The Home as a Place for Rehabilitation After Stroke: Emerging Empirical Findings

Health care is moving toward integrated services where care and rehabilitation are provided at home rather than in institutions. This, together with the requirement that care must be person-centered, has proven to be a considerable challenge. Older adults living with complex health conditions such as stroke are vulnerable to change when their responsibility for care and rehabilitation becomes extensive. Health care tends to be governed by quick fixes rather than taking people’s own goals, resources, and life situations. Factors in the environment that can affect a person’s health and social, emotional, and physical aspects of daily life are crucial to consider in person-centered care. Nevertheless, the environment is often neglected in both research and clinical practice. This chapter addresses findings within the REARCH (Rehabilitation and Architecture) project. The project was initiated in response to Swedish law in 2018, making it more common for older adults with stroke to be rehabilitated at home rather than in a hospital. The purpose was to explore environmental factors to fulfill person-centered rehabilitation. The results are based on qualitative and quantitative data collected from patients and interdisciplinary care staff. We describe the challenges for people with stroke during rehabilitation and how their possibilities to engage in everyday life in their homes and immediate surroundings are influenced by environmental factors. Our contribution will improve the understanding of how environmental factors relate to everyday life and recovery at home. The discussion aims to guide evidence-based care models for rehabilitation at home.