The short answer
- The therapists set the plan, and you carry it through the weekPhysiotherapists, occupational therapists and speech and language therapists decide how your client moves, eats and practises. Your job is to follow what they set on every visit and pass on what you notice.
- Handle the weak side only the way you were shownTransfers, the number of people needed and the way the weak arm is supported are therapy decisions. Ask to be shown before you do any of them.
- Food and drink go to the level written downIf a speech and language therapist has set a texture or a drink thickness, make it to that level every time. Coughing or a wet voice at meals is a reason to call the GP the same day.
- Face, arms and speech: call 999If the signs of a stroke appear, even for a few minutes before they pass, the NHS says to call 999 straight away. Do not wait to see whether they go.
Checked against NICE guideline NG236, NHS and Stroke Association guidance, 22 September 2026. This is general information for carers, not clinical advice about any one client.
Who decides what
The therapists decide the plan, and you carry it through the rest of the week
Stroke recovery at home is led by the NHS. A physiotherapist, an occupational therapist and a speech and language therapist assess your client, set goals with them and decide how the work is done. A self-employed carer does not replace any of them. What you do is follow their plan in the hours they are not there, which is most of the week.
Moving and positioning
Who decides
The physiotherapist and occupational therapist: how each transfer is done, how many people it takes, which equipment is used and how the weak arm is supported.
What you do on each visit
Follow the method you were shown, support the weak arm the way the therapist set, and let your client do the parts of each move they can.
Pass it on the same day if
There is new or worse pain in the shoulder, a fall or a near miss, or a transfer no longer feels safe done the way it was set.
Communication
Who decides
The speech and language therapist: what kind of difficulty it is, and which strategies, charts or apps suit your client.
What you do on each visit
Talk in a quiet room, give time for an answer, use the aids that were left, and keep your client in every conversation about them.
Pass it on the same day if
Your client is withdrawing, has stopped trying to communicate, or seems anxious or low about it.
Eating, drinking and mouth care
Who decides
A dysphagia-trained professional, usually the speech and language therapist: food texture, drink thickness, position and how food is served.
What you do on each visit
Make food and drinks to the level written down, sit your client as advised, and help with mouth care if they cannot manage it alone.
Pass it on the same day if
They cough or choke when eating or drinking, have a wet or gurgly voice afterwards, or keep getting chest infections.
Fatigue
Who decides
The GP or therapist, who can check whether medication or an infection is part of the cause.
What you do on each visit
Plan the visit around your client’s energy, with rests between tasks and the exercises at the time of day they manage best.
Pass it on the same day if
The tiredness is new, getting worse, or stopping your client from doing the programme the therapists set.
Mood and behaviour
Who decides
The GP and the stroke team, who assess emotional changes, mood and how your client is coping.
What you do on each visit
Notice what is normal for your client, listen, and do not take irritability or tears as being about you.
Pass it on the same day if
Low mood lasts most of the time over several weeks, or your client talks about not wanting to go on living.
Drawn from NICE guideline NG236, the NHS and the Stroke Association. Signs of a new stroke are a 999 call, not something to pass on later.
The NICE guideline on stroke rehabilitation, NG236, recommends needs-based rehabilitation of at least 3 hours a day on at least 5 days a week where the person can take part. It also recommends that family members and carers who are willing and able to help are offered training, for example in moving somebody and helping them to dress, and that families and carers are involved in rehabilitation sessions when appropriate. That training is aimed at the people around the patient, so it is reasonable to ask for it.
In practice, the first thing to do with a new stroke client is to find out who is on their team and what they have set. Ask your client and the family for the discharge plan and any written exercise sheets, eating and drinking instructions or communication advice. If a therapist is due while you are there, ask your client whether you can sit in. Seeing how a transfer is done once is worth more than any description of it.
The contract between you and your client matters here too. Under the contract between each client and carer, the client agrees to tell you in advance about known risks, including mobility, handling needs and cognitive impairment, and to update you when things change. You agree not to take on work you feel unqualified to do, and to tell the client so other arrangements can be made. The client also agrees not to pressure you into anything you feel unable to do safely. So if a task is beyond what you have been shown, saying no and explaining why is part of the agreement.
Families have been told much of this already. What families are told about stroke recovery care and what families are told about rehab at home show the picture they are working from, which helps when you agree the visits with them. The rest of the guides for working carers are on carer resources.
Positioning and transfers
Moving a client with one weak side, the way the therapist set it
A stroke often leaves one side of the body weak, numb or stiff, and that changes every move between the bed, a chair, the toilet and the car. The therapists decide how each move is done and what equipment it needs. Your part is to do it their way each time and to notice when it stops working.
What to do
- Ask the physiotherapist or occupational therapist to show you each transfer before you do it alone
- Support the weak arm on a pillow or support in the position the therapist showed you
- Use the equipment that was prescribed, in the way it was demonstrated
- Give your client time to do the parts of each move they can manage
- Write down any fall, near miss or new pain, and tell the family the same day
What to avoid
- Pulling on the weak arm or lifting through it to help somebody up
- Taking on a transfer the plan says needs two people when you are alone
- Putting a sling, splint or strapping on differently from the way you were taught
- Changing how a move is done because it would be quicker for you
The shoulder on the weak side needs particular care. The Stroke Association explains that when the arm muscles are weak, the weight of the arm can strain the joint and lead to pain, and that correct positioning helps reduce that strain. It says a therapist will make sure anyone who handles the arm knows how to do it without straining the shoulder. NICE recommends that people at risk of shoulder pain, and their families and carers, are told how to prevent it. If you have not been shown, ask before you handle the arm at all.
NICE also recommends that people with a splint, and their families and carers, are taught how to put it on and take it off, how to care for it and how to watch for redness and skin breakdown. If your client has one, that is part of what to ask about on the first visit.
The general rules on lifting, equipment and your own back are in moving and handling when working for private clients. What families are told about transfers with one-sided weakness sets out the four transfers from their side, which helps when a family asks why you are doing a move a particular way.
Communication
Talking with a client who has aphasia
The Stroke Association says around one in three people in the UK have aphasia after a stroke. It affects language, so your client may find it hard to speak, understand, read, write or use numbers, while still thinking as they always did. Other problems, such as weak speech muscles, can make speech slurred or hard to follow.
Before and during a conversation
0 of 9 ticked
Before you start
While you talk
That list follows the Stroke Association's tips for aiding communication, which also say that people with communication problems often feel invisible. Talking over your client to the family, or answering for them, is the habit to avoid. The NHS page on aphasia adds that speech and language therapy usually involves the people around the person, including anyone who helps care for them, and that aphasia can bring anxiety, low mood and isolation.
NICE says speech and language therapists should coach the people around the person, including carers, in supportive ways of communicating. If you see your client regularly, ask the therapist what they want you to practise and what to avoid, and write it down where the family and any other carer can see it.
Aphasia also affects decisions. Your client may understand a choice perfectly well and be unable to tell you in words. Take the time to find out what they want before assuming they cannot decide. Mental capacity: MCA and DoLS explains how capacity is assessed when there is doubt. What families are told about aphasia and communication covers the kinds of aphasia and the therapy in more depth.
Eating and swallowing
Eating, drinking and mouth care when the swallow is affected
Swallowing problems, called dysphagia, are very common after a stroke. The Stroke Association explains that food, drink or saliva can go into the airway and lungs, which can lead to pneumonia. A dysphagia-trained professional decides how your client eats and drinks, and your part is to follow it at every meal.
Signs to watch at and after meals
| What you might see | What to do | |
|---|---|---|
| At the table | Coughing or choking while eating or drinking, food or drink going down the wrong way, or a meal taking much longer than it used to. | Stop the meal and tell the family. The NHS says to ask for an urgent GP appointment or call 111 if somebody coughs or chokes when eating or drinking. |
| After a meal | A wet or gurgly voice, shortness of breath, or a feeling that food is stuck in the throat. | The same: ask for an urgent GP appointment or use 111, and note what was eaten and how it was prepared. |
| Over the weeks | Weight loss, signs of dehydration, or repeated chest infections. | Keep a simple record of what is eaten and drunk and share it with the family, so the GP or therapist can see the pattern. |
| Every day | Food or drink left in the mouth after swallowing, or a client who cannot manage their own mouth care. | Help with mouth care as you have been shown. NICE says good mouth care reduces the risk of aspiration pneumonia in people with dysphagia. |
At the table
- What you might see
- Coughing or choking while eating or drinking, food or drink going down the wrong way, or a meal taking much longer than it used to.
- What to do
- Stop the meal and tell the family. The NHS says to ask for an urgent GP appointment or call 111 if somebody coughs or chokes when eating or drinking.
After a meal
- What you might see
- A wet or gurgly voice, shortness of breath, or a feeling that food is stuck in the throat.
- What to do
- The same: ask for an urgent GP appointment or use 111, and note what was eaten and how it was prepared.
Over the weeks
- What you might see
- Weight loss, signs of dehydration, or repeated chest infections.
- What to do
- Keep a simple record of what is eaten and drunk and share it with the family, so the GP or therapist can see the pattern.
Every day
- What you might see
- Food or drink left in the mouth after swallowing, or a client who cannot manage their own mouth care.
- What to do
- Help with mouth care as you have been shown. NICE says good mouth care reduces the risk of aspiration pneumonia in people with dysphagia.
From the NHS page on dysphagia, the Stroke Association's guide to swallowing problems and NICE NG236. If your client is choking and cannot breathe, call 999.
NICE lists what a dysphagia-trained professional may advise: changing the person's position, taking small sips or thickened drinks, changing the texture of food, serving food differently, for example with different cutlery, and specific swallowing techniques. Whatever has been set for your client is written down for a reason. If your client asks for a thinner drink or a food off their list, explain that the level was set by the therapist and pass the request on, rather than deciding it between you. NICE also says families and carers should be given information on how to help someone who is coughing or choking while eating or drinking, so ask the team for it if nobody has offered.
Tablets can be part of this. NICE says that when somebody with dysphagia cannot take tablets, the medication should be reviewed, and its form or the way it is given changed if it is still needed. If your client struggles to swallow tablets, tell the family so the prescriber can review them, rather than changing how they are given yourself. Helping with medication as a carer covers what you can and cannot do.
The food itself is covered in delivering good food and nutrition as a carer, including the IDDSI levels used to describe texture-modified food and drink. What families are told about dysphagia diets explains each level from the family's side.
Fatigue and mood
Fatigue, mood and changes in personality
The effects of a stroke that nobody can see are often the ones that shape a visit most. Fatigue, low mood and changes in how somebody reacts are common, and they affect how much your client can do and how they are with you. Knowing what they are helps you plan the visit and tell the right people.
Common effects you may see after a stroke
| What it can look like | What helps on a visit | |
|---|---|---|
| Fatigue | Tiredness that does not improve with rest, trouble thinking clearly, and needing to rest or sleep more than before. It can follow any stroke, big or small. | Space tasks out with rests between them, do the exercises when your client is freshest, and keep a note of what tires them so the pattern can be shared. |
| Emotionalism | Sudden crying, or sometimes laughing, with little warning and out of proportion to how the person feels. It is most common in the first few months. | Ask your client how they would like you to respond. The Stroke Association says some people prefer others to carry on as normal, and some find reassurance comforting. Do not assume they are upset. |
| Low mood and anxiety | Feeling sad or down most of the time, losing interest in things, avoiding people, or worrying a great deal, including about having another stroke. | Listen, keep some of each visit for things your client enjoys, and tell the family if the low mood lasts for weeks. |
| Changes in behaviour | Irritability, frustration or anger, a lack of motivation, or behaving in ways that are out of character. | The Stroke Association says damage from the stroke, pain, fatigue and frustration can all play a part. Keep the routine steady and talk to the family about what is new. |
Fatigue
- What it can look like
- Tiredness that does not improve with rest, trouble thinking clearly, and needing to rest or sleep more than before. It can follow any stroke, big or small.
- What helps on a visit
- Space tasks out with rests between them, do the exercises when your client is freshest, and keep a note of what tires them so the pattern can be shared.
Emotionalism
- What it can look like
- Sudden crying, or sometimes laughing, with little warning and out of proportion to how the person feels. It is most common in the first few months.
- What helps on a visit
- Ask your client how they would like you to respond. The Stroke Association says some people prefer others to carry on as normal, and some find reassurance comforting. Do not assume they are upset.
Low mood and anxiety
- What it can look like
- Feeling sad or down most of the time, losing interest in things, avoiding people, or worrying a great deal, including about having another stroke.
- What helps on a visit
- Listen, keep some of each visit for things your client enjoys, and tell the family if the low mood lasts for weeks.
Changes in behaviour
- What it can look like
- Irritability, frustration or anger, a lack of motivation, or behaving in ways that are out of character.
- What helps on a visit
- The Stroke Association says damage from the stroke, pain, fatigue and frustration can all play a part. Keep the routine steady and talk to the family about what is new.
From the Stroke Association's pages on fatigue, emotionalism, depression and anxiety, and emotional and behavioural changes.
The Stroke Association says fatigue is different from normal tiredness because rest does not seem to fix it, and that it can make it hard to take part in rehabilitation. It suggests speaking to the GP or therapist, who may be able to find out whether a medication or an infection is part of the cause. So tiredness that is new or getting worse is worth passing on, even if it seems to fit the stroke.
On emotionalism, the charity says about one in five people have it in the first few months, and that many find it improves or goes within six months. On depression and anxiety, it says around one in three stroke survivors will have some form of depression within the first year, and around one in four will have anxiety within five years. Depression can also appear months or years later, so a client who was coping well may not stay that way.
Working with a client whose personality has changed is also hard on the carer. The Stroke Association's helpline, on 0303 3033 100, is open Monday to Friday 9am to 5pm and Saturday 10am to 1pm and is for family, friends and carers as well as stroke survivors. Looking after yourself as a paid carer covers the rest.
Signs of another stroke
What to do if you see the signs of another stroke
The signs of a stroke can appear again in a client who is recovering from one, and a mini stroke is a warning sign that a full stroke may follow. The NHS uses the word FAST to remember the main signs, and the instruction is the same whether they last a few minutes or keep going: call 999.
- 1
Check the face, the arms and the speech
F, A, SThe face may have dropped on one side or they cannot smile. They may not be able to lift both arms and keep them up. Speech may be slurred or garbled, or they may not understand you. Other signs include sudden loss of sight, confusion, dizziness or a severe headache. - 2
Call 999 straight away
T for timeDo not wait to see whether the signs pass, and do not drive your client to A&E yourself. The NHS says that even if the symptoms stop while you wait for the ambulance, they still need to be assessed in hospital. - 3
Follow the call handler, and note what you saw
While you waitThe NHS says the person you speak to at 999 will tell you what to do. Stay with your client, and write down what you saw and when you first noticed it, so you can tell the ambulance crew and the family. - 4
Tell the family
Once help is on the wayRing the family or whoever your client has chosen to speak for them. Under the contract, sharing information needed for emergency medical care is allowed.
The NHS page on transient ischaemic attack explains that a mini stroke has the same signs as a stroke but its effects fully resolve within 24 hours, and that in the early stages nobody can tell which it is. That is why the advice is 999 either way. A mini stroke is a warning sign of a full stroke, and the NHS page on stroke symptoms says to call 999 if somebody has had signs of a stroke in the last 24 hours, even if they have stopped. If your client tells you about symptoms that came and went earlier, when nobody was there, that applies too.
If your client goes back into hospitalSection titled If%20your%20client%20goes%20back%20into%20hospital
An unplanned admission affects your booked visits. Under the contract, a visit the client cancels is payable in full, except for unplanned hospitalisation, illness or another reason you and the client agree, and you can waive part or all of a fee if you choose. Notice to end the arrangement is 48 hours for hourly care, and 7 days for live-in once you have worked 168 hours, with 48 hours before that. When a client cancels or goes into hospital sets out what that means for your pay and how to plan for the gap. If the family is thinking about live-in care after discharge, what families are told about live-in care after a stroke shows how they are weighing it up.
If this is work you already do well, you can register as a carer on PrimeCarers and describe your stroke experience on your profile in your own words, or see the carer jobs open near you first. PrimeCarers does not verify qualifications or training, so families read what you write and ask you about it. Writing a carer profile that gets hired covers how to set it out.
Questions
Questions carers ask about stroke clients
Yes, if the physiotherapist has shown you how and your client wants to do them. NICE recommends that families and carers are involved in rehabilitation and offered training in things like moving and dressing. Ask to see the exercises done, keep to what is written down, and do not add exercises of your own.
No qualification is required by law before you start paid care work in England. Ask the community stroke team to show you the transfers, positioning and eating plan for your client, since NICE recommends training for carers who are willing and able to help. PrimeCarers does not verify qualifications or training: describe what you have done on your profile and families can ask you about it.
Call 999 anyway. The NHS says that in the early stages nobody can tell a mini stroke from a full stroke, and that even if symptoms stop while you wait, the person still needs to be assessed in hospital. If your client mentions symptoms that came and went earlier, the NHS says to call 999 for signs within the last 24 hours.
It may be emotionalism, which the Stroke Association says affects about one in five people in the first few months after a stroke and often improves within six months. Ask your client how they would like you to respond, and mention it to the family so the GP knows. Crying that comes with low mood most of the time over weeks may be depression, which is worth raising the same day.
Not if a speech and language therapist has set a drink thickness or a food texture. The level is there because thinner drinks or the wrong texture can go into the airway. Explain why, and pass the request to the family or the therapist so it can be reviewed.
Under the contract between you and your client, a cancelled visit is payable in full except for unplanned hospitalisation, illness or another reason you both agree. An emergency admission is one of those exceptions. When a client cancels or goes into hospital goes through it in full.