In-Home Care Supports Stroke Recovery
Most stroke survivors have the goal of returning to live independently at home. But even with the help of family caregivers, recovery can be a challenge. What support services promote the highest possible level of recovery?
Each year, almost 800,000 Americans experience a stroke. The National Stroke Association predicts that with the aging of the baby boomers, the annual rate will increase sharply within the next few decades. And although the risk of stroke is higher as we grow older, stroke is by no means exclusively a disease of old age: Researchers report an increasing number of younger stroke victims, a result of higher rates of obesity, diabetes and high blood pressure. Stroke takes the lives of 130,000 people each year, and many who survive are living with physical and cognitive impairment that robs them of independence and limits their quality of life.
But the news isn't all bad: Many stroke survivors make a full recovery with no or minor long-term effects. What can stroke survivors and their families do to increase the chances of regaining the highest possible degree of independence and function?
The outcome depends in part on the severity of the stroke and the area of the brain that is damaged—and often, on how early treatment begins to halt damage to the brain. Neurologists urge everyone to be familiar with the signs of stroke. (Visit the American Stroke Association website to find the easy-to-remember F.A.S.T. symptom list.)
Rehabilitation therapy usually begins in the hospital as soon as the patient's medical condition is stable, often within 24 to 48 hours. When the patient is ready for discharge, a hospital social worker will help develop a plan for continuing rehabilitation and care. Some patients go from the hospital to a skilled nursing facility or other care setting specializing in rehabilitative therapy before returning home. Others return home directly.
Once a patient returns home from the hospital or intermediate care setting, support services are often needed to ensure continued rehabilitation. Outpatient rehabilitation facilities provide access to physicians and a full range of therapists specializing in stroke rehabilitation. Depending on the patient's needs, this includes:
- Physical therapy to help restore physical functioning and treat problems with movement, balance and coordination.
- Occupational therapy to help patients relearn or develop adaptive strategies for performing the skills of daily living, such as eating, walking and dressing.
- Speech-language therapy to regain language and communication skills and address swallowing problems.
- Mental health counseling to help the patient cope with emotional and behavior changes that sometimes occur after a stroke.
The Centers for Disease Control and Prevention (CDC) reports that caring for stroke patients costs $38.6 billion each year. And though recovery at home is usually more cost-effective, today's emphasis on controlling healthcare costs isn't the only reason more patients return home sooner after a stroke these days. Stroke survivors themselves often prefer to recover in the comfort of their own home. The patient's healthcare team will help develop a plan for recovery and rehabilitation at home, which might include:
Skilled home healthcare and rehabilitation services, offering some of the treatment options available in the outpatient setting, that let patients practice skills in their familiar environment.
Home modifications to make life easier and safer, such as handrails on stairs, grab bars and a raised toilet seat in the bathroom, and rearrangement of the home to accommodate one-story living.
Nonmedical in-home care, available at a lower cost than medical home healthcare, to support independence and recovery. During recovery, most patients need a good deal of help if they are to stay at home. Family caregivers and friends usually want to help, but they may not have the time, physical ability or knowledge to do all that needs to be done. Nonmedical companion in-home care can be the ideal solution. In-home caregivers provide:
Care coordination and transportation. Stroke rehabilitation can be lengthy and complex, at a time when patients are struggling with mobility and cognitive challenges. In-home caregivers help patients keep track of appointments, and drive them to the stroke center, doctor's office and support group meetings. This reduces anxiety and allows patients to focus on their recovery.
Supervision during home rehabilitation. Rehabilitation professionals agree that the most important key to successful recovery is carefully directed, well-focused repetitive practice. Many patients are given a set of exercises to perform at home. In-home caregivers provide reminders, encouragement and supervision to help the patient stick with the program.
Assistance with the activities of daily living. In-home caregivers help clients with bathing, grooming, dressing, using the toilet and other personal care tasks that they are unable to do by themselves. Trained caregivers are careful to preserve the dignity of clients at this challenging time.
Housekeeping and meal preparation. In-home caregivers can keep the home clean, do laundry, and remove fall hazards inside and outside the home. They can go to the grocery store and prepare meals with ingredients and preparation methods as instructed by the client's healthcare provider. For clients who have difficulty eating, the presence of a caregiver provides an extra measure of safety and encouragement.
Companionship. Loneliness and inactivity increase post-stroke depression and make it less likely that patients will follow their treatment plan. In-home caregivers help clients avoid a debilitating sense of isolation. And having a caregiver at the ready gives patients the confidence to follow their healthcare provider's recommendation for physical activity. The American Stroke Association suggests walking as a good choice. With a caregiver close at hand, patients feel more confidence as they venture out of the house.
Support for family caregivers. Family caregivers play an important role in the recovery of their loved one. In many cases, the availability of family support makes it possible for the patient to recover at home rather than in a nursing home. But caring for a stroke survivor is hard work. Many family members report feeling unprepared for the tasks they must perform. They feel torn between their caregiver tasks, job duties and other responsibilities. Those who live at a distance worry constantly and may need to make many trips back and forth at a high cost. Studies even show that stroke caregivers may put their own health at risk: Caregiver stress leads to depression, heart problems, and even an increased risk that the caregiver, too, will suffer a stroke. For many families, in-home care provides an indispensable support resource.
In-home care can be provided for a few hours per week up to full-time and overnight. Caregivers can be hired temporarily as a patient recovers, or long-term for patients who have not regained their full range of abilities. In-home care helps stroke patients regain the highest possible degree of independence and quality of life, whether their home is their own house or apartment, a retirement or assisted living community, or a family member's.
May is Stroke Month. Find resources, support groups and information about stroke and stroke recovery on the websites of the National Institute of Neurological Disorders and Stroke, the National Stroke Association and the American Stroke Association.
For information on topics related to home care and healthcare, visit our Home Care and Healthcare Advocacy group on LinkedIn.
Find out more about home modifications in "Online Buzz: Home Safety Tips for Seniors" in this issue.