Living with stroke

The right to health care

After a stroke you have a right to necessary health care and care services, including physiotherapy, home help, and speech therapy. Family members may have a right to respite care. Pursuant to the Health and Care Services Act, the municipalities shall provide necessary health and care services to their inhabitants. This personal right is set out in the Patients and Users’ Rights Act, which establishes that patients and users have a right to necessary health and care services from the municipality.

The right to health care also applies if you require health care from the specialist health service. You shall be given a time limit that determines by when this must be initiated and this deadline must build on sound medical judgement. If the hospital is not able to commence your treatment within the time limit, you have a right to treatment through the Norwegian Health Economics Administration (HELFO). This means that you can have treatment somewhere else.

Individual plan

Some people who have had a stroke also need health and care services after their discharge from hospital. If it is likely that this need will persist over time and if several different services are required, you have a right to an individual plan. The objective of individual plans is to help coordinate the various services so that they work well together and to ensure that the patient/user is involved in preparing the plan.

The municipality’s coordinating unit will select a coordinator who will be in charge of following up and coordinating the individual plan. Health personnel have an obligation to contribute to preparing the individual plans and the G.P. is responsible for organising the medical treatment. In addition, it is important that the patient and their family members, assuming the patient wants this, are given an opportunity to participate actively. The coordinator who is appointed is responsible for the day-to-day follow-up of the plan.

Section 19 of the regulation on habilitation and rehabilitation, individual plans, and coordinators describes what elements individual plans should cover.

Free choice of treatment

When the G.P. refers you to a hospital or the specialist health service, they appraise your right to treatment or assessment. If you are granted health care, you can decide which treatment centre you wish to use. The right covers treatment centres included in the free choice of treatment scheme. Helsenorge’s website has information about places of treatment.

The free choice of treatment scheme also covers your rehabilitation needs

The regional health authorities have dedicated units to assess habilitation and rehabilitation referrals. If you want treatment at a private treatment centre, the referral should be sent to your regional assessment unit, but if you prefer you can send the referral to a different regional assessment unit than where you live.

Physical medicine/physiotherapy

After a stroke, you may benefit from physiotherapy. The physiotherapist will select manual techniques, exercises, and in some cases technical assistive devices to suit your needs. In Norway, physiotherapists must be licensed.

You do not require a referral from a doctor or the hospital for physiotherapy; you can contact the physiotherapist directly for an appointment. To be reimbursed the cost of your physiotherapy from the National Insurance Scheme, you need to secure treatment with a physiotherapist in receipt of an operating grant from the municipality. The user fees you pay will be recorded with HELFO and are subject to annual adjustments. When you have paid user fees up to the scheme’s ceiling 2, you will be sent an exemption card. This means that there are no more user fees payable the rest of the year.

Assistance for speech therapist

The national professional guideline for treatment and rehabilitation of stroke recommends that people with aphasia be provided with intervention as early as possible after the stroke, and that speech therapy should be frequent. The language training should commence in hospital, in the acute phase. To improve the ability to function, extensive treatment will be required. After you are discharged from hospital, the municipality is responsible for your speech therapy. If the municipality does not offer speech therapy, you can obtain support through the national insurance scheme to see a private speech therapist.

To apply, you need a referral from a doctor/specialist stating that the speech therapy is required for treatment or follow-up treatment after stroke. If circumstances make it especially difficult to obtain a statement from a specialist, this requirement can be waived.

Once you have a referral and a specialist’s statement, you can contact a speech therapist directly. The speech therapist will decide whether the requirements to have the cost of therapy covered, have been met.

If more than 25 hours of speech therapy are required, the doctor and speech therapist must undertake a new assessment in which they justify the need for further therapy.

User-controlled personal assistance

Persons under the age of 67 with long-lasting and complex needs for personal assistance have a right to user-controlled personal assistance (abbreviated as BPA in Norwegian – short for “brukerstyrt personlig assistanse”). BPA is a scheme to facilitate circumstances so that persons with disabilities and extensive assistance requirements can live an independent and active life. It is a different and flexible way of procuring municipal services in cases with a long-lasting need. You or your family members are involved in hiring the assistant and will be managing their work. The municipality will cover the wages. You are responsible for paying the user fees.

If you require 25 hours of BPA per week or more, the municipality may only deny your application if the scheme proves significantly more costly than alternative services. If you need 32 hours or more, the municipality must approve the BPA application. You will find more information about BPA on the Helsenorge website.

Orthopaedic assistive devices

If the stroke has caused any paralysis, you may need orthopaedic assistive devices. There are different types, the most common being orthoses such as immobilisers/braces.

To be eligible for subsidised orthopaedic assistive devices, the stroke patient must have a permanent disability in an arm, leg, or the back. A medical specialist, neurologist, specialist in physical medicine, or specialist in inner medicine needs to requisition the assistive device.

NAV provides financial support for orthopaedic assistive devices; no user fees are payable for orthoses.

An orthopaedic engineer with an orthopaedic workshop can help you select the right assistive device and help with the required adjustments. You will find a list of orthopaedic workshops on our website.

Parking

You can apply to the municipality to be issued a parking permit for persons with disability.

The parking permit can be for:

• Drivers of motor vehicles who have a special need for parking facilitation by their home, work and/or other activities because they cannot walk or have great difficulties moving any distance.
• Passengers who regularly require help from the driver outside of the motor vehicle itself and who have a special need for parking facilitation by their home, work and/or other activities because they cannot walk or have great difficulties moving any distance.

If the application for a special parking permit is denied, you can file an appeal with the municipal council or with a special board of appeals. Once the first-instance decision to deny the appeal has been made by the municipal board, this can be appealed to the Norwegian Directorate of Public Roads, which is the administrative appeal body.

Dental treatment

Persons who live in an institution or who receive home nursing care for more than three months, are offered free dental treatment by the public dental health service.
Social security entitlements

When life circumstances change after a stroke, you have a number of rights. Examples include the right to work trialling, facilitation and measures to return to work, a variety of disability benefits or work assessment allowance, adapting the home in cases of disability, or rights linked to family members’ needs for respite care or carer’s wages. You will find more information about your rights on LHL’s web pages about stroke.

The right to appeal

If the municipality denies your application for health and care services, you can appeal to the Office of the County Governor. You can send the appeal to the municipal unit that denied your application.

Patient injuries

If you believe that there has been a medical error or an adverse effect of care, you can ask the Office of the County Governor to investigate the incident. You can send your complaint directly to the Office of the County Governor. The matter may be processed in different ways. In many cases, the Office of the County Governor will initiate a supervisory review and contact the service or therapist. You will be given an opportunity to state your view. The Office of the County Governor will inform you of their findings and conclusions in writing.

If you have suffered an injury due to failings on the part of the health care service, you can apply for compensation. You can file an application with the Norwegian System of Patient Injury Compensation (abbreviated as NPE in Norwegian, short for “Norsk Pasientskadeerstatning”), where your application will be processed. To be eligible for compensation, certain criteria must be met. The harm you suffered must be the consequence of an error in the treatment, examination, diagnosis, or follow-up care from the health service, and it must have caused you a significant financial loss or considerable and long-lasting harm.

If your application for compensation is rejected, you can appeal. The time limit for the appeal is three weeks.

Driving after stroke

Having a stroke does not necessarily mean that you lose your driving licence. However, the stroke may trigger different after-effects that may affect your ability to drive a car. The Norwegian Directorate of Health’s guidance document for driving licences of 1 October 2016 specifies a series of conditions and what action to take in respect of driving after disease and injuries (also check the Norwegian Directorate of Health’s driving licence guidance document, to make sure that you have the most recent version of the provisions).

Driving licence class 1

For strokes where the symptoms disappear completely within a week, a three-month temporary driving ban is issued. If the symptoms persist more than a week, a six-month ban is issued. For TIAs, a driving ban of at least four weeks is issued. This is because the danger of having a new TIA or stroke is greatest in the first four weeks. After this period, driving is considered safe because the prophylactic treatment reduces the risk of new disease. The cause of the TIA or stroke must also be investigated. Relevant risk factors such as atrial fibrillation, diabetes, high blood pressure, plaque in the carotid arteries (carotid artery stenosis), and any cardiac disease must be assessed and, if necessary, treated. The same time frame also applies to people who quickly become symptom-free after stroke. The Office of the County Governor is not notified of these driving bans. Notification is only sent if there is reason to believe that that the difficulties will persist more than six months. Epilepsy normally results in a one-year driving ban.

Who is responsible?

Anybody with a driving licence who no longer meets the health requirements for driving a car is obligated to notify the authorities. Assessing one’s own ability to drive a car can be difficult. It is therefore standard procedure in all stroke cases that health personnel assess whether a person can continue to hold a driving licence.

Some hospitals and rehabilitation institutions have special assessment services to evaluate whether a person can continue to hold a driving licence. If there is any doubt about whether a person affected by stroke can resume driving, the G.P. can refer them to these centres. Here, stroke patients are examined and do different tests, including a practical driving test, using either a car or a simulator. Primary responsibility for assessing whether the health requirements for a driver’s licence have been met lies with the G.P. If the G.P. isn’t sure, they can seek advice from the Office of the County Governor or refer their patient to a practical driving test. If the G.P. considers that the health requirements for holding a driving licence have not been met, the Office of the County Governor is notified. The Office of the County

Governor then notifies the police, who will suspend the driving licence.

Being able to drive affects how active you can be and your level of involvement in different activities. While road safety is important, your driving licence should not be suspended just “to be on the safe side” without first thoroughly assessing your ability to drive. If you lose your driving licence, you should have help and support in adapting to your new life.
Guidelines and legislation

The guidelines governing the treatment path and rehabilitation for stroke patients are the “National professional guideline for treatment and rehabilitation of stroke” and the “stroke pathway”. The regulation on habilitation and rehabilitation are part of Norwegian legislation.

Unlike the rules set out in the legislation, the guidelines do not confer any rights but are the Norwegian Directorate of Health’s recommendations. Nevertheless, the guidelines are an overarching management tool that plays a role in streamlining treatment and securing a high level of service quality.