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Trauma-Informed Care

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. 

NORC Resources

Trauma-Informed Care: Nursing Home Requirements and Ombudsman Program Advocacy (LTCOP Reference Guide)
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.

Person-Centered Trauma-Informed Care in a Time of COVID-19 (April 29, 2020)

View the slides as a PDF or PowerPoint with presenter notes.

This webinar is Part I of a four-part webinar series titled, COVID-19 and Ombudsman Programs: Understanding How Trauma Impacts You, Residents, and Your Advocacy. The webinar series highlights important themes related to trauma-informed care, person-centered care, compassion fatigue, and vicarious trauma. The series includes case studies, self-reflection activities and exercises, and materials for attendees. View the recordings and materials from the entire webinar series.

Part I in the webinar series addressed person-centered, trauma-informed care. Highlights included:

  • What "person-centered care" and "trauma-informed" care means. 
  • Why person-centered care and trauma-informed care is critical in a crisis. 
  • The impact that re-traumatizing events can have on a trauma survivor, including residents, facility staff, and Ombudsman program representatives. 
  • How to recognize and respond to the effects of all types of trauma. 
  • The bio-psycho-social components of trauma-informed care to support survivors in rebuilding a sense of control and empowerment.

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

View the slides as a PDF.

Ensuring that residents who are trauma survivors 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. 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. Presenters included Nancy Kusmaul, Assistant Professor at the University of Maryland Baltimore County, and Patricia Hunter, Washington State LTC Ombudsman. 

 

Federal Resources

ACL Guidance to the Aging Services Network: Outreach and Service Provision to Holocaust Survivors

 

Substance Abuse and Mental Health Services Administration (SAMHSA)

Substance Abuse and Mental Health Services Administration Website 

SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach

 

State Operations Manual

State Operations Manual, Appendix PP - Guidance to Surveyors for Long Term Care Facilities (applicable excerpts below)

F699 (Rev. 173, Issued: 11-22-17, Effective: 11-28-17, Implementation: 11-28-17)

§483.25(m) Trauma-informed care

The facility must ensure that residents who are trauma survivors receive culturally competent, trauma-informed care in accordance with professional standards of practice and accounting for residents’ experiences and preferences in order to eliminate or mitigate triggers that may cause re-traumatization of the resident. [§483.25(m) will be implemented beginning November 28, 2019 (Phase 3)]

F659 (Rev. 173, Issued: 11-22-17, Effective: 11-28-17, Implementation: 11-28-17)

§483.21(b)(3)  Comprehensive Care Plans 

The services provided or arranged by the facility, as outlined by the comprehensive care plan, must—

(ii) Be provided by qualified persons in accordance with each resident's written plan of care.
(iii) Be culturally-competent and trauma–informed. [§483.21(b)(iii) will be implemented beginning November 28, 2019 (Phase 3)]

F689 (Rev. 173, Issued: 11-22-17, Effective: 11-28-17, Implementation: 11-28-17) §483.25(d)

Accidents. The facility must ensure that – 

§483.25(d)(1) The resident environment remains as free of accident hazards as is possible; and

§483.25(d)(2) Each resident receives adequate supervision and assistance devices to prevent accidents.

Resident-to-Resident Altercations

The interventions listed below include supervision and other actions that could address potential or actual negative interactions:

  • Evaluating staffing levels to ensure adequate supervision (if it is adequate, it is meeting the resident’s needs) (refer to F725, §483.35(a)(1)(2), to evaluate staffing levels for any nursing services not related to behavioral health care or dementia care and F741, §483.40, for any staff caring for residents with dementia or a history of trauma and/or post-traumatic stress disorder); 
  • Evaluating staffing assignments to ensure consistent staff who are more familiar with the resident and who thus may be able to identify changes in a resident’s condition and behavior;… 

F741 (Rev. 173, Issued: 11-22-17, Effective: 11-28-17, Implementation: 11-28-17)

§483.40(a) The facility must have sufficient staff who provide direct services to residents with the appropriate competencies and skills sets to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care and considering the number, acuity and diagnoses of the facility’s resident population in accordance with §483.70(e). These competencies and skills sets include, but are not limited to, knowledge of and appropriate training and supervision for:

§483.40(a)(1) Caring for residents with mental and psychosocial disorders, as well as residents with a history of trauma and/or post-traumatic stress disorder, that have been identified in the facility assessment conducted pursuant to §483.70(e), and [as linked to history of trauma and/or post-traumatic stress disorder, will be implemented beginning November 28, 2019 (Phase 3)]

F742 (Rev. 173, Issued: 11-22-17, Effective: 11-28-17, Implementation: 11-28-17) 

§483.40(b) Based on the comprehensive assessment of a resident, the facility must ensure that— §483.40(b)(1) A resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder, receives appropriate treatment and services to correct the assessed problem or to attain the highest practicable mental and psychosocial well-being;

 

Additional Resources

The Things They Carry: Advancing Trauma – Informed Responses to Elder Abuse (January 2020)
On October 18, 2018, the NYC Elder Abuse Center and the Weinberg Center for Elder Justice held a daylong symposium bringing together more than 75 experts across disciplines to consider the effect of trauma in the lives of older adult victims of abuse. The symposium was held because there is growing interest in the elder justice field in developing trauma-informed responses to elder abuse. This document conveys the ideas discussed at the symposium and recommendations developed at that gathering in the areas of practice, education, research, and policy. The intention is for this document to serve as a guide for the field in developing an impactful response to trauma. 

Trauma-Informed Care Implementation Resource Center. Center for Healthcare Strategies, Inc.

Overview of Phase 3 Nursing Home Regulations: A Look Ahead (Consumer Voice webinar)
On November 28, 2019 - 3 years after the revised federal nursing home rules were issued - “Phase 3” requirements will go into effect.  These include a number of new requirements that nursing homes must implement, and in some cases, new systems that must be put in place. The  webinar includes presentations from experts from the Center for Medicare Advocacy, Justice in Aging and Consumer Voice on the following topics and more: compliance and ethics program; infection preventionist; trauma-informed care; quality assurance and performance improvement program; and training.

Download the webinar Powerpoint. Access the Summary of Key Changes handout.

State Resources

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