Individuals who have experienced a catastrophic injury, often need to have their ongoing care needs quantified. A life care plan can be thought of a way to budget and plan for future expenditures.
THE PROFESSION
Life care planning is a profession with its own standards of practice, certified professionals, with peer-reviewed journals, textbooks, and annual conferences. “Life Care Planner” is a trademarked term to be used by those who are certified by the International Commission on Health Care Certifications or ICHCC. When a life care plan is developed using a methodology consistent with the standards of practice for life care planners the plan should be able to be replicated by another life care planner.
CREDENTIALING
Life Care Planning is a transdisciplinary practice. To be a Certified Life Care Planner is to be an experienced rehabilitation professional licensed to practice within a healthcare profession, e.g. Register Nurse (RN), Occupational Therapist (OT), Physical Therapist (PT), Vocational Counsellor or a Medical Doctor (MD). Certification requires 120 hours of education specific to the practice of life care planning, a certification exam and submission of a life care plan to be approved by the ICHCC board. Continuing education in life care planning is required to maintain certification. The education must include a component on ethics.
DEFINITION
A Life Care Plan is defined as “a dynamic document based upon published standards of practice, comprehensive assessment, data analysis, and research, which provides an organized, concise plan for current and future needs with associated costs for individuals who have experienced catastrophic injury or have chronic health care needs.” (International Conference on Life Care Planning and the International Academy of Life Care Planners. Adopted 1998, April.) It is a way to plan for the lifetime needs of an individual with a disability.
PURPOSE
Life Care Plans are often used in a forensic setting to help resolve personal injury cases where an individual has sustained an injury at the fault of another person. The subject of the life care plan is referred to as an evaluee. The life care plan is intended to be educational and written so that the plan is understandable by the lay person, using non-technical language which can realistically be implemented.
METHODOLOGY
The standard methodology used to develop a life care plan consists of step-by-step procedures which include: initial case intake, review of medical records and supporting documentation, interview with evaluee and a collateral interview (if appropriate, e.g. TBI), consultation with therapeutic team members, formulation of preliminary opinions, cost research, and confirmation of projections with the evaluee.
INTERVIEW AT HOME
Best practice is to conduct the interview at the evaluee’s home; however, due to COVID-19 restrictions and individual preferences, a virtual assessment has become common practice. The home assessment enables the life care planner to consider the social and physical environment that may facilitate or restrict the evaluee’s function. For example, for an evaluee who uses a wheelchair, the need for home or vehicle modifications can be assessed; or for an evaluee with chronic pain, the need for ergonomic equipment or in-home rehabilitation may be considered.
COLLATERAL INFORMATION
Especially when the evaluee has experienced changes in cognition, collateral interview with a family member, caregiver and/or a close friend will assist with determining the change in function since the subject event and the current level of care being provided. It is standard practice to replace the gratuitous support provided to the evaluee as it is not deemed a reliable source of long-term support.
CONSULTATIVE
Given the transdisciplinary nature of life care planning, for areas of the plan that are outside the scope of practice of the life care planner, the life care planner relies on the medical records, consultation with the evaluee’s treating team members (e.g. specialist physicians, chiropractor, physical therapist, psychologist, etc.) or other experts involved with the case (e.g. orthotist, psychiatrist, physiatrist, etc.) to help develop the medical foundation for the life care plan. The life care planner is not intended to be a “secretary” simply providing the cost of the recommendations or others; nor, are they intended to be a “know-it-all,” relying on themselves to provide the foundation for the entire life care plan. In forensic practice, the life care planner applies their knowledge and experience in life care planning to vet care recommendations to ensure each item in the life care plan is likely to be beneficial and appropriate for the evaluee, e.g. a recommendation for pool therapy is not appropriate for someone allergic to chlorine or if an evaluee who would have likely incurred the expense for a gym pass or childcare absent the subject event, they would not be entitled to be compensated for these expenses related to the subject event.
COSTING RECOMMENDATIONS
The litigation process is usually the evaluee’s one shot at receiving the funding they require for future care; therefore, it is important that the pricing in a care plan be up-to-date, accurate and enable multiple options of providers within their geographical area. Collateral sources are not relied upon as a reliable source of lifetime funding. There are 18 standard categories of care considered in a life care plan which include: medical services, evaluations, medications, therapies, orthotics and prosthetics, wheelchair equipment, wheelchair maintenance, aides for independent living, home modifications, health maintenance and leisure, vocational/education. Given the potential longevity of the life care plan, e.g. decades, the life care planner provides accurate and geographically specific costing. It is of no help to the evaluee or their caregivers to provide resources that do not provide the intended services, e.g. a case manager who does not work with individuals under the age of 65 with a TBI but specializes in geriatric case management. Providing backup documentation for the resources is best practice and allowed by the majority of subscription fee reference databases given the forensic application.
CONCLUSION
The goal of each life care plan is to assist the evaluee is to restore function where possible; maintain function and prevent or reduce the risk of secondary complications, e.g. falls, pressure sores, etc. The plan details the services and charges for the services needed by the evaluee over the course of their lifetime. Alternatives for care take into account the developmental stages of the evaluee and the least restrictive environment. The life care planner must be willing and available to communicate the life care plan and objectives to the evaluee and the relevant parties, e.g. attorneys, judge and/or jury.