Dad had a stroke, and home looks different now

What changes at home after a stroke?

What changes depends on which part of the brain was affected, so no two homecomings look alike. Common changes include weakness or numbness on one side, balance problems, trouble speaking or finding words, difficulty swallowing, vision changes, fatigue and shifts in mood. The National Institute of Neurological Disorders and Stroke notes that rehabilitation usually begins in the hospital within 48 hours and that relearning basic daily activities is the first stage of returning to independence.

Many people come home in steps: the hospital, then an inpatient rehabilitation hospital such as Penn State Health Rehabilitation Hospital in Hummelstown or a skilled nursing facility, then outpatient or home-based therapy. Each step means a new discharge date and a new question about who will be at the house. Our pages on coming home from rehab and coming home from the hospital cover those handoffs.

How a caregiver helps day to day

• Transfers and walking. Getting out of bed, onto the toilet, into the shower and into the car, using the exact technique and equipment (gait belt, walker, transfer bench) the physical therapist set up. Caregivers are trained in safe transfers as part of Pennsylvania's home care competency requirements.
• Bathing and dressing. Following the dressing order the occupational therapist taught, letting your father do every step he can and helping with the rest. See personal care.
• Meals. If a speech-language pathologist ordered soft foods or thickened liquids, we follow that order as written and do not change it on our own. Food is cut small, your father sits upright, and meals go slowly. See Meal Preparation.
• Communication. Giving him time to find words, asking simple questions, and using any picture board or app the speech therapist provided.
• Exercises. Reminding and encouraging the home exercise program between visits, and writing down what got done. The therapy itself comes from the therapists.
• Mood and energy. Stroke recovery is tiring and discouraging. A caregiver notices withdrawal, tearfulness or a loss of interest and tells the family so the doctor hears about it.

How do we work with the rehab team?

Physical, occupational and speech therapy after a stroke come from the rehab team, either at an outpatient clinic or through a home health agency when a doctor orders it. Home health visits are scheduled and intermittent; the hours in between are where most of daily life happens. We fill those hours with non-medical help and keep a daily note the family can share with the therapists and the neurologist. A caregiver can also accompany your father to outpatient therapy and doctor visits. Our guide to home care versus home health care explains the difference.

What are the warning signs of another stroke?

Every family of a stroke survivor should know the signs. The CDC teaches B.E. F.A.S.T.: Balance loss, Eye changes, Face drooping, Arm weakness, Speech that is slurred or strange, and Time to call 911. The CDC also advises noting the time symptoms began and not driving the person to the hospital yourself. Our caregivers call 911 first, then you.

What does a typical starting plan look like?

• The first two weeks home: mornings for bathing and dressing, evenings for dinner and bedtime, and often overnight care while night-time bathroom trips are unsteady.
• As strength returns: fewer hours, focused on showers, meals and therapy days.
• For a spouse caregiver: a regular block of respite each week.

Where this happens in our 16 counties

Families bring a parent home from Penn State Health Milton S. Hershey Medical Center, WellSpan York Hospital, Reading Hospital and Lehigh Valley Hospital–Cedar Crest, often with a stay at a rehabilitation hospital in between. Homes in Perry and Juniata counties can be a long drive from outpatient therapy, which is when a caregiver who comes along to appointments matters most. In rural areas, longer or recurring shifts are easier to staff than short visits, and we will tell you plainly what we can cover. Your county Area Agency on Aging, such as the Perry County Area Agency on Aging at (717) 582-5128, can explain OPTIONS for residents 60 and older. To plan the first weeks, request a consultation.