Ftag of the Week – F699 Trauma-Informed Care (Pt. 4)

In this week’s post, we’ll wrap up our review of F699 Trauma-Informed Care, an area that many nursing staff have a hard time wrapping their heads around. In Part 1, we discussed the regulatory requirements for this Ftag along with some key definitions. Next, we reviewed cultural competence, including its link to the Facility Assessment, in Part 2. Last week, in Part 3 of this Ftag of the Week series, we reviewed types of trauma, reviewed some additional guidance from SOM Appendix PP, and reviewed the idea of “retraumatization” and identification of potential triggers.

There’s a bit more guidance to review, courtesy of SAMHSA, which was adapted for Appendix PP.

Key Principles of a Trauma-Informed Approach . . . in Nursing Homes

The IG references SAMHSA’s “Concept of Trauma and Guidance for a Trauma-Informed Approach” (no longer available via the link in the IG but can be viewed here), which are six key principles to guide a trauma-informed approach. These aren’t nursing home-specific but are certainly applicable to this setting.

• Safety – Safety is about ensuring residents feel both physically and psychologically safe. We have a responsibility not only to monitor and supervise residents under our care, but to foster an environment where they feel safe.
• Trustworthiness and Transparency –Building and maintaining trust with residents, their families and staff should be a goal of all organizations. Residents and staff alike often crave transparency and the ability to be meaningfully involved.
• Peer Support – Support from others who have experienced trauma can assist residents with building trust and improving their feelings of safety and hope. Facilitating support groups is an under-utilized tool in nursing homes, especially post-COVID. Consider if residents could attend online support groups if they can’t be arranged in the facility.
• Collaboration and Mutuality – This addresses the need to level “power differences” between staff and residents – and among staff. This is of paramount importance in the nursing home setting, since residents may be more dependent on staff than in other settings.
• Empowerment, Voice and Choice – This includes involving residents in decision-making, goal setting and addressing choices/ preferences. We know these are important parts of resident rights regulatory requirements.
• Cultural, Historical and Gender Issues – Involves the organization moving beyond cultural stereotypes and other biases and ensuring policies are responsive to the cultural, ethnic and racial needs of individuals. We discussed cultural competence in Part 2 of this Ftag series for F699 Trauma-Informed Care. 

Now let’s review some areas where providers may benefit from review.

Where We’re Dropping the Ball

Screening for Trauma

Something that I don’t always see when I’m providing services to our nursing home clients is that every resident has been screened for trauma. Sometimes, I’m told that no one knew there was a requirement to screen for trauma. Best practice is that this is part of the admission process when you’re obtaining psychosocial and other history. This doesn’t necessarily mean that staff will be successful in identifying trauma, since a new resident may not want to open up to a stranger, but that’s the minimum attempt that should be made at the time of admission.

Remember – if you’re using a simple yes/no trauma screen as part of the admission process, you may be missing out on valuable information. It’s also something that may come up when obtaining the resident’s psychosocial history. Taking time not to rush during the admission process can save you time in the future when the IDT is scurrying around trying to figure out how to help a resident who’s exhibiting a change in their  psychosocial status. You always have the opportunity to check again in the future or check with the family once there is an indication that something from a resident’s past is affecting the resident’s behavior, demeanor, etc. Wouldn’t it be nice to try to head off a stressful situation at the pass? Knowing in advance a resident’s needs, history, and individual problems  can help improve quality of life for your residents – and the staff responsible for their care. It’s the difference between having no knowledge of the resident and their history and:

• understanding that a resident may just need a nightlight vs. the resident having “insomnia” and not staying in bed at night
• recognizing that a resident may fear going in the shower vs. being “non-compliant”
• identifying that a combat veteran may not want to attend your 4^th of July fireworks display vs. not want to attend outdoor activities

Lack of Communication

Another area where issues arise is that there isn’t sufficient communication among staff and medical providers. I’ll often see a Psych consult where there’s been an illuminating discussion with a resident . . . does that information get used by anyone else? Ensure you’re closing the loop so you can best help the resident – whether it’s initiating a trauma-informed care plan, reviewing/ revising interventions to minimize potentially re-traumatizing the resident or something else. Ensure staff follow-up appropriately and share what’s necessary to help provide a safe environment for the resident. If no one ever looks at the Psych note, how does the resident’s preference for a same-sex caregiver get identified and implemented? How does Recreation know that the resident experienced a traumatic event in the fall and doesn’t want to reminisce about that time of the year or participate in autumn-themed activities? Do the resident – and your staff – a favor.  All staff have the responsibility to take the time to “know” the resident so that the resident receives quality care and services.

Elevate Your Care and Services with CMSCG

Is your facility equipped to meet the behavioral health needs of residents through a trauma-informed lens? F699 requires more than awareness—it demands a culture of compassion, safety, and clinical competence.

👉 Let’s build a safer, more supportive environment together. Contact us today to learn how we can help your team elevate care through trauma-informed strategies.