I was relieved last month when I saw that my fellow Psychologists in LTC member, Lisa Lind, Ph.D., had written an article for McKnight’s about Preparing for trauma-informed care in LTC. As McKnight’s resident behavioral health expert, I was feeling like I should write something on the subject, but I was struggling with how to do so given my apprehensions about it.
Now that Dr. Lind has provided a practical guideline, let us turn to what’s kept me up at night.
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 a psychologist, residents talk to me about their painful past experiences every day. I’ve heard about children born of rapes, hidden abortions, violent childhood homes and all manner of intensely personal information, to which I was often the only one told after a lifetime of carrying a secret. It is a sacred honor to be the listener to a late-life unburdening and it comes after trust has been established over time.
Traumas are sensitive emotional wounds and I’m concerned that in their well-meaning efforts to comply with the new F-tag directives, staff members and surveyors will be poking these emotional wounds with a big stick.
There are many aspects of the situation which contribute to my uneasiness:
- Nursing homes are medically focused institutions. An in-service training or two won’t make up for the general lack of psychological training of the staff.
- Teams are still having difficulty identifying major triggers for psychological evaluation in the present day, such as an amputation or the death of a roommate.
- There are cultural and generational differences in comfort in discussing one’s personal life.
- There’s very little privacy in nursing homes. Roommates and residents seated near nursing stations and team rooms frequently overhear discussions of their peers’ personal information despite staff efforts at discretion.