Most stroke patients should go to inpatient rehab facilities, not nursing homes, heart/stroke association says

Stroke patients may benefit from the IRF's intense therapy focus more than they would from skilled nursing care, the recommendations say
Stroke patients may benefit from the IRF's intense therapy focus more than they would from skilled nursing care, the recommendations say

The majority of people recuperating from a stroke should be treated in an inpatient rehabilitation facility, rather than a nursing home, according to new recommendations from the American Heart Association/American Stroke Association.

The new recommendations, released Wednesday, urge stroke patients to receive treatment in an inpatient rehabilitation facility “whenever possible,” unless they have a condition that would require more skilled nursing care.

“If the hospital suggests sending your loved one to a skilled nursing facility after a stroke, advocate for the patient to go to an inpatient rehabilitation facility instead — unless there is a good reason not to — such as being medically unable to participate in rehab,” wrote Carolee J. Winstein, Ph.D., P.T., lead author of the guidelines.

Winstein's team found “considerable evidence” that stroke patients benefit from a rehab-focused facility's minimum three hours of daily therapy and “team approach” in the early period after a stroke.

“For a person to fulfill their full potential after stroke, there needs to be a coordinated effort and ongoing communication between a team of professionals as well as the patient, family and caregivers,” Winstein said.

The guidelines, published in Stroke, also encourage stroke patients and their caregivers to insist upon participation in a “structured” education program on preventing falls. That program may include ways to make their homes safer, decreasing the risk of falls linked to medication side effects, and how to safely use wheelchairs, walkers and canes.

For stroke patients, the association recommends “intense” mobility task training to relearn tasks such as climbing stairs, individually tailored exercise programs, speech therapy, balance training, and eye exercises. Rehab providers should also provide an “enriched environment” with computers, books, music and virtual reality games to increase patient engagement.

While the new guidelines are the eighth set to be released by the American Stroke Association, they are the first recommendation developed to specifically focus on rehabilitation, the researchers noted.