A national audit of stroke care was carried out by the Irish Heart Foundation in association with the Department of Health and Children. It was published in April 2008. A Nursing Home Survey was included as part of its research.

The report confirmed the impression of professional working in the field that services in Ireland are so poorly organised that they are ineffective. It identified the following problems: -

• Stroke units are virtually non-existent—only one hospital has such a unit
• A tiny fraction of patients who might benefit from acute interventions such as thrombolysis are assessed for this therapy
• Acute rehabilitation is only available to one in four patients or is delayed beyond the point at which it is most effective
• Continuing care and long-term recovery programmes are haphazardly organised or do not exist

• The patient journey is not a steady progression through a seamless and properly organised unitary service
• The quality of care is determined by chance, location and a haphazard combination of circumstances
• The results are predictable
• Too many people die from stroke because they cannot access optimal treatment sufficiently rapidly
• Too many survivors are left with unavoidable and unduly prolonged disability

The study included: -

• An organisational study involving interviews with senior managerial and clinical staff in the 37 public hospitals providing acute stroke care
• A clinical audit of medical charts for a selected sample of patients with stroke in 36 acute hospitals providing stroke care
• A survey of 204 GP’s
• Semi-structured interviews with Public Health Nurses and Allied Health Professionals
• A national interview survey investigated the experiences of nursing home proprietors, staff and residents
• A survey of the current health status of 200 patients with stroke, and their carers, following discharge from hospital

The aim of the nursing home aspect of the survey was to document the current status of community stroke provision in the nursing home context with a specific focus on service provision as perceived by key nursing home staff and residents with stroke.

The report notes that stroke is the third most common cause of death and the most common cause of acquired major physical disability in Ireland. A stroke is an interruption of the blood supply to part of the brain. The term “stroke” comes from the fact that it usually happens without any warning, “striking” the person from out of the blue. A stroke is caused by a major blockage of an artery supplying blood to the brain (cerebral thrombosis) or a bleed into the brain form a burst blood vessel (cerebral haemorrhage) Approximately 10,000 people are admitted to hospital each year with stroke disease as a primary diagnosis.

In his foreword to the report the medical director of the Irish Heart Foundation states that “A failure to recognise effective therapies has led to a fatalistic approach to treatment and an often nihilistic approach to coping with survivors”

Nursing home proprietors raised a number of concerns in relation to care after discharge to the community. Access to health professionals, apart from GP’s, was reported as low. Some homes employed a physiotherapist either on a full-time or part-time basis. Access to occupational, and speech and language, therapists (OT and SLT) was reported as poor. Access to dietician was described as very limited while psychological and counselling services in public nursing homes was almost non-existent.

Almost 600 (18%) of the 3,239 residents surveyed in 60 nursing homes had previously had a stroke. Less than 1% had suffered a stroke since admission to the nursing home.

Almost all managers reported that there were no specific guidelines for stroke rehabilitation in their nursing home. Most of their stroke residents had been discharged from all active rehabilitation and were admitted some time after their stroke with no instructions relating to maintenance therapy required.

Balance and mobility problems were the most common disability, with over 80% of nursing home residents with stroke being affected. Most (87%) were deemed to be at risk of falls. Over 60% were deemed to have some level of cognitive impairment while over half had problems with swallow or communication.

The report is seen as indicating substantial deficits in primary prevention, timely and thorough assessment, investigation and treatment, rehabilitation, secondary prevention, discharge planning, preparation of patients and family for discharge and ongoing community rehabilitation and support for patients and their families in the community, both for patients living at home and those residing in nursing homes. The report suggests the need for a radical and urgent review of stroke services in Ireland to provide appropriate care for those suffering from stroke.

The above is a very brief synopsis of a comprehensive and informative report. The survey presents opportunities for nursing homes to consider providing specialised care for persons who have had a stroke. Some nursing homes are moving towards providing specialised care.

The report is published by the Irish Heart Foundation, 4 Clyde Road, Ballsbridge, Dublin 4.