Three days after suffering from a stroke, Paivi, a 52-year-old nurse, was discovered at home after she had not shown up for her shift.  Paivi entered a rehabilitation program in an acute care hospital. They informed her that she could not be rehabilitated and that she would need to live in complex care for the rest of her life.  According to Paivi, the Toronto Grace Health Centre was the only place that would accept her.

When Paivi arrived she asked the Toronto Grace staff for help. They asked her what her goal was?  Paivi said, “To live outside these hospital walls.”  The interdisciplinary health team heard her desire, need, wish and want. They worked with Paivi to improve her  physical abilities to help reach her goal.  With the support of the social worker Paivi is now living independently in Supportive Housing in the community.

Paivi continues to improve in the community and is receiving physiotherapy. She is currently walking with a cane, a long way from being dependent on a wheelchair and living in complex care.


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