Saudi Stroke Standards

Long term care Purpose A range of services are in place and easily accessible to support the individual long-term needs of individuals and their care givers. This support should be at home or in long term care facilities, when home is not an option. Rationale  Support for stroke patients and their family members needs to be tailored based on the individual circumstances. A coordinated approach is needed, not just between health and social care, but also involving housing, transport, employment, education and leisure services, as well as the voluntary sector.  Stroke patients can find that the accommodation they are in is no longer suitable. There are a range of solutions to this: for example, simple pieces of equipment to aid independence.  Many stroke patients suffer from emotional difficulties, and this can have an impact on their long-term physical recovery and lead to depression and isolation. Family members are also vulnerable to difficulties of coping with loved ones who have suffered a stroke, and to depression. This may make returning to activities and roles that were part of normal life before the stroke difficult.  Patients who find it difficult to adjust to the longer-term effects need support from emotional support services.  Stroke can lead to a range of pain symptoms and physical consequences like spasticity which require monitoring and management.  Professionals who are in charge of stroke patients need to train the paid care givers to avoid preventable physical or emotional harm to both the patients and care givers. Standards 1. All stroke patients should be screened to check if they would benefit from mental health and psychological services before discharge from the acute hospital. 2. All staff working with stroke should provide emotional and psychological support to the patient and family/ care givers. These can range from access to good peer support or local counselling services through to referral for psychiatric and psychological services. Ideally, services need to develop long-term psychological and emotional support, with coordinated programs starting with psychological support in hospital and longer-term support involving the voluntary sector. 3. Rehabilitation teams at different settings along the stroke care pathway need to address various physical issues related to pain, spasticity, continence, mobility, selfcare and mental capacity. 4. All stroke patients should be assessed to check whether equipment and adaptations can make their home environment more accessible for them, improve their independence and make it easier for their families to look after them. Increasingly, telecare and telehealth solutions can help people to live in their own homes for longer. 5. Younger stroke patients may have different needs. For example, they may have a family to support. Specific attention should be paid to the communication difficulties experienced by many individuals and the need to commission long-term support services from voluntary organizations that are able to meet these long-term needs. 6. Paid care givers should be trained to deal with stroke patients. 7. Stroke patients in long term facilities need to be reviewed regularly to identify their changing needs. QM