AVC : How to organize the return home ?

At the request of the French Society of Physical Medicine and Rehabilitation ( Sofmer ), the National Agency for Accreditation and Evaluation in Health ( Anaes ) is issued to health and social professionals recommendations on how to medical organization , paramedical and social return home patients with cerebrovascular accident (CVA ) .
A debilitating disease
These recommendations focus on the preparation for the return , the return itself and monitoring.

Stroke is the leading cause of dependency and loss of autonomy. Each year, nearly 130,000 people suffer this type of vascular complication. The incidence (number of new cases per year) is increasing , mainly because of the aging population and increased life expectancy of patients with vascular risk factors . In the long run , almost a third of survivors remain disabled . The effects can have serious consequences for the physical, neuro- psychological, family and professional.

Stage a comeback in the best conditions
So far, the question of the conditions for the return home of patients with stroke has been relatively little studied , while its human and financial costs prove higher.

The recommendations proposed by Anaes must be adapted to each case , depending on the type of stroke and its sequelae , special needs, conditions earlier life and socio-familial context of each patient. They must also take into account local or regional peculiarities of their care .

Three main recommendations can be made:
1 / Prepare the patient to return home informing him of his health and the likely evolution as well as his rights as a person with a disability. It is important to consider the project , family and socio -economic .

The patient and his family should be involved. Preparing to return home focuses on medical, social and psychological aspects . It requires the availability of health and social professionals, a home accessible and safe , as well as the assessment of the financial resources that the patient will need .

2 / Organize early return home after a stroke is possible only if there is a team that specializes in rehabilitation and rehabilitation at home , who has the time and resources required . Favorable conditions include, among others , the functional capabilities , the patient's wishes and his entourage , the absence of debilitating disease associated (dementia , depression ... ) , the stability of the condition.

3 / The medical care at home must be provided and coordinated in the early years in order to provide personalized support to the patient and his entourage, to anticipate and prepare for the discontinuation of certain activities and therapeutic care .

The Anaes also recommends financial recognition of the involvement of private practitioners in preparation for the return home and travel associated with this support before and during the maintenance of the patient's home .