April is Sexual Assault Awareness Month. In senior care, that conversation often feels distant — associated more with younger populations, prevention campaigns or community-based advocacy. Yet there is a reality within long-term care settings that remains insufficiently addressed: sexual violence does not disappear with age, and neither does the trauma associated with it.
According to the Centers for Disease Control and Prevention, approximately one in three women and one in four men have experienced sexual violence in their lifetime. Those individuals are not abstract statistics; they are residents and staff within nursing homes, memory care settings and assisted living communities,
Senior care models are typically organized around diagnoses such as dementia, chronic illness and functional decline. Far less attention is paid to trauma history, despite its profound and lasting impact. For many residents, particularly women, sexual trauma is part of their lived experience. Trauma is not only remembered cognitively but is also carried physiologically, embedded in the nervous system.
As a result, routine care interactions — including bathing, dressing and toileting — may not always be experienced as supportive or therapeutic. For some individuals, these encounters can trigger feelings of fear, loss of control or violation, particularly among those living with dementia, where emotional memory may persist even as cognitive context fades. In these situations, the issue is not caregiver intent but resident perception and response.
Trauma among caregivers and residents
The workforce dimension of this issue is equally significant. The majority of direct care staff in senior care are women, many of whom, statistically, have their own histories of trauma, including sexual violence. This creates a dynamic that is rarely acknowledged: both the caregiver and the resident may enter the same interaction carrying unresolved experiences that influence how care is given and received.
Absent a trauma-informed framework, these interactions are frequently documented as behavioral challenges or resistance to care. From an operational perspective, this contributes to staff burnout, turnover, inconsistent care delivery and the escalation of resident distress.
The regulatory environment has begun to reflect this reality. Under F-Tag 699, skilled nursing facilities are required to provide trauma-informed care, including recognizing trauma histories, identifying potential triggers and actively working to prevent re-traumatization. For providers, this is not merely a conceptual standard but a survey and compliance expectation.
However, many organizations continue to approach trauma-informed care as resident-focused compliance. In practice, it requires a system-wide approach. Without equipping staff to understand trauma — both their own and that of the residents they serve — implementation efforts are likely to be incomplete.
Trauma is also a public health issue with well-documented links to long-term outcomes such as depression, cardiovascular disease and cognitive decline. The behaviors and reactions observed in senior care settings are often manifestations of these cumulative experiences intersecting with the vulnerabilities of aging and institutional care.
Moving toward a trauma-informed approach to care
For leaders, awareness must move beyond symbolic recognition. It requires integrating trauma-informed questions into daily practice: What might this individual have experienced? How is this interaction being perceived? What support do staff need to respond effectively?
F-Tag 699 establishes a baseline expectation, but organizational culture determines outcomes. A trauma-informed approach includes training staff to recognize trauma responses, reframing behaviors as communication, creating psychologically safe work environments and embedding meaningful support systems.
When these elements are in place, organizations often experience improved staff retention, more consistent care interactions and a reduction in escalated resident distress.
If one in three women and one in four men have experienced sexual violence, then trauma is already present within every senior care setting, among both residents and staff. The issue is not its existence, but whether organizations are prepared to recognize it and respond in ways that strengthen care delivery and workforce stability.
Sexual Assault Awareness Month serves as a reminder. In senior care, it should also serve as a call to integrate trauma-informed care not only as a regulatory requirement, but as a standard of practice.
Jean Hartnett is a visionary leader with over 25 years of executive experience serving older adults. She is a dedicated expert in trauma-informed care, and she founded Radical Sabbatical to help others turn past adversity into self-advocacy. She earned a Bachelor of Science in Social Work from the University of Nebraska Omaha and a Master’s in Health Services Administration with Long-Term Care Specialty from George Washington University.
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.
Have a column idea? See our submission guidelines here.
