Stroke survival chances better but rehab units are failing patients, says report

The treatment of stroke patients in Ireland is, to use a sporting cliche, a game of two halves.

Improved emergency care for people who have suffered a stroke has reduced the death rate by more than 15 per cent in recent years, and rates of major impairment have also dropped.

The problems for stroke survivors start after the initial phase of intensive treatment. Rehabilitation is a long and slow process for many patients who need intensive therapeutic support to regain the faculties the rest of us take for granted, such as speech and motor skills.

A report by the Irish Heart Foundation (IHF) and the national stroke programme of the Health Service Executive looks at the fate of patients after their first week of post-stroke care, when many are moved to rehabilitation units across the country while remaining inpatients. The shortcomings in services are striking, with a clear majority of units admitting they are unable to provide the recommended level of therapy a patient needs.

So, having saved the lives of patients thanks to faster emergency treatment and new drugs, the system is effectively abandoning many survivors by failing to provide them with the rehabilitation services they need thereafter.

"Lives are being saved on an unprecedented scale, only for this improvement to be squandered afterwards," says Chris Macey, advocacy director of the IHF.

Every year, about 10,000 people in Ireland suffer a stroke, of whom 7,000 will be hospitalised. There were more than 30,000 people living in the community with disabilities as a result of a stroke.

With the level of resources static and an additional 350 stroke patients each year, some of the achievements of recent times have started to unwind. Fewer people are making it to a stroke unit, the average length of stay is up, and the number of patients going home directly afterwards is down.

After heart disease and lung cancer, stroke imposes the greatest disease burden on the Irish health service, according to the World Health Organisation. Caring for patients who are disabled by strokes imposes significant long-term costs on the health service.

Arguably, the worst option is to warehouse stroke patients in nursing homes with little or no access to rehab. This option costs at least €35,000 a year, far more than the cost of providing patients with appropriate therapy in the community.

The report’s recommendation is for stroke patients to receive at least 45 minutes a day of each of the therapies they need, five days a week, but the report shows that only 15 per cent of units are reaching this target.

There are also large local variations. One woman told the launch that she received physio three times a week when living in Co Roscommon but that treatment dropped to once every three months after she moved to Co Mayo.