utilization of trauma-informed approaches is an essential part of person-centered care.” (CMS, 2016)
This means that skilled nursing facilities (SNFs) and assisted living communities (ALFs) must integrate trauma-informed practices into daily operations, ensuring that care is compassionate, sensitive, and avoids re-traumatization. Since many individuals carry experiences of trauma, whether known or unknown to caregivers, a trauma-informed approach is essential in fostering a supportive environment.
What is Trauma-Informed Care?
A trauma-informed care approach recognizes that trauma can have lasting impacts on an individual’s health and behavior. The goal is to create environments that promote healing and prevent further harm by understanding and addressing the effects of trauma. A trauma-informed system:
Realizes the widespread impact of trauma and understands potential paths for recovery.
Recognizes signs and symptoms of trauma in residents, families, staff, and others involved.
Responds by integrating trauma knowledge into policies, procedures, and practices.
Seeks to actively resist re-traumatization.
Six Key Principles of Trauma-Informed Care
Safety – Creating a physically and emotionally safe environment.
Trustworthiness & Transparency – Building trust through clear communication.
Peer Support – Encouraging a support network among residents and staff.
Collaboration & Mutuality – Promoting shared decision-making.
Empowerment, Voice, & Choice – Valuing individual preferences and autonomy.
Culture, Historical, and Gender Issues – Recognizing the influence of identity and experiences.
Addressing Challenging Behaviors
Residents who have experienced trauma may exhibit behaviors that are difficult to manage. Here are some steps to better understand and respond to these behaviors:
Identify the purpose of the behavior.
Anticipate situations that might lead to maladaptive responses.
Recognize early warning signs and intervene promptly.
Assess how staff responses may contribute to the resident's behavior.
The 6 W’s of behavior can help caregivers assess and respond effectively:
What is happening?
Who is involved?
Where does the behavior occur?
When does the behavior occur (time of day, after certain events)?
Why is this behavior happening?
What needs to be done?
Common Triggers for Behavioral Distress
Pain or medication changes
Unmet basic or social needs
Boredom or overstimulation
Desire for personal choice and control
Misinterpretation of situations or reality
De-escalation Strategies for Trauma-Informed Care
When responding to residents in distress, consider these trauma-informed de-escalation strategies:
Show empathy and validate feelings.
Ensure the resident feels safe, respected, and in control.
Stay calm, breathe, and lower your voice.
Use non-threatening language and neutral body language.
Respect personal space and avoid confrontational postures.
Listen actively to the resident’s words and emotions.
Provide options to resolve the issue and move forward.
Redirect attention to a less stimulating or private space when necessary.
Offer clear next steps and set compassionate boundaries.
Recognize that silence can be okay; allow residents time to process.
Avoid taking negative reactions personally.
CMS Guidelines and Regulatory Requirements
CMS has incorporated trauma-informed care into its regulatory framework for nursing homes. The Phase 3 Requirements of Participation (RoP), effective as of October 24, 2022, include specific guidance on trauma-informed care. Facilities are required to ensure that residents who are trauma survivors receive culturally competent, trauma-informed care in accordance with professional standards, accounting for residents’ experiences and preferences to eliminate or mitigate triggers that may cause re-traumatization (CMS, 2022).
Additionally, CMS has identified several F-Tags related to trauma-informed care proficiency, including:
F699: Trauma-Informed Care
F656: Developing and Implementing Comprehensive Care Plans
F726: Competent Nursing Staff
F742: Treatment and Services for Mental and Psychosocial Concerns (AHCA/NCAL)
These tags guide surveyors in assessing compliance with trauma-informed care requirements and ensure facilities prioritize residents' emotional and psychological well-being.
A Commitment to Trauma-Informed Care
By integrating trauma-informed care principles into daily practice, skilled nursing and assisted living communities can foster a supportive and healing environment. This approach not only improves resident well-being but also enhances staff satisfaction and overall quality of care.
Implementing trauma-informed strategies ensures that every resident receives care that acknowledges their past experiences and supports their path to healing. Let’s continue to create spaces where residents feel safe, empowered, and comfortable.