Dr. Nancy Mayo

PHOTO: OWEN EGAN

Stroke victims lack services

HÉLÈNA KATZ | Although more people are surviving a stroke than was the case 20 years ago, their quality of life is being compromised by health care cuts that aren't giving them access to the services they need, says Dr. Nancy Mayo, an associate professor at the School of Physical and Occupational Therapy. She has been conducting stroke research for the past 15 years.

Canada has one of the lowest death rates due to stroke, the rate has dropped by about half in the past 20 years to 50 per 100,000 people. Controlling such risk factors as hypertension and smoking has helped reduce the condition's incidence.

"The good news is that if you have a stroke, your probability of dying is lower," Mayo says. "But the bad news is that you will live with [the after-effects] of stroke." That can include impairments to your vision, perception, mood, motor function and the ability to speak as well as a loss of control of basic bodily functions.

"It's the only condition that has that kind of impact on every bodily system," she comments.

That makes it difficult for a person to return to their previous lifestyle and reintegrate into the community. Canadian stroke patients spend more days in acute-care hospitals than do their American counterparts.

"That's largely because our health care system in Canada hasn't built facilities outside of acute-care hospitals," Mayo says. "There's nowhere to send them to, so they either go home or to rehabilitation services."

That shifts the burden of care to families. "Now families are being asked to care for someone six or seven days post-stroke, find their own resources and that becomes very wearing for the family," Mayo says.

That sentiment turned up in a study Mayo conducted to compare patients sent home with and without home care services. Families left on their own "felt totally abandoned and felt totally angry because they hadn't gotten services and didn't know how to get through the system," she recalls.

Families aren't the only ones to suffer. There may, indeed, be no place like home to recover from an illness after a hospital stay, but not if patients have trouble getting the kind of support services they need to improve their recovery.

Existing community-based services have focused on maintaining the elderly in their homes to avoid institutionalization. By contrast, stroke patients need care that will help them improve their physical functioning.

"In order to move somebody up the hill to get them better, you have to put in daily resources," Mayo says. These can include physical, occupational and speech therapy and nursing care. "They're not at risk of dying, nor of being institutionalized right away. Hence they didn't get anything."

More outpatient facilities for stroke patients are being set up, but a two-tiered health care system is already evident in the way physiotherapy services are offered, Mayo says. The only way to have them paid for is to get them through designated facilities. Anyone who wants to receive physiotherapy at home has to pay from their own pocket.

Titled "No Place Like Home," Mayo's most recent study found that giving stroke patients four weeks of home-based rehabilitation improved their quality of life. With rehab beds costing the government about $150 a day and home visits $50 each, it also proved to be cost effective for patients who needed fewer than three types of rehab services daily. That option also depends on having someone at home who can take care of the stroke patient.

Inpatient services should be reserved for people who need at least three types of rehab services or those who don't have anyone at home to care for them, Mayo and her colleagues recommend.

The stroke patients whose needs are most neglected are the 40 per cent who have had a relatively mild stroke. "These people can do basic things, but they can't go back to (playing) golf, bowling and their level of activity deteriorates," Mayo says. Since they aren't as physically active, that reduces their quality of life and makes them at risk of having another stroke. They need to be shown that they can be active again.