The impact of discharge to a care home on longer term stroke outcomes

Objective: To examine the impact of discharge to a care home on the longer term recovery after stroke. Design: An uncontrolled naturalistic study of stroke survivors, matched for stroke severity, discharged from a stroke rehabilitation unit to either a care home (n = 65) or to their own home (n = 65). Stroke-related variables were assessed in both groups shortly before discharge and again at six months after discharge. Setting: A stroke rehabilitation unit, care homes in the community and subjects' own homes. Outcome measures: Functional activities of daily living (ADL), cognitive function, depression, health service utilization, health-related quality of life. Results: Despite low levels of rehabilitation in both groups, at six months subjects discharged home had a better functional improvement in ADL (Barthel score 14.9 compared with 10.8) and health-related quality of life (HRQoL) (five-item EuroQol score 0.60 compared with 0.35). Conclusions: Poorer outcome in subjects discharged to care homes may be remediable and could respond to better rehabilitative efforts and increased social support and encouragement for this group of stroke survivors.