In my inaugural blogpost for my company, Radical Sabbatical, I want to take you on a journey of how I became so passionate about trauma and trauma informed care. You will learn in this post the incredible potential the concept of trauma informed care provides senior living organizations to enhance the quality of care provided to older adults and to enrich the lives of the people who work in senior care. I believe so strongly in this concept that I am willing to go out on a limb and say that trauma informed care is THE vehicle to help organizations achieve that ever elusive goal of transforming culture.
I was first introduced to the concept of trauma informed care in 2017. At the time, I was the Chief Executive Officer of Nebraska’s largest skilled nursing facilities. A significant part of my job was implementing what was known as The Requirements of Participation or ROP. The ROP represented the most significant enhancement to nursing home regulation since The Nursing Home Reform Act of 1987. The Centers for Medicare and Medicaid Services, the government agency charged with regulating nursing homes, recognized the burden of implementing the new reforms so they were phased over time. Trauma informed care was part of the third and final phase.
The regulation states:
“The facility must 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.”
When I first read the language of the regulation, I thought, "How would I know which of my residents is a trauma survivor?" Sure, I could surmise that veterans of war or Holocaust survivors would fall into that category, but what about everyone else? How would I even begin to uncover whether or not a person is a trauma survivor?
The answer came to me after visiting with a close friend of mine, a 90-year-old woman who lives a couple of doors down from me. Helga and I have shared a lot with one another over our ten-year friendship but it wasn't until recently that she told me she was a Holocaust survivor. Helga did not want to divulge many details about her experience but what I learned is that her father perished in the Holocaust while she, her mother and siblings survived and emigrated to the United States. At one point in our conversation, Helga said "Jeannie, I may not have a tattoo (referring to the serial number the Nazi's used to identify prisoners) but I still have the scars."
And that is when it dawned on me. We may never know the specifics of what an older adult has endured in their lives but we can assume a history of trauma. The Centers for Disease Control and Prevention indicates that 90% of older adults have experienced at least one traumatic event in their lifetime. If we really explore a person's life, we can begin to identify that what we label as "behaviors" or maladaptive ways of living are, in fact, an older adult's way to manage and cope with trauma. How many times have we developed a care plan that attempts to manage an older adult’s behavior without truly understanding what lies beneath their actions?
Trauma informed care opens up the discussion of what might be motivating an older adult to behave in the way that they do and allows for creative problem solving, curiosity and solution finding to ensure that the older adult is living in a way that is congruent with their values and lived experience.
Rarely do I champion regulation as a means for change in long term care. "Regulatory requirement" feels more stick (punitive) than carrot (incentive). However, the CMS got it right this time by placing this provision on the books. Well, they almost got it right.
You see, there is nothing in the regulation that addresses the trauma the people that work in senior living have endured. So, I have to ask myself “Why aren’t we applying the same standard of trauma informed care to the lives of our team members? Shouldn’t we recognize and understand the trauma they experience too?” This is where the regulation falls short. In my exploration of trauma, I know that an unregulated individual cannot regulate another individual. In other words, team members cannot be expected to remedy trauma in nursing home residents without a pathway to identify and heal their own. Isn't it ironic that a trauma informed regulation is not, in and of itself, trauma informed?
Since the onset of the global pandemic, the senior care profession has experienced a mass exodus of employees with seemingly no end in sight. Managers and leaders struggle to retain employees paying high fees to staffing agencies to fill staff vacancies. On the flip side, the pandemic presents senior care leaders an opportunity to rethink the role of their organizations. Now more than ever, leaders have the power to make work places engines for mental health and well-being for employees. Doing so will require organizations to rethink how they protect employees from harm, foster a sense of connection, and make space for their lives outside work. In other words, organizations must adopt a trauma informed management approach for their employees.
Senior living communities have an opportunity to provide trauma-informed care to their employees so they can show up and care for others from a healing vantage point. By becoming trauma informed, leaders can create safe places for healthy expression of emotion. Supportive environments promote safety for individuals to come forward and open up their emotional wounds so they can be healed.
My company, Radical Sabbatical, is on a mission is to identify and heal team member trauma first so they can in turn help older adults. Will you join me in this movement to transform long term care?
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