F699 Trauma Informed Care

In 2016 with the major revision to the nursing home regulations, trauma informed care was included in the federal regulations and nursing home providers have spent nearly the last decade trying to understand what regulators expect for compliance. You will note in the survey trend report that this deficiency was cited recently.  

Nursing homes are required to 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. In the surveyor guidance, trauma is defined as results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being. What stands out to me in this definition is that trauma can be different for everyone. Historically, we associate trauma with post-traumatic stress disorder or PTSD and with veterans fighting in war. While this is a traumatic event, there are many other types of traumas that we need to assess for in those we serve.

According to the surveyor guidance, the Substance Abuse and Mental Health Services Administration (SAMHSA) noted that 70% of adults have experienced some type of traumatic event at least one time in their life and that these events have a direct correlation between health conditions such as diabetes, COPD, heart disease and others.

Additionally, CMS expects that providers take a culturally competent approach to trauma informed care as we know that individuals of various cultural backgrounds have different triggers along with various beliefs on how assistance in overcoming the traumatic event varies.

What are nursing homes expected to do? Conduct an assessment that identifies each resident’s traumatic experiences in life. These events must be identified in the resident’s care plan. Additionally, with the traumatic events, providers must establish possible triggers that may re-traumatize the residents and instruct staff on how to avoid these triggers. For example, veterans with PTSD may experience triggers from fireworks or loud bangs. While it is outlined in F741, staff must be competent in providing care under behavioral health, therefore providers should also ensure that staff know what trauma informed care is and how they provide these services to residents.

A recent example of noncompliance includes that a resident diagnosed with PTSD did not have a trauma care plan focus, goals, and interventions.