Should I put my loved one who has had a stroke in a nursing home?

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Introduction

This information will help you understand your health care choices and what the results may be, whether you share in the decision-making process or rely on your doctor's recommendation.

Key points in making your decision

The decision to put a loved one in a nursing home is difficult. Taking care of someone at home after the person has had a stroke requires significant social, financial, and personal sacrifices. Every family has different needs, preferences, and limitations.

Consider the following when making your decision:

• People who have had a stroke need a safe, healthy, structured environment. Some families are able to provide this at home; in other cases, nursing home placement is a better choice.
• Many of those cared for at home eventually have to be moved to a long-term care facility.
• Adult day care programs and part-time help, whether hired or offered by other family members and friends, are options for some caregivers.
• Your physical and emotional health are as important as that of the person you are caring for. If you are not physically able to care for someone or you have health problems that make caregiving difficult, you may need to consider nursing home placement for your loved one.
• Deciding to put your loved one in a nursing home does not mean that you have failed as a caregiver.

Medical Information

What happens after a stroke?

When brain cells are damaged or die, the body parts controlled by those cells lose their ability to function. The loss of function may be mild or severe, temporary or permanent. This depends on where and how much of the brain is damaged and how fast the blood supply can be returned to the affected cells.

Life-threatening complications may occur after a stroke. Stroke is the most common nervous system–related cause of physical disability. Of the people who survive a stroke, 15% to 30% will have a permanent disability, and 20% will need institutional care within 3 months of having a stroke.¹

Your ability to care for a loved one at home will depend on his or her level of disability, your health, and the amount of support you have from family members or outside help.

Disabilities from stroke can be related to:

• Movement. Your loved one may not be able to use his or her arms or to walk. This is usually because of weakness or paralysis on one side of the body (hemiparesis).
• Speech and language. Your loved one may not be able to speak, read, or write. Also, he or she may not be able to understand what someone else is saying.
• Thinking and reasoning. Your loved one may not be able to think clearly. The stroke may cause changes in behavior.
• Senses. Your loved one may not be able to feel when something or someone touches his or her affected body parts, such as the arms or legs. Sight or hearing (rare) may be affected.

Regaining some abilities, such as speech, comes slowly, if at all. Many people who have a stroke will have some long-term problems with talking, understanding, and decision-making. They also may have behavior problems that affect their relationships with family and friends.

Long-term complications of a stroke may develop right away or within months to years after a stroke. They include:

• Weight loss, if the person has difficulty swallowing and does not eat well.
• Seizures.
• Skin sores (pressure sores) or blood clots within deep veins if the person sits or lies in one position for a long period of time.
• Shoulder pain.
• A stiff joint that cannot be straightened (a contracture) if the person holds the affected arm or leg in the same position over time.
• Depression.
• Infection, especially pneumonia or a urinary tract infection.
• Tight muscles and muscle spasms in the affected arm or leg.

People who have had a stroke tend to be slow, cautious, and disorganized when they are doing unfamiliar activities. They appear anxious and hesitant, which is often quite different from the way they were before the stroke.

There may be problems with memory or behavior. The person may need help learning how to analyze behavior and respond appropriately to situations.

The level of care and assistance your loved one requires may increase if his or her condition gets worse. Basic activities like eating, dressing, bathing, using the bathroom, and simply moving around may become more difficult or impossible for the person to do alone. Taking care of your loved one at home often becomes more difficult or even impossible, both physically and emotionally.

What kinds of long-term care facilities are available?

“Nursing home” is commonly used when referring to any long-term care facility, but there are several kinds of long-term care facilities. Each provides different levels of medical care, personal assistance, and programs and support services. The quality and costs of care and services at long-term care facilities vary widely, and options vary from community to community.

• Assisted-living facilities usually provide private, apartment-style housing and offer a range of services. These services may include meals, cleaning and laundry services, and help with personal needs such as bathing, grooming, and dressing. However, assisted-living facilities do not provide medical care. An assisted-living facility may be appropriate for people who cannot live alone but can still function fairly well on their own.
• Residential care facilities, which include board-and-care homes, retirement homes, and foster care homes, typically provide a greater level of supervision than assisted-living facilities. They offer community-style housing, meals, laundry and cleaning services, and help with other personal needs. They do not provide daily medical care. A residential care facility may be appropriate for a person who needs daily assistance and supervision but does not require daily nursing care. Residential care facilities are less expensive than nursing homes.
• Nursing homes can provide skilled nursing care up to 24 hours per day. All aspects of care are provided, including medical attention, medicine, housing, meals, laundry, help with personal needs (such as dressing, bathing, and using the toilet), and other support services. A nursing home is the most expensive type of long-term care facility, but it also may be the most appropriate choice for someone with extensive disabilities.
• Continuing-care communities offer different levels of care, from assisted living to full nursing care, within the same facility. These facilities are an expensive but appealing option for caregivers who are looking at long-term care because these facilities are well-equipped to meet the person's changing needs.

What are the options for part-time care?

Some people find that part-time help allows them to keep their loved one at home for a longer time. Part-time care may take place either at home or in an adult day care facility. As in long-term care facilities, home care can provide different levels of assistance. A home health aide, for instance, can help with tasks like bathing, cleaning, and washing clothes and linens, while a nurse may provide medical care and help with behavior issues. Adult day care and respite services assume temporary responsibility for the person and allow the regular caregiver to take a break. This may relieve some of the stress of caregiving and allow time for other responsibilities and activities.

Hiring health professionals or other caregivers to provide around-the-clock care in the home is another option. This option is very expensive—more than a nursing home—and also requires time to hire, supervise, and coordinate the team of caregivers.

Your Information

Your choices are to:

• Care for your loved one at home. Some caregivers may also consider part-time care at home with a home health aide or nurse or time in an adult day care facility.
• Put your loved one in a nursing home or other long-term care facility.

The decision about nursing home placement should take into account your personal feelings and the medical facts.

These personal stories may be helpful in making your decision.

Wise Health Decision

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about putting your loved one in a nursing home. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to put your loved one in a nursing home or to keep him or her at home.

Check the box below that represents your overall impression about your decision.

Return to the topic:

• Stroke
• Stroke Rehabilitation

References

Citations

1. American Heart Association (2007). Heart disease and stroke statistics—2007 update. Circulation, 115(5): e69–e171. Also available online: http://www.americanheart.org/presenter.jhtml?identifier=1928.

Credits

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Last updated:	July 06, 2007
Author:	Monica Rhodes
Reviewed By:	Anne C. Poinier, MD - Internal Medicine, Richard D. Zorowitz, MD - Physical Medicine and Rehabilitation
Editors:	Kathleen M. Ariss, MS, Michele Cronen