Stroke Recovery: Staying Home Alone Safely After A Stroke

Whether a person who has had a stroke can stay at home alone depends on a variety of factors, including the severity of the stroke, their ability to perform activities of daily living (ADL), and their support system. Geri, a 64-year-old woman who had a severe stroke, was able to return home and live alone with the support of her best friend, who helped with medical decisions and updates to family and friends. Geri also underwent rehabilitation, including physical, speech, and occupational therapy, which helped her regain her ability to walk, talk, and use her right arm. Other factors that can influence a person's ability to live alone after a stroke include age, gender, family structure, financial situation, and access to community resources. It is important to have a support system in place and to consider the person's safety and well-being when making this decision.

Discharge planning for stroke patients

Standardized Discharge Plan:

A standardized discharge plan is crucial for ensuring continuous medical care and effective discharge management for stroke patients. This includes a comprehensive assessment of the patient's needs, such as medication guidance, rehabilitation requirements, and social and emotional support. Developing a detailed plan helps to address the specific needs of stroke patients and their caregivers, reducing the risk of complications and readmission.

Multidisciplinary Approach:

Discharge planning should involve a multidisciplinary team, including medical, nursing, pharmacy, and allied health professionals. This collaborative approach ensures that all aspects of the patient's care are addressed and that the plan is tailored to their unique needs. It also helps to identify any gaps or inconsistencies in the patient's care plan and facilitates a seamless transition between different care settings.

Patient and Caregiver Education:

Education and training for both stroke patients and their caregivers are essential components of discharge planning. Caregivers play a crucial role in the patient's recovery, and they need to be equipped with the necessary knowledge and skills to provide adequate care. This includes understanding the patient's medication regimen, early rehabilitation techniques, and how to manage any potential complications.

Discharge Care Plan and Checklists:

Developing a patient-held discharge care plan and checklist is vital to ensure a clear understanding of the patient's needs and goals. These documents should be easily accessible and provide comprehensive information on the patient's condition, medications, follow-up appointments, and any necessary lifestyle modifications. They serve as a reference for both the patient and their caregivers during the recovery process.

Assessment of Carer's Needs and Home Environment:

The discharge plan should also consider the needs and capabilities of the carer. A home visit by an occupational therapist before discharge can help ensure the home environment is safe and any necessary aids or modifications are in place. This assessment helps identify potential challenges or barriers that the carer may face and allows for the provision of additional support or services if needed.

Continuous Monitoring and Follow-up:

Discharge planning should not end with the patient's release from the hospital. Continuous monitoring and follow-up are essential to track the patient's progress and identify any issues that may arise. Regular reviews by a multidisciplinary team can help evaluate the patient's rehabilitation, adjust the care plan as needed, and provide ongoing support to both the patient and their caregivers.

By implementing these strategies and involving a multidisciplinary team, discharge planning for stroke patients can be optimized. This comprehensive approach helps to ensure a smooth transition, improve patient outcomes, and enhance the quality of life for stroke survivors and their caregivers.

Living alone after a stroke

Assess Functional Abilities and Support System

It is crucial to assess the person's functional abilities and support system before deciding if they can live alone. This includes evaluating their ability to perform basic ADLs such as feeding, dressing, bathing, and using the bathroom independently. It is also important to consider their cognitive abilities, such as memory and decision-making skills. Additionally, the person's support system should be evaluated. Do they have family or friends who can regularly check on them and provide assistance if needed? Are there community resources or professional organisations that can provide support?

Make Necessary Home Modifications

If the person is determined to be able to live alone, it is essential to make necessary modifications to their home to ensure their safety and independence. This may include installing grab bars in the bathroom, placing frequently used items within reach, and removing trip hazards. A medical alert system or emergency call buttons can also be installed to ensure help is readily available in case of a fall or emergency.

Encourage Continued Rehabilitation

Encourage the person to continue with their rehabilitation exercises and therapies, even after returning home. This can help improve their functional abilities and increase their independence over time. Outpatient rehabilitation services or home health care providers can assist with this process. Additionally, consider joining support groups or participating in social activities to maintain social connections and combat feelings of isolation.

Have a Plan for Emergencies

It is important to have a plan in place for emergencies. This includes ensuring the person can easily access a phone or medical alert device to call for help if needed. Inform neighbours or nearby friends or family members about the situation so they can keep an eye out and provide assistance if necessary.

Monitor Progress and Adjust as Needed

Recovery and rehabilitation

The first few weeks of recovery are critical, and it is important to have a support system in place. This can include family, friends, or a professional caregiver. During this time, the patient may need help with basic activities of daily living (ADLs) such as eating, walking, and speaking. They may also need help with medical care, such as giving real-time updates to doctors and family members.

The patient's home environment should be evaluated for any safety concerns, such as fall risks. Assistive equipment and home modifications can be made to reduce the likelihood of a fall and increase the patient's independence. A medical alert system or a cell phone should also be easily accessible in case of an emergency.

The patient's progress should be continuously monitored through physical, speech, and occupational therapy. The goal is to help the patient regain as much independence as possible and improve their ability to perform ADLs. This may include relearning and practicing basic tasks such as moving around the home and preparing meals.

The patient's social life and emotional well-being should also be considered. They may benefit from regular social interaction and engagement with friends or family. Joining an online support group or community can also provide additional support and help keep loved ones updated on the patient's progress.

It is important to keep in mind that recovery is a dynamic process, and the patient's needs may change over time. Regular assessments and evaluations should be conducted to determine the patient's progress and adjust their care plan accordingly.

• Have a medical and financial power of attorney in place.
• Post medications and health information on the fridge or in an easily accessible location.
• Consider investing in an insurance policy that covers disability.
• Utilize online groups or communities to stay connected and update loved ones.

Risk of falling

People who have had a stroke are at a higher risk of falling than many other hospitalized patients. The reported incidence ranges from 14 to 65 percent, with almost half of the fallers experiencing at least two falls. The risk of falling is increased following a stroke due to leg weakness, impaired balance, visual disturbances, functional dependence, cognitive impairment, and sensory loss.

Risk Factors

• Leg weakness
• Impaired balance
• Visual disturbances
• Functional dependence
• Cognitive impairment
• Sensory loss

Screening and Assessment

All patients should be screened for fall risk by an experienced clinician at admission, at all transition points, after a fall, and/or whenever there is a change in health status. Screening should include identification of medical, functional, cognitive, and environmental factors associated with the risk of falling and fall injuries. Those identified as being at risk for falls should undergo a comprehensive interdisciplinary assessment that includes medical and functional history and evaluation of mobility, vision, perception, cognition, cardiovascular status, and environment.

Falls Prevention Plan

Based on risk assessment findings, an individualized falls prevention plan should be implemented for each patient. The patient, their family, and caregiver should be made aware of the patient's increased risk for falls and given a list of precautions to reduce their risk of falling. They should also receive skills training to enable them to safely transfer and mobilize the patient, including what to do if a fall occurs and how to get up from a fall.

Gait Aids, Footwear, and Transfers

The patient, family, and caregiver should receive education regarding suitable gait aids, footwear, transfers, and wheelchair use, considering the healthcare and community environment.

Bed and Chair Alarms

Bed and chair alarms should be provided for patients at high risk for falls according to local fall prevention protocols.

After a Fall

If a patient experiences a fall, they should be assessed for possible injury prior to an assessment of the circumstances surrounding the fall to identify precipitating factors. Pre-existing falls prevention plans should be modified to reduce the risk of further falls.

Support systems

The treatment of a stroke patient is multidisciplinary, requiring the support of a team of medical professionals. This includes rehabilitation specialists, rehabilitation nurses, physical, occupational, speech and language therapists, and mental health professionals. These teams work together to provide optimal care and ensure the best outcomes for the patient.

In addition to medical professionals, it is beneficial to have a friend or family member who can take on a leading role in the recovery process, talking to doctors, giving updates to family and friends, and ensuring the patient has a voice when they cannot speak. This person can provide emotional support and help the patient feel empowered.

It is also important to have a medical and financial power of attorney in place, and to have any medications or health conditions, as well as insurance information, easily accessible.

Frequently asked questions