Suffering from a stroke can be an overwhelming and frightening health crisis. Strokes can happen out of nowhere and leave a person unable to move, talk, or function as normal. However, the effects don’t just occur in the moments when the stroke happens, they can result in serious, long-term impact. Most people who suffer from a stroke will require rehabilitation.
After the stroke occurs, you have many important decisions ahead of you as a caregiver. One of the most important decisions is where your loved one will receive rehabilitation and begin the recovery process. We’ll discuss how a stroke can affect your loved one’s abilities, how to choose the right setting, when assisted living might be best, and how to find the right facility for your loved one.
What is a Stroke?
A stroke is a type of brain injury. There are two main types: ischemic and hemorrhagic.
- Ischemic strokes occur when blood vessels become blocked by a clot or are too narrow for blood to get through. Due to the reduced blood flow, brain cells in the area die from lack of oxygen. This is the most common form of stroke.
- Hemorrhagic strokes occur when a blood vessel bursts and blood leaks into the brain, causing damage.
There is also a related condition called transient ischemic attack (TIA). This has the same symptoms as a stroke, but only lasts for a few hours or a day and does not cause permanent brain damage. A TIA is not a stroke, but it is an important warning signal. Someone who’s had a TIA needs treatment to help prevent an actual stroke in the future.
Impact of a Stroke
Each stroke is different depending on the part of the brain injured, the extent of the injury, and the person's general health. We’ll list some of the effects of stroke here, but it’s important to ask your healthcare team exactly what you should expect for your loved one specifically. This information is adapted from a pamphlet on StrokeCenter.org called Recovering After a Stroke: A Patient and Family Guide.
- Weakness or paralysis on one side of the body - This may affect the whole side or just the arm or the leg. The weakness or paralysis is on the side of the body opposite the side of the brain injured by the stroke. For example, if the stroke injured the left side of the brain, the weakness or paralysis will be on the right side of the body.
- Balance or coordination problems - These issues can make it hard for the person to sit, stand, or walk, even if muscles are strong enough.
- Problems using language (aphasia and dysarthria) - A person with aphasia may have trouble understanding speech or writing. Or, the person may understand but may not be able to think of the words to speak or write. A person with dysarthria knows the right words but has trouble saying them clearly.
- Being unaware of or ignoring things on one side of the body (bodily neglect or inattention) - Often, the person will not turn to look toward the weaker side or even eat food from the half of the plate on that side.
- Pain, numbness, or odd sensations - These symptoms can make it hard for the person to relax and feel comfortable.
- Memory, thinking, attention, or learning problems (cognitive problems) - A person may have trouble with many mental activities or just a few. For example, they may have trouble following directions, get confused if something in a room moved, or be unable to track the date or time.
- Being unaware of the effects of the stroke - The person may show poor judgment by trying to do unsafe things as a result of the stroke.
- Trouble swallowing (dysphagia) - This can make it hard for the person to get enough food. Also, caregivers must prevent the person from breathing in food (aspiration) while trying to swallow it.
- Problems with bowel or bladder control - Individuals may need to use portable urinals, bedpans, and other toileting devices.
- Getting tired very quickly - This may limit the person's participation and performance in a rehabilitation program.
- Sudden bursts of emotion, such as laughing, crying, or anger - These emotions may indicate that the person needs help, understanding, and support in adjusting to the effects of the stroke.
- Depression - This is common in people who have had strokes. It can begin soon after the stroke or many weeks later, and family members often notice it first.
Stages of Recovery
Choosing the right setting for your loved one will require flexibility over time, as the stroke recovery process is quite different at each stage.
- Acute Care - Treatment for stroke begins in a hospital. This includes helping the patient survive, preventing another stroke, and taking care of any other medical problems.
- Spontaneous Recovery - This happens naturally to most people. Soon after the stroke, some lost abilities usually start to come back. This process is quickest during the first few weeks, but sometimes continues for a long time.
- Rehabilitation - This helps the person keep abilities and gain back lost abilities to become more independent. It usually begins while the patient is still in acute care. The goal for rehabilitation following a stroke is to return the patient to the highest level of functionality possible. For most patients, recovery from stroke takes six months to one year of focused, intensive rehabilitative therapy. Depending on stroke severity, this could occur in a skilled nursing facility or outpatient rehabilitation program. Medicare and many health insurance policies will help pay for rehabilitation.
- Long-Term Adjustment - The last stage in stroke recovery overlaps with rehabilitation. This begins with the person's return to community living – whether that means home, assisted living, or a nursing home. This stage can last a lifetime as the stroke survivor and family learn to live with the effects of the stroke. This may include doing common tasks in new ways or making up for damage to or limits of one part of the body by greater activity of another.
Deciding on the Right Setting for Care
Talk to Your Hospital Discharge Planner
The purpose of discharge planning is to help maintain the benefits of rehabilitation after the patient has been discharged from the program. Your discharge planner should work with you to:
- Make sure your loved one has a safe place to live after discharge
- Decide what care, assistance, or special equipment are needed
- Arrange for more rehabilitation services in the home or assisted living facility
- 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
Consider the Age Factor
Strokes are more common in older people. Almost 75% of all strokes occur in people over 65 years of age. It’s important to discuss how your loved one’s age might affect the medical plan and any rehabilitation strategies. Speak frankly with their healthcare team to understand how your loved one’s age-related complications might affect whether they decide to proceed with rehabilitation, and what this means for their long-term care. This will help you make the best decision. Are you preparing for rehabilitation and recovery or long-term medical care? It’s hard to ask those questions, but they will help you create a safe and comfortable environment for your loved one.
Evaluate Your Home Setting
With a better understanding of what to expect, think through the following questions.
- Can we meet their physical and mental needs at home during this time?
- Are we able and willing to manage their medication or medical equipment at home?
- Should they be home alone? Would there be someone available to help them at all times of the day?
- Do their symptoms require 24/7 attention?
- Are we worried about falls in the home?
- If your home is on two levels, will we need to get a hospital bed for the lower level?
- Is there enough room in the living space for rehabilitation specialists to provide therapy?
Would Home Care Be Appropriate?
You may decide that your loved one can safely remain at home once they’ve sufficiently recovered from the stroke. If you can’t provide the care needed, you could get supplemental support through a home care agency. An in-home caregiver could make meals, help with medications, and keep your loved one safe and comfortable. They can also facilitate the in-home rehabilitation necessary for ongoing recovery. The healthcare team and family should re-assess regularly to determine if an assisted living facility could offer more comprehensive care than at home.
Considering Assisted Living
When Assisted Living Makes Sense
One of the most important benefits of assisted living for stroke survivors is a safe environment. You can have peace of mind knowing your loved one is getting healthy meals, has a clean and tidy living space, and has emotional support. No more worrying about if they’ll fall going to the bathroom at night or if they’re able to take care of personal hygiene during their stroke recovery process. For many individuals, having a healthcare professional tend to personal care needs is more comfortable than having a family member assist.
It’s also important to note that for individuals who require a lot of home care (having an in-home caregiver present most of the time), the cost of an assisted living facility can be less over time. And if you’re relying on Medicaid, most Medicaid programs don’t pay for extended home health care, such as eight to ten hour shifts. Medicaid may pay for assisted living, but the requirements vary by state.
Think about the long-term needs of your loved one. If the stroke will have long-lasting effects that will make it difficult for them to manage the tasks of daily living, an assisted living facility might be best, especially if they have other conditions or age-related issues that make living at home more challenging.
Scenarios That Might Not Be Appropriate
If the stroke has created a need for ongoing medical care, it’s important to note that assisted living facilities do not provide medical care. They can help ensure your loved one is taking their medications as prescribed and has transportation to medical appointments. Many facilities also have a visiting doctor. But if your loved one needs 24/7 monitoring and care, a nursing home may be a better choice.
More and more, there are facilities with both assisted living and nursing home facilities on one campus. This allows residents to shift over to assisted living as they recover and their needs decrease. It’s reassuring to know that your loved one is already in a facility that can handle their changing care needs. Also, some nursing homes have a skilled nursing unit, specifically designed for patients who require more medical care. This might be needed immediately following their hospitalization. They could then be transferred to the assisted living or nursing home as they recover.
Choosing an Assisted Living Community
Where to Begin
As a starting point, keep a list of standard questions so you can compare answers across all options. AARP provides a printable resource Caregiver Checklist for Evaluating Assisted Living Facilities. Their checklist covers everything from safety to resident rights to fees. Be sure to add your own questions as they pertain to the specific needs and preferences of your senior, such as whether pets are permitted, if couples can live together, how they welcome LBGT residents, and if they have bilingual staff.
Check out online overviews and reviews on third-party sites. It's vital to get feedback from individuals who have experienced their services first-hand. Ask your doctor, family, friends, neighbors and clergy about their experiences. Ask a hospital's discharge planner or social worker for recommendations, especially if your senior was recently in the hospital.
Tour several facilities. We recommend making multiple visits. Late morning and mid-day hours are usually the best times to get a feeling for the day-to-day operations. For your first visit, make an appointment with the admissions director to tour on a weekday.
Choosing an assisted living community specifically for a stroke survivor can be a little more complex and require more research. Consider these additional questions as you look at assisted living facilities:
- What training does the staff have specific to stroke recovery?
- Do they have different levels of care? It might be make sense to choose a facility that can respond to their changing needs over time. That way, you can avoid the expense and disruption of moving.
- Is there always a nurse on duty at your facility? Since assisted living facilities are regulated state by state, be sure to understand the requirements, as well as what they can provide/treat.
- When does a physician visit the residents? What does he/she do? How is information communicated to their primary care physician?
- Can their rehabilitation specialist provide services in their apartment?
- Are there additional costs for transportation? This is especially important if your loved one will need frequent trips to a rehabilitation center, if a family member cannot take them during the day.
- What are your procedures for responding to an emergency medical incident? You want to make sure you loved one is promptly transferred to a hospital if needed.
A stroke is frightening for both the patient and family. It helps to remember that stroke survivors usually have at least some spontaneous recovery or natural healing and often recover further with rehabilitation. Finding the right setting for your loved one will help speed up this recovery process.