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Caring for someone recovering from a stroke at home

A practical guide to stroke recovery at home for Atlanta families. What changes after a stroke, setting up the house, therapy homework and BE FAST signs.

By the Tale Circle Care team · · 9 min read

Bringing someone home after a stroke is a relief and a worry at the same time. Much of the daily work of recovery now happens in the living room, the bathroom and the kitchen. This guide covers what tends to change after a stroke, how to set up the first weeks at home and what family can do to lower the chance of another one.

What changes after a stroke?

Every stroke is different. The CDC lists lasting effects that can include paralysis or weakness, problems with thinking and memory, trouble speaking, emotional changes, numbness, pain, swallowing problems and depression. Some people recover fully. Others live with long-term changes, and recovery can take weeks, months or years.

Weakness and balance

Weakness on one side of the body is one of the most common changes. It affects walking, getting up from a chair, dressing and bathing. The National Heart, Lung, and Blood Institute notes that muscle weakness or paralysis after a stroke raises the risk of falling, and the CDC reports that stroke reduces mobility in more than half of stroke survivors age 65 and older.

Speech and language (aphasia)

Aphasia is a language disorder caused by damage to the parts of the brain that handle language. According to the National Institute on Deafness and Other Communication Disorders, about one third of stroke survivors have aphasia. It can affect speaking, understanding, reading and writing.

Fatigue

Tiredness after a stroke can be heavy and out of proportion to what the person did that day. A shower and getting dressed may be enough activity for a whole morning. Plan the day around energy, with harder tasks early and rest built in.

Depression and mood changes

MedlinePlus describes depression after a stroke as common. It can start soon after the stroke, or symptoms may not appear for up to two years. Cleveland Clinic notes that depression and anxiety are extremely common after a stroke. Watch for lasting sadness, loss of interest, sleeping much more or less than usual and refusing therapy exercises. These are worth raising with their doctor, since depression is treatable and can slow recovery if it's ignored.

Swallowing

Some survivors have trouble swallowing and may cough or choke while eating. If a speech therapist has recommended a modified diet (softer foods, thickened liquids), follow it at every meal and snack.

What should you expect in the first weeks home?

MedlinePlus notes that problems with movement, thinking and speech often improve in the first weeks or months after a stroke, and that some people keep improving months or years later.

  • Keep the discharge papers in one place. Note follow-up appointments, therapy schedules and the full medication list.
  • Go to every therapy and follow-up appointment. Most rehab can happen at home or in an outpatient clinic, with physical, occupational and speech therapists.
  • Don't stop or change medicines on your own. MedlinePlus is direct about this: stroke survivors are often prescribed medicines to prevent another stroke, such as antiplatelets, blood thinners, blood pressure medicine and cholesterol medicine. Don't add supplements without asking their doctor.
  • Watch the skin. People who sit or lie in one position for long stretches can develop pressure sores. Tell the care team about any red or broken skin.

Many metro Atlanta families come home from Piedmont, Emory, Northside or Wellstar with a stack of instructions. Ask the discharge planner before you leave which follow-ups are already booked and who to call with questions in the first week.

How should you set up the house?

A stroke often changes how someone moves through their own home. MedlinePlus recommends removing fall hazards like throw rugs, making sure the bed and bathroom are easy to get to, and adding devices that make cooking, bathing and moving around safer.

  • Set up a bedroom on the main floor if stairs are hard.
  • Clear walkways of cords, clutter and loose rugs.
  • Add grab bars by the toilet and in the shower, and use a shower chair.
  • Put a nightlight between the bed and the bathroom.
  • Keep everyday items (phone, glasses, water, remote) on the stronger side, within reach.

Falls are one of the biggest risks in the first months. Our guide to preventing falls at home covers room-by-room changes in more detail.

How can you help with therapy exercises at home?

Therapists usually send people home with exercises to practice between sessions. This "homework" matters, and family can help by keeping it on the schedule.

  • Ask to sit in on a session. Cleveland Clinic encourages family and caregivers to take part in therapy so new skills carry over at home. Watch how the therapist cues each movement.
  • Get the exercises in writing. Ask for a printed sheet or photos, plus how many repetitions and how often.
  • Stick to what was assigned. Don't add exercises or push harder than the therapist advised. If something hurts or seems unsafe, stop and ask.
  • Encourage the weaker side. If the therapist wants the affected arm used during daily tasks, gently remind them to use it for things like holding a cup.

Talking with someone who has aphasia

NIDCD suggests these habits for family:

  • Use short, simple sentences, and keep the tone adult.
  • Turn off the TV or radio during conversations.
  • Write down key words or point to things.
  • Give them time to answer without finishing their sentences.
  • Don't correct every error. Accept gestures, pointing and drawing as communication.
  • Include them in family conversations and decisions.

How do you prevent a second stroke?

The CDC reports that about 185,000 of the more than 795,000 strokes in the US each year, nearly 1 in 4, are in people who have had a stroke before. It also notes that 1 in 4 stroke survivors has another stroke within five years. A prior stroke or TIA (mini-stroke) is itself a risk factor.

The good news is that many of the risk factors can be managed. The CDC lists these:

  • High blood pressure, a leading cause of stroke. It usually has no symptoms, so regular checks matter.
  • Heart disease, including atrial fibrillation (irregular heartbeat), which can cause clots.
  • Diabetes. Our article on diabetes care for seniors at home covers daily routines.
  • High cholesterol.
  • Smoking and secondhand smoke.
  • Too much alcohol, too little physical activity and a diet high in salt and saturated fat.

What helps at home is mostly consistency. Take prescribed medicines every day as directed, keep doctor visits, follow the eating plan the care team gave you and stay as active as the therapists allow. Georgia has a particular reason to take this seriously. The Georgia Department of Public Health notes the state sits in the "stroke belt," a region of the Southeast with stroke death rates about 30 percent higher than the rest of the country.

Heart conditions and stroke often travel together. If your parent also has heart failure, see our guide to heart failure care at home.

What are the warning signs of another stroke?

Use BE FAST, from the CDC:

  • B, Balance. Sudden loss of balance or dizziness.
  • E, Eyes. Sudden trouble seeing.
  • F, Face. One side of the face droops when they smile.
  • A, Arms. One arm drifts down when both are raised.
  • S, Speech. Slurred or strange speech, or trouble understanding.
  • T, Time. Call 911 right away.

Other sudden signs include numbness or weakness on one side, confusion and a severe headache with no known cause. Call 911 instead of driving. The CDC notes that people who arrive by ambulance can be diagnosed and treated faster, and some treatments only work within hours of the first symptoms. Write down the time symptoms started.

Call their doctor (not 911) for a fall without injury, new skin sores, worsening pain, signs of a urinary infection like fever or burning, trouble eating or swallowing and a mood that keeps getting lower.

How do family caregivers take care of themselves?

Stroke recovery is long, and caregivers wear out. Cleveland Clinic describes caregiver burnout as physical, emotional and mental exhaustion, and suggests building a support network (friends, family, support groups or a mental health professional), accepting that you'll need help and setting aside time for your own health. Regular, balanced meals are part of the plan for you, too.

In metro Atlanta, Empowerline, run by the Atlanta Regional Commission, is a free starting point for caregiver support and local services for older adults. You can reach them at (404) 463-3333. If you're not sure whether your parent needs more help than family can give, our list of signs a parent needs help at home may help you think it through.

How in-home care helps after a stroke

An in-home caregiver can take on the daily work that fills a family's day after a stroke. At Tale Circle Care, caregivers help with bathing, dressing and toileting, walking around the home and routine transfers as the care plan allows. They make meals that follow the diet instructions the care team gave you. They give medication reminders on the existing schedule (they don't give medication), drive or go along to therapy and follow-up appointments, and keep walkways clear. They also watch for changes like new confusion, weakness or a drop in mood and report them to family right away. When care calls for a nurse, a licensed one can be arranged.

We serve families across metro Atlanta, including Marietta and East Cobb, Roswell, Sandy Springs and Peachtree City. To understand what this costs, see our guide to the cost of in-home care in Atlanta, or call Taly at (346) 278-3018 to talk through what your family needs.

Common questions

How long does stroke recovery take?

It varies a lot. The CDC says recovery can take weeks, months or even years. Many people see the most change in the first weeks and months, but some keep improving for years.

Can stroke rehab be done at home?

Yes. Most physical, occupational and speech therapy can happen at home or in an outpatient clinic. Ask the discharge team what's been ordered and who will schedule it.

What's the difference between home care and home health after a stroke?

Home health is skilled care, such as nursing and therapy, ordered by a doctor. Home care is help with daily life, like bathing, meals and getting to appointments. Many families use both. Our comparison of home care, assisted living and home health in Georgia explains the differences.

Sources

This guide is general information for families, not medical advice. Ask the person's doctor about their care, and call 911 in an emergency.

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