Identifying Residents with Trauma-Related Issues
Jeannine LeCompte, Compliance Research Specialist
With the November 28, 2019 deadline for implementing the “trauma-informed care” Centers for Medicare & Medicaid Services’ (CMS) rule looming close, it is important that all long-term care (LTC) staff are trained to be on the lookout for any signs of trauma-related behavior in residents. A failure to do so can result in sanctions against the facility.
Ideally, all LTCs should use a multi-pronged approach to identifying a resident’s history of trauma, which may include the following:
- Resident Assessment Instrument (RAI)
- Admission assessment
- Resident’s personal history and physical condition
- Assessment of the resident’s medical records
- A discussion with family and friends
Unusual behavior may also indicate past trauma.
It is important to keep in mind that being admitted to a nursing home, where an individual’s independence might be dramatically curtailed, can trigger trauma, or, in some cases, re-ignite former traumatization. This could occur if the resident experiences a lack of privacy or feels a sense of confinement in a crowded or small space; is exposed to certain loud noises or bright/flashing lights; or by having unknown people helping with dressing, toileting, or bathing.
It is often helpful to seek input from the resident’s family and friends, and facility staff should not hesitate to make use of outside organizations and consultants to help develop individualized interventions.
Changes to the environment can be made to help relieve immediate trauma:
- Ensure that all common areas are well-lit, including bathrooms, entrances, and exits.
- Prevent loiterers from gathering outside entrances.
- Ensure that a visible security system is in place to prevent random passers-by from entering the facility.
- Keep noise levels in common areas to a minimum.
It is also important to ensure that all residents are personally engaged upon enrollment, and that staff are educated about the necessity of behaving in such a way that residents feel respected and supported.
Maintaining healthy interpersonal boundaries will help with conflict management in the case of trauma-related behavior, while communication that is always consistent, open, respectful, and compassionate can often head off major problems before they escalate.
