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Stroke Care and Assisted Living

Page Reviewed / Updated -  Sept. 2019

Introduction

According to the Centers for Disease Control and Prevention (CDC), approximately 800,000 Americans have a stroke each year, and about 25 percent of those persons have had a prior stroke. This fact is particularly relevant for seniors, as nearly 75 percent of those who have strokes are at least 65 years of age, and the risk of having a stroke continues to grow greater with age. Additionally, strokes are one of the most prevalent causes of long-term disabilities.

Some stroke survivors recover naturally. This is known as spontaneous recovery, and generally occurs within a few weeks to six months following the stroke. Other stroke survivors require more extensive rehabilitation, which includes relearning of lost skills and/or learning new ways to function, and will recover within a couple of years. Still others never fully recover and are left with lifetime disabilities.

In a situation where stroke care is required, it is common that a relative, such as an adult child, serves as an informal (unpaid) caregiver. This role can be challenging, particularly when a caregiver has to juggle caregiving duties with a full-time job, a family, and other responsibilities. In addition to the time commitment, the care needs of a stroke survivor can be very taxing. In some cases, the responsibility can be too much for an untrained family caregiver to handle. For example, caring for a loved one who has extremely limited functioning on one side of his or her body is not physically possible for everyone. Taking on too much as a caregiver not only leads to high stress levels, but also can lead to caregiver burnout.

The good news is that there are stroke care options, providing an alternative to family members taking on the role of informal caregiver. Assisted living is one such option. This type of care allows stroke survivors to maintain a degree of independence, while also giving relatives peace of mind knowing that their loved one is being cared for in a safe environment. Some assisted living residences even provide stroke-specific care.

What Exactly is a Stroke?

Before we dive into stroke care and assisted living, it is important to understand what a stroke is and how it might impact a stroke survivor’s functioning.

Simply put, a stroke occurs when the blood supply to the brain is interrupted. While the exact cause varies, a stroke damages the brain, and the way a person is impacted depends on which part of the brain is injured. The following list, although not exhaustive, includes some common effects of having a stroke which may deem both short and long-term care essential.

  • Weakness or loss of functioning on the right or left side of the body
  • Coordination or balance issues
  • Cognitive impairments such as memory loss, trouble concentrating, poor judgment, and difficulty following directions
  • Vision issues such as double vision, blurred vision, and difficulty processing depth perception and movement
  • Language issues such as slurred speech, jumbled words, and difficulty understanding what others say
  • Emotional outbursts and depression
  • Lack of bowel and bladder control
  • Difficulty swallowing

Who Should Consider Assisted Living Following a Stroke?

Assisted living residences provide room and board, personal care assistance, housekeeping and laundry, medication reminders, and therapies (physical, occupational, and speech) as needed. Most facilities offer various levels of care, so residents can access the services they need while maintaining independence in other areas of their lives. This can range from the need for very little supervision and assistance, to the need for more extensive assistance with several activities of daily living (bathing, grooming, mobility, toiletry, etc.), to the need for some medical care.

The following two scenarios are examples in which stroke survivors might be well suited for assisted living:

  • The individual requires limited rehabilitation and limited assistance
  • The individual has a stroke-related long-term disability and requires regular assistance with a few activities of daily living

To be very clear, while assisted living might be a great option for some stroke survivors, it is not the right fit for everyone. This is largely due to the fact that the seriousness of a stroke and the resulting physical, behavioral, and emotional side effects vary widely. Some stroke survivors have care, medical, and rehabilitation needs that are greater than can be provided in an assisted living setting.

Pros and Cons of Assisted Living for Stroke Survivors

Pros

  • Home-like living situation that allows residents to maintain some independence
  • Safe living environment with on-site staff available 24 hours a day
  • Personal care assistance, housekeeping and laundry, preparation of meals, medication management, and more assistance provided
  • Access to healthcare professionals, such as physicians and physical therapists, onsite or by offering transportation
  • Stroke-care trained staff (in some assisted living residences)
  • Social, recreational, and therapeutic activities
  • Varying levels of care are available

Cons

  • Not all assisted living residences are able to handle the needs of stroke survivors
  • Extensive medical care is not provided
  • The cost can be expensive

What to Look for in Assisted Living Facilities for Stroke Survivors

When considering assisted living for stroke survivors, ensuring the environment is safe and the staff is able to handle the needs of someone who has had a stroke is key. As mentioned previously, some facilities have staff that is trained specifically in stroke care, which means they are well equipped to handle the needs of residents who have had a stroke by offering specialized services.

Physical and social activities can also be extremely beneficial for stroke survivors and help them with their recovery. This includes a variety of activities, such as yoga, walking, dancing, gardening, painting, playing card games, listening to music, and meditation. Therefore, the amenities and the availability of activities should be considered.

Remember, not all assisted living residences offer identical services, nor do all facilities cater to stroke survivors. When researching assisted living options for stroke care, there are some important questions to ask:

  • Are there various levels of care available? Is there advanced care to assist with limited mobility issues?
  • Can the stroke survivor’s needs be met in this setting?
  • Is the staff trained to work with stroke survivors? If so, what training have they had?
  • Is there a staff nurse on duty 24 hours a day? Is there a doctor on-site, and if so, when do they visit?
  • Is there onsite rehabilitation staff? For example, is physical therapy and occupational therapy available at the assisted living residence?
  • here an extra cost for transportation if the resident has to go offsite for medical and rehabilitation appointments?

The overall goal is to match the stroke survivor to an assisted living residence that meets all of their needs and will help them to flourish.

Paying for Assisted Living

The monthly cost of assisted living can be very expensive. According to Genworth’s Cost of Care Survey 2018, the nationwide average monthly cost is $4,000. While some persons have the resources to pay out of pocket, many others require financial assistance to cover the cost of assisted living. Below are some available options to help pay for assisted living.

Medicaid / HCBS Medicaid Waivers

While Medicaid does not cover room and board in assisted living residences, it may cover the cost of supportive services, such as personal care assistance, housekeeping, laundry, medication management, and in some cases, therapies (physical, speech, occupational) in these facilities. Although not uniform nationwide, some states will cover assistance with activities of daily living (bathing, personal hygiene, transitioning, eating, etc.) in assisted living residences.

Most of the states that do provide long-term care benefits in assisted living do so via HCBS (home and community-based services) Medicaid Waivers. These programs are intended to prevent or delay unnecessary nursing home placements by providing supportive services outside of this setting. For many states, this means providing personal care assistance and homemaker services in assisted living residences.

It is important to note that state Medicaid plans are entitlements, which means meeting the eligibility requirements ensures one will receive benefits. On the other hand, HCBS Medicaid Waivers are not entitlement programs. This means that there are a select number of participant enrollment slots for each waiver program, and once all of the slots have been filled, a waitlist will form. Learn more about Medicaid’s assisted living benefits here.

State Supplemental Payments

For federal Supplemental Security Income (SSI) recipients, some states offer an additional cash payment, called a state supplemental payment. The amount of the state supplement varies based on the state in which one resides. In addition, the setting in which the SSI recipient lives might determine the amount of the state supplement. For instance, some states offer a higher payment amount for persons who live in assisted living rather than in their homes. These monthly payments (in addition to the federal SSI payment) can help cover the cost of assisted living. Remember, not all states offer a state supplemental payment, and of those that do, not all offer a supplemental payment for assisted living. To see if your state offers a supplemental SSI payment for assisted living, click here.

Long-Term Care Insurance

Paying for assisted living using long-term care insurance is an option for those who already have a long-term care insurance policy when the need for care arises. For those that currently require assisted living, but do not have this type of insurance, it is very unlikely that a policy can still be purchased. Even if one does find an insurance company that will still sell a long-term care insurance policy, it would likely be extremely expensive and not a viable option.

Medicare

Original Medicare will not pay for assisted living room and board, nor personal care assistance or other non-medical supportive services in these residences. However, it will pay for medically necessary physical, speech, and occupational therapy prescribed by one’s physician.

Medicare Advantage (MA) plans provide the same benefits as regular Medicare, but unlike regular Medicare, MA plans may also cover the cost of personal care assistance and other supportive benefits in assisted living.

Other Stroke Care Options

For those who require stroke recovery and rehabilitation, or long-term care due to a disability resulting from a stroke, there are other options aside from assisted living. It is vital that one’s needs be matched with a setting that is best equipped to handle them.

Inpatient Rehabilitation Facility
Inpatient rehabilitation facilities, sometimes called acute care rehabilitation centers, are standalone facilities or a unit of a hospital. This type of setting provides specialized medical care and offers the most intensive rehabilitation of all settings. On average, rehab is provided a minimum of three hours per day, five days per week, and is supervised by a rehabilitation physician.

Skilled Nursing Home Facility
Skilled nursing homes also provide rehabilitation therapy, but it is generally only provided an hour or two per day. In addition, nursing homes provide around the clock supervision, care assistance, and skilled nursing services.

In-Home Care
In-home care can look differently for different stroke survivors depending on the person’s specific needs. In some cases, it might mean hiring a home health care provider and rehabilitation therapists to come to the home to provide needed medical care and therapies. In other cases, it might mean hiring a personal care aide to come to the home to assist with activities of daily living.
While stroke survivors might live alone, they might also live with an informal family caregiver with in-home care services supplementing the care provided by the family. Although not an in-home care option, adult day care provides an alternative option for persons who need daytime supervision.