Home Care After a Stroke: The First Six Weeks at Home

The first six weeks at home after a stroke are when rehabilitation, safety and routine matter most. Canadian stroke guidelines say community rehabilitation should ideally begin within 48 hours of leaving an acute hospital. Ontario’s publicly funded home care can supply nursing, therapy and personal support, and private hours are often used to cover what the plan does not.

Below is what to expect week by week, what Ontario funds, and what the family caregiver needs.

• How quickly rehabilitation should start
• What Ontario’s home care covers after a stroke
• The first week at home
• Weeks two to six
• What the family caregiver needs
• When to call for help
• Where private home care fits

How quickly rehabilitation should start after discharge

The Canadian Stroke Best Practice Recommendations, in their 2025 rehabilitation planning update, state that outpatient and community-based rehabilitation services “should ideally begin within 48 hours of discharge from an acute hospital (emergency department or inpatient) or within 72 hours of discharge from inpatient rehabilitation.”

They also set out what adequate rehabilitation looks like: therapy “for 60 minutes per session per required discipline, for 2 to 5 days per week,” delivered by an interdisciplinary stroke rehabilitation team with appropriate training and expertise. Where an Early Supported Discharge programme is used, the guidelines say services should be offered “five days per week at the same level of intensity as they would have received in the inpatient setting.”

Treat those numbers as a benchmark to ask about, not a promise. If nobody has contacted you within a few days of discharge, that is reasonable to chase.

What Ontario’s publicly funded home care covers after a stroke

Publicly funded home care is arranged through Ontario Health atHome. Ontario lists what can be funded:

• Professional services — nursing care, physiotherapy, occupational therapy, speech-language pathology, social work and nutrition assistance
• Personal support — help with bathing, dressing, toileting and mobility
• Homemaking — housecleaning, laundry, shopping, banking, paying bills, and planning and preparing meals

Physiotherapy, occupational therapy and speech-language pathology are all on that list, which matters after a stroke, because those three usually do the recovery work.

If a referral has not already been made from hospital, anyone can make one. Ontario Health atHome states: “Anyone can make a referral to us on your behalf and with your consent – a family doctor, friend, family member, caregiver, neighbour and even you, yourself.” The number is 1-833-515-1234. To be assessed you need to be an Ontario resident with a valid OHIP card.

If a parent is still in hospital, ask the team whether a home care referral has gone in before discharge, and who will be calling. We have set out the process in full in how to get home care in Ontario, including what to do if the plan you are offered is not enough, and what the assessment involves in what happens during a home care assessment.

The first week at home

The first week is about safety and orientation rather than progress. Expect it to be harder than the discharge conversation suggested.

• Clear the routes. Bed to bathroom, bed to kitchen, and the path taken at night. Loose rugs, trailing cords and low furniture are the usual culprits.
• Sort the medications. Know what each one is for, who gives it, and the plan if a dose is missed. Ask the pharmacist to go through the list.
• Write down every appointment and phone number in one place anyone in the house can find, including the care coordinator’s name.
• Watch for fatigue. Post-stroke tiredness is not laziness and not a bad attitude. Plan the day around one or two real activities, not a full schedule.
• Eating and swallowing. If the hospital gave instructions about food textures or thickened fluids, follow them exactly and ask for a speech-language pathologist review if anything changes.

Weeks two to six

This is where recovery either builds momentum or stalls, and the difference is usually consistency rather than effort. The guidelines describe a case coordination approach with regular team communication to review goals and plans — so if nobody seems to be holding the whole picture, ask your care coordinator who is.

• Keep the therapy going between visits. A therapist who visits twice a week is relying on the exercises being done on the other days. Ask exactly what should be practised, how often, and what counts as too much.
• Name the goals in plain terms. “Get to the bathroom without help” is a goal a whole household can work towards. “Improve mobility” is not.
• Reassess as things change. If someone is weaker than expected, or improving faster, ask the care coordinator to review the plan. Reassessment is routine, not a complaint.
• Watch mood and thinking, not just movement. The guidelines call for “ongoing surveillance of physical, psychological, social and emotional recovery, coping and adaptation following discharge.” Low mood, irritability and difficulty concentrating are things to raise with the care team, not to absorb privately.

What the family caregiver needs

Stroke recovery usually reorganises one other person’s life entirely, and that person is often not asked how they are coping.

The guidelines are direct about this. They call for “skills training appropriate to individual needs and goals – for both people with stroke and their families and informal caregivers – to facilitate safe transitions,” and for “ongoing education for people with stroke, their families and caregivers that reinforces key information and verifies understanding, regardless of setting.”

So if you are the spouse or the adult child doing the lifting, transferring, washing and medication, you are entitled to be shown how, properly, and more than once. Ask to be taught the transfer technique before discharge, and ask again at home if it is not working. Being shown once in a hospital corridor is not training.

Ask what to do on a bad night before you have one. And build in relief early rather than after you are exhausted — respite care exists for this, and a caregiver reaching breaking point is one of the most common reasons a recovery at home ends in a readmission or a move.

When to call for help

A stroke raises the risk of another one, and the signs need to be recognised by whoever is in the house.

Heart & Stroke’s guidance on the FAST signs of stroke is unambiguous about what to do: “If you experience any of these signs, call 9-1-1. Do not drive to the hospital. An ambulance will take you to the closest hospital that provides urgent stroke care.”

Learn the signs from Heart & Stroke’s signs of stroke page and put them somewhere visible. For anything that is not an emergency but worries you — a new swallowing problem, a fall, a sudden change in mood or confusion — call the care coordinator or the family doctor. They know the medical situation and this page does not.

Where private home care fits alongside a public plan

Ontario’s own guidance says it in one line: “You can also pay for your own care through private companies.” The two are not alternatives.

After a stroke the gaps are fairly predictable. Overnights, when getting to the bathroom is the risk. Weekends, when the roster thins. Supervision while the main caregiver returns to work. Continuity, so whoever supports a transfer already knows how this body moves.

Go through the public assessment even if you expect to pay privately, because the plan may cover more than you assume. And if you use both, make sure each side knows what the other is doing, so no visit is assumed to be covered when it is not.

Help Now Healthcare is a private provider with a network of over 1,000 healthcare professionals, supporting families across Ontario including Toronto, Mississauga and Ottawa. We are not part of Ontario Health atHome and cannot influence a public allocation or shorten a public waitlist. What we can do is cover the hours the plan does not.

Related reading

• Stroke recovery care at home — what our support covers
• Post-hospital and transitional care
• Personal support — bathing, dressing, mobility and daily assistance
• Where we provide care across Ontario

Frequently asked questions

A note on what this article is

This is general information about home care and rehabilitation after a stroke in Ontario. It is not clinical advice and does not replace guidance from your own doctor, nurse practitioner, therapist or care coordinator, who know the medical situation. Please bring any health question to them.

Talk to someone about care at home

If someone is coming home after a stroke and you are working out what the public plan will and will not cover, we are happy to talk it through — including if the answer is that you do not need us yet.

Book a free consultation

Or call us at 1-888-507-6236.

Sources

• Canadian Stroke Best Practices — Outpatient and community based rehabilitation, and early supported discharge (2025 update)
• Canadian Stroke Best Practices — Transitions and community participation following stroke
• Ontario — Home and community care
• Ontario Health atHome — Making a referral
• Ontario Health atHome — Getting started
• Heart & Stroke — Signs of stroke