bedside supporter holding patient's hand

You or a loved one has survived a stroke. Now what? Of the more than 700,000 people in the United States who suffer a stroke each year, about two-thirds will require rehabilitation, according to the National Institute of Neurological Disorders and Stroke (NINDS). The goal of rehabilitation is to relearn basic skills such as walking, eating, bathing, and dressing, that may have been impaired by the stroke. Proper rehabilitation can allow stroke victims the best chance at regaining independence and achieving a higher quality of life.

Whether you're a stroke survivor or are a caregiver for someone who is recovering from a stroke, it's important to be aware of what to expect going forward. Those who have lived through a stroke may still have a variety of needs for rehabilitation in the aftermath of the event. These needs may include relearning how to walk or move independently, how to communicate effectively, and how to carry out daily activities. To be most effective, rehabilitative therapy may need to begin within 24 hours after a stroke. Depending on stroke severity, patients may need to continue to work with specialists to maintain and refine skills for months--or even years--after the event.

With needs this serious and potentially long-term, it is important for stroke survivors and their caregivers to know where to turn for support services. Post-stroke care generally involves ongoing work with a team of medical professionals, including physicians, nurses, therapists (physical, occupational, recreational, speech, and vocational), and mental health specialists.

In order for a stroke patient to continue receiving coordinated care from these professionals after discharge from the hospital, NINDS suggests several resources in the medical community for patients and their families to seek assistance. Hospital social workers can help you determine which of the following options may offer the best course of action for you or your loved one at the time of discharge.

Home-based Care
For stroke patients who require treatment from only one type of rehabilitation therapist rather than by a team of medical providers, undergoing treatment at home may be an option. Home rehabilitation generally involves following an intensive level of therapy several hours per week to promote independent movement and incorporating progressively more complex, step-based tasks. When considering this option, keep in mind that while home therapy allows greater flexibility for the patient's individual schedule, a disadvantage is the lack of specialized equipment offered in a medical facility.

In-patient Facilities
The needs of stroke patients may be too severe for family caregivers and their medical support team to handle at home. In this case, one option is for patients to stay at an in-patient facility in the weeks immediately following discharge from the hospital. Here, patients receive coordinated care and a comprehensive range of medical support services, which could include rehabilitation nursing, occupational therapy, physical therapy, speech therapy, and social work. These programs usually provide a minimum of three hours of active therapy a day, up to six days a week. A full-time physician is generally on duty, along with a range of therapists specializing in post-stroke rehabilitation.

Out-patient Facilities
Out-patient care usually entails traveling to a facility for rehabilitative therapy for several hours a day on certain days of the week. Out-patient services are generally the same as those offered at in-patient facilities, but may include additional specialized services, such as psychological counseling and secondary stroke prevention, designed to help rehabilitate patients to their maximum recovery.

Nursing Facilities
The rehabilitative services for stroke survivors available at skilled nursing facilities can differ widely between programs. Some provide more limited services and offer fewer hours of therapy than others. Because of this variability, it's important to do your research and get information about each facility.

For further assistance with long-term decision-making for stroke patients and caregivers, National Stroke Association (NSA) provides a number of free resources that you can download from its website. The Internet Stroke Center also provides a free guide on post-stroke issues for patients and their families.