The ACAS is a new assessment tool developed for the home care service and inpatient rehabilitation that highlights the activities of daily life and includes communication. The ACAS was not appropriate for patients with severe aphasia or cognitive impairment. Stroke nurses assessed stroke patients  .
In contrast to SLTs, PWA and FMs value the mental functions of language, rating energy and drive functions as the most important. Clinicians need tools that identify contextual and personal factors  .
SLTs commonly contribute to the assessment of the decision making capacity of persons with aphasia in both inpatient and rehabilitation settings.
The scope of the assessment by SLTs and their contribution to the interdisciplinary team are not clear. The SLTs use a wide variety of formal assessment tools and informal assessment.  .
A PSC assessment tool was developed. The PSC is a brief and easy to use tool for identifying long-term problems  .
Immediate assessment is important for the rehabilitation process and utilization of the inpatient period  .
Interdisciplinary team member negotiation is necessary to improve the quality of assessments  .
Assessment of mood, cognitive problems and communication disabilities was improved, leading to less avoidance of patients with aphasia  .
Care home nurses required accredited education and training in stroke assessment.
The senior care assistants required more knowledge about team work in the assessment procedure  .
Aphasia seems to lead to discrimination against patients in the assessment. The international Classification of functioning, disability and health is relevant for assessment. Patients with aphasia are negatively labelled  .
The follow-up care should be tailored to a structured assessment procedure and individual needs. Few patients with aphasia were referred to the interdisciplinary team  .
The interdisciplinary team should cooperate and include FMs to contribute to improvements, even for chronically aphasic persons  .
Successful interventions are dependent on a skilled multidisciplinary team  .
Interventions were supervised continuously  .
The interdisciplinary team was more alert and confident in the interventions  .
In order to perform relevant interventions senior care assistants required education and training in how to communicate with dysphasic residents with cognitive, communication and speech problems  .
Interventions are poor if assessment and goal setting are inadequate, which discriminates against patients with aphasia  .
The ACAS was used as a structured referral system to guarantee continuity.  .
Collaboration between SLTs, PWA and FMs is important for the provision of appropriate rehabilitation   .
Referrals for treatment should be followed up using the PSC  .
A skilled team is required to reassess the skills and needs of patients with LIS  .
Core team members shared knowledge, experiences and values in negotiations about decisions pertaining to agreed goals  .
Measurable standards and guidelines are warranted in the stroke rehabilitation process to identify patient needs  .