CERTIFIED LIFE CARE PLANNER
Each occupational therapist at Turning Point who opines on future care has attained Certification as a Life Care Planner from the International Commission on Healthcare Certification (ICHCC). This is no small feat! ICHCC has the most rigorous credentialing process in the area of life care planning. It is considered the gold standard for certification in the area of life care planning. To apply for certification, an applicant must have at least three years of rehabilitation experience, complete 120 educational hours specific to life care planning, pass a 3-hour proctored ICHCC board exam and receive ICHCC board approval of a submitted life care plan. As part of our commitment to the profession of life care planning, we meet bi-monthly to stay current with changes in the industry, attend IARP conferences, present at IARP conference, and publish in the Journal of Life Care Planning. Each life care plan authored by a Certified Life Care Planner at Turning Point is peer-reviewed to ensure adherence to the standard methodology in Life Care Planning. But is certification necessary? Ask yourself, do you want a defensible life care plan or one that can easily be critiqued and found unreliable, not following the published standards in life care planning. The unique qualifications and CV of each of our experts is located on the Our Team page.
When completing cost of future care assessments (CFC) also known as life care plans (LCP), we adhere to the published standards of practice of the International Academy of Life Care Planners. Our training and experience prepare us to opine on the comprehensive care needs of those who have sustained catastrophic injuries or suffer from chronic health conditions including but not limited to: mild to severe TBI, spinal cord injury, amputation, chronic pain, blindness, burns, facial disfigurement and catastrophic psychiatric injuries. These standards include:
We request all available and relevant documents pertaining to the individual, their injury and recovery to date. We prefer electronic records two weeks prior to a schedule assessment but understand when that cannot occur.
IN-HOME COMPREHENSIVE ASSESSMENT
In preparation of the home assessment, the evaluee is often sent screening questionnaires ahead of time to aid in the home assessment. If they are unable to be completed prior to the assessment day and time, then the OT will assist during the home assessment.
Typically, the in-home assessment takes 2-5 hours depending upon the individual, injury and level of disability. The components of the this assessment include part or all of the following: interview, medication verification, physical testing, cognitive testing, psychosocial screen, functional assessment (completion of household tasks or home exercise routine), ergonomic assessment of home office, equipment assessment, mobility assessment, home accessibility assessment. While we are in the home we are evaluating the internal and external environment for use of pain management or compensatory strategies, functional performance and need for home supports. In addition, most of the time, we are able to observe the social environment including relationship dynamics and demands. In cases of severe disability such as TBI, if the individual is a poor or inaccurate historian, we continue to attempt the interview to consider and attain the individual's perspective, but will rely more heavily on the medical records and collateral information.
With consent, collateral interview is conducted if indicated including assessment of caregiver stress and/or caregiver burden. This is more typical of catastrophic cases where a family member is providing assistance or supports that were not required absent the subject injury. In general, we ask the collateral source if they have noticed any physical, cognitive and/or emotional changes; if they have any concerns about the individuals; and if they provide regular physical assistance or emotional support for the individual.
With consent and as indicated, we connect with treating providers to get a sense of the current treatment plan and treatment goals. Most of the time care aids or treating providers do not have the benefit of the full medical records and that information is not divulged during the consultation. However, the treater's perspective can be valuable regardless in terms of response to therapy, participation and barriers to treatment that informs the care recommendations.
When addition information is needed, we will rely on published clinical practice guidelines to determine the most likely frequency and duration of a service. For example, someone who may undergo a surgery in 5 years will likely require a course of physiotherapy. If there is not a treating physiotherapist, then the clinical practice guidelines help establish the foundation.
As occupational therapists, we are qualified to opine on areas of the life care plan that are deemed within our scope of practice as an OT, which covers a lot! Of the 18 standard categories of care, occupational therapist are qualified to opine on evaluations, therapies, vocational/educational services, ergonomics, home modifications, aids for independent living, home furnishings, home care, orthotics/prosthetics, transportation, health maintenance and leisure. The remaining categories of care require medical opinion and/or consultation. Although able to opine on several categories of care, the OT life care planner still must collect multiple sources of information to analyze in order to develop the individualized life care plan. For example, the OT life care planner relies on the medical records to establish the medical diagnosis and prognosis as well as consider the medical recommendations. No two plans are exactly the same. The data is analyzed to determine what will likely help restore the individual as close as possible to their pre-injury state, restore household roles, replace gratuitous assistance being provided by family or friends and be realistically available for the individual. The life care planner is trained to analyze the information to determine which items to include or exclude from the plan. For example, if a physiatrist recommends an aquatic program for an individual who is allergic to chlorine and there are no alternate type of pools near the individual's home, then the life care planner should not include that recommendation within the life care plan.
ORGANIZED & CONCISE PLAN
When a life care plan is being utilized for litigation purposes, the expert report rules are different depending upon where the plan is being utilized. We are well trained and experienced at writing expert reports for different court systems and as knowledgable enough to ask for the rules when we are operating in a new jurisdiction. The individual rule differences do not change that each item is the care plan will be built on a foundation of sound medical information and well-justified. The life care plan is always written in non-technical language and is intended to actually be helpful to the evaluee and their family/caregivers. The plan is written to be easily read and realistically implemented, serving as a navigation tool. When written in this form, another life care planner should be able to easily replicate the plan if the same facts are relied upon. All medical-legal reports are professionally edited and peer-reviewed for quality assurance. We take pride on presenting a professional product.
The ICHCC and IARP standard methodology for life care planning is utilized by each of our experts to generate an individualized and defensible care plan. Our final task in the life care planning process is to take on the role of an educator. We recognize that some judges or juries may not know that cervical refers to the neck. We are patient and have numerous real-life examples that help explain complex topics such as why someone with chronic pain and Major Depressive Disorder may be physically able to do an individual task but their energy and motivation are preventing them from getting all the tasks done that they need to do in a day. Or, COVID-19 has been stressful and exacerbated their pain and anxiety symptoms.
Developing a comprehensive care plans typically requires 30-50 hours depending on the complexity. For comprehensive care plans, we are able to provide a tiered flat rate.
We are able to provide an initial free consultation to answer all your questions and if we don't know the answer, we likely know who will. Upon request, we provide sample reports and our fee schedule. Expert qualifications and CVs are located on the Our Team page.