Improved patient and staff satisfaction are among the most significant returns on investment for hospices that are pouring greater resources into trauma-informed training.

The ability to build a trusting relationship with patients and their families is a key skill set for any hospice professional to possess, but one that takes on a profoundly different meaning when caring for survivors of abuse, violence and trauma. This is according to Amber Ash, pediatric hospice and palliative care social worker at Ohio-based Hospice of the Western Reserve.

Trauma-informed education should be a normalized part of hospice’s interdisciplinary training to help staff recognize and respond to a range of experiences, Ash indicated. This type of training can help provide opportunities for improved goal-concordant care while also aligning with staff’s professional goals and personal values, she stated.

“We see a lot of benefit from taking a trauma-informed care approach,” Ash told Hospice News. “There is a positive return on investment, both with retention and with patient and family satisfaction. We’re able to meet that patient where they’re at and look at things from a trauma-informed lens. Not only is it better care for patients, but also empowering for the clinicians. It’s not another task to complete, but rather something that can actually make their work richer.”

Hospices need to take a wide lens around the operational and financial considerations involved in trauma-informed training, Ash added. In 2018 Hospice of the Western Reserve launched a Trauma-Informed Care Committee designed to create various training programs across its interdisciplinary workforce, volunteer base and back-office administrative staff. The committee has since aided in creating various evidence-based virtual and in-person educational initiatives.

Having training resources available to staff is an important part of understanding both their own personal responses to trauma as well as the experiences of their patients as they near the end of life, said Ash. While recognition around trauma issues has grown, the needle has much farther to go to address the systemic challenges.

Greater awareness and education are key components to breaking the silent cycle of violence, abuse and trauma. More than half of women and roughly 60% of men reported experiencing at least one traumatic event in their lifetime in a National Comorbidity Study (NCS).

The proliferation has led to increased recognition at national levels. The United States has observed Domestic Violence Awareness Month every October since 1987. Since then researchers have dug further into the range of physical, emotional and psychosocial effects of trauma and violence.

Early childhood and cumulative lifetime trauma experiences can have negative impacts on an individual’s end-of-life experience, according to findings from a recent study published in the Journal of the American Geriatrics Society (JAGS).

Researchers examined end-of-life outcomes among seniors in a national Health and Retirement Study from 2006 to 2020. Increasing cumulative trauma was “significantly associated” with higher reports of moderate to severe pain levels at the end of life, along with increased fatigue, loneliness, depression and lower life satisfaction.

Understanding the multitude of potential trauma impacts is “imperative” for providers, according to Yelena Zatulovsky, vice president of patient experience in hospice at AccentCare. Individuals with a history of these experiences often report worsening symptoms as their illnesses progress compared to others, she stated.

Hospices investing in trauma-informed training stand to gain a leg up on competitors when it comes to improved retention and organizational reputation, Zatulovsky said. The benefits can be two-fold with increased staff and patient satisfaction, as well as helping to build a supportive organizational culture, she added.

“Hospice professionals who feel equipped to engage in these dialogues compassionately, and to recognize the non-verbal signs and symptoms, often report higher levels of connectedness with those they care for, and the reverse,” Zatulovsky told Hospice News in an email. “Feeling fulfilled and supported has a direct correlation to employee retention. From a business perspective, positive patient experiences often result in word-of-mouth promotion from those who received care and support to their own communities, which can only increase the number of patients agencies get the privilege of serving.”

Trauma-informed education equips staff with the tools and information needed to understand and avoid a potential crisis situation, said Larry Hetu-Robert, bereavement manager and veteran liaison for VITAS Healthcare, a subsidiary of Chemed Corp (NYSE: CHEM). Hetu-Robert is also a veteran of the U.S. Navy Reserve.

Having staff who are well-versed in trauma-informed care can be particularly helpful when serving veterans who tend to have higher rates of post-traumatic stress disorder compared to others, he stated. Staff have indicated that they feel more aware of the issues that patients may be dealing with and better prepared to help address these challenges, Hetu-Robert.

“Trauma-informed care averts the crisis. Hospice providers cannot afford not to invest in trauma-informed care” Hetu-Robert told Hospice News in an email. “When team members are properly trained and know what to expect and how to care for the unique needs of veterans, they are more confident and less likely to suffer burnout. Morale increases. It gives our care experts a greater sense of accomplishment when given the resources they need. The return is not only monetary, it is emotional and physical. It is both qualitative and quantitative. The reward for our patients and care team is priceless.”