4 Long-Term Care Options for Stroke Patients

Updated

Certified Care Manager, Aging Life Care Professional, and National Master Guardian Emeritus

Having a stroke is a serious emergency medical event that can lead to long-term disability if not immediately treated. Even in cases where a patient receives immediate medical attention, there can be long-term effects. There are three main types of strokes: Ischemic, which accounts for about 87 percent of strokes, Hemorrhagic and Transient Ischemic Attack (TIA).

Depending on where in the brain a stroke occurs, the consequences can be very different. Some stroke victims will have permanent physical disabilities, where others might have some language difficulty but have no physical problems. 

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Stroke treatment and rehabilitation have come a long way over the years with increased understanding and attention given to intensive rehabilitation practices. If a patient is stable enough, medical providers can start rehabilitation within the first 48 hours of getting a stroke.

If your loved one has had a stroke, be patient and take advantage of the best rehabilitation available at the time. A stroke can be a devastating medical event, but aiming to have a positive, patient attitude will help you recover.

Almost everyone would prefer to recover and rehabilitate at home after short-term rehab. Home is considered a long-term care option with the right support system in place. Let’s look at all of the options for your loved one after having a stroke.

Signs a Loved One Might Need Long-Term Care After a Stroke

Ongoing long-term care will depend on the severity of the stroke and availability of family members to help. Finances can also play a part. Stroke disabilities can vary, and two people with the same stroke type may have different outcomes.

Because a stroke impacts the brain, complications can be minor or significant. Your loved one may have several of these signs, or just one or two.

Paralysis

Paralysis is weakness or loss of voluntary movement that usually affects one side of the body. A loss of function on one side can profoundly affect day-to-day abilities such as bathing, driving, cooking, dressing, and transferring. Another consequence of stroke can be problems with balance, posture, and walking.

Problems swallowing (dysphagia)

Problems swallowing can be mild to being unable to swallow at all. The risks of dysphasia include choking and pneumonia. In extreme cases, a feeding tube might be necessary.

Sensory problems

Sensory problems include numbness, loss of bowel and bladder control, and losing the ability to feel pain or temperature.

Problems understanding or using language (aphasia)

At least a fourth of all stroke victims end up with language impairment. Different kinds of aphasia can include the inability to speak or write words, problems understanding written or spoken language, or losing all ability to understand or use language.

Problems with thinking and memory

A stroke can affect the part of the brain responsible for awareness, memory, and learning. In regards to day-to-day activities, impairment in this area can include things like:

  • Being unable to recognize one’s disabilities
  • Losing the ability to respond to stimuli on the stroke-affected side of the body
  • difficulty planning or sequencing steps needed to manage everyday activities 

Many stroke patients have emotional problems like depression, frustration, anger, grief, fear, and anxiety. It is important to treat emotional issues like physical ones, as a patient recovering from a stroke may not know what to do with the loss of control of their body. Although these symptoms can linger, psychotherapy and medications can help.

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Common Long-Term Care Options for Stroke Patients

As you consider your options for a loved one who has a stroke, consult with healthcare providers and rehabilitation personnel to get their opinions on what setting would be best. You may have to be flexible and try one or more before making a long-term decision.

Most stroke patients qualify for inpatient rehabilitation before being discharged to one of the senior housing options below. The purpose of this type of short-term care is to maximize your loved one’s function and determine what kind of care they need moving forward. It is possible that continued rehabilitation would be very beneficial, but insurance tends not to cover it.

It is not unusual for healthcare providers to indicate that 24-hour monitoring and supervision are necessary. Their job is to ensure that your loved one has the support and care needed to stay safe. But 24-hour care is expensive and may not be realistic. 

1. Home

Rehabilitation for stroke will be time-limited based on insurance requirements and the progress your loved one makes. You might not have much time to decide, but if you choose to stay home, you will need to prepare.

The first step is to get an order for home health, which will also be time-limited but will provide a cushion of time and support while you assess the situation. An occupational therapist can make recommendations on home modifications.

Home modifications could be minimal or extensive, depending upon what your loved one requires. For someone with paralysis, a multi-step home could require a glide chair, and a step-in tub can be converted to a walk-in. 

You may need to consider private in-home care to help with tasks like bathing, dressing, food preparation, and transportation. The days and hours will depend on how much time you or other family members can help. If you are the spouse or partner of someone who has had a stroke, consider what you can realistically do.

Of course, you will want to help, but caregiving is a time-consuming and stressful endeavor. Look to state and federal resources to help you craft a plan that works for everyone. 

2. Board and care homes

Board and care homes can be a long-term care option for a stroke patient with minor disabilities.  A board and care home is a residential group home for older adults and people with similar medical conditions. A board and care home’s advantages are the cost and the relatively small size.

Some of the amenities offered in assisted living may not be available in a board and care home, but individual attention can make up for those omissions. Ensure that the community under consideration is licensed, and do a thorough investigation of the safety protocols and accessibility features.

You may need to add home care services, especially in the beginning, to make sure your loved one is safe.

3. Assisted living

Assisted living is a logical choice for patients who can’t return home because they have needs that exceed what others can provide. Assisted living can offer a layer of support for someone who has had a stroke by providing meals, housekeeping, aide service for help with daily living activities, and transportation.

In some cases, your loved one might have disabilities that are beyond what assisted living can safely handle.

Assisted living care can be augmented by home health or private home care when necessary. Keep in mind that assisted living is unlikely to accept someone who is bed-bound or requires significant assistance with getting in and out of bed.

Nursing care in assisted living is typically limited to checking vital signs and coordinating care and is not available 24-7. If your loved one needs ongoing and daily nursing, assisted living will not offer that. 

4. Nursing home

Few people want to go to a nursing home, but it is necessary for some situations. If your loved one has multiple disabilities related to their stroke, it might not be possible to care for them at home safely, especially if they need ongoing nursing care.

Nursing homes have 24-hour nursing care available along with the ability to manage swallowing issues, incontinence care,  wound care, respiratory issues, intravenous medications, and feeding tubes. Aides are also available whenever they are needed, day and night. 

The decision to choose nursing home placement isn’t easy. If your loved one does go to a nursing home, advocate for continued therapies to improve functioning and provide a purpose. In time you might be able to consider a move to a less restrictive environment like assisted living.

But, if nursing home care is the only option for the foreseeable future, provide all the support and comfort you can to make the experience a beneficial one.

Long-Term Care Options for Stroke Patients

Having a stroke can be a devastating and overwhelming experience. If you are a loved one trying to support a stroke patient, remember that you do have options. However, you will need to plan carefully. As you go through this journey, try to have patience and believe that your loved one will get better with support and compassion.


Sources:

  1. Abrahms, Sally. “Group Homes An Alternative to Seniors Who Can’t Age in Place.” AARP, 12 February 2020.  www.aarp.org/caregiving/basics/info-2020/group-homes.html 
  2. Clery, Amanda. “Long-Term Trends in Stroke Survivors Discharged to Care Homes.” Stroke, The American Heart Association, 6 November 2019, www.ahajournals.org/doi/10.1161/STROKEAHA.119.026618
  3. Delgado, Amanda. “Stroke Recovery: What to Expect. Healthline, 7 June 2018, www.healthline.com/health/stroke/recovery#outlook
  4. “Effects of Stroke” Health, John Hopkins Medicine. www.hopkinsmedicine.org/health/conditions-and-diseases/stroke/effects-of-stroke
  5. “Post Stroke Rehabilitation Fact Sheet.” National Institute of Neurological Disorders and Stroke, April 2020, www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Post-Stroke-Rehabilitation-Fact-Sheet
  6. “Types of Stroke.” Stroke, Centers for Disease Control and Prevention, 31 January 2020, www.cdc.gov/stroke/types_of_stroke.htm
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