What is Trauma-Informed Care? Definition and Examples for Geriatric Providers
If you work in senior care or healthcare in general, you may recognize the term trauma-informed care. The exact definition of this methodology may be different depending on who you ask. Some providers use the term to mean kindness toward residents. Others assume this type of care means staff is delivering trauma therapy directly on the floor.
The term originates from a federal agency, SAMHSA, and describes the six principles that inform how a facility runs its day-to-day operations. This includes everything from how a staff member begins a resident’s shower to how leadership writes policy.
What Is Trauma-Informed Care?
The Substance Abuse and Mental Health Services Administration (SAMHSA) defines a trauma-informed organization by how it operates. Staff at every level of the organization need to understand how widespread trauma is and how people recover from it. That way, they can spot the signs of trauma in residents, families, staff and anyone else connected to the facility.
A trauma-informed organization incorporates what it knows about trauma into policy and everyday practice. It also works to resist re-traumatizing people, and SAMHSA applies that to employees as well as the people in their care. This methodology can be simplified into the "four Rs": Realize, Recognize, Respond and Resist re-traumatization.
An even shorter version comes down to one question. Instead of asking, "What's wrong with you?" staff ask, "What happened to you?"
What Are the Six Principles of Trauma-Informed Care?
SAMHSA built its approach on six principles. Each one applies to residents and staff alike:
- Safety: People feel physically and emotionally safe throughout the building.
- Trustworthiness and Transparency: Leadership makes decisions in the open, so residents and staff know what to expect.
- Peer Support: People with lived experience of trauma support one another.
- Collaboration and Mutuality: Everyone shares responsibility for care, from the administrator to the overnight care team.
- Empowerment, Voice, and Choice: Residents keep as much control over their own care as possible.
- Cultural, Historical, and Gender Issues: Policies reflect the cultural backgrounds and histories of the people the facility serves.
Why Do Older Adults Need Trauma-Informed Care?
Trauma-informed care started out in mental health services. A 2022 case series in Frontiers in Rehabilitation Sciences notes how little published evidence exists for this approach in geriatric care settings. The same paper reports that up to 70% of older adults have experienced a psychologically traumatic event in their lifetime. These findings were sourced from a small group. A University of Toronto continuing education course makes a similar point and describes most older adults as having experienced some form of trauma during their lifetime.
A fall, adverse early childhood experiences, intergenerational trauma and cultural trauma are all common examples seen in older adults. Trauma doesn’t have a set timeline or an expiration date.
What Does Trauma-Informed Care Look Like in Geriatric and Senior Care Settings?
Trauma-informed care starts with traditional care methods and builds on them. For example, a staff member might tell a resident what's about to happen before it happens, giving them time to mentally prepare. Resident autonomy is a huge factor: little things like which side a transfer starts from, whether the door stays open or closed, whether the shower happens now or in twenty minutes, who's in the room. Each one hands the resident a bit of control back.
Consistent staff assignment facilitates trust. A resident who sees the same staff member most mornings is more likely to trust them than someone who meets a new face every shift.
What Are the Limits of Trauma-Informed Care in Long-Term Care?
A single training day isn’t enough to make a facility fully trauma-informed, and the CDC says so directly. The agency wrote that no single technique or checklist accomplishes a trauma-informed approach. Instead, the organization may need to implement cultural changes across the whole system.
SAMHSA's 2023 Practical Guide for Implementing a Trauma-Informed Approach splits implementation into 10 domains, including but not limited to staff training, financing, physical environment, governance and leadership, policy, and ongoing evaluation.
The physical environment is one of the hardest domains to change in long-term care. A facility has its own versions of that problem: shared bathrooms and locked unit doors are built in, as are routines like a bed bath by an unfamiliar staff member. Good intentions on staff soften those moments, but they can’t remove them.
A facility can follow all six principles well and still have a resident who needs a licensed clinician to work through a trauma history. Staff can notice that need, but a qualified professional must act on it.
Bringing Trauma-Informed Care to Your Facility
Pacific Coast Psychology provides on-site geriatric mental health services to nursing homes and skilled nursing facilities throughout California. Our clinicians come to your building and work directly with your residents and your staff.
If you'd like a clinical partner for residents whose trauma history is shaping their care, contact Pacific Coast Psychology to talk about on-site geriatric mental health services for your California nursing home or SNF.
