ModuleFallsMental health
Persona: Social workers/case managers — stroke discharge planning + social determinants
Care coordination module: discharge destination options, caregiver capacity assessment, equipment/home safety coordination, insurance/benefits navigation, and SDOH screening themes
ClinicianClinicianIntermediate25 minClinical (pro)
Educational only
Educational only — eligibility criteria and local resources vary.
Get help now
If there is immediate danger (unsafe home situation, abuse risk, suicidal ideation, or acute neurologic decline): activate local emergency/social work escalation pathways immediately per policy.
What you'll learn
- Compare discharge settings (IRF/SNF/home health/outpatient)
- Assess caregiver capacity and burnout risk
- Identify core SDOH barriers impacting recovery
- Build a practical resource/referral plan
Discharge settings
- IRF vs SNF vs home
- Eligibility themes (concept)
- Tradeoffs: intensity vs access
Caregiver capacity
- Who can help?
- Training needs
- Respite planning
Home + equipment coordination
- Safety plan
- Transport
- DME documentation
SDOH screening themes
- Housing
- Food access
- Transport
- Language access
- Costs
Resource plan
- Stroke support groups
- Community services
- Financial assistance pathways
Practice check
Check your understanding
A few untimed questions. Pick an answer to see instant feedback, then continue to the next lesson.
0 of 2 answered
References
- World Stroke OrganizationGlobal Stroke Services Guideline / Action Plan (Roadmap)