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Caring for Stroke Survivors SPECIAL EDITION

• Independence Is the Goal for You and Your Survivor • Take One

Day at a Time

• Understanding Common Side Effects of Stroke


SPECIAL EDITION

Contents

4 Becoming

a Caregiver If you are new to caregiving, learning and accepting your role is a vital part of helping your loved one during stroke recovery. But that doesn’t mean you should neglect your own needs!

10 Understanding Rehabilitation

Rehabilitation helps stroke survivors regain essential life skills. Learn how you can offer support as a caregiver.

12 Understanding Common

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Side Effects of Stroke… and How to Respond to Them

There are many side effects that are common to stroke survivors. It’s important to recognize and address different side effects properly. Pseudobulbar Affect (PBA). . . . . 13 Post-Stroke Depression. . . . . . . 15 Memory Loss. . . . . . . . . . . . . . . 16 Aphasia. . . . . . . . . . . . . . . . . . . 19

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Forming a Partnership Caregiving is about forming a working relationship with the stroke survivor in your life. Hone your communication skills, and practice patience and understanding. This benefits both you and your loved one over time.

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Classes for Caregivers You aren’t expected to know everything about caregiving! There are resources you can take advantage of that will give you the tools you need to be successful.

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Practicing Self-Care Don’t forget—you have feelings, needs, and challenges of your own. Take the time to care for yourself, and you will be a better caregiver to your loved one.

28 Understanding

Financial Issues Money issues can be a big challenge for caregivers. Learn tips, tricks, and resources that can help you make sense of financial matters involving your stroke survivor.

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Stroke Information Resources Remember—you’re not alone. There are many resources and programs dedicated to stroke survivors and their loved ones.

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Becoming a Caregiver

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roviding care for a stroke survivor can be very rewarding. But it can be stressful and frustrating when you’re suddenly thrust into the role of caregiver. Even under the best circumstances, caregiving is a tough job. In fact, caring for a loved one who is ill is among life’s most challenging roles. There’s often little rest and little time to prepare. If you’ve just become a caregiver, keep this in mind: To be successful, you must take care of your own needs as well as those of the survivor. The suddenness of a stroke often means taking on this new role quickly. Because of the immediate need, the role of caregiver may fall on the person who lives closest, has the most flexible schedule or feels most responsible. This may or may not be the person who’s best prepared or most suited to care for a stroke survivor.

Understanding and Accepting Your Role Whether you come to it by choice, family pressure or others’ expectations, taking care of a loved one with a serious health issue is probably a new role for you. Accepting your role as caregiver and understanding what that means can ease the process of taking on this responsibility. Accept the possibility that it may be long-term. Recognize that this role is vital for your stroke survivor and different from other roles in your life. As such, it has new, different and potentially challenging requirements.

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What Does Stroke Caregiving Involve? A stroke survivor’s family is often the most important source of support during recovery and rehabilitation. Family members provide encouragement, celebrate improvements and can empower the survivor to be as independent as possible. Caregivers and family should reassure stroke survivors that they’re wanted, needed and important. Depending on how severe the stroke is, the role of caregiver may be too big for one person. It’s important to be able to rely on others when you need to. Recognizing this and seeking help can help ease the stress of caring for your loved one. Help may come from family, friends, community members, your place of worship and government or nonprofit agencies. In a practical sense, caregiving may mean: • Learning how to work with doctors and other healthcare professionals. You’re an important part of the survivor’s healthcare team. • Learning how to use wheelchairs, lifts and other devices that assist your survivor day-to-day. • Learning about insurance issues, Medicare, Medicaid, Social Security and other public programs. • Asking for help from others. Mentally and emotionally, caregiving can involve: • Wondering “Why?” • Wishing things were different. • Feeling joy when your survivor regains or improves a skill that was lost due to the stroke. • Experiencing a thrill when your survivor says he or she feels good today or is able to do something by themselves that they couldn’t before.

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Talking to the Doctor Learn what kind of stroke your loved one had, what the probable cause was and what symptoms to expect.

• Don’t be afraid to ask questions. Make sure you understand the answers. Ask the doctor to clarify his or her answer, if needed.

Neurologists and other doctors are trained to understand the complexities of the brain. But doctors sometimes communicate in technical terms. They may not always understand the emotional needs of a stroke survivor and their family. So it’s important to be patient and persistent.

• Make sure you know which drugs your stroke survivor must take. Learn what each is for and their correct dose and frequency.

• Have someone with you when you talk with doctors so you don’t miss important information. Two pairs of ears are better than one.

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• Use a notebook for notes (with names, dates and times) from every visit with any and all medical personnel. • Use another notebook for all medical records and correspondence, insurance receipts and medical bills.


A Picture Is Worth a Thousand Words

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ave your loved one’s doctor highlight a drawing of the brain, showing exactly where the stroke occurred. Ask the scientific name for that area. And make sure to ask the doctor to explain what body functions are controlled by that injured part of the brain. This will come in handy every time you speak to a new doctor, nurse or therapist.

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Understanding

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Rehabilitation Rehabilitation (rehab) is a critical part of recovery for many stroke survivors. Rehab will begin when your doctor determines that your loved one is medically stable and able to benefit from therapy. Most rehab services require a doctor’s order.

What Happens in Rehab? The effects of stroke may mean that the survivor must change, relearn or redefine how he or she lives. This often requires different types of therapy, including:

Independence Is the Goal The most important goal for the survivor is to become as independent as possible. The more independent they are, the better they’ll feel about themselves. And you’ll have more time and energy for other activities. As a caregiver, you can encourage your survivor’s independence by praising small achievements and focusing on the positive. Resist the desire to help stroke survivors with tasks they can do themselves, no matter how difficult. You may find it hard to watch their struggle. But in the end, it’s best for the survivor to practice tough skills to become independent.

• Occupational therapy for self-care skills such as feeding, grooming, bathing and dressing • Physical therapy for mobility skills such as transferring, using a wheelchair or walking; range of motion of affected limbs; and fine motor skills such as picking up small objects with the fingers • Speech therapy for communication and motor skills, such as managing speech and language problems and swallowing difficulties Rehab services are provided in many different places: • Acute care and rehab hospitals • Long-term care facilities • At home, through home health agencies • Outpatient facilities Caring for Stroke Survivors |

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Understanding Common Side Effects of Stroke‌

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…and How to

Respond to Them

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ll stroke caregivers and survivors have one thing in common: Their lives will be forever changed in some way. In addition, family members and friends—in fact, everyone you and the survivor are close to—will need to adjust, too. The support of family and friends is critical to a survivor achieving the best possible degree of recovery. By understanding the side effects of the survivor’s stroke, you’ll be more prepared to deal with them. The most common side effects of stroke are explained on the following pages.

Pseudobulbar Affect (PBA) PBA (also referred to as reflex crying or emotional lability) occurs when some areas of the brain that control the emotions are injured by a stroke. A survivor may cry easily or have sudden mood swings for no apparent reason. Laughing uncontrollably also may occur, but it isn’t as common as crying. In the weeks and months after a stroke, the reflex crying will often become less and less frequent. These changing emotional responses with no obvious cause are a physiological response to a stroke. If this is a persistent problem for your loved one, discuss treatment options with your healthcare team. There is now an approved medication for PBA.

How to Respond to Reflex Crying At a time when the survivor isn’t crying, discuss how he or she wants to be treated when the crying comes on. These are some common preferences: • Treat reflex crying as any other inconvenient facial reflex, such as sneezing or hiccups. Continue to interact normally. The crying is only a passing problem that will go away. • Touch is often helpful. A touch on the arm or hand, an arm across the shoulder or a long hug can all help. This may increase the crying, but the survivor may prefer that to feeling ignored. • With genuine crying, or crying full of emotion, empathy and understanding are often helpful. You might say, “It looks like you are really frustrated,” “Yes, I know it’s hard” or “I’m sorry you feel so bad.” Many people are uncomfortable with crying, whether it is reflex or genuine. Some behaviors aren’t helpful: • Don’t look away in embarrassed silence. • Don’t leave because of the crying, unless that’s what the person says they want. • Don’t tell the person not to cry. This won’t help. • Don’t minimize the person’s feelings by saying “There, there, it will be all right; it’s not that bad.”

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Post-Stroke Depression Depression occurs in about 35 percent of all stroke survivors. It may be caused by biochemical changes in the brain caused by the stroke. Or, it may be a psychological reaction to the stroke. Depression can occur soon after a stroke or months later. Either way, it can be treated. Failing to treat post-stroke depression prolongs the misery. Depression may have long-lasting effects because it can keep people from fully engaging in their rehab program at the time it is typically most effective. Depressed patients stay in the hospital longer and have higher mortality and suicide rates. The good news is that post-stroke depression responds well to treatment. Studies indicate that a combination of three approaches works best: 1. Psychotherapy, such as motivational enhancement therapy, an early intervention intended to engage survivors in a treatment and improve their motivation for rehab.

2. Cognitive behavioral therapy, a form of psychotherapy based on the idea that the way survivors think about things affects how they feel and what they do.

3. Drug therapy, including antidepressants as well as psycho-stimulants or cognitive enhancers, which help with the emotional flatness and decreased arousal that survivors often have.

The mix of therapies is determined by the severity of symptoms and is designed to address each survivor’s particular emotional, cognitive and behavioral functioning.

Symptoms of Depression: • Persistent sadness, anxiety or “empty” mood • Feelings of hopelessness or helplessness • Feelings of guilt or worthlessness

• Difficulty concentrating, remembering or making decisions • Insomnia, waking up early or oversleeping • Appetite and/or weight changes

• Loss of interest or pleasure in • Thoughts of death or suicide, or suicide attempts hobbies and activities that were once enjoyed, including sex • Restlessness or irritability • Decreased energy, fatigue, feeling “slowed down” Caring for Stroke Survivors |

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Adapted from “Simple Techniques Can Help Memory,” Stroke Connection® magazine, November/December 2002.

Memory Loss Stroke can sometimes cause memory loss. Simple techniques can improve a survivor’s memory. But first, you must learn how memory works. Three stages must take place for memory to occur:

1. Encoding or input. In this stage, you pay attention, process information and give it meaning.

2. Storage. During the processing period, the information is held in your mind long enough to be stored for later recall.

3. Retrieval. The brain recalls the information previously encoded and stored. The following pages discuss techniques you can use to help your survivor encode and store information.

STAGE 1 ENCODING Your loved one can learn to remember something more easily. This can be done by associating it with something they already know or remember. To recall a specific date, connect it with another well-known date. For example, November 25 is a month before Christmas. The survivor might recall an important date by its relationship to their birthday, or by making the date into a price ($9.29) or a time (12:15).

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To help remember names, associate the new name with a famous person or someone they already know. Easily forgotten chores or tasks can be paired with something the person always remembers to do. For example, if they take their pills on time every morning but often forget to water their plants, put the watering can beside their pillbox.


STAGE 2 STORAGE To store a piece of information, form a picture in your mind of the thing you want to remember. If your survivor is trying to remember something for the future, he or she can try to picture him- or herself in the action or situation.

There are other techniques for helping your survivor remember things. You can write notes to your stroke survivor and post them in easily seen places. Or, try setting an alarm clock or oven timer.

Encourage your stroke survivor to speak new pieces of information out loud several times. Space out these repetitions over time. This might mean directions, names or dates.

STAGE 3 RETRIEVAL If your loved one is trying to recall something from the past, suggest that they use their imagination to relive the situation. Also, having a good external system for recording information is very important. This usually means a calendar for appointments and a “memory notebook.” Consider sectioning the notebook for different types of information, for example: 1. A “reference” area for information such as names, phone numbers and medications. 2. A list of things to do, including a space to mark off tasks when they are done. 3. A section for notes or other things to remember.

You can also use a small tape recorder to store important information. Improving your loved one’s memory means you must be aware that he or she may forget. Once you realize this, you can then make a conscious effort to use some type of memory tool. Try different things to find what works for you. And try to have fun!

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Aphasia Stroke recovery can be a difficult period. Your loved one may have problems using language (aphasia) because of their stroke. People with expressive aphasia know what they want to say but have trouble saying it. Those with receptive aphasia have trouble understanding words other people speak. If your loved one is having language challenges, a speech therapist may be part of their healthcare team. Talk with the therapist to better understand your loved one’s condition. Ask for tips to make communication easier. Here are a few that may be helpful: • Avoid large groups of visitors at one time.

• Don’t pretend to understand if you don’t. Ask the survivor for clarification. • Be patient. If the survivor feels pressured, it may make it more difficult to express himor herself. • Plan conversations for when he or she is well-rested. Gestures, facial expressions, tone of voice and demonstrations can all help you give and receive information. But sometimes stroke survivors, such as those with a right-brain injury, may have a hard time interpreting inflections and facial expression. They may also have trouble controlling their own.

• Reduce noise. Turn off the TV or radio.

Adapting Communication Communicating with your loved one may be easier if you:

• Don’t correct the survivor’s grammar or misuse of words. Communication is the goal now.

• Get the survivor’s attention before you start speaking.

• Use short sentences that are to the point. Instead of saying “Bob called and he will be here tomorrow to pick you up and take you to therapy,” say, “Bob called.” (pause) “He’ll be here tomorrow.” (pause) “He’ll take you to therapy.”

• Keep a natural tone and volume, but speak slower. Give the survivor enough time to respond. • Provide reassurance by letting them know when you’ve understood them. • Include the survivor in your conversation. ALWAYS assume they can hear and understand. Don’t talk about them as if they aren’t there, even if they don’t seem able to respond.

• Don’t expect that someone with aphasia will always be able to say a word or phrase just because they said it before. • Remember that someone with aphasia may tire easily and may not respond as well when fatigued.

• Stand where the survivor can see you when you speak. Don’t stand in front of a bright light.

• Remember that the stroke survivor is an adult and should be treated that way.

• Allow only one person to speak at any time. Extra voices create confusion.

• Always ask if the survivor wants help before giving it.

• Try to steer the conversation to make it easier for the survivor to respond. This may mean asking yes-or-no questions. Never force the survivor to respond.

• Never promise people with aphasia complete recovery, or tell them that they will never improve. Focus attention on small improvements they have made up to that point. Caring for Stroke Survivors |

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Forming a Partnership

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t’s important for you to think about why you’re choosing to care for a stroke survivor. You may be an adult child returning the care your parents gave you. Or you may be extending the love and dedication of a long marriage. There may be other reasons. No matter the reason, don’t be afraid to talk about why you became a caregiver. Sharing your emotions with family and friends takes good communication skills. What we choose to say—or not to say—affects our relationships. Good communication can be defined as telling other people how you feel in a way that they understand. Communication is also a two-way street. It involves both talking and listening.

Don’t Be Shy Whether speaking to the survivor or other family members, talk frankly about what you need. Then let your loved one do the same. Hear each other out. You both need to express your concerns. Over time, needs can change. An honest interchange of thoughts, feelings and concerns allows the two of you to come to respectful agreement. It also may bring you closer together.

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Important points to remember about communication: • Sometimes the hardest person to communicate with is the one we care about the most. • Each person has a unique communication style. That style can either improve or inhibit your ability to “give voice” to emotions you’re feeling. • Good communication involves active listening. That means repeating and clarifying what you’ve heard. This lets the other person know that you’ve understood them correctly. • Only 7 percent of communication is words. The rest comes through tone of voice (20 percent), facial expression (23 percent) and body position (50 percent). • Watch for a “conspiracy of silence.” This happens when survivors or family members put out a false image that everything is “all right.” Silence strengthens the negative emotions that are being hidden.

Accept Your Limitations The better you understand the needs of your loved one, the less stressful caring for them will be. Understanding the effects of the stroke helps you decide the type of help you will need from others. Some areas where you will likely need more information include: • Dealing with emotional and behavioral changes that result from stroke • Support in activities of daily living, including the physical aspects of care

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Get Dialed In While your loved one is still in the hospital or in rehab, find time, or enlist the help of others, in taking care of some immediate and important matters discussed on these pages.

The Stroke Warmline 1-888-4-STROKE (1-888-478-7653): Learning about a stroke can help you understand and deal with your situation better. Calling the American Stroke Association’s Stroke Family Warmline lets you speak directly with a stroke survivor or caregiver who knows what you’re going through. You can also ask them about stroke support groups that may be in your area.

Your Friends: Reaching out to friends and others is important. Other people caring can be important support as you share your feelings, whether sadness or joy, triumph or defeat. And the better your friends understand your situation, the more likely they are to be able to lend a hand when it’s needed.

The Insurance Company: Get the name and DIRECT phone number of a caseworker you can call regularly. This person may become one of your most important resources.

The Stroke Survivor’s Employer: Speak to your loved one’s immediate supervisor and to the head of Human Resources. Discuss long-term disability, sick leave and Social Security disability.

A Social Worker or Patient Advocate: Ask your healthcare provider if it’s possible to speak to a social worker. Such a person can help to identify local, state and federal programs and services that you may qualify for. A social worker can also prove very helpful in many other situations that may be overlooked.

Social Security Office: Look in the phone book for the phone number of the local Social Security office. Or, look up Social Security online at www.ssa.gov. Find out what benefits are available and how to apply for them. Apply for benefits as soon as possible, because the approval process takes time. If your situation improves before benefits begin, you can withdraw your application. If possible, discuss this with your medical social worker before you call. He or she may be able to guide you through the process.

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Classes for Caregivers Excerpted from “Classes for Caregivers” by Jon Caswell, Stroke Connection® magazine, November/December 2010.

uniform program or curriculum. To find an When suddenly thrust into the role of Area Agency on Aging office near you, visit caring for a loved one after stroke, most eldercare.gov. This website is run by the caregivers receive little or no training that AoA and is valuable for caregivers because isn’t “on the job.” Stroke-specific training for caregivers is rare, it is a conduit to although some larger many other helpful rehab centers are resources. Unless you’re a nurse, beginning to provide In addition, each some training to family nutritionist, physical state has programs caregivers with for the disabled that therapist, occupational therapists before can provide options discharging survivors. therapist, psychologist to assist caregivers. Dr. David Coon is Where to and cheerleader, you a geropsychologist Get Training (focused on midprobably don’t have Finding caregiver training life and aging) and locally can be hit or miss. all the training you a professor at the A good place to start College of Nursing could use as a stroke is with your local Area and Health Agency on Aging. There family caregiver. Innovation at are 659 of these Arizona State agencies across the University. He country; they are funded studies the effects of caregiving on caregivers, by the federal Administration of Aging (AoA). particularly in those caring for dementia Local agencies are tasked with providing patients. “Some of these programs provide support to family caregivers through programs basic information,” Dr. Coon said. that include information, assistance, “Others teach skills for living that are very education, case management, resources, useful, e.g., stress reduction and better and respite and day care services. All local communication with family and patient. agencies are supposed to offer caregiver Learning stress management and how to training, but there is no

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infuse pleasant events into your life has a huge impact on quality of life. Some programs are support-driven, while others are educational. Different programs appeal to different people and help meet caregivers’ varied needs.” More programs are being developed, but what is available varies from region to region. Finding all that is available in a given locale will likely take some determination. Dr. Coon also suggests checking with nonprofits like the National Family Caregivers Association, the National Alliance for Caregiving and the Family Caregiving Alliance (see page 30 for more information about these groups). Programs vary by age and type of impairment. “You may have to call several places before you find someone that can address your concern,” Dr. Coon said. “You may have to be referred by a professional to get certain services or have to meet someone who can authorize you for services. If you don’t have a clue about where to go, ask your healthcare provider, therapist, social worker, support group leader or another family caregiver about information sources and services.”

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Practicing Self-Care Excerpted from “Message to Caregivers: Ask for and Accept Help.” Stroke Connection® magazine, November/December 2005.

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oping with your emotional reactions to caregiving is crucial. It will help you become a healthier caregiver and provide better support for your stroke survivor. The following pages discuss techniques for coping with your emotional reactions to caregiving.

Taking One Day at a Time

Caregivers often feel one or more of these emotional reactions:

Taking Breaks

• Anxiety • Guilt • Depression • Frustration

• Resentment • Impatience • Fear

Accepting Help Sometimes it’s hard to ask for help. But learning to say “yes” when someone offers help is a gift you can give to both yourself and them. It’s simple: People feel good doing something nice for someone else. Don’t get caught in the common trap of thinking you should handle everything yourself. In fact, taking breaks and accepting support are essential. They reduce burnout and help you to be more patient. Over time, help from others may even prevent early placement of your loved one in an outside facility.

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Stroke recovery is very unpredictable and varies with each person. Try to take life one day at a time. Feel joy in each moment of progress, and know that there is always room for hope.

Sometimes your needs and what you believe to be the survivor’s needs conflict. This is especially true when a caregiver feels the effects of caregiving’s emotional roller-coaster ride and the stress from the demands of caring for a loved one’s health. It’s important to put the needs of others on the back burner sometimes in order to take care of you. Take 10 to 15 minutes each day to remember your own needs. Make sure your own goals are being met. • Take a trip to the spa • Listen to music • Exercise • Go shopping

• Visit with friends • Watch TV • Read a book • Watch a sports event


Vacations Are Not a Thing of the Past A lot of caregivers make the mistake of not taking time away. You aren’t failing as a caregiver just because you take some time off. Hospitals and nursing homes sometimes offer respite care for short periods (up to a week). Local colleges, places of worship and senior centers may also offer help. Your social worker can help you find programs in your area.

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Understanding

Financial Issues

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roviding care for someone who has had a stroke may be hard on your wallet. There are direct and indirect costs, which make it important to plan as well as you can. Consider your options based on the costs of various forms of care. Some things to keep in mind: • Lost income, benefits and pensions if the survivor can’t return to work. • Costs of adapting your home with ramps or other aids. • Medical costs, including visiting nurses, doctors, medical insurance, occupational and physical therapists, medications and special equipment. • The cost of nonmedical assistance such as someone to clean, help with personal care and provide respite or day care.

Money Matters Take the time to do the reading, writing and arithmetic. From financial assistance to home care to respite care, the resources below will help you make the most of the situation. Be sure to speak with your medical social worker. He or she will have more information about programs and services you’re eligible for.

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Financial Planning and Assistance AARP Tax-Aide 1-888-OUR-AARP (888-687-2277) www.aarp.org/money/taxaide AARP Money Management Program 1-888-OUR-AARP (888-687-2277) www.aarpmmp.org Financial Planning Association 800-322-4237 www.fpanet.org/public/tools/healthcare.cfm

Medicare and Medicaid Assistance The Centers for Medicare and Medicaid Assistance (CMS) 877-267-2323 www.cms.hhs.gov Medicare Rights Center 888-HMO-9050 (888-466-9050) www.medicarerights.org

Health Insurance and Benefits Resources BenefitsCheckUp and BenefitsCheckUpRx www.benefitscheckup.org HealthInsurance.com 888-969-1020 www.healthinsurance.com National Insurance Consumer Helpline 800-942-4242


Patient Advocates American Health Care Association 202-842-4444 www.ahca.org Hill-Burton Free Medical Care Program 800-638-0742 www.hrsa.gov/hillburton Patient Advocate Foundation 800-532-5274 www.patientadvocate.org

Cutting Prescription Costs NeedyMeds www.needymeds.org RxAssist 401-729-3284 www.rxassist.org Medicare www.medicare.gov Free Medicine Foundation 573-996-3333 www.freemedicine.com Partnership for Prescription Assistance 888-4PPA-NOW (888-477-2669) www.pparx.org

Some Final Money-Saving Tips • Take advantage of credit protection programs on your credit cards. • Review your insurance policies for ways to cash in. • Explore the option of reverse mortgaging. • Assess the size and cost of owning and operating your current vehicle. • Research lower insurance rates. • Plan your food expenses in advance, using coupons and stocking up on sale items you consistently use. • Eliminate unnecessary expenses such as entertainment and eating out. • Buy used instead of new. Consider resell Web sites such as eBay or craigslist.org.

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Information Resources

The American Stroke Association is dedicated to providing education and resources to stroke survivors and their families. Below are some of the programs, products and services that can help you make the “stroke connection.” You can find out more about these and other offerings by calling 1-888-4-STROKE (888-478-7653) or visiting strokeassociation.org.

Stroke Connection Magazine As you read this booklet, you may have noticed several excerpts and articles from past issues of the American Stroke Association’s Stroke Connection magazine. Stroke Connection is a free periodical for stroke survivors and their family caregivers that brings information and inspiration directly to you every two months. Every issue focuses on maximizing independence and quality of life after a stroke and on helping you know that you are not alone in your recovery journey. Sign up for either our interactive eZine or printed version today by visiting strokeassociation.org/strokeconnection. You can also follow Stroke Connection on Facebook and connect with other stroke families there: www.facebook.com/ strokeconnectionmag.

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Additional Resources American Psychiatric Association www.healthyminds.org

Eldercare Locator 1-800-677-1116 www.eldercare.gov

Family Caregiver Alliance 1-800-445-8106 www.caregiver.org

International Foundation for Research and Education on Depression 1-800-789-2647 www.ifred.org

National Stroke Group Registry Support groups can be a very useful service for stroke survivors and their families. Tap into our registry of almost 1,700 support groups by going online at strokeassociation.org/strokegroup and entering your zip code and a mileage radius to find registered stroke groups near you. Or call 1-888-4-STROKE (1-888-478-7653) to find a group near you.

National Aphasia Association

American Stroke Association Warmline Stroke survivors and caregivers can get support and ask questions of others who have been affected by stroke. The Warmline, which is staffed by stroke survivors and caregivers, can be accessed by calling 1-888-4-STROKE (1-888-478-7653). Trained staff can answer questions, just listen or provide information on local support groups.

National Institute of Neurological Disorders and Stroke

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1-800-922-4622 www.aphasia.org

National Family Caregivers Association 1-800-896-3650 www.thefamilycaregiver.org

National Institute of Mental Health 1-866-615-6464 www.nimh.nih.gov

1-800-352-9424 www.ninds.nih.gov

National Rehabilitation Information Center 1-800-346-2742 www.naric.com


For More Information We have many educational booklets to help you and your loved ones recover after stroke. Titles include Changes in Behavior and Emotions After Stroke, Communication Challenges After Stroke, Living with Disability After Stroke and Preventing Another Stroke.

To learn more about these and other stroke-related topics, call us toll-free at 1-888-4-STROKE (1-888-478-7653) or visit us online at strokeassociation.org.

Knowledge is power, so Learn and Live!

Stroke Warning Signs •  Sudden numbness or weakness of the face, arm or leg, ­especially on one side of the body •  Sudden confusion, or trouble speaking or understanding •  Sudden trouble seeing in one or both eyes •  Sudden trouble walking, dizziness or loss of balance or ­coordination •  Sudden, severe headache with no known cause

If you or someone with you has one or more of these signs, don’t delay! Immediately call 9-1-1 or your emergency response number so an ambulance (ideally with advanced life support) can be sent for you. Also, check the time so you’ll know when the first symptoms appeared. It’s very important to take immediate action. If given within three hours of the start of symptoms, a clot-busting drug can reduce long-term disability for the most common type of stroke.

Heart Attack Warning Signs Some heart attacks are sudden and intense, but most of them start slowly, with mild pain or discomfort. Here are some of the signs that can mean a heart attack is ­happening. •  Chest discomfort. Most heart attacks involve discomfort in the ­center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable ­pressure, ­squeezing, ­fullness or pain. •  Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or ­stomach. •  Shortness of breath. This may occur with or without chest discomfort.

•  Other signs. These may include breaking out in a cold sweat, n­ ausea or lightheadedness. As with men, women’s most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting and back or jaw pain. If you or someone you’re with has any of these symptoms, immediately call 9-1-1 or your emergency response number. Don’t wait longer than five minutes before calling for help. You need to get to a ­hospital right away. (Calling 9-1-1 is almost always the fastest way to get l­ifesaving ­treatment.)

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For heart- or risk-related information, call the American Heart Association at 1-800-AHA-USA1 (1-800-242-8721) or visit us online at heart.org. For stroke information, call our American Stroke Association at 1-888-4-STROKE (1-888-478-7653), or visit strokeassociation.org. For information on life after stroke, call and ask for the Stroke Family Support Network.

The statistics in this brochure were up to date at 足publication. For the l足atest 足statistics, see the Heart Disease and Stroke Statistics Update at heart.org/statistics.

National Center 7272 Greenville Avenue Dallas, Texas 75231-4596

息 2012, American Heart Association. All Rights Reserved. Printed in the USA.

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