Where Will You Live After a Stroke?


Who decides whether your loved one will go home or to a rehabilitation facility or to a nursing home after a stroke?


Most strokes are mild and thus the majority of stroke survivors can go back home after leaving the hospital. However, some strokes cause a significant level of disability, dramatically changing a stroke survivor’s life. When it comes to a large stroke that produces severe disability, the answer of where to live after a stroke is not always obvious for the majority of families.

Whether a stroke survivor should go home or to a skilled facility is a complex decision that requires careful consideration of a number of different factors in your loved one’s life.


Stroke Survivors Who Need High Level Medical Care


Medical recommendations about where a stroke survivor should live generally take into account whether a stroke survivor needs moderate to high-level medical intervention and round-the-clock skilled monitoring. Immediately after a large stroke, patients need 24 hour monitoring of neurological function, heart function, kidney function, urination, blood pressure, and blood glucose and body temperature. Most patients also need medications that can only be administered by a nurse by means of a needle or an intravenous injection.  It is customary that unstable patients stay in the hospital after a stroke, until the medical condition is stabilized.


Long-Term Plans


Living arrangements after the serious medical condition is stabilized can pose a tough decision for most families. Options include returning home, making different home living arrangements, rehabilitation units or step-down units, nursing homes or assisted living facilities.


Rehabilitation Units


In-patient rehabilitation units and step-down units are similar to a hospital setting, but do not generally provide care for serious medical problems such as severe infections.

These options are considered short-term transition plans for medically stable patients who still need intense help with physical therapy or learning how to swallow or to take care of themselves. Nurses and doctors staff them, but most of the daily activity involves therapy. Most of the time, health insurance plans cover at least a portion of the cost of a step-down unit or rehabilitation unit for a defined period of time. Once patients are discharged from a rehabilitation unit, they either go home, to a nursing home or to an assisted living apartment.


Nursing Home


A nursing home generally provides nursing care; help with medications, and some light health monitoring such as blood pressure checks and blood glucose monitoring. Some nursing homes have doctors on staff who round on patients at certain intervals. Usually, patients who stay in a nursing home still have to go to their doctor’s office whenever there is a need for more individualized, specialized care. The intensity of medical care may vary depending on the nursing home, and your loved one may need a nursing home that provides more or less medical care, depending on her health situation after her stroke.

The level of health care provided is generally clearly spelled out so that you can make a choice depending on your loved one’s needs.

Usually, nursing home residents can take part in on-site social activities and can receive visitors or go on outings or visits with family and friends. 


Assisted Living


You and your loved one, along with your family, may decide that assisted living is a better option. There are many variations of services offered by assisted living accommodations, but they generally provide less medical care and more independence than nursing homes.  Some assisted living apartments are nearby or adjoining a nursing home, and may offer differing degrees of care to different residents, as needed and as requested. You would do well to ask around and find out what other families think about the places that you are considering so that you can have peace of mind when making this decision.




The home setting may be suitable for some severely disabled stroke survivors who can arrange for frequent nursing visits in the home. Sometimes, accommodations have to be made to the home, or a stroke survivor has to move to a new home, or move in with a relative to avoid living alone. There are many considerations to keep in mind, as care for a severally disabled stroke patient requires a strong knowledge of potential health complications and an understanding of the necessary safeguards.


Financial Matters


Your loved one’s health insurance plan outlines the coverage for home nursing visits, nursing home coverage and assisted living. Many families obtain advice and guidance from knowledgeable social workers. The hospital is a good point of contact for linking you to a social worker with experience in arranging long-term stroke care. Often, staff at the nursing home, assisted living facility or visiting nurse provider can provide you with help in navigating a financial plan that includes obtaining payment from your loved one’s health insurance plan.

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