Home is where the rehab is

Story by Greg Kennedy

EDMONTON — Ruth McIntyre never thought she’d have a stroke, let alone experience one in her 40s, along with its debilitating effects that upended her family life and career.

What has inspired her, however, is the safety net and in-home therapy provided her by Alberta Health Services (AHS) that made it possible for her to go home and work on getting better after only four days in hospital.

When McIntyre had her stroke in February, it affected her speech and memory, and left her with weakness on her left side as well as balance issues. The 49-year-old development manager also experienced extreme fatigue, leaving her too weak to travel to outpatient therapy.

“Having rehabilitation therapy at home is a godsend. I’m unable to drive; getting around is a challenge,” she says.

Like McIntyre, survivors of mild to moderate strokes can now leave hospital sooner and return to the comforts of home thanks to the Stroke Early Supported Discharge Program.

Now in its second year, the program brings into the home a team of therapists with all the tools needed to work towards restoring the abilities, confidence and independence of stroke survivors who experience significant disability that challenges independent living.

“They did an assessment,” says McIntyre, “and then I had physiotherapy, occupational therapy, speech therapy … and a social worker helped me navigate the system and fill out forms and insurance claims. They do so much, it’s amazing. They helped me figure out what I needed to work on — and then we got to work.”

“The fact that this is a multidisciplinary team — physiotherapy, occupational therapy, speech therapy and social work — makes it extremely valuable for our clients,” says Kris Gray, manager of the program team.

“We’re well-rounded in all the rehab disciplines. We work closely together to ensure a positive result. Any part of their independence that we can help them reclaim is a victory for both the clients and the team.”

Over the past year, the program helped more than 200 stroke patients head home, on average, after two weeks in hospital, compared to a typical stay of four weeks or more. This frees up acute care beds for patients who require more serious care.

At any given time, the program oversees the rehabilitation of 16 to 20 clients. This also helps to free up capacity in stroke outpatient programs.

“We don’t have a wait list,” says program team leader Jodi Roberts. “That would defeat the purpose of what we’re all about. Many people, when they’re discharged from hospital and on their own, are not able to get back to the way they were living before their stroke. It’s hugely important for them to be able to do the things they value on their own, whenever they want to, whether it’s brushing their teeth or cooking their own meals.

“We work on getting them back into the activities they enjoyed doing before, back into a normal life,” adds Roberts. “When they find out that we’re going to be there to provide rehab as soon as they get home from hospital, they’re relieved. They feel much better.”

Many of these patients may also face barriers that prevent them from attending outpatient rehabilitation, such as mobility issues or a loss of endurance or stamina.

Referrals to the Stroke Early Supported Discharge Program come from four Edmonton hospitals that have a stroke program: Royal Alexandra, University of Alberta, Grey Nuns and the Glenrose Rehabilitation Hospital. At present, the program is only available to residents who live in the city of Edmonton.

“I have had a number of patients express to me how impressed they are with the program,” says stroke specialist Dr. Tom Jeerakathil. “Rather than feeling they are ‘stepping into a void’ after discharge, they find themselves closely supported. The team helps them figure out how to return to home life while also providing intensive rehabilitation services so they can improve on a number of neurological problems.”

Colleen Taralson, acting manager of the stroke program in the Edmonton area, says the program frees up acute care beds which, in turn, relieves pressure in local emergency departments.

“So often as nurses, we would look at mild to moderate stroke patients and say, ‘This patient does not need to be here’ — but where else do you send them to allow them the time to recover enough to function at home?” Taralson says.

“This program closes that gap. It’s a pathway that not only helps with patient flow, but allows people to be in the best possible place for their recovery.”

The Stroke Early Supported Discharge Program was first piloted in 2009 with funding from the Alberta Provincial Stroke Strategy, now part of the Cardiovascular Health and Stroke Strategic Clinical Network (SCN). Strategic clinical networks are provincewide teams that bring together the experiences and expertise of health care professionals, researchers, government, communities and patients and their families to improve our health care system.