Trauma-informed care is becoming a mandate later this month, and while I think it’s a good thing to pay more attention to the emotional experience of residents, I’m worried about how asking them about their traumas will be implemented in the field.
As of Nov. 28, there will be trauma focused F-tags that surveyors will assess as part of Phase 3 implementation.
Traumas are sensitive emotional wounds and I’m concerned that in their well-meaning efforts to comply with the new F-tag directives, staff and surveyors will be poking these emotional wounds with a big stick.
There are many aspects of the situation that contribute to my uneasiness. An in-service training or two won’t make up for the general lack of psychological training of the staff, for example. And teams are still having difficulty identifying major triggers for psychological evaluation.
There are also privacy concerns, including how and where to hold interviews, and how to safeguard information in records.
In addition to all of this, I operate from a belief that virtually every resident coming into long-term care has been traumatized to at least some extent by the health event that precipitated their admission, the medical procedures they’ve undergone, being away from home and other losses. While not every resident has post-traumatic stress disorder (PTSD), for most people, this experience brings up past times when aspects of their lives were out of control.
The good intention of increasing awareness of mental health issues would be better served by evaluating every resident for psychological services upon admission, the way each resident is assessed by rehab, recreation and other departments, while simultaneously improving the training of staff to refer residents after certain life or personal events.
Better yet, as the field moves away from the fee-for-service model, funding could be directed toward staff positions for psychologists so we can focus not only on individual residents, but on psychoeducational groups for family and staff needs.
Meanwhile, since trauma-informed care regulations are coming, I hope that staff and surveyor training emphasizes the importance of personal information in as private and sensitive a manner as possible.