What Is Trauma-Informed Care? Definition, Principles, and Best Practices

Let’s define trauma-informed care and explore how trauma-informed care practices and principles support the emotional and physical well-being of nursing home residents.

How Do We Define Trauma-Informed Care?

To define trauma-informed care, we look to the trauma-informed care definition provided by the Substance Abuse and Mental Health Services Administration (SAMHSA). Trauma-informed care is an approach that recognizes the widespread impact of trauma and understands potential paths for recovery. It emphasizes safety, trust, collaboration, empowerment, and cultural sensitivity. In long-term care settings, understanding this trauma-informed care definition ensures that care is delivered with compassion and avoids re-traumatization.

A resident with advanced dementia, profound hearing loss, and limited vision is taking a nap in her room when a CNA enters to provide care by changing the resident’s brief. As soon as the CNA touches the resident, the resident lashes out at the CNA, striking her several times. This episode might seem like typical behaviors associated with dementia, but the resident’s behavior is actually a resurfacing of past trauma she experienced when she was a young girl. This real-life example highlights the importance of trauma-informed care practices in long-term care settings.

In this situation, using a trauma-informed care approach could have helped the resident feel safe and potentially prevented the violence. Let’s define trauma-informed care and explore how trauma-informed care principles support nursing home residents.

Understanding the Causes of Trauma in Older Adults

Before exploring trauma-informed care practices, it’s essential to understand what trauma looks like in older adults. Some more commonly thought of causes of trauma in older adults include past physical, emotional, or sexual abuse, but some painful medical experiences can also cause trauma. Many older adults are veterans and served in military combat and wartime service and it is well known that these difficult experiences can cause trauma which lasts a lifetime. Racism and other types of painful bias can also cause trauma for individuals at varying degrees. Older adults are experiencing neglect and loneliness at higher rates which can also lead to trauma. 

Recognizing Behavioral Signs that Call for Trauma-Informed Care

There are many behaviors exhibited by residents in long-term care facilities and these behaviors can often be misunderstood if care providers don’t recognize the need for a trauma-informed care approach.

Depression is a common condition in older adults living in long-term care settings that can be caused by previous traumatic events that a resident experienced. Some residents with varying degrees of cognitive impairment from dementia or other conditions may exhibit resistance to care, such as refusal to take a shower, and may even become violent or combative with staff or other residents in the facility. It is important to keep in mind that these challenging, aggressive behaviors may be triggered by past trauma. Many other residents might isolate themselves from others and remain in their rooms or in bed due to lingering effects from previous traumatic experiences. 

Trauma-Informed Care Core Principles

The trauma-informed care definition includes a framework developed by SAMHSA with six key trauma-informed care principles that guide effective trauma-informed care practices in nursing homes and healthcare settings: safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice, and choice; and cultural, historical, and awareness.

These trauma-informed care principles are designed to shift the mindset from “What’s wrong with you?” to “What happened to you?”—a core component of trauma-informed care practices. By integrating this approach, nursing home staff can better recognize the signs of trauma, respond with empathy, and reduce the risk of re-traumatization. When facilities adopt and consistently apply a trauma-informed care framework, they foster an environment where residents feel safe, respected, and in control of their care decisions. This person-centered model is essential in long-term care, where past trauma can significantly influence present-day behaviors and emotional well-being.

This definition guides trauma-informed care practices across healthcare settings, including nursing homes. The first principle is safety for everyone including residents and staff. It is important to note that this principle involves physical and psychological safety. The second principle involves peer support and in a LTC facility that might involve a veteran staff member or volunteer providing support to a resident who had been through a similar combat experience. The third principle describes the importance of transparency and trustworthiness which can be applied by being honest to residents about care being provided or other topics. Collaboration is essential in patient-centered care and the fourth principle in trauma-informed care. The fifth principle involves understanding how cultural, historical, and gender issues play a role in a resident’s perspective and past experiences about trauma. The sixth and last principle involves offering choice to empower residents to help heal past trauma.

Implementing Trauma-Informed Care Practices in Nursing Homes

It is important that staff understand why a trauma-informed approach is a priority. Trauma-informed care practices empower staff to recognize and respond to signs of trauma while fostering trust and safety through consistent implementation of trauma-informed care practices across all levels of staffing. Residents and families can provide important information about past experiences so that staff can understand a resident’s possible trauma. To ensure consistent application, staff should be trained in trauma-informed care principles so they can recognize emotional triggers and adapt their care appropriately. Staff should also receive training to document resident triggers to avoid in the care plan and other places. Leadership should stress the importance of a team approach and utilize clear, consistent communication about the trauma-informed care approach.

Barriers to Applying Trauma-Informed Care

Despite the clear benefits, trauma-informed care practices face several barriers in nursing homes. Most long-term care facilities face staffing shortages as well as increased turnover which makes it difficult to provide education about the trauma-informed care approach. There is also a lack of understanding among staff about the importance of the care approach. Long-term care leadership may also not understand the importance of supporting the implementation of the trauma-informed care approach. Finally, many staff members may be experiencing trauma themselves, leading to burnout which prevents them from optimally caring for residents with trauma.

Conclusion: Trauma-Informed Care in Action

Let’s revisit the case and explore how it could have unfolded using trauma-informed care practices. When the CNA enters the resident’s room, she notices the resident is sleeping. Instead of proceeding immediately, she follows key trauma-informed care principles by stepping back to the doorway and knocking loudly to announce her presence. As the resident wakes, the CNA ensures she is in the resident’s line of sight and gently hands her glasses to help her feel oriented and secure. She checks whether the resident is wearing her hearing aids to support clear communication. Then, applying a core principle of trauma-informed care—empowerment and choice—the CNA asks if the resident would like her brief changed before lunch and waits for consent before continuing.

This approach aligns with the trauma-informed care definition by creating an environment rooted in safety, trust, and choice. When trauma-informed care principles and practices are consistently applied, residents are more likely to feel empowered, secure, and respected. Practicing trauma-informed care is one of the most effective ways to deliver compassionate, patient-centered care in nursing homes.