When brain cells are damaged or die, the body parts controlled by those cells don't work like they did before. The loss of function may be mild or severe. It could be short-term or permanent. How well your loved one recovers depends on how much of the brain is damaged, where the damage is, and how fast the blood supply returns to the damaged cells.

Many people who have a stroke recover. But a stroke can cause very serious problems. Of the people who survive a stroke, 15 to 30 out of 100 will have a permanent loss of some function, and 20 out of 100 will need long-term care within 3 months of the stroke.¹

Your ability to care for a loved one at home will depend on his or her level of disability, your health, and the amount of support that you have from family members or outside help.

After a stroke, your loved one may have trouble with:

• Movement. Your loved one may not be able to walk or to use his or her arms. This is usually because of weakness or paralysis on one side of the body.
• Speech and language. Your loved one may not be able to speak, read, or write. Also, he or she may not be able to understand what someone else is saying.
• Thinking and reasoning. He or she may not be able to think clearly. The stroke may cause changes in behavior.
• Senses. Your loved one may not be able to feel when something or someone touches parts of his or her body, such as the arms or legs.

It could take a long time for your loved one to regain speech and other skills. And some skills may not come back completely.

Many people who have a stroke will have some long-term problems with talking, understanding, and decision-making. They also may have behavior problems that affect their relationships with family and friends. They may need help learning how to act in social situations.

Your loved one could have other problems that happen right away or within months to years after a stroke. They include:

• Weight loss, if the person has trouble swallowing and does not eat well.
• Seizures.
• Skin sores (pressure sores) or blood clots within deep veins if the person sits or lies in one position for a long time.
• Shoulder pain.
• A stiff joint that cannot be straightened if the person holds the affected arm or leg in the same position for a long time.
• Depression.
• Infection, especially pneumonia or a urinary tract infection.
• Tight muscles and muscle spasms in the affected arm or leg.

People who have had a stroke may act differently than they did before. They may be slow, cautious, and disorganized when they do unfamiliar activities. They may seem anxious.

The level of care and help your loved one needs may increase if his or her condition gets worse. Basic activities like eating, dressing, bathing, using the bathroom, and simply moving around may be harder or impossible for the person to do alone.

Taking care of your loved one at home may get too hard for you, both physically and emotionally.

"Nursing home" is a phrase commonly used to refer to any long-term care center, but there are several kinds of long-term care. Each provides different levels of medical care, personal assistance, and programs and support services. The quality and costs of care and services at long-term care facilities vary widely, and options vary from community to community.

• Assisted living usually provides private, apartment-style housing and offers a range of services. These services may include meals, cleaning and laundry services, and help with personal needs such as bathing, grooming, and dressing. Assisted-living centers do not provide medical care. This type of housing may be a good choice for people who can't live alone but who can still take care of themselves safely.
• Residential care—which includes board-and-care homes, retirement homes, and foster-care homes—usually provides a greater level of supervision than assisted living. These centers offer community-style housing, meals, laundry and cleaning services, and help with other personal needs. They do not provide daily medical care. Residential care may work well for a person who needs daily help and supervision but does not need nursing care. These centers don't cost as much as nursing homes.
• Nursing homes can provide skilled nursing care up to 24 hours a day. All aspects of care are provided, including medical attention, medicine, housing, meals, laundry, help with personal needs (such as dressing, bathing, and using the toilet), and other support services. This is the most costly type of care in a center. But it may be the best choice for many people who have a lot of trouble with daily tasks and need medical care.
• Continuing-care communities offer several levels of care. They offer assisted living up to full nursing care in the same place. These centers cost a lot. But they may be a good choice, because they can meet the person's changing needs.

Some people find that part-time help allows them to keep their loved one at home for a longer time. Part-time care may take place either at home or in an adult day care.

As in long-term care centers, home care can provide whatever help a person needs. For example, a home health aide can help the person bathe and wash clothes and linens. A nurse can give medical care.

Adult day care and respite services take care of the person so that the regular caregiver can take a break. This may relieve some of the stress of caregiving.

Your loved one's doctor may suggest long-term care if:

• Your loved one's health gets worse, and he or she needs more care than you can give.
• Your loved one has several health problems that require skilled nursing care.
• Your own health is at risk, or you could get injured from caring for your loved one (such as from lifting).
• Long-term care may offer a safer, more controlled situation.