Once a discharge date is set, the staff will be working to organise a safe discharge out of hospital. This may include all or some of the following:
The home environment will often be reviewed prior to discharge and any equipment needs based on current functional ability of the person will be provided. This may involve an occupational therapist visiting the home to look at space, current set up and new requirements and then ordering the equipment. The equipment will depend on the level of progression post stroke. For example, if you require assistance with transfers standing aids or hoists may be placed in situ to ensure you are able to safely transfer from bed to chair at home. Changes to your home set up may be needed however these may be temporary, for example, the bed may be required to be placed downstairs until you can safely manage the stairs. (home set- up information page)
When organising care for home, this may involve a discussion with both social workers and occupational therapists prior to discharge to establish what level of support will be needed to return home safely and to meet all of the person’s needs. This can vary from once a day package of care to four times a day double handed package of care, which means two carers attending at one time. The care provided may be for a short period of time or set up for the long term depending on the persons needs.
When organising for ongoing rehabilitation at home, this will usually be completed by the community follow up team. How that is provided and for how long etc unfortunately varies depending on where you live. Some areas have Specialist Stroke Nurses who visit and some areas have Integrated Therapy and Social Services teams.
It may be that the persons needs are high and that going back home would not be safe or provide sufficient care. In these circumstances a residential or nursing home may be considered. This would involved meetings with the person who has had the stroke, next of kin, social workers and hospital health professionals to discuss together the best options.
Who provides support at home?
There are different services both voluntary and NHS in different areas, although the NHS is trying to standardise that by having Stroke pathways and specialist centres.
The Stroke Association is a brilliant source of information and support. They have a phone line, great website with downloadable information and most importantly local support groups. They fund ground breaking research.
Nobody really wants to go to a support group initially. But the information that is shared can be invaluable – as well as the understanding of people who have gone through or are going through similar things.
In some areas there are specialist rehab workers sponsored by the Stroke Association which may result in getting rehab quicker if your local health team has a waiting list.
www.stroke.org.uk or 03303 3033 100.
- These days there is a lot of online support if you search local stroke support
- www.differentstrokes.co.uk – support groups and information.
- Aphasia Care partners and friends can be found on facebook.
There are also apps for therapy such as Tactus, Lingraphia, Talk path, Speech sounds on cue, Lumosity (for cognition)
And for ideas on how to help with repetitive therapy exercises, Pintrest often has a lot of suggestions of things that can be adapted to help with hand therapy and speech therapy. Guidance however, should ideally be sought by a therapist. An app called Dexteria: Fine motor skill development might be appropriate (ask your therapist).
NHS versus private services - can we supplement what we’re getting?
An NHS physiotherapist or occupational therapist will not see a person who is already being seen by a private physiotherapist at the same time. Private services will vary in availability depending on area – it is important to check the registration of private therapists through the council at HCPC www.hpc-uk.org/check
Remember that there are different phases – acute phase, stabilisation, high dependent rehab, person active controller of own rehab, progression, slower progression, plateau, maintenance and ongoing support which can be needed for years. Even though the NHS does not provide rehab for that long there are new developments all the time, it is worth getting in touch with the Stroke Association to find out more.