Tips for Life After Stroke
Planning for effective rehabilitation and recovery from stroke needs good communication and coordination from the patient, family or caregiver, as well as the physicians and therapists. Everyone is working very hard to do the best they can to help your loved one recover.
Here are some questions to help formulate and understand an effective plan of care, so that all sessions and days spent in rehab make the most of everyone’s efforts for recovery.
WHEN do we start planning for rehab?
Planning should begin as early as possible in the hospital stay to allow for review of options and family’s planning. Rehab stays can be a very limited time, and every day is important. Discuss this with your physician and the case manager.
What types of options are available?
- Inpatient rehabilitation (such as Jim Thorpe Rehabilitation Hospital) – must qualify by patient’s status and ability to tolerate 3 hours of therapy daily to be admitted here)
- Outpatient rehabilitation (go to an outpatient rehab clinic several times/week)
- SNF (Skill Nursing Facility) – still inpatient but less intense therapy
- Home-based therapy (often provided through Home Health Agencies)
WHAT are realistic goals for this particular person?
- Find out the current status of the patient from each therapist (EX: Can they feed themselves or do they need to be fed? Can they stand well enough to transfer to the toilet themselves?)
- Letting therapists know what is important to the patient and family helps the therapists focus their efforts to achieve a specific goal.
- Good communication is essential to let the therapists and nurses know what is really important to the patient and family. An example would be that “being able to feed myself” or “being able to hold my grandchild” is a very important goal to them.
WHAT are the specific goals, concerns and expectations for the patient’s Rehab treatments and therapy?
HOW will improvement be measured during Rehab?
- “Will rehab make them “normal again”? Recovery may improve the patient’s function but not always return to “normal”.
- What is a reasonable amount of recovery to expect?
- “Making the hand stronger to be able to feed myself” is much more specific than just “getting stronger”. Ask WHY if you don’t understand the treatment or therapy – very important to understand what you consent to do BEFORE you agree to it.
- Is safety a big issue? If so, specifically which areas are you concerned about? (EX: Can they swallow safely? Can they go to the bathroom by themselves safely? )
- Ask if you can sit in on some of the therapy sessions to see if you can understand how to help the patient once they are discharged, and to be sure you are doing this correctly.
If that patient is able to achieve 50% improvement, how does the family or caregiver assist with the other times when they are struggling to help themselves, i.e. assisting with eating or toileting?
PLANNING FOR DISCHARGE after Rehab:
- Be sure you have a current Medication List when leaving the hospital or rehab facility.
- Make sure you have a clear understanding of what type of follow-up care will be needed and who will be providing it (if known), as well as how to get in touch with that person or facility.
- Will the patient be able to live at home or in their same situation again, or is it time to find other living arrangements? These take time if changes need to be made and families need time to make these arrangements.
- Specific important questions to ask of the therapists or nurses for families/caregivers to provide the most effective assistance to their loved one (please give 2-3 max):
Physical Therapists & Occupational Therapists:
- Determine what the patient will HAVE to be able to do by themselves to go home or independent or assisted living. Often involves safety and independence with toileting, dressing and basic mobility inside the home.
- Sincerely discuss what level of assist the family can realistically provide. If unable to provide ongoing needed care, are hired caregivers or assisted living options? If hiring help or moving to assisted living, make sure to ask how much help they can provide at what cost.
- If the plan is to go home, make note and take measurements of barriers in the home which will help therapy to work with them and tailor treatments to their specific environment, such as: Any steps or stairs
Narrow halls or doorways
Height of toilet, bed, chair they usually use.
- Does the patient understand what is said to them or do they need more time to process what is said?
- Can they accurately express needs, wants and ideas?
- What diet do they need to continue at home – what foods are on that diet?
- Do they need to continue thickeners and where to do I get them?
- What are signs they need to have diet and swallowing re-evaluated?
- What are the signs of aspiration (getting food or fluid into the lungs)? (Coughing, choking, runny nose/watery eyes during meals)
- How do I help them deal with the frustration of not being able to communicate?
- What does my insurance cover (such as equipment? In-home therapy? A skilled nursing facility? If so, how many days?)
- Are they community services that can help with transportation? Meals? Respite care to give the caregiver a break?
- Who can I call if I have questions or need support after the patient is discharged?
- Where can I get help as a caregiver to deal with the fear and frustration of this change in our lives?
- How do I take care of my loved one and still take care of myself?