Recovering at home: A stroke client’s journey with Cavendish Homecare

At Cavendish Homecare, we recognise that the recovery journey following a stroke is unique and care must be tailored accordingly. Many stroke clients choose the option of receiving stroke care at home, as it allows them to remain in a familiar environment with access to caregivers, family, and friends. In this case study, Deputy Nurse Manager Esnart Namakando, describes the progress of a stroke client following their discharge from the rehabilitation unit, highlighting how Cavendish Homecare’s client management facilitated this transition and recovery.

Our client’s journey

The 88-year-old client suffered a left middle cerebral artery (MCA) infarct, which resulted in impaired communication, perception, and voluntary movements. The client experienced contralateral hemiplegia, loss of sensation on the right side, neglect of the right visual field, and global aphasia. The client was admitted to A&E and then taken to an acute stroke unit where she was managed for 12 weeks, followed by 4 weeks of intensive rehabilitation. Initially, the client faced several challenges adjusting to being at home after the stroke. These included eating and drinking difficulties, immobility, sleep apnea, poor vision in one eye, double incontinence, and challenges in communication.

Our involvement and approach

From the outset of the enquiry, our specialist neurological nurse manager, Esnart Namakando, played a vital role. Using her knowledge and experience in the field of neurological injuries, Esnart developed a care package that involved a dedicated team of highly skilled carers that provided round-the-clock care. The client’s self-motivation and interaction with carers, family and friends,  combined with the implementation of a high standard of medical support, enhanced the stroke recovery.

The comprehensive care package took a holistic approach and addressed the following areas:

• Management of motor deficits and physical fitness
• Communication and sight
• Support with personal care
• Continence care
• Eating and drinking
• Social recreation and leisure activities

Collaboration with the Multidisciplinary Team

Our team collaborated closely with the client’s multidisciplinary team, to ensure a comprehensive and integrated approach was implemented. The team consisted of a range of healthcare professionals including:

• Dietician
• Speech and language therapist (SLT)
• Neuro-rehabilitation physiotherapist
• Neuro-rehabilitation occupational therapist
• Wheelchair Services team
• District nurses
• Podiatrist
• Nutrition team
• Pharmacy

Management of motor deficits and physical fitness

Our carers played a crucial role in assisting with all movement and handling needs, including using a full-body sling for hoisting during personal care and transitioning to and from bed.

Communication and sight

The client experienced hearing difficulties, receptive aphasia, and short-term memory challenges following the stroke. Our carers engaged in full conversations with the client, being mindful of the client’s vision impairment and hearing loss due to right-side neglect from the stroke. Being aware of the adaptations required, greatly improved the emotional and mental well-being of the client.

Support with personal care

As part of our comprehensive support, our carers supported the client with personal care, including activities such as combing their hair and brushing their teeth. Our approach prioritised empowering the client to maintain their personal routines while receiving the necessary support.

Continence care

We provided support to the client who experienced challenges with bladder and bowel control, leading to difficulties in recognising and interpreting continence signals. To address this, nurse manager implemented a continence rehabilitation programme aimed at regaining control.

Eating and drinking

Through consultation with carers, the nurse manager and the client’s daughter, the team developed a dietary plan in line with guidelines which was prepared by the speech and language therapist (SALT). The client showed significant progress in eating and drinking, leading to a reduction in PEG feed and successful management of three meals a day with oral fluids. In addition, our nurse manager facilitated PEG feed theory training for the carers followed by practical training conducted in the client’s home by the nutrition team. This ensured that the carers were equipped with the necessary knowledge and skills to confidently and safely handle PEG feeding.

Social recreation and leisure activities

The client had a daily activity plan which our carers worked on in conjunction with the family. It was important to also take advice from family to develop a schedule that supported the interests and hobbies of our client.

This included:

• Trips to the supermarket
• Involvement in helping them to choose food to be cooked for their meals
• Daily exercise plan using exercises that were recommended by the rehabilitation centre
• Watering plants
• Going for walks in the nearby park
• Sitting in the garden

Conclusion

Since discharge from the rehabilitation centre, the client settled back into the comfort of their home surrounded by a loving family, friends and carers. Through seamless collaboration with the multidisciplinary team and close monitoring of the client’s progress, our team successfully managed and coordinated the client’s care, alleviating stress for both the client and their family. As a result, our client continues to make a good recovery, benefitting from the expertise and support provided by our dedicated team.

To understand more about how our stroke care or home care services can help you, contact us and speak with a nurse manager that can guide you through the process to achieve care at home for your family or friend after a stroke.