About half of all people who survive a stroke are dependent on others for activities of daily living (ADL). A large proportion will be able to return to their own homes, sometimes with a care package set up via social services. Most people will not be fully recovered when they are discharged and may need ongoing community rehabilitation and support.
Before discharge from hospital, an assessment is made of the patients disability and likelihood of improvement, need for aids and adaptations, current housing and levels of support available at home. An access visit (a preliminary visit to the patients home by the occupational therapist)and home visit (a visit home with the patient to establish their function at home and to assess practical problems) are often needed.
Home leave or weekend leave where the patient goes home to live with their carer on a trial basis for a few hours to a few days is sometimes useful before a formal discharge from hospital. Some stroke units (including the one at Gloucester) have a rehabilitation flat with its own kitchen and toilet where a patient may spend some time before discharge to assess how they will function independently.
Based on all the pre discharge assessments, it may be decided that the patient will be able to return home without any adaptations or that adaptations, either minor or major are needed. Some patients may have to be re-housed if their current accommodation is unsuitable for their care needs.
Support services to help the person who has had a stroke manage at home are usually arranged through the local authority social services department. The person will usually have seen a social worker in hospital. Once the needs have been assessed, the social worker provide information about what services are available, and whether they will have to be paid for. Services may include:
- general advice and help applying for financial support
- providing aids, equipment and home adaptations
- a place at a day centre – including transport to and from home, hot meals, information and advice activities, and social events
- a home help or care assistant
- home services, such as meals on wheels and a laundry service
- respite care (a short stay in a nursing home or hospital to give carers a break)
It may be realised that caring for someone at home is not the best solution. Some of the options available under these circumstances are:
- Sheltered Housing - which is independent accommodation that has a resident warden on hand for emergencies
- A Residential Home - which provides basic personal care
- A Nursing Home - which has fully qualified nursing staff to provide 24-hour nursing care.