Planning to go Home from Rehab After a Stroke

December 8, 2009 by  
Filed under Education

Discharge planning begins early during rehabilitation. It involves the patient, family, and rehabilitation staff. The purpose of discharge planning is to help maintain the benefits of rehabilitation after the patient has been discharged from the program. Patients are usually discharged from rehabilitation soon after their goals have been reached.

Some of the things discharge planning can include are to:

  • Make sure that the stroke survivor has a safe place to live after discharge.
  • Decide what care, assistance, or special equipment will be needed.
  • Arrange for more rehabilitation services or for other services in the home (such as visits by a home health aide).
  • Choose the health care provider who will monitor the person’s health and medical needs.
  • Determine the caregivers who will work as a partner with the patient to provide daily care and assistance at home, and teach them the skills they will need.
  • Help the stroke survivor explore employment opportunities, volunteer activities, and driving a car (if able and interested).
  • Discuss any sexual concerns the stroke survivor or husband/wife may have. Many people who have had strokes enjoy active sex lives.
  • Preparing a Living Place
  • Many stroke survivors can return to their own homes after rehabilitation. Others need to live in a place with professional staff such as a nursing home or assisted living facility. An assisted living facility can provide residential living with a full range of services and staff. The choice usually depends on the person’s needs for care and whether caregivers are available in the home. The stroke survivor needs a living place that supports continuing recovery.

It is important to choose a living place that is safe. If the person needs a new place to live, a social worker can help find the best place.

During discharge planning, program staff will ask about the home and may also visit it. They may suggest changes to make it safer. These might include changing rooms around so that a stroke survivor can stay on one floor, moving scatter rugs or small pieces of furniture that could cause falls, and putting grab bars and seats in tubs and showers.

It is a good idea for the stroke survivor to go home for a trial visit before discharge. This will help identify problems that need to be discussed or corrected before the patient returns.

Deciding About Special Equipment
Even after rehabilitation, some stroke survivors have trouble walking, balancing, or performing certain activities of daily living. Special equipment can sometimes help. Here are some examples:

  • Cane: Many people who have had strokes use a cane when walking. For people with balancing problems, special canes with three or four “feet” are available.
  • Walker: A walker provides more support than a cane. Several designs are available for people who can only use one hand and for different problems with walking or balance.
  • Ankle-foot orthotic devices (braces): Braces help a person to walk by keepingthe ankle and foot in the correct position and providing support for the knee.
  • Wheelchair: Some people will need a wheelchair. Wheelchairs come in many different designs. They can be customized to fit the user’s needs and abilities. Find out which features are most important for the stroke survivor.
  • Aids for bathing, dressing, and eating: Some of these are safety devices such as grab bars and nonskid tub and floor mats. Others make it easier to do things with one hand. Examples are velcro fasteners on clothes and placemats that won’t slide on the table.
  • Communication aids: These range from small computers to homemade communication boards. The stroke survivor, family, and rehabilitation program staff should decide together what special equipment is needed. Program staff can help in making the best choices. Medicare or health insurance will often help pay for the equipment.
  • dPreparing Caregivers: Caregivers who help stroke survivors at home are usually family members such as a husband or wife or an adult son or daughter. They may also be friends or even professional home health aides. Usually, one person is the main caregiver, while others help from time to time. An important part of discharge planning is to make sure that caregivers understand the safety, physical, and emotional needs of the stroke survivor, and that they will be available to provide needed care.

Since every stroke is different, people have different needs for help from caregivers. Here are some of the things caregivers may do:

  • Keep notes on discharge plans and instructions and ask about anything that is not clear.
  • Help to make sure that the stroke survivor takes all prescribed medicines and follows suggestions from program staff about diet, exercise, rest, and other health practices.
  • Encourage and help the person to practice skills learned in rehabilitation.
  • Help the person solve problems and discover new ways to do things.
  • Help the person with activities performed before the stroke. These could include using tools, buttoning a shirt, household tasks, and leisure or social activities.
  • Help with personal care, if the person cannot manage alone.
  • Help with communication, if the person has speech problems. Include the stroke survivor in conversations even when the person cannot actively participate.
  • Arrange for needed community services.
  • Stand up for the rights of the stroke survivor.

If you expect to be a caregiver, think carefully about this role ahead of time. Are you prepared to work with the patient on stroke recovery? Talk it over with other people who will share the caregiving job with you. What are the stroke survivor’s needs? Who can best help meet each of them? Who will be the main caregiver? Does caregiving need to be scheduled around the caregivers’ jobs or other activities? There is time during discharge planning to talk with program staff about caregiving and to develop a workable plan.

Tags: Grab bar, Plumbing, Stroke, Bathing, Christina Crawford, Shower, Survivor

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