STROKE SURVIVORS CAREGIVER ORANGE COUNTY CA, STROKE REHABILITATION ORANGE COUNTY, STROKE RECOVERY ORANGE COUNTY, Post-Stroke Rehabilitation, stroke rehabilitation

STROKE SURVIVOR CAREGIVER ORANGE COUNTY, HOME CARE
STROKE RECOVERY CARE, STROKE SURVIVOR CARE
, STROKE REHABILITATION CARE
Stroke Rehabilitation, Stroke Recovery, Respite Care, Hospice Care, In Home Care, Assisted Living, Respite, Stroke Recovery, Stroke Rehabilitation, Care Giver, Post-Stroke Rehabilitation, stroke rehabilitation, stroke, post stroke rehabilitation, stroke rehabilitation, rehabilitation, recovery from stroke, stroke therapy, stroke rehab, stroke recovery, information on stroke, stroke information, stroke rehabilitation information, stroke recovery technique, information about stroke rehabiliation, rehabilitation resources, NINDS, Orange County CA, Hoag Hospital Newport Beach, Saddleback Memorial Medical Center, Mission Viejo Hospital, Out Patient Services

(949) 859-4772
Call Today!
STROKE RECOVERY HOME CARE ABOUT STROKES OUR CAREGIVERS STROKE REHABILITATION RESPITE CARE
Stroke Survivor Services:  In Home Care • Stroke Recovery • Stroke Survivor Care • Stroke Rehabilitation • Assisted Living • Post Surgery Care

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CONTACT US:

Stroke Survivor
Care Giver

Orange County CA.com



CareWorks Health Services

23151 Moulton Parkway STE 103C
Laguna Hills, CA 92653

Phone: (949) 859-4772



Hours of Business:
24/7 Service

EMAIL:
Begin@STROKE SURVIVORS
CAREGIVER ORANGE COUNTY CA.COM

 

 

 
ARTICLES:
 
ACADEMIC:
  • GEOGRAPHIC INFORMATION:
    About Orange County
    About Corona Del Mar
    About Newport Beach
    About Laguna Woods
    About Mission Viejo
    About Laguna Hills
    About Laguna Beach
    About Laguna Niguel
    About Anahiem
    About Irvine
    About Lake Forest
    About Huntingon Beach
    About Seal Beach
    About Fullerton
    About Yorba Linda
 


About Us:

 

We provide Stroke Survivors Medical/Non-Medical Home Health Care to all age groups 24/7. Our caregivers believe in and adopt our “Caregivers Ten Commandments”, the cornerstone of success for all our “Compassionate Companions”.

We provide the most compassionate care Stroke Survivors. With our dedicated and committed professionals, our experienced team of caregivers are supported by our diligent Support Staff making them the best in the industry.

 

Geography We Cover:

 

Aliso Viejo 92656, 92698,
Anaheim 92801, 92802, 92803, 92804, 92805, 92806, 92807, 92808, 92809, 92812, 92814, 92815, 92816, 92817, 92825, 92850, 92899,
Atwood, 92811,
Brea, 92821, 92822,92823,
Buena Park, 90620 ,90621,90622, 90624, Capistrano Beach, 92624,
Corona del Mar, 92625,
Costa Mesa, 92626, 92627, 92628,
Cypress, 90630,
Dana Point, 92629,
East Irvine, 92650,
El Toro, 92609,
Foothill Ranch, 92610,
Fountain Valley, 92708, 92728,
Fullerton, 92831, 92832, 92833, 92834, 92835, 92836, 92837, 92838,
Garden Grove, 92840, 92841, 92842, 92843 ,92844, 92845, 92846,
Huntington Beach , 92605, 92615, 92646, 92647, 92648, 92649,
Irvine, 92602, 92603, 92604, 92606, 92612, 92614, 92616, 92617, 92618, 92619, 92620, 92623, 92697,
La Habra, 90631, 90632, 90633,
La Palma, 90623,
Ladera Ranch, 92694,
Laguna Beach , 92651, 92652,
Laguna Hills ,92653, 92654,92607,92677,
Laguna Woods, 92637,
Lake Forest, 92630,
Los Alamitos, 90720, 90721,
Midway City, 92655,
Mission Viejo, 92690, 92691, 92692,
Newport Beach , 92658, 92659, 92660, 92661, 92662, 92663, 92657,
Orange, 92856, 92857, 92859, 92862, 92863, 92864, 92865, 92866, 92867, 92868, 92869, Placentia, 92870, 92871,
Rancho Santa Margarita 92688,
San Clemente, 92672, 92673, 92674,
San Juan Capistrano, 92675, 92693,
Santa Ana , 92701, 92702, 92703, 92704, 92705 ,92706, 92707, 92711, 92712, 92725.92735, 92799,
Seal Beach , 90740,
Silverado 92676,
Stanton, 90680,
Sunset Beach 90742,
Surfside 90743,
Trabuco Canyon, 92678, 92679,
Tustin ,92780, 92781,92782,
Villa Park, 92861,
Westminster, 92683, 92684, 92685,
Yorba Linda, 92885, 92886, 92887

 

 

STROKE SURVIVORS CARE
ORANGE COUNTY
HOMECARE STROKE RECOVERY, CAREGIVERS FOR STROKE REHABILITATION
FREE Home Care Assesment

We are a Home Health Care Company giving
"Compassionate Care From
The Heart"

"In the United States more than 700,000 people suffer a stroke* each year, and approximately two-thirds of these individuals are stroke survivors and may require rehabilitation and care giving."

One of the primary goals of rehabilitation and care giving is to help a survivor become as independent as possible and to attain the best possible quality of life. Rehabilitation and care giving is a not "cure" the effects of stroke in that it does not reverse brain damage, however, rehabilitation and caregiving can substantially help stroke survivors achieve the best possible long-term result.

We
provide Medical/Non-Medical Home Health Care to people that suffer from Strokes. Our caregivers believe in and adopt our “Caregivers Ten Commandments”, the cornerstone of success for all our “Compassionate Companions”.

We handle all the Short and Long Term Care Insurance paperwork!

We provide the most compassionate care to individuals that specifically have Stroke Survivors. With our dedicated and committed professionals, our experienced team of caregivers are supported by our diligent Support Staff making them the best in the industry.

We take extra care to match our clients with their caregivers.
We believe it is extremely important to provide compatibility.    

CareWorks Home Health Care provides quality, loving, in-home Stroke Survivors care for families just like yours. We customize care plans that provide the right mix of services to preserve your loved ones’ independence, maintain in-home safety, and enhance quality of life including:

Care Management Services to help with coordination and assist with medication reminders, meal preparation, errands, incidental transportation, grocery shopping and recreational activities.
Stroke Recovery Personal Care for bathing, grooming, hygiene, transferring, toileting, and other needs.
Stroke Rehabilitation Specific Care provided by special caregivers through our local offices. Transportation to doctor's appointments
Stroke Survivor Post Surgery Care to provide the needed help and care after surgery for patients that have been discharge from the hospital. We care for patients that have been discharged from Hoag Hospital, Saddleback Memorial Hospital, Mission Hospital / Mission Viejo Hostpital and others.
Stroke Survivor Respite Care to give family caregivers the needed relief.
24/7 service

Our caregivers are professional and well trained. What truly sets them above other in-home caregivers is their natural gift for caring for others. They have a heart for caregiving—and CareWorks Home Health Care has the most thorough and strict screening and interviewing process. We have fully trained, experienced, and certified caregivers.

WE CARE ABOUT SAFETY
In order for our caregivers to work for CareWorks Home Health Care we require them to pass a 28 Point Background Investigation”, the strictest and most stringent in the home health care industry. The background investigation verifies from the individual’s name to some of the background points below:

Criminal Check
Education
Professional Certification
Specialized Training
Employment References
Professional and Personal References
Ability To Communicate
2 Years Minimum Verifiable Experience in Health Care Field
Ability To Communicate: in English
Clean Driving Record
TB Tested Negative
Legal to Work in US

Our in-depth background check is performed to ensure our staff’s credentials and their reputation in caring for your family member or loved one. We assure you that our caregivers will treat your senior loved one and family with the loving care they deserve.

Call Us Today (949) 859-4772

REVIEWS - TESTIMONIALS
HOMECARE STROKE RECOVERY, CAREGIVERS FOR STROKE REHABILITATION

Read what our clients are saying...

HIGHLY RECOMMEND!
“We used CareWorks Health Care service and I have to say that it was perfect. My mother received professional service, loving care, and was very comfortable with your person that came out. I would highly recommend Ann and CareWorks Health Services.” - Mike Tisherman

KNOWLEDGEABLE & COURAGEOUS!
"I have found the caregivers that work with me to be knowledgeable, courageous and professional. It is a pleasure to recommend CareWorks Healthcare." - B. Gollis

WELL-TRAINED!
"I highly recommend CareWorks Healthcare to anyone who needs a caregiver. Their caregivers have proven to be well-trained, thorough, competent, friendly and very loving with my wife."
- M. Larsen

EMPLOYEES ARE ANGELS!
"Your employees are angels on earth and words can't express the depth of our appreciation as they so lovingly cared for our mom. They will always have a special place in my heart."
- S. Reed

JUST OUTSTANDING!
“I was bedridden in the hospital for some 3 weeks and my daughter contracted for my care. You sent Mike, Zee, and Norman and the care was just outstanding. There were not enough nurses for the number of patients at the hospital but I had on site someone at all times to help…Then when I came home and needed lots of care, they came with me. 24 hours a day. Please advise Zee, Norman, and Mike how much I appreciate their great care” - Maj. General Hal Vincent, USMC Ret.

For More Reviews and Testimonials Click Here

Call Us Today (949) 859-4772

STROKE RECOVERY
HOME CARE

HOMECARE STROKE RECOVERY, CAREGIVERS FOR STROKE REHABILITATION

Stroke Survivors Home Health Care Today! There are more options than ever before...
24 HOUR CAREGIVER / HOURLY CARE / OVERNIGHT CARE

Stroke Survivors families used to think that nursing homes, assisted living communities and other care centers were the only solutions for aging loved ones when they began to change physically and cognitively. Now parkinson's sufferers and their families have choices to stay right at home.

- We take extra care to match our clients with their caregivers. We believe it is extremely important to provide compatibility.


Seeking exceptional parkinson's in-home care?

Give your love one the gift to remain in the comfort of home.

Thanks to our bonded, screened and trained Home Care Assistance caregivers, your parents will be in excellent hands. We can care for the full time or part time.

24 HOUR CARE & PART-TIME / FULL TIME CARE

24 HOUR HOME CARE
When 24 hour care is needed CareWorks Health Services will make sure that you have available the caregivers which you have selected at the scheduled times to care for your loved one.

“A caregiver is in the home providing care between 24 hours a day, and is available to assist morning, noon, and night. All caregivers are employees of CareWorks Health Services and we schedule and document each agreed upon service. 24 hour care is usually needed when the adult cannot be left unattended during the day or night, yet the client is able to sleep through most of the night. Caregivers assist with daily activities such as cooking, cleaning, laundry, and simple household chores. We also help with personal care such as bathing, dressing, personal hygiene, and incontinence care. Having a caregiver also ensures that medications are taken on time, visits to doctor are made and notes are taken so that the family and client can refer to them later. We are happy to provide transportation and assist with trips into the community as much as you would like to get out and about. It is an important part of maintaining mental health to have as normal a life as possible for both the one being cared for and the family.

Symptoms of depression can be minimized with a caregiver who can provide friendship and care daily. Historically, assisted living facilities and nursing homes have been viewed as the only choice for elderly people who need around-the-clock personal, non-medical home care. Unfortunately, neither institution can guarantee the type of consistent, compassionate, one-on-one attention your elderly loved one deserves in the familiarity and comfort of their own home. “

HOURLY CARE
Hourly care is for an individual who is able to do a few of the activities of daily living on their own but needs assistance with others. We are there to assist as needed either preparing healthy meals, bathing & dressing, toileting or incontinence care, laundry, household chores, shopping, and transportation to appointments and activities. 3 hour minimums are normal in the care industry and additional hours can be added based on need of the adult in the home. The care provided is based on the schedule of the client and can be provided from 3 hours per day to 24x7 per day.

At CareWorks Health Services we handle the business of caregiving at the best possible rate to you, and make room in your life for your life, confident that your loved one is getting the highest standard of care, and enjoying the best possible quality of life while remaining at home safely.

We handle the day to day stuff that eats family member time and can take the fun right out of living for the family member who is quite reasonably getting very tired.

We make it possible for your time with your loved one to remain about the relationship that it is, Mother-Daughter, Husband-Wife, Parent-Child…

Client and Family Support, Caregiver Training, Comprehensive National Background Checks, Drug Screening, Ongoing CHA and HHA Certification, Clean DMV Check, DMV Registration. Scheduling, At CareWorks we make sure that the caregiver has kept current on their CPR and First Aid certification. We take care of Revisions to the Schedule and maintenance of a Steady Pool of Qualified Caregivers for you to choose from. At CareWorks we hire, screen and train constantly so that when one caregiver moves on, another highly qualified caregiver is ready to serve you. We take care of scheduling, so that huge task, while approved by you, is not your headache.

Your loved one will be eating well, getting their medication correctly, getting out into the community, getting to appointments on time, getting the proper exercise, and have friends.

And you can still have a life.

At CareWorks we are available 24/7. We are always available to talk, provide relief, suggest community resources, and help you come up with ideas.

Our Work

CareWorks’s professional team has extensive experience in the health industry and is committed to be there with “Compassionate Care” during the days of need:

- We provide “Compassionate Care From The Heart”.
- We provide 24/7 medical and non-medical services.
- We provide seniors and elders with experienced, trained and screened caregivers.
- We provide patients with their own “Bill Of Rights”.
- We are an approved provider to over 50 network insurance providers and 3rd party payment sources.
- We will assist you in determining all home health care insurance benefits available.

- We are In-depth care management consultation with a specialist for elders & seniors.
- We will make a Professional assessment of the client’s situation and needs.
- We create Personalized care plans and strategies that address changes in health care or with health care providers.
- We are a Hands-on advocacy to secure entitlements and quality of care.
- We are Bonded, Licenced and Insured.
- We are localy owned and operated.


We Also Help Care for Those With:

Major Joint Procedures:

  • Knee & hip replacements
  • Hip fractures
  • Shoulder fractures
  • Broken ankles, legs, arms
  • All post orthopedic surgery
  • Osteoarthritis care
  • Disabled Adults / Children

Neurological Disorders:

  • Post-stroke
  • Post mini-stroke (ITA)

Cognitive Disorders:

  • Alzheimer’s disease
  • Dementia
  • Other memory related disorders

Cardiac Disorders:

  • Post heart attack
  • Pacemaker
  • Heart failure
  • Heart bypass surgery
  • Cardiac catheterization

Lung Disease:

  • Chronic Obstructive Pulmonary Disease (COPD)
  • Asthma
  • Pneumonia

Cancer:

  • All variations of cancer care

Endocrine and Nutritional:

  • Diabetes
  • Hypertension

Immune/Nervous System:

  • Parkinson's Disease
  • Multiple Sclerosis
  • Paralysis

Muscular Diseases:

  • Muscular Dystrophy

Conditions of Pregnancy:

  • High risk pregnancy management
  • Premature delivery

Congenital Anomalies:

  • Birth defects

- We take extra care to match our clients with their caregivers. We believe it is extremely important to provide compatibility..    

Call Us Today (949) 859-4772
or For More Information About Home Care Click Her

STROKE REHABILITATION
RESPITE CARE
HOMECARE STROKE RECOVERY, CAREGIVERS FOR STROKE REHABILITATION

RESPITE - Family... take a break from the daily routine and stress!

Respite care is the provision of short-term, temporary relief to those who are caring for family members who might otherwise require permanent placement in a facility outside the home.

Our experienced respite in-home care service comes to your home home to help. We setup a management plan with you so you are comfortable and that that we can be of service in the best possible way. For some this may include taking a break for short time, for others it may include a regular scheduled break times or full time help.

Call Us Today (949) 859-4772

ABOUT HOME CARE
HOMECARE STROKE RECOVERY, CAREGIVERS FOR STROKE REHABILITATION

Home Care, (commonly referred to as domiciliary care), is health care or supportive care provided in the patient's home by healthcare professionals (often referred to as home health care or formal care; in the United States, it is also known as skilled care) or by family and friends (also known as caregivers, primary caregiver, or voluntary caregivers who give informal care). Often, the term home care is used to distinguish non-medical care or custodial care, which is care that is provided by persons who are not nurses, doctors, or other licensed medical personnel, whereas the term home health care, refers to care that is provided by licensed personnel.

Concept

"Home care", "home health care", "in-home care" are phrases that are used interchangeably in the United States to mean any type of care given to a person in their own home. Both phrases have been used in the past interchangeably regardless of whether the person requires skilled care or not. More recently, there is a growing movement to distinguish between "home health care" meaning skilled nursing care and "home care" meaning non-medical care. In the United Kingdom, "homecare" and "domiciliary care" are the preferred expressions.

Home care aims to make it possible for people to remain at home rather than use residential, long-term, or institutional-based nursing care. Home care providers render services in the client's own home. These services may include some combination of professional health care services and life assistance services.

Professional home health services could include medical or psychological assessment, wound care, medication teaching, pain management, disease education and management, physical therapy, speech therapy, or occupational therapy.

Life assistance services include help with daily tasks such as meal preparation, medication reminders, laundry, light housekeeping, errands, shopping, transportation, and companionship.

  • Activities of daily living (ADL) refers to six activities: (bathing, dressing, transferring, using the toilet, eating, and walking) that reflect the patient's capacity for self-care.
  • Instrumental activities of daily living (IADL) refers to six daily tasks: (light housework, preparing meals, taking medications, shopping for groceries or clothes, using the telephone, and managing money) that enables the patient to live independently in the community.

While there are differences in terms used in describing aspects of home care or home health care in the United States and other areas of the world, for the most part the descriptions are very similar.

Estimates for the U.S. indicate that most home care is informal with families and friends providing a substantial amount of care. For formal care, the health care professionals most often involved are nurses followed by physical therapists and home care aides. Other health care providers include respiratory and occupational therapists, medical social workers and mental health workers. Home health care is generally paid for by Medicaid, long term insurance, or paid with the patient's own resources.

Aide worker qualifications

It is not a requirement that you have a GED or high school diploma, you will need to check with your local department of health for state requirements. Often aide workers have experience in institutional care facilities prior to a home care agency. Workers can take an examination to become a state tested Certified Nursing Assistant (CNA). Other requirements in the U.S.A. often include a background check, drug testing, and general references.

Licensure and providers by state

California IS a licensure state, mandated by Home Care Services Consumer Protection Act- AB1217

The Home Care Services Consumer Protection Act (HCSCPA) provides for the licensure and regulation of Home Care Organizations (HCOs) and the registration of Home Care Aides (HCAs), effective January 1, 2016.

Organizations: The HCSCPA requires HCOs to be licensed by the California Department of Social Services (CDSS). A HCO is an entity that arranges for home care services by an affiliated HCA to a client. This entity can be an individual who is 18 years of age or older, firm, partnership, corporation, Limited Liability Company, joint venture, association, etc. HCOs are not: home health agencies, licensed hospice agencies, licensed health facilities, In Home Supportive Services, employment agencies, community care facilities, clinics, facilities contracted through a regional center or the State Department of Development Services, alcohol or drug abuse recovery facilities, facilities with only Indian children who are eligible under the Indian Child Welfare Act.

The HCA Registry: The HCSCPA requires CDSS to establish, maintain, and continuously update a public registry of registered HCAs and HCA applicants. The HCA Registry will allow consumers to search for HCAs and view the aides name, registration number, registration status, registration expiration date, and, if applicable, the HCO to which the aide is associated.

Affiliated HCA and Independent HCAs: An affiliated HCA is employed by a HCO to provide home care services to a client and is listed on the HCA Registry. They will be required to have a background check by CDSS, tuberculosis screening and training. An affiliated HCA must be listed on the registry before providing home care services to a client. An independent HCA is not employed by a HCO; however, they have chosen to be listed on the HCA Registry and are providing home care services through a direct agreement with a client. Independent aides will be required to have a background check by CDSS.

Home Care Services: Home care services are nonmedical services and assistance provided by a registered HCA to a client who, because of advanced age or physical or mental disability cannot perform these services. These services enable the client to remain in his or her residence and include, but are not limited to, assistance with the following: - bathing - dressing - feeding - exercising - personal hygiene and grooming - transferring/ ambulating - positioning - toileting and incontinence care - making telephone calls - assisting with medication that the client self-administers - meal planning and preparation - transportation - housekeeping/ laundry - companionship - shopping for personal care items or groceries

Background Check Information: All convictions other than minor traffic violations, including misdemeanors, felonies andconvictions that occurred a long time ago require an exemption. Simply defined, an exemption is a CDSS authorized written document that "exempts" the individual from the requirement of having a criminal record clearance. However, individuals convicted of serious crimes such as robbery, sexual battery, child abuse, elder or dependent adult abuse, rape, arson or kidnapping are not eligible for an exemption. Additionally, CDSS examines arrest records to determine if there is possible danger to clients.

CDSS Responsibilities: CDSS will investigate complaints, conduct inspections of HCOs, and determine if a HCO is in compliance with the law. If so, the Department will impose fines. CDSS has the authority to revoke or suspend HCO licenses and HCA's registration for violations of the law.

Payments and Fees

  • CareWorks Health Services will provide you with Certified Health Aides (CHA), Home Health Aides ( HHA) or Companions. Our Caregivers are our employees so we take care of all employer responsibilities including payroll taxes, scheduling, hiring, staffing, extensive background checks, drug testing, and making sure that your caregivers remain up to date on training and certification.
  • For caregivers hired though agency rates are generally $22-$25.00 per hour depending on the needs of your loved one. WE have many payment options including most types of Long Term Health Care policies.
  • Live-in Aides In California a new Law AB241 outlaws live in aides in the traditional way.
  • Now 24 hour care is 24 hour care provided by more than one caregiver. With CareWorks Health Services these caregivers are approved by you and are consistent. So that the care which we provide is familiar and consistent for your loved one. Agencies' fees for non-medical home care can be reimbursed by private medical insurance. Private long-term care insurance will often reimburse policyholders for part of the cost of non-medical home care, depending upon the terms of the policies. We will work with you to make your in home health care affordable, because we are not only CareWorks Health Services, we are Affordable.

Compensation

  • 'Home Health Aides:' Caregivers working for state-licensed agencies bill at an hourly rate of about $11.00 to $25.00, depending on the state. A Home Health Aid employed by the agency is paid between $8.00 (current US minimum wage) and $12.00 or more per hour, depending on location.
  • Direct Hire Caregivers: Direct hire caregivers are either employed by home care agency or are self employed. A direct hire home care aid is paid between $19-$23/hour. Overtime rates will be 1.5X the hourly rate when a caregiver works over 9 hours in a day or 45 hours in a week. Overtime can be avoided by asking the agency to provide a few caregivers should they need more than 9 hours of assistance per day.

Recent AB241 Home Care

On January 1, 2014, passage by the California legislature of AB -241 Caregivers, Companions, and domestic workers, employed by all Agencies, or by individual clients directly, is changing the method of payment by requiring that the live in caregivers are compensated on an hourly basis rather than daily rate. Furthermore the legislation requires that the caregiver be paid overtime for all hours worked over 9 in a day or 45 in a work week. This is a mandatory law and all legally operating agencies have to comply. If you decide to employ a caregiver directly you will be classified as an employer of record and would be required to pay overtime and pay all the matching FICA, unemployment insurance and withholdings, keep appropriate records, file tax returns and submit timely payments to the State of California and IRS. Agencies (not registries) are already complying with state and federal law mandates.

California AB 241

- Effective January 1, 2014, a new law called The Domestic Worker Bill of Rights was enacted which defines domestic work as services related to the care of persons in private households or maintenance of private households or their premises.

- Domestic work occupations include caregivers of elderly persons, people with disabilities, sick or convalescing, and other household occupations, either full time or part time work.

- "Domestic work employer" includes an individual who employs or exercises control over the wages, hours, or working conditions of a domestic work employee.

- This definition confirms the private person organizing the care rather than the individual needing the care as the employer.

- Before AB241 families in need of 24 hour care would typically hire a live in caregiver. Providing room and board has traditionally been part of the caregiver's compensation in addition to an agreed upon monthly monetary payment.

- After Jan 1, 2014, the room and board portion cannot be considered part of the compensation to the caregiver for their services. Compensation/wages now are entirely an hourly calculation of at least minimum wage (currently $ 9 per hour) for every hour worked, (asleep or awake in the household).

- Now 24 hour care is 24 paid hours at your negotiated hourly rate.

- A shift over 9 hours in a day or 40 hours in a week is earns wages at time and 1/2

- This makes how those hours are structured vital to how much each day of care costs. The least possible cost is 4 caregivers in 8 hour shifts. One alternate caregiver would be needed to cover any sick days of the other 4 caregivers so that everyone stays under 45 hours a week.

- AB241 also requires that the private employer withhold and pay all regular employee / employer taxes. Such as Federal and State withholding, California Disability Insurance, California Unemployment Insurance along with a few other minor taxes.

- Worker's Compensation Insurance is a separate insurance from regular payroll taxes and is required also. (The CA State Compensation Insurance Fund can be contacted at 888-782-8338.)

- AB241 includes a provision for employees to apply for and receive Unemployment Insurance payments or Disability Insurance payments, regardless of whether or not the employer has purchased the insurance.

- This allows the state to both protect the worker and to verify with the individual-employer that all tax payments and-or penalties have been applied.

- Personal assets of the employer can be attached by the State or Federal government to pay the domestic worker all unpaid wages and related taxes.

2004 Study by NIHS

In February 2004, the National Center for Health Statistics (NCHS) conducted the "National Home and Hospice Study," which was updated in 2005.

The data was collected on about approximately 1.3+ million (1,355,300) persons receiving home care in the USA. Of that total, almost 30% (29.5% or 400,100 persons) were under 65 years of age, while the majority, almost 70%, were over 65 years old (70.5% or 955,200 persons).

The 2005 chart data of estimates based on interviews with non-institutionalized citizens, however, shows a relatively stable number of about 6 to 7 percent of adults age 65 who needed help for personal care (ADLs) - this has remained about the same between 1997 and 2004. (Data has a 95% reliability.) Those aged 85 or older were at least 6 times more likely (20.6%) to need ADL assistance than those of age 65. Between age 65 and 85 years, more women than men needed help.

To review the 2005 Early Release data used, visit the NCHS-NHIS website to see the PDF files. [NOTE: * The 2005 data reflects data, still between 6 to 7%, is only based on interviews conducted between January to June 2005, so it remains to be seen whether the figure remained constant or changed through the end of 2005.] Again, the 1998-2005 data is specific for over 65 or older and does not include any data for adults under 65 years old.

In the 2004 data, just over 30% (30.2% or 385,500) of the total 1.3+million persons lived alone, but the study did not break this down by age groups. A large portion, 1,094,900 or 80.8% had a primary caregiver, and almost 76% (75.9% or 831,100 lived with the primary caregiver, typically the spouse, child or child-in-law, other relative or parent, in that order. (Paid help and the category of neighbor/friend/ or unknown caregiver would be, for the majority, were living with non-family (4.3%) or unknown living arrangement .) Most patients still need external help, even if the primary caregiver is a spouse.

A total of 600,900 persons received personal care.

Payment described in the 2004 study

Page 4 of the study describes the population break-down by type of payment used. Of the 1.3+ million:

710,000 paid by Medicare - Medicare often is the primary billing source, if this is the primary carrier between two types of insurance (like between Medicare and Medicaid). Also, if a patient has Medicare and that patient has a "skilled need" requiring nursing visits, the patient's case is typically billed under Medicare.

277,000 paid by Medicaid - This number seems low for Community Based Services (CBS) or Home Care (HC), especially as a nationwide statistic.

235,000 paid by private insurance, or self/family - Private insurance includes VA (Veterans Administration), some Railroad or Steelworkers health plans or other private insurance. "Self/family" indicates "private pay" status, when the patient or family pays 100% of all home care charges. Home care fees can be quite high; few patients & families can absorb these costs for a long period of time.

133,200 all other payments - including patients unable to pay, or who had no charge for care, or those whose payment "source not yet determined or approved." Sometimes after "opening a case" (the formal paperwork process of admitting a patient to home care services, there can be a short period of time when the office has not yet received approval by one of two or more insurances held by the patient. This is not unusual. There can also be cases where the office must make phone calls to be sure a particular diagnosis is "covered" by the patient's primary insurance. This is not unusual. These delays explain, in part, a couple circumstances where payment source would be listed as "unknown."

CBLTC expenditures

Community-Based Long Term Care (CBLTC) is the newer name for Home Health Care Services paid by States' Medicaid programs. Most of these programs have a category called 'Medicaid Waiver' to define level of care being delivered.

The Study "Medicaid Home and Community-Based Long Term Care – Trends in the U.S. and Maryland" funded by the National Institute of Disability and Rehabilitation Research, Department of Education, Information Brokering for Long Term Care, The Robert Wood Johnson Foundation, focused on expenditures. In this study, the Medicaid Waiver Expenditures by Recipient Group in 2001 based on total expenditure of $14,218,236,802 was broken down in this manner of actual spending (presumably this is based on nationwide figures):

  • MR/DD 74%
  • Aged/Disabled 17%
  • Disabled/Phy. Disabled 4%
  • Aged 3%
  • Children 1%
  • TBI/Head Injury 1%
  • AIDS < 1%
  • Mental Health <1% (less than 1%)

But, the same report included figures on "Participants by Recipient Type" in 2001 based on a total number of 832,915. Participant types were broken down thus (presumably this is based on nationwide figures):

  • Aged/Disabled 41%
  • MR/DD 39%
  • Aged 11%
  • Disabled /Phy. Disabled 5%
  • AIDS 2%
  • Children 1%
  • TBI/Head Injury 1%
  • Mental Health <1% (less than 1%)


This data would be interpreted that the MR/DD population represents 39% of the study population of 832,915, and this population used 74% of the available resources of the total expenditure of $14,218,236,802. The aged/disabled population had a higher number of patients in need at 41%, but only had 17% of the total dollar expenditure. The Disabled/Physically Disabled Group (presumably minus the aged in the statistics given - but this group was not well defined in this study's report, as to age etc.), represented 5% of the population and used just 4% of allocated funding. Adding the Aged/Disabled with those of "Disabled/Physically Disabled," the total group would represent 45% in population which used just 22% of funding. Again, the 39% MR/DD used 74%, more than three times higher than the larger group of disabled citizens.

ABOUT A STROKE
HOMECARE STROKE RECOVERY, CAREGIVERS FOR STROKE REHABILITATION

A stroke, sometimes referred to as a cerebrovascular accident (CVA), is the rapid loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia (lack of blood flow) caused by blockage (thrombosis, arterial embolism), or a hemorrhage. As a result, the affected area of the brain cannot function, which might result in an inability to move one or more limbs on one side of the body, inability to understand or formulate speech, or an inability to see one side of the visual field.

A stroke is a medical emergency and can cause permanent neurological damage and death. Risk factors for stroke include old age, high blood pressure, previous stroke or transient ischemic attack (TIA), diabetes, high cholesterol, tobacco smoking and atrial fibrillation. High blood pressure is the most important modifiable risk factor of stroke. It is the second leading cause of death worldwide.

An ischemic stroke is occasionally treated in a hospital with thrombolysis (also known as a "clot buster"), and some hemorrhagic strokes benefit from neurosurgery. Treatment to recover any lost function is termed stroke rehabilitation, ideally in a stroke unit and involving health professions such as speech and language therapy, physical therapy and occupational therapy. Prevention of recurrence may involve the administration of antiplatelet drugs such as aspirin and dipyridamole, control and reduction of high blood pressure, and the use of statins. Selected patients may benefit from carotid endarterectomy and the use of anticoagulants.

Classification

A slice of brain from the autopsy of a person who suffered an acute middle cerebral artery (MCA) stroke

Strokes can be classified into two major categories: ischemic and hemorrhagic. Ischemic strokes are those that are caused by interruption of the blood supply, while hemorrhagic strokes are the ones which result from rupture of a blood vessel or an abnormal vascular structure. About 87% of strokes are caused by ischemia, and the remainder by hemorrhage. Some hemorrhages develop inside areas of ischemia ("hemorrhagic transformation"). It is unknown how many hemorrhages actually start as ischemic stroke.

Definition

In the 1970s the World Health Organization defined stroke as a "neurological deficit of cerebrovascular cause that persists beyond 24 hours or is interrupted by death within 24 hours", although the word "stroke" is centuries old. This definition was supposed to reflect the reversibility of tissue damage and was devised for the purpose, with the time frame of 24 hours being chosen arbitrarily. The 24-hour limit divides stroke from transient ischemic attack, which is a related syndrome of stroke symptoms that resolve completely within 24 hours. With the availability of treatments that, when given early, can reduce stroke severity, many now prefer alternative concepts, such as brain attack and acute ischemic cerebrovascular syndrome (modeled after heart attack and acute coronary syndrome, respectively), that reflect the urgency of stroke symptoms and the need to act swiftly.

Ischemic

In an ischemic stroke, blood supply to part of the brain is decreased, leading to dysfunction of the brain tissue in that area. There are four reasons why this might happen:

  1. Thrombosis (obstruction of a blood vessel by a blood clot forming locally)
  2. Embolism (obstruction due to an embolus from elsewhere in the body, see below),
  3. Systemic hypoperfusion (general decrease in blood supply, e.g., in shock)
  4. Venous thrombosis.

Stroke without an obvious explanation is termed "cryptogenic" (of unknown origin); this constitutes 30-40% of all ischemic strokes.

There are various classification systems for acute ischemic stroke. The Oxford Community Stroke Project classification (OCSP, also known as the Bamford or Oxford classification) relies primarily on the initial symptoms; based on the extent of the symptoms, the stroke episode is classified as total anterior circulation infarct (TACI), partial anterior circulation infarct (PACI), lacunar infarct (LACI) or posterior circulation infarct (POCI). These four entities predict the extent of the stroke, the area of the brain affected, the underlying cause, and the prognosis. The TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification is based on clinical symptoms as well as results of further investigations; on this basis, a stroke is classified as being due to (1) thrombosis or embolism due to atherosclerosis of a large artery, (2) embolism of cardiac origin, (3) occlusion of a small blood vessel, (4) other determined cause, (5) undetermined cause (two possible causes, no cause identified, or incomplete investigation). Abuser of stimulant drugs such as cocaine and methamphetamine are at a high risk for ischemic strokes.

Hemorrhagic

An intraparenchymal bleed (bottom arrow) with surrounding edema (top arrow)

Intracranial hemorrhage is the accumulation of blood anywhere within the skull vault. A distinction is made between intra-axial hemorrhage (blood inside the brain) and extra-axial hemorrhage (blood inside the skull but outside the brain). Intra-axial hemorrhage is due to intraparenchymal hemorrhage or intraventricular hemorrhage (blood in the ventricular system). The main types of extra-axial hemorrhage are epidural hematoma (bleeding between the dura mater and the skull), subdural hematoma (in the subdural space) and subarachnoid hemorrhage (between the arachnoid mater and pia mater). Most of the hemorrhagic stroke syndromes have specific symptoms (e.g., headache, previous head injury).

Signs and symptoms

Stroke symptoms typically start suddenly, over seconds to minutes, and in most cases do not progress further. The symptoms depend on the area of the brain affected. The more extensive the area of brain affected, the more functions that are likely to be lost. Some forms of stroke can cause additional symptoms. For example, in intracranial hemorrhage, the affected area may compress other structures. Most forms of stroke are not associated with headache, apart from subarachnoid hemorrhage and cerebral venous thrombosis and occasionally intracerebral hemorrhage.

Early recognition

Various systems have been proposed to increase recognition of stroke. Different findings are able to predict the presence or absence of stroke to different degrees. Sudden-onset face weakness, arm drift (i.e., if a person, when asked to raise both arms, involuntarily lets one arm drift downward) and abnormal speech are the findings most likely to lead to the correct identification of a case of stroke increasing the likelihood by 5.5 when at least one of these is present). Similarly, when all three of these are absent, the likelihood of stroke is significantly decreased (– likelihood ratio of 0.39). While these findings are not perfect for diagnosing stroke, the fact that they can be evaluated relatively rapidly and easily make them very valuable in the acute setting.

Proposed systems include FAST (face, arm, speech, and time), as advocated by the Department of Health (United Kingdom) and the Stroke Association, the American Stroke Association, the National Stroke Association (US), the Los Angeles Prehospital Stroke Screen (LAPSS) and the Cincinnati Prehospital Stroke Scale (CPSS). Use of these scales is recommended by professional guidelines.

For people referred to the emergency room, early recognition of stroke is deemed important as this can expedite diagnostic tests and treatments. A scoring system called ROSIER (recognition of stroke in the emergency room) is recommended for this purpose; it is based on features from the medical history and physical examination.

Subtypes

If the area of the brain affected contains one of the three prominent central nervous system pathways—the spinothalamic tract, corticospinal tract, and dorsal column (medial lemniscus), symptoms may include:

In most cases, the symptoms affect only one side of the body (unilateral). Depending on the part of the brain affected, the defect in the brain is usually on the opposite side of the body. However, since these pathways also travel in the spinal cord and any lesion there can also produce these symptoms, the presence of any one of these symptoms does not necessarily indicate a stroke.

In addition to the above CNS pathways, the brainstem gives rise to most of the twelve cranial nerves. A stroke affecting the brain stem and brain therefore can produce symptoms relating to deficits in these cranial nerves:

  • altered smell, taste, hearing, or vision (total or partial)
  • drooping of eyelid (ptosis) and weakness of ocular muscles
  • decreased reflexes: gag, swallow, pupil reactivity to light
  • decreased sensation and muscle weakness of the face
  • balance problems and nystagmus
  • altered breathing and heart rate
  • weakness in sternocleidomastoid muscle with inability to turn head to one side
  • weakness in tongue (inability to protrude and/or move from side to side)

If the cerebral cortex is involved, the CNS pathways can again be affected, but also can produce the following symptoms:

If the cerebellum is involved, the patient may have the following:

  • altered walking gait
  • altered movement coordination
  • vertigo and or disequilibrium

Associated symptoms

Loss of consciousness, headache, and vomiting usually occurs more often in hemorrhagic stroke than in thrombosis because of the increased intracranial pressure from the leaking blood compressing the brain.

If symptoms are maximal at onset, the cause is more likely to be a subarachnoid hemorrhage or an embolic stroke.

Causes

Thrombotic stroke

Illustration of an embolic stroke, showing a blockage lodged in a blood vessel.

In thrombotic stroke a thrombus (blood clot) usually forms around atherosclerotic plaques. Since blockage of the artery is gradual, onset of symptomatic thrombotic strokes is slower. A thrombus itself (even if non-occluding) can lead to an embolic stroke (see below) if the thrombus breaks off, at which point it is called an "embolus." Two types of thrombosis can cause stroke:

Sickle-cell anemia, which can cause blood cells to clump up and block blood vessels, can also lead to stroke. A stroke is the second leading killer of people under 20 who suffer from sickle-cell anemia.

Embolic stroke

An embolic stroke refers to the blockage of an artery by an arterial embolus, a travelling particle or debris in the arterial bloodstream originating from elsewhere. An embolus is most frequently a thrombus, but it can also be a number of other substances including fat (e.g., from bone marrow in a broken bone), air, cancer cells or clumps of bacteria (usually from infectious endocarditis).[citation needed]

Because an embolus arises from elsewhere, local therapy solves the problem only temporarily. Thus, the source of the embolus must be identified. Because the embolic blockage is sudden in onset, symptoms usually are maximal at start. Also, symptoms may be transient as the embolus is partially resorbed and moves to a different location or dissipates altogether.

Emboli most commonly arise from the heart (especially in atrial fibrillation) but may originate from elsewhere in the arterial tree. In paradoxical embolism, a deep vein thrombosis embolises through an atrial or ventricular septal defect in the heart into the brain.[citation needed]

Cardiac causes can be distinguished between high and low-risk:

Systemic hypoperfusion

Systemic hypoperfusion is the reduction of blood flow to all parts of the body. It is most commonly due to heart failure from cardiac arrest or arrhythmias, or from reduced cardiac output as a result of myocardial infarction, pulmonary embolism, pericardial effusion, or bleeding.[citation needed] Hypoxemia (low blood oxygen content) may precipitate the hypoperfusion. Because the reduction in blood flow is global, all parts of the brain may be affected, especially "watershed" areas - border zone regions supplied by the major cerebral arteries. A watershed stroke refers to the condition when blood supply to these areas is compromised. Blood flow to these areas does not necessarily stop, but instead it may lessen to the point where brain damage can occur.

Venous thrombosis

Cerebral venous sinus thrombosis leads to stroke due to locally increased venous pressure, which exceeds the pressure generated by the arteries. Infarcts are more likely to undergo hemorrhagic transformation (leaking of blood into the damaged area) than other types of ischemic stroke.

Intracerebral hemorrhage

It generally occurs in small arteries or arterioles and is commonly due to hypertension, intracranial vascular malformations (including cavernous angiomas or arteriovenous malformations), cerebral amyloid angiopathy, or infarcts into which secondary haemorrhage has occurred. Other potential causes are trauma, bleeding disorders, amyloid angiopathy, illicit drug use (e.g., amphetamines or cocaine). The hematoma enlarges until pressure from surrounding tissue limits its growth, or until it decompresses by emptying into the ventricular system, CSF or the pial surface. A third of intracerebral bleed is into the brain's ventricles. ICH has a mortality rate of 44 percent after 30 days, higher than ischemic stroke or subarachnoid hemorrhage (which technically may also be classified as a type of stroke).

Silent stroke

A silent stroke is a stroke that does not have any outward symptoms, and the patients are typically unaware they have suffered a stroke. Despite not causing identifiable symptoms, a silent stroke still causes damage to the brain, and places the patient at increased risk for both transient ischemic attack and major stroke in the future. Conversely, those who have suffered a major stroke are also at risk of having silent strokes. In a broad study in 1998, more than 11 million people were estimated to have experienced a stroke in the United States. Approximately 770,000 of these strokes were symptomatic and 11 million were first-ever silent MRI infarcts or hemorrhages. Silent strokes typically cause lesions which are detected via the use of neuroimaging such as MRI. Silent strokes are estimated to occur at five times the rate of symptomatic strokes. The risk of silent stroke increases with age, but may also affect younger adults and children, especially those with acute anemia.

Pathophysiology

Ischemic

Micrograph showing cortical pseudolaminar necrosis, a finding seen in strokes on medical imaging and at autopsy. H&E-LFB stain.
Micrograph of the superficial cerebral cortex showing neuron loss and reactive astrocytes in a person that suffered a stroke. H&E-LFB stain.

Ischemic stroke occurs because of a loss of blood supply to part of the brain, initiating the ischemic cascade. Brain tissue ceases to function if deprived of oxygen for more than 60 to 90 seconds, and after approximately three hours will suffer irreversible injury possibly leading to death of the tissue, i.e., infarction. (This is why fibrinolytics such as alteplase are given only until three hours since the onset of the stroke.) Atherosclerosis may disrupt the blood supply by narrowing the lumen of blood vessels leading to a reduction of blood flow, by causing the formation of blood clots within the vessel, or by releasing showers of small emboli through the disintegration of atherosclerotic plaques. Embolic infarction occurs when emboli formed elsewhere in the circulatory system, typically in the heart as a consequence of atrial fibrillation, or in the carotid arteries, break off, enter the cerebral circulation, then lodge in and occlude brain blood vessels. Since blood vessels in the brain are now occluded, the brain becomes low in energy, and thus it resorts into using anaerobic metabolism within the region of brain tissue affected by ischemia. Unfortunately, this kind of metabolism produces less adenosine triphosphate (ATP) but releases a by-product called lactic acid. Lactic acid is an irritant which could potentially destroy cells since it is an acid and disrupts the normal acid-base balance in the brain. The ischemia area is referred to as the "ischemic penumbra".

Then, as oxygen or glucose becomes depleted in ischemic brain tissue, the production of high energy phosphate compounds such as adenosine triphosphate (ATP) fails, leading to failure of energy-dependent processes (such as ion pumping) necessary for tissue cell survival. This sets off a series of interrelated events that result in cellular injury and death. A major cause of neuronal injury is release of the excitatory neurotransmitter glutamate. The concentration of glutamate outside the cells of the nervous system is normally kept low by so-called uptake carriers, which are powered by the concentration gradients of ions (mainly Na+) across the cell membrane. However, stroke cuts off the supply of oxygen and glucose which powers the ion pumps maintaining these gradients. As a result the transmembrane ion gradients run down, and glutamate transporters reverse their direction, releasing glutamate into the extracellular space. Glutamate acts on receptors in nerve cells (especially NMDA receptors), producing an influx of calcium which activates enzymes that digest the cells' proteins, lipids and nuclear material. Calcium influx can also lead to the failure of mitochondria, which can lead further toward energy depletion and may trigger cell death due to apoptosis.[citation needed]

Ischemia also induces production of oxygen free radicals and other reactive oxygen species. These react with and damage a number of cellular and extracellular elements. Damage to the blood vessel lining or endothelium is particularly important. In fact, many antioxidant neuroprotectants such as uric acid and NXY-059 work at the level of the endothelium and not in the brain per se. Free radicals also directly initiate elements of the apoptosis cascade by means of redox signaling.[citation needed]

These processes are the same for any type of ischemic tissue and are referred to collectively as the ischemic cascade. However, brain tissue is especially vulnerable to ischemia since it has little respiratory reserve and is completely dependent on aerobic metabolism, unlike most other organs.

In addition to injurious effects on brain cells, ischemia and infarction can result in loss of structural integrity of brain tissue and blood vessels, partly through the release of matrix metalloproteases, which are zinc- and calcium-dependent enzymes that break down collagen, hyaluronic acid, and other elements of connective tissue. Other proteases also contribute to this process. The loss of vascular structural integrity results in a breakdown of the protective blood brain barrier that contributes to cerebral edema, which can cause secondary progression of the brain injury.[citation needed]

Hemorrhagic

Hemorrhagic strokes result in tissue injury by causing compression of tissue from an expanding hematoma or hematomas. This can distort and injure tissue. In addition, the pressure may lead to a loss of blood supply to affected tissue with resulting infarction, and the blood released by brain hemorrhage appears to have direct toxic effects on brain tissue and vasculature. Inflammation contributes to the secondary brain injury after hemorrhage.

Diagnosis

A CT showing early signs of a middle cerebral artery stroke with loss of definition of the gyri and grey white boundary

Stroke is diagnosed through several techniques: a neurological examination (such as the NIHSS), CT scans (most often without contrast enhancements) or MRI scans, Doppler ultrasound, and arteriography. The diagnosis of stroke itself is clinical, with assistance from the imaging techniques. Imaging techniques also assist in determining the subtypes and cause of stroke. There is yet no commonly used blood test for the stroke diagnosis itself, though blood tests may be of help in finding out the likely cause of stroke.

Physical examination

A physical examination, including taking a medical history of the symptoms and a neurological status, helps giving an evaluation of the location and severity of a stroke. It can give a standard score on e.g., the NIH stroke scale.

Imaging

For diagnosing ischemic stroke in the emergency setting:

  • CT scans (without contrast enhancements)
sensitivity= 16%
specificity= 96%
  • MRI scan
sensitivity= 83%
specificity= 98%

For diagnosing hemorrhagic stroke in the emergency setting:

  • CT scans (without contrast enhancements)
sensitivity= 89%
specificity= 100%
  • MRI scan
sensitivity= 81%
specificity= 100%

For detecting chronic hemorrhages, MRI scan is more sensitive.

For the assessment of stable stroke, nuclear medicine scans SPECT and PET/CT may be helpful. SPECT documents cerebral blood flow and PET with FDG isotope the metabolic activity of the neurons.

Underlying cause

12-lead ECG of a patient with a stroke, showing large deeply inverted T-waves. Various ECG changes may occur in people with strokes and other brain disorders.

When a stroke has been diagnosed, various other studies may be performed to determine the underlying cause. With the current treatment and diagnosis options available, it is of particular importance to determine whether there is a peripheral source of emboli. Test selection may vary, since the cause of stroke varies with age, comorbidity and the clinical presentation. Commonly used techniques include:

Prevention

Given the disease burden of strokes, prevention is an important public health concern. Primary prevention is less effective than secondary prevention (as judged by the number needed to treat to prevent one stroke per year). Recent guidelines detail the evidence for primary prevention in stroke. Because stroke may indicate underlying atherosclerosis, it is important to determine the patient's risk for other cardiovascular diseases such as coronary heart disease. Conversely, aspirin confers some protection against first stroke in people who have had a myocardial infarction or those with a high cardiovascular risk. In those who have previously had a stroke, treatment with medications such as aspirin, clopidogrel and dipyridamole may be given to prevent platelets from aggregating.

Risk factors

The most important modifiable risk factors for stroke are high blood pressure and atrial fibrillation (although magnitude of this effect is small: the evidence from the Medical Research Council trials is that 833 patients have to be treated for 1 year to prevent one stroke). Other modifiable risk factors include high blood cholesterol levels, diabetes, cigarette smoking (active and passive), heavy alcohol consumption and drug use, lack of physical activity, obesity, processed red meat consumption and unhealthy diet. Alcohol use could predispose to ischemic stroke, and intracerebral and subarachnoid hemorrhage via multiple mechanisms (for example via hypertension, atrial fibrillation, rebound thrombocytosis and platelet aggregation and clotting disturbances). The drugs most commonly associated with stroke are cocaine, amphetamines causing hemorrhagic stroke, but also over-the-counter cough and cold drugs containing sympathomimetics.

No high quality studies have shown the effectiveness of interventions aimed at weight reduction, promotion of regular exercise, reducing alcohol consumption or smoking cessation. Nonetheless, given the large body of circumstantial evidence, best medical management for stroke includes advice on diet, exercise, smoking and alcohol use. Medication or drug therapy is the most common method of stroke prevention; carotid endarterectomy can be a useful surgical method of preventing stroke.

Blood pressure

Hypertension (high blood pressure) accounts for 35-50% of stroke risk. Blood pressure reduction of 10 mmHg systolic or 5 mmHg diastolic reduces the risk of stroke by ~40%. Lowering blood pressure has been conclusively shown to prevent both ischemic and hemorrhagic strokes. It is equally important in secondary prevention. Even patients older than 80 years and those with isolated systolic hypertension benefit from antihypertensive therapy. The available evidence does not show large differences in stroke prevention between antihypertensive drugs —therefore, other factors such as protection against other forms of cardiovascular disease should be considered and cost.

Atrial fibrillation

Those with atrial fibrillation have a 5% a year risk of stroke, and this risk is higher in those with valvular atrial fibrillation. Depending on the stroke risk, anticoagulation with medications such as warfarin or aspirin is warranted for stroke prevention.

Blood lipids

High cholesterol levels have been inconsistently associated with (ischemic) stroke. Statins have been shown to reduce the risk of stroke by about 15%. Since earlier meta-analyses of other lipid-lowering drugs did not show a decreased risk, statins might exert their effect through mechanisms other than their lipid-lowering effects.

Diabetes mellitus

Diabetes mellitus increases the risk of stroke by 2 to 3 times. While intensive control of blood sugar has been shown to reduce microvascular complications such as nephropathy and retinopathy it has not been shown to reduce macrovascular complications such as stroke.

Anticoagulation drugs

Oral anticoagulants such as warfarin have been the mainstay of stroke prevention for over 50 years. However, several studies have shown that aspirin and antiplatelet drugs are highly effective in secondary prevention after a stroke or transient ischemic attack. Low doses of aspirin (for example 75–150 mg) are as effective as high doses but have fewer side effects; the lowest effective dose remains unknown. Thienopyridines (clopidogrel, ticlopidine) "might be slightly more effective" than aspirin and have a decreased risk of gastrointestinal bleeding, but they are more expensive. Their exact role remains controversial. Ticlopidine has more skin rash, diarrhea, neutropenia and thrombotic thrombocytopenic purpura. Dipyridamole can be added to aspirin therapy to provide a small additional benefit, even though headache is a common side effect. Low-dose aspirin is also effective for stroke prevention after sustaining a myocardial infarction. Except for in atrial fibrillation, oral anticoagulants are not advised for stroke prevention —any benefit is offset by bleeding risk.

In primary prevention however, antiplatelet drugs did not reduce the risk of ischemic stroke while increasing the risk of major bleeding. Further studies are needed to investigate a possible protective effect of aspirin against ischemic stroke in women.

Surgery

Carotid endarterectomy or carotid angioplasty can be used to remove atherosclerotic narrowing (stenosis) of the carotid artery. There is evidence supporting this procedure in selected cases. Endarterectomy for a significant stenosis has been shown to be useful in the prevention of further strokes in those who have already had one. Carotid artery stenting has not been shown to be equally useful. Patients are selected for surgery based on age, gender, degree of stenosis, time since symptoms and patients' preferences. Surgery is most efficient when not delayed too long —the risk of recurrent stroke in a patient who has a 50% or greater stenosis is up to 20% after 5 years, but endarterectomy reduces this risk to around 5%. The number of procedures needed to cure one patient was 5 for early surgery (within two weeks after the initial stroke), but 125 if delayed longer than 12 weeks.

Screening for carotid artery narrowing has not been shown to be a useful screening test in the general population. Studies of surgical intervention for carotid artery stenosis without symptoms have shown only a small decrease in the risk of stroke. To be beneficial, the complication rate of the surgery should be kept below 4%. Even then, for 100 surgeries, 5 patients will benefit by avoiding stroke, 3 will develop stroke despite surgery, 3 will develop stroke or die due to the surgery itself, and 89 will remain stroke-free but would also have done so without intervention.

Diet

Nutrition, specifically the Mediterranean-style diet, has the potential for decreasing the risk of having a stroke by more than half. It does not appear that lowering levels of homocysteine with folic acid affects the risk of stroke.

Secondary prevention

Anticoagulation can prevent recurrent ischemic strokes. Among patients with nonvalvular atrial fibrillation, anticoagulation can reduce stroke by 60% while antiplatelet agents can reduce stroke by 20%. However, a recent meta-analysis suggests harm from anti-coagulation started early after an embolic stroke. Stroke prevention treatment for atrial fibrillation is determined according to the CHADS/CHADS2 system. The most widely used anticoagulant to prevent thromboembolic stroke in patients with nonvalvular atrial fibrillation is the oral agent warfarin while dabigatran is a new alternative which does not require prothrombin time monitoring.

Anticoagulants, when used following stroke, should not be stopped for dental procedures.

If studies show carotid stenosis, and the patient has residual function in the affected side, carotid endarterectomy (surgical removal of the stenosis) may decrease the risk of recurrence if performed rapidly after stroke.

Management

Ischemic stroke

Definitive therapy is aimed at removing the blockage by breaking the clot down (thrombolysis), or by removing it mechanically (thrombectomy). The philosophical premise underlying the importance of rapid stroke intervention was crystallized as Time is Brain! in the early 1990s. Years later, that same idea, that rapid cerebral blood flow restoration results in fewer brain cells dying, has been proved and quantified.

Tight control of blood sugars in the first few hours does not improve outcomes and may cause harm. High blood pressure is also not typically lowered as this has not been found to be helpful.

Thrombolysis

Thrombolysis with recombinant tissue plasminogen activator (rtPA) in acute ischemic stroke, when given before three hours of symptom onset increases the risk of death in the short term but in the long term improves the rate of independence; the change in long term mortality is not significant. When broken down by time to treatment it increases the chance of being alive and living independently by 9% in those treated within three hours, however the benefit for those treated between three and six hours is not significant. These benefits or lack of benefits occurred regardless of the age of the person treated. There is no reliable way to determine who will have an intracranial hemorrhage post treatment versus who will not.

Its use is endorsed by the American Heart Association and the American Academy of Neurology as the recommended treatment for acute stroke within three hours of onset of symptoms as long as there are not other contraindications (such as abnormal lab values, high blood pressure, or recent surgery). This position for tPA is based upon the findings of two studies by one group of investigators which showed that tPA improves the chances for a good neurological outcome. When administered within the first three hours thrombolysis improves functional outcome without affecting mortality. 6.4% of people with large strokes developed substantial brain hemorrhage as a complication from being given tPA thus part of the reason for increased short term mortality. Additionally, it is the position of the American Academy of Emergency Medicine that objective evidence regarding the efficacy, safety, and applicability of tPA for acute ischemic stroke is insufficient to warrant its classification as standard of care.Intra-arterial fibrinolysis, where a catheter is passed up an artery into the brain and the medication is injected at the site of thrombosis, has been found to improve outcomes in people with acute ischemic stroke.

Mechanical thrombectomy

Removal of the clot may be attempted in those where it occurs within a large blood vessel and may be an option for those who either are not eligible for or do not improve with intravenous thrombolytics. Significant complications occur in about 7%. As of October 2013, trials have not shown positive results.

Hemicraniectomy

Large territory strokes can cause significant edema of the brain with secondary brain injury in surrounding tissue. This phenomenon is mainly encountered in strokes of the middle cerebral artery territory, and is also called "malignant cerebral infaction" because it carries a dismal prognosis. Relief of the pressure may be attempted with medication, but some require hemicraniectomy, the temporary surgical removal of the skull on one side of the head. This decreases the risk of death, although some more people survive with disability who would otherwise have died.

Hemorrhagic stroke

People with intracerebral hemorrhage require neurosurgical evaluation to detect and treat the cause of the bleeding, although many may not need surgery. Anticoagulants and antithrombotics, key in treating ischemic stroke, can make bleeding worse. People are monitored for changes in the level of consciousness, and their blood pressure, blood sugar, and oxygenation are kept at optimum levels.[citation needed]

Stroke unit

Ideally, people who have had a stroke are admitted to a "stroke unit", a ward or dedicated area in hospital staffed by nurses and therapists with experience in stroke treatment. It has been shown that people admitted to a stroke unit have a higher chance of surviving than those admitted elsewhere in hospital, even if they are being cared for by doctors without experience in stroke.

When an acute stroke is suspected by history and physical examination, the goal of early assessment is to determine the cause. Treatment varies according to the underlying cause of the stroke, thromboembolic (ischemic) or hemorrhagic.

Rehabilitation

Stroke rehabilitation is the process by which those with disabling strokes undergo treatment to help them return to normal life as much as possible by regaining and relearning the skills of everyday living. It also aims to help the survivor understand and adapt to difficulties, prevent secondary complications and educate family members to play a supporting role.

A rehabilitation team is usually multidisciplinary as it involves staff with different skills working together to help the patient. These include physicians trained in rehabilitation medicine, clinical pharmacists, nursing staff, physiotherapists, occupational therapists, speech and language therapists, and orthotists. Some teams may also include psychologists and social workers, since at least one third of the people manifest post stroke depression. Validated instruments such as the Barthel scale may be used to assess the likelihood of a stroke patient being able to manage at home with or without support subsequent to discharge from hospital.

Good nursing care is fundamental in maintaining skin care, feeding, hydration, positioning, and monitoring vital signs such as temperature, pulse, and blood pressure. Stroke rehabilitation begins almost immediately.

For most people with stroke, physical therapy (PT), occupational therapy (OT) and speech-language pathology (SLP) are the cornerstones of the rehabilitation process. Often, assistive technology such as wheelchairs, walkers and canes may be beneficial. Many mobility problems can be improved by the use of ankle foot orthoses. PT and OT have overlapping areas of expertise, however PT focuses on joint range of motion and strength by performing exercises and re-learning functional tasks such as bed mobility, transferring, walking and other gross motor functions. Physiotherapists can also work with patients to improve awareness and use of the hemiplegic side. Rehabilitation involves working on the ability to produce strong movements or the ability to perform tasks using normal patterns. Emphasis is often concentrated on functional tasks and patient’s goals. One example physiotherapists employ to promote motor learning involves constraint-induced movement therapy. Through continuous practice the patient relearns to use and adapt the hemiplegic limb during functional activities to create lasting permanent changes. OT is involved in training to help relearn everyday activities known as the Activities of daily living (ADLs) such as eating, drinking, dressing, bathing, cooking, reading and writing, and toileting. Speech and language therapy is appropriate for patients with the speech production disorders: dysarthria and apraxia of speech, aphasia, cognitive-communication impairments and/or dysphagia (problems with swallowing).

Patients may have particular problems, such as dysphagia, which can cause swallowed material to pass into the lungs and cause aspiration pneumonia. The condition may improve with time, but in the interim, a nasogastric tube may be inserted, enabling liquid food to be given directly into the stomach. If swallowing is still deemed unsafe, then a percutaneous endoscopic gastrostomy (PEG) tube is passed and this can remain indefinitely.

Treatment of spasticity related to stroke often involves early mobilisations, commonly performed by a physiotherapist, combined with elongation of spastic muscles and sustained stretching through various positioning. Gaining initial improvements in range of motion is often achieved through rhythmic rotational patterns associated with the affected limb. After full range has been achieved by the therapist, the limb should be positioned in the lengthened positions to prevent against further contractures, skin breakdown, and disuse of the limb with the use of splints or other tools to stabilize the joint. Cold in the form of ice wraps or ice packs have been proven to briefly reduce spasticity by temporarily dampening neural firing rates. Electrical stimulation to the antagonist muscles or vibrations has also been used with some success.

Stroke rehabilitation should be started as quickly as possible and can last anywhere from a few days to over a year. Most return of function is seen in the first few months, and then improvement falls off with the "window" considered officially by U.S. state rehabilitation units and others to be closed after six months, with little chance of further improvement. However, patients have been known to continue to improve for years, regaining and strengthening abilities like writing, walking, running, and talking. Daily rehabilitation exercises should continue to be part of the stroke patient's routine. Complete recovery is unusual but not impossible and most patients will improve to some extent: proper diet and exercise are known to help the brain to recover.

Some current and future therapy methods include the use of virtual reality and video games for rehabilitation. These forms of rehabilitation offer potential for motivating patients to perform specific therapy tasks that many other forms do not. Many clinics and hospitals are adopting the use of these off-the-shelf devices for exercise, social interaction and rehabilitation because they are affordable, accessible and can be used within the clinic and home.

Other novel non-invasive rehabilitation methods are currently being developed to augment physical therapy to improve motor function of stroke patients, such as transcranial magnetic stimulation (TMS) and transcranial direct-current stimulation (tDCS) and robotic therapies.

A stroke can also reduce people's general fitness. Reduced fitness can reduce capacity for rehabilitation as well as general health. A systematic review found that there are inadequate longterm data about the effects of exercise and training on death, dependence and disability after a stroke. However, cardiorespiratory training added to walking programs in rehabilitation can improve speed, tolerance and independence during walking.

Prognosis

Disability affects 75% of stroke survivors enough to decrease their employability. Stroke can affect peoples physically, mentally, emotionally, or a combination of the three. The results of stroke vary widely depending on size and location of the lesion. Dysfunctions correspond to areas in the brain that have been damaged.

Some of the physical disabilities that can result from stroke include muscle weakness, numbness, pressure sores, pneumonia, incontinence, apraxia (inability to perform learned movements), difficulties carrying out daily activities, appetite loss, speech loss, vision loss, and pain. If the stroke is severe enough, or in a certain location such as parts of the brainstem, coma or death can result.

Emotional problems resulting from stroke can result from direct damage to emotional centers in the brain or from frustration and difficulty adapting to new limitations. Post-stroke emotional difficulties include anxiety, panic attacks, flat affect (failure to express emotions), mania, apathy, and psychosis.

30 to 50% of stroke survivors suffer post stroke depression, which is characterized by lethargy, irritability, sleep disturbances, lowered self esteem, and withdrawal. Depression can reduce motivation and worsen outcome, but can be treated with antidepressants.

Emotional lability, another consequence of stroke, causes the patient to switch quickly between emotional highs and lows and to express emotions inappropriately, for instance with an excess of laughing or crying with little or no provocation. While these expressions of emotion usually correspond to the patient's actual emotions, a more severe form of emotional lability causes patients to laugh and cry pathologically, without regard to context or emotion. Some patients show the opposite of what they feel, for example crying when they are happy. Emotional lability occurs in about 20% of stroke patients.

Cognitive deficits resulting from stroke include perceptual disorders, Aphasia, dementia, and problems with attention and memory. A stroke sufferer may be unaware of his or her own disabilities, a condition called anosognosia. In a condition called hemispatial neglect, a patient is unable to attend to anything on the side of space opposite to the damaged hemisphere.

Cognitive and psychological outcome after a stroke can be affected by the age at which the stroke happened, pre-stroke baseline intellectual functioning, psychiatric history and whether there is pre-existing brain pathology.

Up to 10% of people following a stroke develop seizures, most commonly in the week subsequent to the event; the severity of the stroke increases the likelihood of a seizure.

Epidemiology

Disability-adjusted life year for cerebral vascular disease per 100,000 inhabitants in 2004.
  no data
  <250
  250-425
  425-600
  600-775
  775-950
  950-1125
  1125-1300
  1300-1475
  1475-1650
  1650-1825
  1825-2000
  >2000

Stroke was the second most frequent cause of death worldwide in 2008, accounting for 6.2 million deaths (~11% of the total). Approximately 17 million people had a stroke in 2010 and 33 million people have previously had a stroke and were still alive. Between 1990 and 2010 the number of strokes decrease by approximately 10% in the developed world and increased by 10% in the developing world. Overall two thirds of strokes occurred in those over 65 years old.

It is ranked after heart disease and before cancer. In the United States stroke is a leading cause of disability, and recently declined from the third leading to the fourth leading cause of death. Geographic disparities in stroke incidence have been observed, including the existence of a "stroke belt" in the southeastern United States, but causes of these disparities have not been explained.

The incidence of stroke increases exponentially from 30 years of age, and etiology varies by age. Advanced age is one of the most significant stroke risk factors. 95% of strokes occur in people age 45 and older, and two-thirds of strokes occur in those over the age of 65. A person's risk of dying if he or she does have a stroke also increases with age. However, stroke can occur at any age, including in childhood.

Family members may have a genetic tendency for stroke or share a lifestyle that contributes to stroke. Higher levels of Von Willebrand factor are more common amongst people who have had ischemic stroke for the first time. The results of this study found that the only significant genetic factor was the person's blood type. Having had a stroke in the past greatly increases one's risk of future strokes.

Men are 25% more likely to suffer strokes than women, yet 60% of deaths from stroke occur in women. Since women live longer, they are older on average when they have their strokes and thus more often killed (NIMH 2002). Some risk factors for stroke apply only to women. Primary among these are pregnancy, childbirth, menopause and the treatment thereof (HRT).

History

Hippocrates first described the sudden paralysis that is often associated with stroke.

Episodes of stroke and familial stroke have been reported from the 2nd millennium BC onward in ancient Mesopotamia and Persia. Hippocrates (460 to 370 BC) was first to describe the phenomenon of sudden paralysis that is often associated with ischemia. Apoplexy, from the Greek word meaning "struck down with violence," first appeared in Hippocratic writings to describe this phenomenon.

The word stroke was used as a synonym for apoplectic seizure as early as 1599, and is a fairly literal translation of the Greek term.

In 1658, in his Apoplexia, Johann Jacob Wepfer (1620–1695) identified the cause of hemorrhagic stroke when he suggested that people who had died of apoplexy had bleeding in their brains. Wepfer also identified the main arteries supplying the brain, the vertebral and carotid arteries, and identified the cause of ischemic stroke [also known as cerebral infarction] when he suggested that apoplexy might be caused by a blockage to those vessels. Rudolf Virchow first described the mechanism of thromboembolism as a major factor.

The term cerebrovascular accident was introduced in 1927, reflecting a "growing awareness and acceptance of vascular theories and (...) recognition of the consequences of a sudden disruption in the vascular supply of the brain". Its use is now discouraged by a number of neurology textbooks, reasoning that the connotation of fortuitousness carried by the word accident insufficiently highlights the modifiability of the underlying risk factors.

Research

Angioplasty and stenting

Angioplasty and stenting have begun to be looked at as possible viable options in treatment of acute ischemic stroke. Intra-cranial stenting in symptomatic intracranial arterial stenosis, the rate of technical success (reduction to stenosis of <50%) ranged from 90-98%, and the rate of major peri-procedural complications ranged from 4-10%. The rates of restenosis and/or stroke following the treatment were also favorable. This data suggests that a randomized controlled trial is needed to more completely evaluate the possible therapeutic advantage of this preventative measure.

Neuroprotection

Drugs that scavenge reactive oxygen species, inhibit apoptosis, or inhibit excitatory neurotransmitters have been shown experimentally to reduce tissue injury caused by ischemia. Agents that work in this way are referred to as being neuroprotective. Until recently, human clinical trials with neuroprotective agents have failed, with the probable exception of deep barbiturate coma. However, more recently NXY-059, the disulfonyl derivative of the radical-scavengin phenylbutylnitrone, is reported to be neuroprotective in stroke. This agent appears to work at the level of the blood vessel lining or endothelium. Unfortunately, after producing favorable results in one large-scale clinical trial, a second trial failed to show favorable results. Benefit of NXY-059 is questionable.

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ABOUT ORANGE COUNTY CALIFORNIA
HOMECARE STROKE RECOVERY, CAREGIVERS FOR STROKE REHABILITATION


Orange County
is a county in California, within the United States. Its county seat is Santa Ana. As of the 2000 census, its population was 2,846,293, while a July 2008 estimate placed the population at 3,010,759, making it the second most populous county in California, behind Los Angeles County and ahead of San Diego County.

The county is famous for its tourism, as the home of such attractions as Disneyland and Knott's Berry Farm, as well as several beaches along its more than 40 miles (64 km) of coastline. It is also known for its affluence and political conservatism. In fact, a 2005 academic study listed three Orange County cities as being among America's 25 "most conservative," making it the only county in the country containing more than one such city. It also became well-known for being the largest US county ever to have gone bankrupt, when in 1994 citizens rejected tax increases to pay back debts incurred by the county treasurer's misinvestments.

Whereas most population centers in the United States tend to be identified by a major city, there is no defined urban center in Orange County. It is mostly suburban, except for some traditionally urban areas such as those of Anaheim, Santa Ana, Orange, Huntington Beach, and Fullerton. There are also several edge city-style developments such as South Coast Metro and Newport Center.

While Santa Ana serves as the governmental center of the county, Anaheim is its main tourist destination, and Irvine its major business and financial hub. Four Orange County cities have populations exceeding 200,000: Santa Ana, Anaheim, Irvine, and Huntington Beach.

Thirty-four incorporated cities are located in Orange County; the newest is Aliso Viejo, which was incorporated in 2001. Anaheim was the first city incorporated in Orange County, in 1870 when the region was still part of neighboring Los Angeles County.

Geography

According to the U.S. Census Bureau, the county has a total area of 2,455 km2 (948 sq mi), making it the smallest county in Southern California. Surface water accounts for 411 km2 (159 sq mi) of the area, 16.73% of the total; 2,044 km2 (789 sq mi) of it is land. The average annual temperature is about 68 °F (20 °C). Despite its small size as a county, Orange County's total area in square miles is actually just smaller than the State of Rhode Island's land area.

Orange County is bordered on the southwest by the Pacific Ocean, on the north by Los Angeles County, on the northeast by San Bernardino County and Riverside County, and on the southeast by San Diego County.

The northwestern part of the county lies on the coastal plain of the Los Angeles Basin, while the southeastern end rises into the foothills of the Santa Ana Mountains. Most of Orange County's population reside in one of two shallow coastal valleys that lie in the basin, the Santa Ana Valley and the Saddleback Valley. The Santa Ana Mountains lie within the eastern boundaries of the county and of the Cleveland National Forest. The high point is Santiago Peak (5,689 feet (1,734 m)), about 20 mi (32 km) east of Santa Ana. Santiago Peak and nearby Modjeska Peak, just 200 feet (60 m) shorter, form a ridge known as Saddleback, visible from almost everywhere in the county. The Peralta Hills extend westward from the Santa Ana Mountains through the communities of Anaheim Hills, Orange, and ending in Olive. The Loma Ridge is another prominent feature, running parallel to the Santa Ana Mountains through the central part of the county, separated from the taller mountains to the east by Santiago Canyon.

The Santa Ana River is the county's principal watercourse, flowing through the middle of the county from northeast to southwest. Its major tributary to the south and east is Santiago Creek. Other watercourses within the county include Aliso Creek, San Juan Creek, and Horsethief Creek. In the North, the San Gabriel River also briefly crosses into Orange County and exits into the Pacific on the Los Angeles-Orange County line between the cities of Long Beach and Seal Beach. Laguna Beach is home to the county's only natural lakes, Laguna Lakes, which are formed by water rising up against an underground fault.

Incorporated cities

As of August 2006, Orange County has 34 incorporated cities. The oldest is Anaheim (1870) and the newest is Aliso Viejo (2001).

Noteworthy communities

Some of the communities that exist within city limits are listed below:

Unincorporated communities

These communities are outside of city limits in unincorporated county territory:

Planned communities

Orange County has a history of large planned communities. Nearly 30% of the county was created as master planned communities, the most notable being the City of Irvine, Coto de Caza, Anaheim Hills, Tustin Ranch, Tustin Legacy, Ladera Ranch, Talega, Rancho Santa Margarita, and Mission Viejo. Irvine has become the model master planned city, encompassing many villages which were all planned under a master plan by the Irvine Company in the mid-1960s.

Adjacent counties

Business

Orange County is the headquarters of many Fortune 500 companies including Ingram Micro (#69) and First American Corporation (#312) in Santa Ana, Western Digital (#439) in Lake Forest and Pacific Life (#452) in Newport Beach. Irvine is the home of numerous start-up companies and also is the home of Fortune 1000 headquarters for Allergan, Broadcom, Edwards Lifesciences, Epicor, Standard Pacific and Sun Healthcare Group. Other Fortune 1000 companies in Orange County include Beckman Coulter in Fullerton, Quiksilver in Huntington Beach and Apria Healthcare Group in Lake Forest. Irvine is also the home of notable technology companies like PC-manufacturer Gateway Inc., router manufactuer Linksys, and video/computer game creator Blizzard Entertainment. Many regional headquarters for international businesses reside in Orange County like Mazda, Toshiba, Toyota, Samsung, Kia Motors, in the City of Irvine, Mitsubishi in the City of Cypress, and Hyundai in the City of Fountain Valley. Fashion is another important industry to Orange County. Oakley, Inc., the renowned sunglasses company, is headquartered in the City of Lake Forest. Hurley Inc. is headquartered in Costa Mesa. The shoe company Pleaser USA, Inc. is located in Fullerton. St. John is headquartered in Irvine. Wet Seal is headquarted in Lake Forest. Restaurants such as Del Taco, Wahoo's Fish Tacos, Taco Bell, El Pollo Loco, In-N-Out Burger, Claim Jumper, Marie Callender's, Wienerschnitzel, have headquarters in the City of Irvine as well.

Shopping

Orange County contains several notable shopping malls. Among these are the world-renowned South Coast Plaza in Costa Mesa and Fashion Island in Newport Beach. Other significant malls include the Brea Mall, The Shops at Mission Viejo, The Block at Orange, and the Irvine Spectrum Center. There is also Downtown Disney adjacent to Disneyland.

Tourism

Tourism remains a vital aspect of Orange County's economy. Anaheim is the main tourist hub, with the Disneyland Resort's Magic Kingdom Park being the second most visited theme park in the country. The Anaheim Convention Center receives many major conventions throughout the year. Resorts within the Beach Cities receive visitors throughout the year due to their close proximity to the beach, biking paths, mountain hiking trails, golf courses, shopping and dining.

Tallest buildings in Orange County

City Structure Height (feet) Stories Built
Santa Ana One Broadway Plaza 497 37 Proposed
Costa Mesa Center Tower 285 21 1985
Costa Mesa Plaza Tower 282 21 1992
Santa Ana Macarthur Skyline Tower 1 278 25 2009
Santa Ana Macarthur Skyline Tower 2 278 25 2009
Orange City Tower 269 21 1988
Irvine Jamboree Center - 5 Park Plaza 263 19 1990
Irvine Jamboree Center - 4 Park Plaza 263 19 1990
Irvine Jamboree Center - 3 Park Plaza 263 19 1990
Irvine Edison International Tower 263 19 N/A
Irvine Opus Center Irvine II 246 14 2002
Irvine Wells Fargo Center 230 18 1990
Orange Doubletree Hotel Anaheim N/A 20 1986
Newport Beach The Island Hotel (Formerly the Four Seasons) N/A 20 1986
Orange City Plaza N/A 18 N/A
Newport Beach 610 Tower N/A 18 N/A
Costa Mesa Park Tower 240 17 1979
Irvine Waterfield Tower (formerly Tower 17) 220 17 1987
Newport Beach 660 Tower N/A 17 N/A
Newport Beach 620 Tower N/A 17 1970
Irvine Irvine Marriott (Koll Center Irvine) N/A 17 N/A
Anaheim Anaheim Marriot - Palms Tower N/A 19 N/A
Costa Mesa Westin South Coast Plaza N/A 17 N/A
Orange 1100 Executive Tower 210 16 N/A
Santa Ana Xerox Centre N/A 16 1988
Newport Beach Marriott Newport Beach Hotel N/A 16 N/A
Irvine 2600 Michelson N/A 16 N/A
Garden Grove Hyatt Regency Orange County N/A 16 1987
Anaheim Anaheim Marriott - Oasis Tower N/A 16 N/A
Costa Mesa DiTech.com Tower (Two Town Center) 213 15 N/A
Costa Mesa Comerica Bank Tower (Two Town Center) 213 15 N/A
Buena Park Supreme Scream (amusement ride) 312 N/A N/A
Anaheim The Twilight Zone Tower of Terror (amusement ride) 183 --- 2004
Anaheim Anaheim Convention Center

Arts and culture

Points of interest

 

1965 aerial photo of Anaheim Disneyland, Disneyland Hotel with its Monorail Station. The Disneyland Heliport, surrounding orange groves, Santa Ana Freeway (now I-5) and the Melodyland Theater "in the round," and part of the City of Anaheim.

The area's warm Mediterranean climate and 42 miles (68 km) of year-round beaches attract millions of tourists annually. Huntington Beach is a hot spot for sunbathing and surfing; nicknamed "Surf City, U.S.A.", it is home to many surfing competitions. "The Wedge", at the tip of The Balboa Peninsula in Newport Beach, is one of the most famous body surfing spots in the world. Other tourist destinations include the theme parks Disneyland and Disney's California Adventure in Anaheim and Knott's Berry Farm in Buena Park. Water parks in Orange County include Wild Rivers in Irvine and Soak City in Buena Park. The Anaheim Convention Center is the largest such facility on the West Coast. The old town area in the City of Orange (the traffic circle at the middle of Chapman Ave. at Glassell) still maintains its 1950s image, and appeared in the That Thing You Do! movie. Little Saigon is another notable tourist destination, being home to the largest concentration of Vietnamese people outside of Vietnam. There are also sizable Taiwanese, Chinese, and Korean communities, particularly in western Orange County. This is evident in several Asian-influenced shopping centers in Asian American hubs like the city of Irvine.

Some of the most exclusive (and expensive) neighborhoods in the U.S. are located here, many along the Orange County Coast, and some in north Orange County.

Historical points of interest include Mission San Juan Capistrano, the renowned destination of migrating swallows, and the Richard Nixon Presidential Library and Museum in Yorba Linda. The Richard Nixon Birthplace home, located on the grounds of the Presidential Library, is a National Historic Landmark. Other notable structures include the home of Madame Helena Modjeska, located in Modjeska Canyon on Santiago Creek; Ronald Reagan Federal Building and Courthouse in Santa Ana, the largest building in the county; the historic Balboa Pavilion in Newport Beach; and the Huntington Beach Pier. It is also recognized for its nationally known centers of worship, such as Crystal Cathedral in Garden Grove, the largest house of worship in California; Saddleback Church in Lake Forest, one of the largest churches in the United States; and the Calvary Chapel.

Since the premiere in fall 2003 of the hit Fox series The O.C., and the 2007 Bravo series "The Real Housewives of Orange County" tourism has increased with travelers from across the globe hoping to see the sights seen in the show. However, the former was rarely filmed anywhere in Orange County.

Orange County has also been used as a shooting location for several films and television programs. Examples of movies at least partially shot in Orange County are Tom Hanks's That Thing You Do, the Coen Brothers' The Man Who Wasn't There, and the Martin Lawrence movie Big Momma's House. All three of which were filmed in or around the Old Towne Plaza in the City of Orange.

Education

Orange County is the home of many colleges and universities, including:

Some institutions not based in Orange County operate satellite campuses, including the University of Southern California and Pepperdine University.

 

STROKE SURVIVOR CAREGIVER ORANGE COUNTY, HOME CARE
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Geography That Stroke Survivor Caregiver in Orange County Covers:

Aliso Viejo 92656, 92698,
Anaheim 92801, 92802, 92803, 92804, 92805, 92806, 92807, 92808, 92809, 92812, 92814, 92815, 92816, 92817, 92825, 92850, 92899,
Atwood, 92811,
Brea, 92821, 92822,92823,
Buena Park, 90620 ,90621,90622, 90624, Capistrano Beach, 92624,
Corona del Mar, 92625,
Costa Mesa, 92626, 92627, 92628,
Cypress, 90630,
Dana Point, 92629,
East Irvine, 92650,
El Toro, 92609,
Foothill Ranch, 92610,
Fountain Valley, 92708, 92728,
Fullerton, 92831, 92832, 92833, 92834, 92835, 92836, 92837, 92838,
Garden Grove, 92840, 92841, 92842, 92843 ,92844, 92845, 92846,
Huntington Beach , 92605, 92615, 92646, 92647, 92648, 92649,
Irvine, 92602, 92603, 92604, 92606, 92612, 92614, 92616, 92617, 92618, 92619, 92620, 92623, 92697,
La Habra, 90631, 90632, 90633,
La Palma, 90623,
Ladera Ranch, 92694,
Laguna Beach , 92651, 92652,
Laguna Hills ,92653, 92654,92607,92677,
Laguna Woods, 92637,
Lake Forest, 92630,
Los Alamitos, 90720, 90721,
Midway City, 92655,
Mission Viejo, 92690, 92691, 92692,
Newport Beach , 92658, 92659, 92660, 92661, 92662, 92663, 92657,
Orange, 92856, 92857, 92859, 92862, 92863, 92864, 92865, 92866, 92867, 92868, 92869, Placentia, 92870, 92871,
Rancho Santa Margarita 92688,
San Clemente, 92672, 92673, 92674,
San Juan Capistrano, 92675, 92693,
Santa Ana , 92701, 92702, 92703, 92704, 92705 ,92706, 92707, 92711, 92712, 92725.92735, 92799,
Seal Beach , 90740,
Silverado 92676,
Stanton, 90680,
Sunset Beach 90742,
Surfside 90743,
Trabuco Canyon, 92678, 92679,
Tustin ,92780, 92781,92782,
Villa Park, 92861,
Westminster, 92683, 92684, 92685,

Yorba Linda, 92885, 92886, 92887

STROKE SURVIVORS CAREGIVER ORANGE COUNTY CA, STROKE REHABILITATION ORANGE COUNTY, STROKE RECOVERY ORANGE COUNTY, Post-Stroke Rehabilitation, stroke rehabilitation, stroke, post stroke rehabilitation, stroke rehabilitation, rehabilitation, recovery from stroke, stroke therapy, stroke rehab, stroke recovery, information on stroke, stroke information, stroke rehabilitation information, stroke recovery technique, information about stroke rehabiliation, rehabilitation resources, NINDS, brain attack, cerebral apoplexy, Cerebrovascular Accident, CVA, disease treatment overview, Stroke, stroke recovery, Stroke self-care, Strokes, Care Giver, fountain valley, orange, los angeles county, ca, long beach, information, referral center

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