We need trauma-informed care in long-term care homes

Canada needs trauma-informed aged care, training and strategies in long-term care homes across the country.

“Trauma” is a heavy word, but it’s the right word.

“Trauma” describes what has been happening in long-term care facilities across Canada during the pandemic, where the majority of COVID-19 deaths have occurred, and where highly restrictive visitor policies and short staffing have meant extreme isolation and deprivation for the residents who live there.

But there are often two layers of trauma in long-term care.

Dr. Carole Estabrooks is the scientific director of Translating Research in Elder Care (TREC) and a professor in the Faculty of Nursing at the University of Alberta.
Dr. Carole Estabrooks

Overlooked in these discussions is how the pandemic can also trigger symptoms of post-traumatic stress disorder (PTSD) in seniors who have experienced psychological trauma earlier in their lives. Earlier trauma could have resulted from any number of events that caused deep psychological harm, such as a car accident, physical or sexual abuse or fleeing an armed conflict, for example.

In our recently published analysis and review, we highlight how PTSD in long-term care residents is significantly more common than previously understood, how the pandemic has exacerbated PTSD in some residents, and recommend ways that nursing homes can manage the effects of trauma.

While not everyone who has experienced trauma will develop PTSD, those who do are likely to see symptoms re-emerge as they age, develop dementia or are admitted to a long-term care home, which can also be a traumatic event in itself. For vulnerable seniors living in care, the spread of a deadly virus can also trigger intense PTSD symptoms including intrusive thoughts, nightmares and feelings of panic.

Well over two thirds of seniors living in long-term care have some form of dementia. PTSD symptoms can occur when practices or environmental sights and sounds in the home inadvertently trigger an individual. When this occurs on top of dementia, it may cause extreme behaviours.

What’s more, symptoms associated with PTSD are similar to behaviours exhibited by those living with dementia such as anger, aggression or agitation. Since long-term care homes do not routinely screen for a history of psychological trauma on admission, staff may have a difficult time identifying which behaviours stem from PTSD and which stem from dementia.

All of this points to an urgent need for more person-centred care and well-trained staff who are equipped to meet the needs of residents.

Through trauma-informed practices, ensuring the quality of life of residents becomes an achievable goal and individuals living with PTSD will receive the care they need.

With the proper resources and training, nursing homes can be transformed into places worth living.

So, what does trauma informed care look like?

It means creating a safe environment with adequate staffing, training the workforce, screening residents for trauma upon admission and taking a personal history to be used as the basis for future care. It means management consults residents, their loved ones, and staff in all aspects of care planning as well as providing staff with access to specialized services like mental health teams.

It means incorporating strategies to support residents that focus on bodily senses to address symptoms and behaviours associated with PTSD. This includes the use of weighted blankets, music, breathing exercises or animal-assisted therapy to increase sleep quality, improve mental health and decrease pain and agitation.

A trauma informed approach also means centring staff well-being.

When visitation from caregivers and companions became severely restricted, staff who already did not have time to provide residents with adequate care saw their workload increase. Additionally, staff dealt with the moral injury of watching residents suffer and die alone.

Burnout levels amongst staff are nearing catastrophic levels and supporting staff with trauma means introducing cognitively based processes that regulate attention and set intention or somatic-based processes such as modified yoga therapies and stress reduction strategies.

While policy makers develop important industry wide standards and practices, we need to work locally towards fully integrating trauma-informed methods into long-term care homes across the country.

COVID-19 is a psychological wrecking ball and only trauma-informed practices and policies can build a sturdier system able to withstand the next pandemic or catastrophic event. This requires a commitment from those managing long-term care homes to work towards ensuring a trauma informed approach in their facilities.

Staff must be equipped with the basic knowledge of the effects of trauma and receive training on how to integrate this knowledge into their daily care routines. Additionally, supporting residents as well as staff means providing them with access to educators, nurse practitioners and those who have specialized knowledge of mental health.

Vulnerable seniors in LTC have suffered enough. It’s time for policymakers, funders and long-term care home managers to prioritize trauma-informed aged care.

By Carole Estabrooks


About the author:

Dr. Carole Estabrooks is the scientific director of Translating Research in Elder Care (TREC) and a professor in the Faculty of Nursing at the University of Alberta.