Nova Scotia Health’s at home rehab for stroke patients hits six-month milestone

Denise Peters planned to be in the hospital for a couple of days when she underwent a heart procedure in February of 2023. When she woke up, she learned she’d had a stroke. 

 A few days in hospital turned into four weeks as she underwent therapy to restore movement in her left hand and arm and battled an infection.  So, when a bed opened in the Nova Scotia Rehabilitation Centre for intensive therapy, she was reluctant because it would extend her hospital stay.  “Because I was in hospital for a long time, being an inpatient was a difficult decision to make. I felt like I needed to be home,” said Peters.

Peters lives alone and friends were looking after her two Shih Tzus.  They stepped up to take out the garbage, throw out rotting food, shovel the driveway and keep her pipes from freezing.  But as her hospital stay dragged on, Peters was hesitant to ask for more help.  She chose to go home and travel to the rehab centre for therapy rather than spend three more weeks in the rehab hospital.  

The decision felt right for Peters, but she couldn’t get an outpatient appointment for two weeks.  “By now I had lots of time to read up on stroke and those two weeks when I couldn’t get into physio worried me,” said Peters. Research shows rehabilitation is most effective when there is no gap between hospital care and therapy.

Nova Scotia Health now offers what would have been the perfect solution for Peters - an intensive Early Supported Stroke Discharge program delivered in the patient’s home.  Patients who have a mild or moderate stroke can be released to their home and immediately get the same intensity of treatment they would receive as an inpatient at the rehab centre. 

“I was so elated,” said Dr. Anita Mountain, a physiatrist and medical co-lead for the Acquired Brain Injury program at the Nova Scotia Rehabilitation Centre at the QEII. “The impact on the patient’s quality of life, and to their caregivers and family, is immense. To be able to say ‘you don’t need the medical care so let’s have you go home’ means patients are truly receiving the right care at the right time at the right place.”

The program, a first of its kind in the Atlantic region, recently celebrated six months of helping patients at home. It is currently available in areas of the Central Zone. 

To date, 50 patients have been cared for at home, which translates to saving 2145 bed days for more acute patients. 

“I always say for every one patient we take home we free up two beds in the system - one in acute care and one at rehab,” said Joy Boyce, the program coordinator. “Early data suggests that as a result, the wait for stroke patients to go to rehab is down, from six days in 2022 to just one day in our first six months.” 

In December 2023, Don Currie experienced a stroke and spent 11 days at the QEII. He and his wife, Maureen, were very impressed with the at-home Early Supported Stroke Discharge program.

“The specialists who came to our home are highly competent and are skilled experts in their fields,” said Maureen Currie. “The ESSD program doesn’t just consider the needs of the stroke patient but also the caregiver. “I learned so much about how Don’s recovery was going. I received counselling and plenty of information on understanding stroke recovery.”

In-home therapy after a stroke can be equal to or better than inpatient rebab, while reducing the length of hospital stays. 

“We practice things in rehab with the intention of people being able to do them in their homes, but actually being able to give that intervention in the home where people are going to be doing that activity is such a benefit,” said Mountain.