On this page:
Planning your discharge from hospital
Your community stroke team
Reviewing the support you need

Your recovery from a stroke isn't limited to the time you spend in hospital. When you're ready to leave hospital, your stroke team will work with you to agree and arrange the support you need to continue your recovery at home. 

Planning your discharge from hospital

When you are ready to leave hospital, your stroke team will work with you to agree what support you will need at home and put together a discharge plan. This will cover all the arrangements for your continued rehabilitation and care at home, including the community services that will be helping you and any aids or equipment you need.

Early supported discharge (ESD) allows you to receive the same rehabilitation care you would get in hospital at home. ESD isn't suitable for everyone, so it's only likely to be offered to you if you have a certain amount of movement (if you're able to safely move yourself from a bed to a chair, for example) and your stroke team is sure that you have a safe and secure environment to go to. 

Your social worker should work with you to arrange any practical help that you need at home. This could include carers coming in to help you get washed and dressed, or adaptations for your home. So they should complete a community care assessment with you to work out what help and support you need.

Your social worker also needs to ensure that anyone who is helping to care for you gets the right support too. So any friends or family members that are providing unpaid support need to have a carer's assessment.

These assessments should happen before you leave hospital, but sometimes they happen afterwards. When you have an assessment, be honest about your needs. 

Your community stroke team

Your community stroke team will help you with your continued care and rehabilitation once you leave hospital. Like your hospital stroke team, your community team will be made up of different healthcare professionals, including:

  • Community stroke nurses.
  • Physiotherapists.
  • Speech and language therapists.
  • Occupational therapists.
  • Dietitians.
  • Psychologists. 

Reviewing the support you need

Around six months after you leave hospital, you should get a review of your progress. This makes sure you are getting the right support if your needs have changed. The review may be carried out by a Stroke Association Coordinator, or by a specialist nurse or other stroke professional. The process can vary in different parts of the UK, so contact your community stroke team to find out more. If you need more help and support with the effects of stroke at any time, contact your GP or stroke nurse.

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