In 2009, the South West LHIN funded the Community Stroke Rehabilitation Teams (CSRT) initiative to deliver specialized rehabilitation services to rural communities. As part of the Aging at Home Strategy, the CSRT established three interprofessional rehabilitation teams, one in each of the LHIN’s three planning areas (North, Central and South), consisting of a physio therapist, occupational therapist, speech language pathologist, social worker, registered nurse, therapeutic recreation specialist, and two rehabilitation therapists. The new model of care focuses on providing individualized in-home therapy to patients, incorporating a variety of rehabilitation needs into normal daily activities.

Through this initiative, the number of clients receiving rehabilitation has increased, and patients’ acute care length of stay, ALC length of stay, and wait times for admission to rehabilitation have decreased. The majority of patients indicated that this initiative met their needs and allowed them to stay at home and return to family roles and social activities.