Top Things to Know: Improving Access to Stroke Rehabilitation & Recovery
Published: July 31, 2025
- The symptoms of stroke can occur within minutes, but the impact of stroke on the patient, their caregivers, their community and the public at-large can be long-lasting. Advancements in stroke treatment over the past several decades have resulted in decreased mortality and an increase in the number of stroke survivors living with functional impairment.
- Systems of care designed to promote stroke recovery through the provision of rehabilitation in the United States are inadequate, leading to large gaps in care and health inequities, particularly affecting rural populations and under-resourced racial and ethnic groups.
- In the United States (U.S.), stroke is one of the most expensive medical conditions covered by Medicare. Forecasting the economic burden of cardiovascular disease and stroke in the US through 2050, annual inflation-adjusted health care costs are expected to triple between 2020 and 2050, from $400 billion to $1.3 trillion. Stroke is projected to account for the largest absolute increase in costs.
- While the AHA/ASA Guideline for Adult Stroke Rehabilitation and Recovery indicate discharge destination and rehabilitation access should be solely driven by the stroke survivor’s needs, numerous studies demonstrate that a variety of factors determine access to post-acute rehabilitation, including geographic region, insurance type, regional penetration of Medicare Advantage and Accountable Care Organizations, the characteristics of the acute care hospital (i.e., for profit, non-profit, safety net), regional availability of inpatient rehabilitation facilities and skilled nursing facilities, home health, and outpatient therapy services.
- The goals of this policy statement are to identify key public policy levers to improve access to stroke rehabilitation and improve patient health outcomes.
- This paper also identifies key evidence gaps regarding successful, equitable, and cost-effective stroke rehabilitation care to continue to improve stroke rehabilitation access.
- The statement also describes the importance of developing and implementing performance measures that incentivize optimal patient care and improve stroke rehabilitation access.
- The acute care environment provides a prime opportunity to optimize a stroke survivor’s readiness and discharge to the most appropriate post-acute-care setting. As such, it is expected that acute care providers consult physical therapy (PT), occupational therapy (OT), speech and language pathology (SLP), and rehabilitation specialists early in the hospital course to assist with evaluation, management, and assistance with determining the appropriate disposition plan, coordinating with family and caregivers.
- Geographic, racial and socioeconomic disparities continue to have a negative impact on the full spectrum of stroke care in the United States.
- Access to equitable, high quality stroke rehabilitation care that is based on the patient’s functional impairments and needs that are designed to prevent complications of stroke, facilitate recovery, and limit disability should be a requirement for all stroke survivors in the United States. To facilitate a paradigm shift, there is a need for greater clarity in the referral process, collaboration with stroke survivors, caregivers, clinicians, health systems and insurers to create truly patient-centered models of care, and greater use of research to inform health policy and practice.
Citation
Ifejika NL, Awosika OO, Black T, Duncan PW, Harvey RL, Katz DI, Kimberley TJ, Lutz B, O’Neil F, Stein J, Yallapragada AV, Reeves MJ. Improving access to stroke rehabilitation and recovery: a policy statement from the American Heart Association/American Stroke Association. Stroke. Published online July 31, 2025. doi: 10.1161/STR.0000000000000493