From where I sit...by Harriet Faris
As a social worker at Waccamaw Rehabilitation Center, one of my job responsibilities is to provide a discharge plan for patients. Many come to rehab after experiencing mild to severe strokes, ranging in age from 40 to 90+. Today, I am discharging a 45-year-old woman renamed Jo for this article.
Jo had a severe stroke several weeks ago. This patient is a single mom with two young children. Prior to her stroke, Jo was working full time, caring for her children and maintaining their home. During rehab stay, Jo worked three hours a day with a physical therapist, occupational therapist, and a speech therapist for more than a month. Despite her efforts, Jo continues to experience difficulty walking, slurred speech, and weakness in her left arm and hand.
For me, this discharge plan is especially challenging because the patient is young and resources are so limited. Sending Jo to a Skilled Nursing Facility (SNF) for further therapy is not an option because she wants to go home to be with her children. If she were to consent to a SNF placement, Jo would likely be one of the youngest patients with little in common with others.
None of these issues apply to older stroke patients who have grown children and fixed incomes. Further, Medicare pays SNF expenses for older patients, if needed. In contrast, such resources are scarce for young stroke patients.
Because Jo is now unemployed, she is unable to afford to have someone come into her home to help with the children, to prepare meals, to assist with housekeeping, or to help with her personal care. Despite her health insurance coverage through her previous employer, Jo finds her COBRA eligibility results in payments which are far too expensive for her new budget. Although she intends to apply for social security disability income, the process routinely takes months to complete.
Jo's children have also experienced tremendous loss. Their mom is no longer able to care for them as she did before the stroke. Ironically, they may now have to take care of her. Despite their young ages, they fear mom may never be the same. Where do I find help for them?
In the interim, there are many unanswered questions which warrant immediate resolution: How will she pay her bills? How will she make her home more accessible for her newly incurred disabilities? How will she resume her role as a parent? What does she do to meet her family's immediate needs?