Rehabilitation after stroke. Financial implications for survivors of stroke

Hope Olivia Ward*, Beth McIldowie, Sarah Kibble, Amanda Squire, Andrew Carson-Stevens

*Corresponding author for this work

Research output: Contribution to journalLetterpeer-review

1 Citation (Scopus)


The new National Institute for Health and Care Excellence
guidelines on stroke rehabilitation recognise that high quality
stroke care services should include physical rehabilitation, as
well as specialist psychological and emotional support to
survivors1 2. However, the financial burden of long term care
can cause considerable anxiety and stress to stroke survivors
and their families during rehabilitation.
In Wales, we have formed a multi-professional student group3,
as a collaboration between Institute for Healthcare Improvement
open school chapters4, to work with higher education, healthcare,
and volunteer organisations, including the Stroke Association
and patients themselves.
We meet monthly to learn about the role of each healthcare
professional in the stroke care pathway through peer led
teaching. We also run group activities such as identifying the
“top five basic care needs” that all students can help stroke
patients with while on placement.
Stroke patients share their stories at our meetings, and their
experiences consistently highlight the harsh realities of “life
after discharge.” Recurring themes include frustration with the
lack of available psychological support and anxiety caused by
the financial burdens associated with long term care needs
during rehabilitation. Patients highly rate the support provided
up to six weeks after discharge, but NHS and local authority
funded care can diminish rapidly after this point, leaving many
patients without access to full rehabilitation services or having
to fund rehabilitation themselves5.
One patient had saved his whole life for early retirement. After
his stroke, he was unable to return to work and his wife gave
up work to help him with activities of daily living. They have
since endured nearly a decade of financial hardship, living off
their savings. Only now that their savings are depleted, are they
entitled to help in adapting their home. There is a huge
discrepancy between the level of care available acutely and in
the rehabilitation phase. Many stroke survivors are forced to
spend their life savings before they can access even basic care
funded by the NHS and social services.

1 National Institute for Health and Care Excellence. Stroke rehabilitation. CG162. 2013.
2 Dworzynski K, Ritchie G, Fenu E, MacDermott K, Playford ED; on behalf of the Guideline
Development Group. Rehabilitation after stroke: summary of NICE guidance. BMJ
2013;346:f3615. (12 June.)
3 Squire A, Carson-Stevens A, Jones A, Hearle A, Evans E. 2013. Joined up
care—interprofessional approaches to improving patient care [poster]. Learning and
working together to improve safety through better prescribing. 17 May 2013, Cardiff.
4 Institute for Healthcare Improvement. Open school. Overview. 2013.
5 Stroke Association. Struggling to recover. 2012.
Original languageEnglish
Article numberf4999
Pages (from-to)1-1
Number of pages1
JournalBMJ (Clinical research ed.)
Publication statusPublished - 2013


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