After a stroke
Coming home after a stroke
Rehab does its job and then it ends. What happens the following Monday is usually left to the family to work out. Here is how that part actually goes.
A stroke does not respect age. We work with people in their forties and fifties as often as people in their eighties, and the younger the person is, the more likely it is that nobody has explained their options to them — because everyone assumes home care is a thing for the elderly.
What help usually looks like in the first months
Every stroke is different, so this is a shape rather than a list. Most of the families we work with need some combination of:
- Getting up, washed and dressed. Often the hardest part of the day, and the one where falls happen.
- Safe transfers. Bed to chair, chair to bathroom. This is technique, not strength — and it is where an untrained helper gets hurt.
- Meals. Including preparing food to whatever texture a speech therapist has specified, if swallowing was affected.
- Medication reminders. Blood pressure and anticoagulant schedules after a stroke are unforgiving.
- Getting to outpatient therapy. Missed appointments are one of the main reasons recovery stalls.
- Company. Aphasia and sudden isolation are a heavy combination, and the low mood that follows a stroke is very common and very underestimated.
We are home care, not home health. Nursing, physical therapy and speech therapy come from a home health agency, usually ordered by the doctor and covered by Medicare for a limited period. We do the daily, ongoing, hands-on part — which Medicare does not cover. Most families end up needing both, and they work alongside each other.
The window that matters
The first weeks after discharge are when readmissions happen — a fall, a missed medication, dehydration, an infection nobody caught early. It is also when families are most exhausted and least able to organise anything.
If a discharge date is already set, call before it arrives rather than after. Arranging care in advance is straightforward; arranging it during a crisis at 8pm on a Friday is not.
Who pays for it — and the part people miss
If the person who had the stroke is between 18 and 59, there are two Pennsylvania programs that most families are never told about:
- Act 150 — a state-funded program for people with a physical disability whose income is too high to qualify for Medicaid. There is a weekly fee on a sliding scale, capped at the cost of the services. More on Act 150.
- The OBRA waiver — a Medicaid waiver for adults with a severe physical disability requiring an intermediate care level of support. More on the OBRA waiver.
For someone 60 or over, the routes are different: Community HealthChoices, VA benefits, long-term care insurance, or private pay. Our guide to paying for home care lays all of them out side by side.
Ask the hospital one specific question. Not “what are our options” — ask the case manager: “has anyone screened them for Act 150 or the OBRA waiver?” Those two do not always come up on their own, particularly for a working-age patient.
If a family member is going to do the caring anyway
Very often a spouse cuts their hours, or a daughter moves back in. Under Act 150 and the OBRA waiver, we may be able to hire that family member and pay them for the care they are already providing — not a spouse, legal guardian or power of attorney, but an adult child, parent, sibling, niece, nephew, friend or neighbour.
How getting paid to care for a family member works →
How we work
One caregiver assigned to one family, not a rotation — which matters more after a stroke than almost anywhere else, because communication may be difficult and a familiar person is far easier to work with than a new one every week. We staff cases of twenty hours a week and up. Our caregivers speak English, Spanish, Russian, Ukrainian and Farsi.
We serve Lehigh, Northampton and Monroe counties — Allentown, Bethlehem, Easton, Whitehall, Emmaus, Stroudsburg, East Stroudsburg, Mount Pocono and the surrounding towns.
Call 610-466-5715. Even if you are only at the stage of thinking out loud, that is a fine reason to call.