Stroke Patient Care at Home

First, what home care is not

A stroke itself cannot be treated at home. If someone shows new face drooping, arm or leg weakness, slurred speech, sudden vision loss, a sudden severe headache or sudden imbalance, call 112 or 108 for an ambulance straight away. The steps are on our page about what to do when someone is having a stroke.

This guide is about the weeks and months after the hospital, when the person is medically stable and the family takes over the daily care of a CVA patient. It sits alongside the bigger picture in our guide to stroke recovery.

Getting the room ready

If possible, set up the person's bedroom on the ground floor or at least on the same floor as a usable bathroom. Then think about the bed. A bed pushed against a wall has only one side to get out of, so make sure that side lets the person get up toward their stronger side, at least in the early weeks. It sounds backwards, but family members should still sit, talk and place the television on the weaker side, because that draws the person's attention and head toward it.

A bedside table within reach of the good hand holds water, glasses, the phone and a bell. A commode next to the bed saves a risky night-time walk. A night light along the route to the bathroom matters more than most expensive equipment. Take up loose rugs, tape down wires, and move the furniture people tend to grab for balance if it would tip.

If the person spends long hours in bed, how they lie matters for comfort, the shoulder and the skin. Our separate guide on bed positioning after a stroke shows the positions in detail.

A daily routine that actually holds

Routine helps a recovering brain. It saves energy, reduces confusion and makes it easier for the family to share the work. A typical day might look like this: wake, toilet, wash and dress at the same time each morning; breakfast sitting in a chair, not in bed; a short exercise block; rest; lunch; a longer rest; a second practice session or a walk in the corridor; time with family in the main room; dinner; a simple wind-down before sleep.

Keep rest periods, because post-stroke fatigue is real. But rest in a chair rather than lying flat when possible. Every hour spent upright helps breathing, digestion, blood pressure control and alertness.

Skin care and pressure sores

A person who cannot shift their own weight is at risk of pressure sores, especially over the tailbone, hips, heels, shoulder blades and the back of the head. Sores can form within hours if someone lies in one position on a hard surface, and once open they heal slowly.

• Change position regularly, roughly every two hours in bed or as the nurse advises, and use pillows to keep bony points apart.
• Check the skin daily at the pressure points. Redness that does not fade within a short while after the pressure is removed is an early warning.
• Keep skin clean and dry. Damp skin from sweat or incontinence breaks down faster.
• Float the heels on a pillow under the calves rather than letting them rest on the mattress.
• Ask about a pressure-relieving mattress if the person is in bed most of the day.

Our page on bedridden patient care at home goes further for people who are largely confined to bed.

Moving them safely: bed, chair and toilet

Most falls at home happen during transfers, not walking. The basic rules: get the person to sit at the edge of the bed first and pause, because blood pressure can drop on sitting up. Make sure both feet are flat on the floor and the chair or commode is close, angled toward the stronger side. Help from the hips and trunk, never by pulling the weak arm. Count together so you move at the same moment.

A physiotherapist can teach the exact method for your person and your furniture, and transfer training exercises show the stages. If you are lifting most of the person's weight, stop and ask for help. Neither of you benefits from a back injury in the carer.

Toileting and bladder care

Bladder and bowel problems are common after stroke and are often a bigger source of embarrassment than weakness. Some people cannot feel the urge in time; others cannot get to the toilet quickly enough. A regular toileting schedule (for example on waking, after each meal and before bed) prevents many accidents. Make the route easy and the clothes easy, with elastic waistbands rather than buttons or a belt.

Constipation is very common because of reduced movement, lower fluid intake and some medicines. It also tends to increase muscle stiffness. Talk to the doctor if it persists. Burning when passing urine, cloudy or smelly urine, or fever should also go to the doctor, because urinary infections can cause sudden confusion in older stroke survivors.

Eating and drinking safely

Swallowing can be affected by a stroke even when speech seems fine. Before you start regular meals at home, check what the hospital advised about food consistency and thickened fluids, and follow it.

At meals, sit the person fully upright in a chair, not propped in bed. Small mouthfuls, slow pace, no talking with food in the mouth. Food can pocket in the cheek on the weak side, so check the mouth after meals. Keep them upright for about half an hour after eating. Coughing or a wet, gurgly voice during or after meals, or repeated chest infections, mean swallowing needs reassessment; the reasons are explained in our guide on swallowing and chest infections after stroke.

Medicines, blood pressure and appointments

Many stroke survivors go home on several medicines whose job is to prevent a second stroke. Missed doses matter. A weekly pill organiser filled by one responsible person, plus a phone alarm, prevents most errors. Never stop, skip or change a medicine because the person "feels fine"; any question goes to the prescribing doctor.

If the doctor has asked for blood pressure or sugar readings, keep them in a notebook with the date and time and take it to every appointment. Keep the discharge summary, scan reports and the medicine list together in one folder, so anyone who visits (doctor, nurse or physiotherapist) can see the history quickly.

When to bring in professional help

Families do remarkable work, but some things go better with training or an extra pair of hands. A physiotherapist teaches safe handling and builds the exercise routine; our home stroke physiotherapy visits cover Indirapuram, Ghaziabad, Raj Nagar Extension and Noida. A trained nurse can manage catheters, feeding tubes, wound care and injections; PhysioSolution arranges nursing support for stroke patients at home.

Equipment such as a commode, walker or shower chair is covered in our guide to recovery equipment after stroke. And whoever is doing most of the caring needs looking after too. Our guide for stroke caregivers is written for them. For a list of complications to keep an eye on, from shoulder pain to blood clots, see common problems after a stroke.

Frequently asked questions