Understanding Trauma-Informed Care
Jeannine LeCompte, Compliance Research Specialist
November 28, 2019 will see the “trauma-informed care” part of the Centers for Medicare & Medicaid Services’ (CMS) Phase 3 implemented. This requires all long-term care (LTC) facilities to implement a trauma-informed program as part of its obligations to ensure the well-being of all residents.
A trauma-informed care program is, according to CMS, one which “realizes the widespread impact of trauma and understands potential paths for recovery; recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; and responds by fully integrating knowledge about trauma into policies, procedures, and practices, and seeks to actively resist re-traumatization.”
CMS lists a number of principles which support an effective trauma-informed care program:
– Safety: The LTC facility staff must create an environment that protects residents from physical harm and promotes a sense of emotional security.
– Trustworthiness: The LTC facility staff must earn residents’ trust through open, respectful communication.
– Choice and collaboration: The LTC facility staff must provide services according to residents’ individual preferences and values and encourage them to make their own care choices.
– Empowerment: The LTC facility staff must offer avenues through which residents can provide feedback and advocate for their own needs, including an ombudsman or dedicated staff member who can advocate on behalf of the residents.
Trauma-informed care therefore requires providers to be able to identify and assess past trauma in a resident, develop and provide suitable care to address that past trauma, and ensure staff competency in recognizing and caring for trauma survivors.
A trauma-informed approach to care delivery will recognize the widespread impact and signs and symptoms of trauma in residents, and incorporate knowledge about trauma in policies, procedures, and practices to avoid re-traumatization. A critical element of developing the program will be the ability to engage referral sources and partnering organizations.
Part §483.40(b) of the CMS rule states that “based on the comprehensive assessment of a resident,” a facility must ensure that 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.
This requires the creation of a plan which empowers employees to become part of the trauma-informed program. Strategies will have to be developed to explain the rationale and benefits to both staff and patients. It will be up to each LTC facility to develop its own particular strategy based upon its size and structure. Staff will need to be trained to identify the signs of trauma as they may manifest themselves in residents.
