Stroke Recovery: When Can You Leave The Hospital?

how long after a stroke can you leave hospital

The length of a hospital stay after a stroke depends on the individual and the severity of the stroke. Two-thirds of people who have had a stroke are admitted to hospital, and the length of their stay is based on their needs. The first few hours after a stroke are critical, as this is when doctors will work to stabilise the patient and prevent further damage to brain cells. After this, the patient will be monitored and their risk factors will be managed. The patient and their family will also be involved in creating a discharge plan, which will include their rehabilitation goals and any care they will need after leaving the hospital. The length of time this takes will vary depending on the individual, but it generally takes at least a week for someone to be discharged from the hospital after a stroke.

Characteristics Values
Time spent in hospital 1-3 weeks
Discharge destination Home, inpatient rehabilitation, long-term care or another living situation
Discharge plan A plan for the near future, including goals for the next weeks and months, and a list of appointments, contacts, and medications
Recovery time Weeks, months, or years
Rehabilitation Inpatient rehabilitation, subacute rehabilitation, outpatient therapy, home health

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Inpatient rehabilitation

Inpatient rehab centers are an excellent option for patients who can tolerate intensive therapy (at least 3 hours per day), but are not independent enough to live at home yet. At the inpatient facility, the rehab team will design a treatment plan to address the person's unique needs. They will receive at least 3 hours of therapy throughout the day, 5-7 days a week. The length of stay in an inpatient rehab facility may vary, with some individuals staying for a week or less, and others for up to a month.

The treatment plan will include physical, occupational and speech therapy, 24-hour nursing care, and regular physician visits. Physical activities include motor-skill exercises to improve muscle strength and coordination, and mobility aid training for using a walker, canes, wheelchairs or ankle braces. Speech therapy helps with speaking and swallowing, while spasticity therapy uses exercises to ease muscle tension and help regain a full range of motion. Cognitive activities might include therapy to help with lost cognitive abilities such as memory, processing, problem-solving, social skills, judgement and safety awareness.

In addition to the above, activities of daily living allow patients to practice daily household and lifestyle tasks such as dressing, cooking and driving. These activities also help patients relearn signatures, medication management and handling finances.

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Discharge planning

The length of a hospital stay after a stroke varies depending on the severity of the stroke and the number of medical complications that occur. On average, a person may spend 1-3 weeks in the acute care hospital. During this time, a team of experts assesses the patient's condition, identifies any secondary effects, and determines their ability to care for themselves.

Before leaving the hospital, it is crucial to have a comprehensive discharge plan in place. This plan should involve the patient, their family, social workers, therapists, nurses, and physicians. Here are some key components of a successful discharge plan:

  • Current functional abilities and prior level of function: Understanding what the patient was able to do before the stroke and their current abilities helps determine the level of care needed.
  • Family/caregiver support: The availability of family or caregiver support is essential, especially if the patient requires assistance with daily activities.
  • Motivation to improve: The patient's motivation to participate in rehabilitation and their tolerance for therapy are important considerations.
  • Safe living environment: Ensuring the patient has a safe place to live after discharge is crucial. This may involve home modifications or recommending adaptive equipment.
  • Follow-up appointments: It is recommended that individuals have follow-up visits with their primary care provider or a stroke clinic to monitor their recovery and manage risk factors.

Possible Discharge Settings:

Depending on their condition, patients may be discharged directly home or to a different facility for further care:

  • Discharging directly home: About half of those admitted to the hospital due to a stroke can return home. Some may be independent, while others require assistance from family or home health services. Outpatient therapy is often recommended for those who go home.
  • Inpatient rehabilitation: For patients who can tolerate intensive therapy (at least 3 hours per day) but are not yet independent enough to return home, inpatient rehab centers offer treatment plans tailored to their unique needs. The length of stay can vary from a week to a month or more.
  • Skilled nursing facilities: These facilities are suitable for individuals with more medical needs and those without a strong family or caregiver support system. They may also be recommended for patients who cannot tolerate several hours of therapy each day.

Planning for Long-Term Care:

For individuals who have experienced a more severe stroke, long-term care may be necessary. This involves extra help with personal care and daily activities. It is important to consider the patient's specific needs and create a plan that ensures they receive the necessary care and support.

Making Your Discharge Plan:

  • Destination upon discharge: Determine whether the patient will be going home, to inpatient rehabilitation, long-term care, or another location.
  • Healthcare contacts and appointments: Create a list of appointments, including locations, contact information, and reasons for each appointment.
  • Therapists and their contact information: List the names and contact details of the patient's therapists, along with the reason for seeing them.
  • Recovery and rehabilitation needs: Identify the patient's recovery needs, any devices that may assist them, and the types of rehab they require.
  • Plan to prevent another stroke: Review risk factors, set goals for reducing risk, and schedule follow-up appointments to manage these factors.
  • Medications and dietary considerations: Provide a list of medications, including possible side effects and any food restrictions.
  • Daily life routines: Identify assistive devices and strategies to help with daily routines such as getting around, eating, bathing, and using the toilet.

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Recovery timelines

The recovery timeline after a stroke is complex and unique to each individual. It depends on several factors, such as the size and location of the stroke, age, and overall health before the stroke. Generally, recovery tends to be faster for minor strokes and can take weeks, months, or even years for more severe cases. Here are some key points regarding recovery timelines:

Days 1-3: Initial Treatment and Stabilization

During the first few hours after a stroke, the primary goals are to stabilize the patient, identify the type of stroke (ischemic or hemorrhagic), and provide early treatment to prevent further damage. This often involves administering clot-busting drugs or surgical intervention.

Week 1-3: Acute Care in the Hospital

Most stroke patients will spend 1-3 weeks in the acute care hospital, where a team of experts will assess their condition, identify any secondary effects, and determine their ability to perform daily activities independently. Before leaving the hospital, a rehab team will create a rehabilitation plan.

Post-Acute Rehabilitation Options

Depending on the patient's needs and abilities, they may transition to different rehabilitation options, including inpatient rehabilitation, subacute rehabilitation, outpatient therapy, or home health services. Inpatient rehab is suitable for those who can benefit from intensive therapy (at least 3 hours per day). Subacute rehab, such as skilled nursing facilities, offers a lower level of therapy (1-2 hours daily). Outpatient therapy involves visiting clinics as needed, and home health services bring therapists and nurses to the patient's home.

1-3 Months: Notable Recovery

During the first three months, the brain is still in a heightened state of plasticity, making this a critical period for rehabilitation. Notable improvements can be observed, and spontaneous recovery is also common. Inpatient therapy during this time can maximize the chances of progress.

6 Months: Gait Improvements

By the six-month mark, many survivors who engage in regular rehabilitation can expect improvements in their ability to walk. In one study, around 60% of non-ambulatory survivors who participated in inpatient rehabilitation were able to walk again at this stage.

1 Year: Varied Recovery Journeys

At the one-year mark, some individuals may have fully recovered their functions, while others continue their rehabilitation journey. Improvements in motor function, self-reported health, and the capacity to perform daily activities can still be observed.

5 Years and Beyond: Continued Functional Recovery

Even years after a stroke, functional recovery can continue with dedicated rehabilitation. There is documented proof of chronic stroke recovery as far as 23 years after the initial event. Consistent rehabilitation exercises and healthy daily habits can optimize overall wellness and reduce the risk of a second stroke.

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Leaving the hospital

Before leaving the hospital, it is important to have a discharge plan in place. This plan should consider factors such as your current functional abilities, your living situation, and the level of family or caregiver support you have. The plan may include home modification ideas, adaptive equipment recommendations, and caregiver training to ensure a safe transition.

There are several options for discharge settings, including returning home, transferring to inpatient rehabilitation, or moving to a long-term care facility. About half of those admitted to the hospital due to a stroke return straight home, while others may need more intensive care at a different facility.

If you are discharged home, you may participate in outpatient therapy or have home health services come to your home to provide health care and caregiver training. If you need more intensive therapy, you may be transferred to an inpatient rehabilitation facility, where you will receive at least three hours of therapy per day. For those who require a lower level of therapy, subacute rehabilitation at a skilled nursing facility may be an option.

Regardless of your discharge setting, it is important to continue with rehabilitation and therapy to maximize your recovery. This may include physical, occupational, and/or speech therapy, as well as psychological support. The more you participate in your prescribed therapy exercises, the greater your potential for recovery.

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Post-acute rehabilitation

The length of a hospital stay after a stroke varies depending on the severity of the stroke, the patient's progress, and the availability of resources. On average, patients stay in the hospital for around two weeks after a stroke, but some may require a longer stay, especially if they have severe impairments or complications.

  • Inpatient Rehabilitation: Some patients may be transferred to inpatient rehabilitation facilities if they require intensive therapy but are not yet independent enough to return home. These facilities provide at least 3 hours of therapy per day, 5-7 days a week, and offer individualized treatment plans. The length of stay can vary from a week to a month or more, depending on the patient's progress.
  • Skilled Nursing Facilities: These facilities are suitable for patients who require more medical attention and have limited family or caregiver support. While they may not be able to tolerate several hours of therapy each day, it is still important for them to be in a facility that offers rehabilitation programs to promote their recovery.
  • Home Therapy: For those who can return home after a stroke, outpatient therapy or home health services are often recommended. Outpatient stroke clinics provide access to medical professionals who can continue the patient's rehabilitation journey. Additionally, home therapy devices can assist patients in practicing their exercises at home, stimulating their brain's neuroplasticity and accelerating recovery.
  • Discharge Planning: A comprehensive discharge plan is crucial for a smooth transition from the hospital to the next step in the recovery process. This plan should consider the patient's current functional abilities, their living situation, the support system available, and any necessary home modifications or adaptive equipment. A caregiver training session may also be included to ensure the patient receives adequate assistance.
  • Long-term Care: In some cases, patients may require long-term care if they have more severe effects from the stroke and need extra help with personal care. This can be determined as part of the discharge planning process, where realistic goals and plans are set for the patient's ongoing recovery.
  • Community Programs: Depending on their condition, some patients may benefit from community programs that offer rehabilitation services closer to their homes. These programs can provide continued support and assistance during the recovery journey.

Frequently asked questions

The length of stay in the hospital after a stroke depends on several factors, including the severity of the stroke, the patient's recovery progress, and their ability to care for themselves. On average, patients stay in the acute care hospital for 1-3 weeks after a stroke.

The discharge plan takes into account the patient's current functional abilities, prior level of function, family/caregiver support, motivation to improve, and tolerance for therapy. The plan may include home modification recommendations, adaptive equipment, and caregiver training.

Depending on the patient's needs and abilities, they may continue with inpatient rehabilitation, subacute rehabilitation, outpatient therapy, or home health services. Inpatient rehabilitation typically involves at least 3 hours of therapy per day, while subacute rehabilitation offers a lower intensity of 1-2 hours of therapy daily. Outpatient therapy and home health services provide flexibility for patients who are more mobile or have assistance at home.

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