When a hospice patient suffering from dementia began to hoard milk and other fluids, he was almost asked to leave the skilled nursing facility caring for him. But hospice staff trained in trauma-informed care recognized his fear response and pursued interventions, bringing the patient relief and allowing him to remain in the place he called home. Due to scenarios like these, hospices increasingly are beginning to embrace the concept of trauma-informed care.
Individual trauma results from events or circumstances that an individual experiences as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and well-being, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).
“Hospices are not called necessarily to treat the trauma itself; it may not be within our scope of practice. It is within our scope of practice to monitor and tend to their symptoms,” Carla Cheatham, principal and lead trainer for Carla Cheatham Consulting Group, LLC. “It’s looking at every aspect of our care and of our organizations, to decrease the risk and to respond in a way that’s helpful rather than harmful.”
Cheatham is also a member of the National Hospice & Palliative Care Organization’s Trauma-Informed End-of-Life Care Task Force.
While confronting their mortality is inherently traumatic for patients, hospices are seeing that some who have gone through extreme events may need an extra layer of support in order to address their psychological and emotional symptoms, including veterans or victims of past abuse, among others.
According to SAMHSA, a trauma-informed organization realizes the widespread impact of trauma and understands potential paths for recovery; recognizes the signs and symptoms of trauma in patients, families and staff; and responds by fully integrating knowledge about trauma into policies, procedures, and practices. They seek to actively resist re-traumatization of the patient.
“I would say that 60 to 70% of our patients probably have dealt with one form or another of trauma that we have to address as part of our comprehensive care. It’s a really big issue for us,” said Walter George, M.D, director of hospice services for Crossroads Hospice & Palliative Care “The problem is not every member of the care team is intimately educated and informed about what trauma is, how to recognize it and what to do about it.”
The need for trauma-informed services may be rising due to the COVID-19 pandemic. One recent study examined trauma-informed palliative care during COVID-19 and indicated that an increasing wave of trauma response from patients, caregivers and clinicians was likely.
Trauma-informed care is oriented around six principles, SAMHSA indicates: safety; trustworthiness and transparency; peer support; collaboration; empowerment; and cultural, historical and gender issues. While the need for some patients to receive this care may be great, the number of hospices that have staff trained in trauma-informed care is unknown, but experts in the field say that it is growing.
“[Hospice] is behind the curve, but we’re catching up,” Cheatham told Hospice News. “It’s finally now making way into hospice and palliative care and to health care in general. We just still have a long way to go to educate people about what it is and how to respond appropriately, and it does begin with education.”