American Heart Association / American Stroke Association Recommend Dyad Interventions for Stroke Survivors
Stroke ranks as one of the leading causes of severe, long-term disability in the United States, and the majority of stroke survivors require the ongoing assistance of a family caregiver to avoid institutionalization.¹ Eventual institutionalization of the stroke survivor is often associated with caregiver stress.²⁻⁴ Caregiver stress has also been shown to interfere with rehabilitation, result in social isolation, cause declining health, cause caregiver depression at rates exceeding stroke survivor depression, and increase caregiver mortality.⁵⁻¹⁰ Fortunately, a systematic review and scientific statement for healthcare professionals from the American Heart Association and the American Stroke Association (AHA / ASA) reports that dyad interventions consisting of only five to nine visits can significantly improve the health outcomes of both the stroke survivor and the family caregiver.¹¹
In this context, the term “dyad” refers to interventions that assess and address the needs of the caregiver as well as the needs of the stroke survivor. The recommended interventions consist of skills training and possibly psychosocial education. The dyad approach can be well worth the effort, as studies have found dyad interventions to improve survivor outcomes including reduced institutionalization and fewer illnesses, emergency room visits, and rehospitalizations. In this AHA / ASA statement, skills training refers to coaching caregivers and/or stroke survivors in problem solving, goal setting, communicating with healthcare professionals, lifting, mobility techniques, daily activity strategies, and communication tailored to the needs of the stroke patient. Psycho-educational intervention refers to warning signs of future stroke, lifestyle changes, resource coordination, emotional and behavioral support, medication management training, and personal care training. The statement recommends that the skills training and psycho-educational support should be tailored according to an individual needs assessment. Intervention should be face-to-face or by telephone, and should consist of five to nine encounters over and above what might be considered physical and speech therapy for restoration of ability.
This AHA / ASA recommendation and the potential available from dyad interventions underscores the utility of a referral to Five Star Home Health any time a patient is homebound and there is a new stroke-related disability. Whether home health is prescribed for extensive stroke rehabilitation or to facilitate transition from rehab facility to self-care at home, Five Star provides interventions focused on both your patient and his or her family caregivers as a matter of course. We assess patient and caregiver needs in the home environment, train family caregivers in personal care tasks, train the dyad in strategies for activities of daily living, coordinate other community resources, and engage in other interventions described in this AHA / ASA study. As long as patients are homebound and a skilled need is present, Medicare will pay 100% of allowable charges for stroke rehabilitation and this sort of dyad intervention from Five Star Home Health.
Providing Both Interim and Long-Term Home Care
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