Life Care Plans

“The Life Care Plan is 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.”

As defined by the International Academy of Life Care Planners, 2003. Established during the 2000 Life Care Planning Summit.

Careful consideration is given to the goals, needs and interests of the individual patient and his/her family, given the patient’s geographical location. A comprehensive in-person interview and assessment with the patient is conducted, preferably in his/her current living environment so as to assess barriers to access, caregiver proficiency, equipment status, etc. Interviews with knowledgeable individuals (e.g., close family members, friends, significant others, etc.) are conducted with regard to the patient’s pre- and post-injury/illness personality, behavior and function. Pre- and post-injury/illness medical records are reviewed/summarized; school and employment records are reviewed in appropriate situations; treating and retained expert health care professionals are consulted, and any reports are reviewed; clinical practice guidelines and relevant research materials are analyzed and incorporated; and, the depositions of experts, treating health care providers, parties, and family members/significant others are reviewed/summarized. Once these steps have been accomplished, the information is then linked, establishing a solid medical, psychological, rehabilitative and case management foundation for a credible Life Care Plan.

Typically, the following categories are included within a Life Care Plan:

• Procedural/Surgical Intervention
• Home Care/Home Maintenance/Facility Care
• Future Medical Care/Aggressive Treatment
• Future Procedural/Surgical Intervention
• Routine Future Medical Care
• Diagnostic Testing
• Orthotics/Prosthetics/Therapeutic Equipment
• Orthopedic Equipment
• Psychological Services
• Projected Evaluations
• Projected Therapeutic Modalities
• Wheelchair Accessories/Maintenance
• Home Furnishings/Accessories
• Aids for Independent Function
• Vocational/Educational Services
• Supplies
• Medications
• Transportation
• Architectural Renovations
• Leisure Time/Recreational
• Legal Needs

A Life Care Plan is tailored to meet the specific needs of an individual and his/her family, and, clearly identifies the cost of each recommended item; the replacement schedule; dates of implementation and suspension; and, the name of the professional qualified to make each recommendation. Items included in the Life Care Plan should have a greater than 50% probability of being needed; any items holding less probability, or likely needed irrespective of the disability/injury, should be appropriately caveated. Variations between plans of individuals with similar disabilities/injuries will occur due to unique individual characteristics.

Life Care Plans specify an individual’s medical, surgical, psychological, and rehabilitation needs over life expectancy and are regarded as a valuable case management tool for patients, families, catastrophic case managers, trustees of Special Needs Trusts, and rehabilitation professionals outside of the litigation setting. The insurance industry and the judicial system rely on Life Care Plans to accurately portray lifetime needs causally related to the onset of a particular disability and/or injury, and the associated costs. Regardless of the setting, Life Care Plans are utilized to effectively manage an individual’s disabling condition(s) so as to prevent potential complications and optimize quality of life. Life Care Plans are also used to portray future medical needs, with the goal of demonstrating hardship, in Bankruptcy and Medical Lien Cases.

Many professionals (e.g., psychiatrists, registered nurses, rehabilitation specialists, psychologists, etc.) who practice Life Care Planning choose to pursue board certification in Life Care Planning (i.e., CLCP), offered through the International Commission on Health Care Certification (ICHCC). Registered nurses may choose to pursue certification through the American Association of Nurse Life Care Planners (AANLCP), and use the designation “CNLCP.” Board certification as a case manager is not required, but considered helpful, as such individuals have experience in implementing Life Care Plans.

A Life Care Planner’s primary role is that of an educator. The planner is responsible for ensuring that the involved parties, and the jury, understand the basis for the Life Care Plan recommendations, how/when the recommended services should be provided, and how the plan is best implemented. The planner must understand, and be able to clearly articulate: the nature of the disability/catastrophic injury and the individual’s resultant residual functional limitations; the associated economic losses; and, the expected impact of a particular disability/injury over life expectancy. A Life Care Planner is NOT an advocate.

No; a consistent approach to the fundamental Life Care Planning methodology, regardless of the referral source, is critical to consistency and credibility. One obstacle in a defense case is that the planner is typically not allowed access to the patient and his/her family members, or any interaction with the treating health care providers. This can be overcome to some degree by preparing relevant questions for the patient, family members, treating health care providers, and the opposing Life Care Planner to be utilized by the referral source when deposing those individuals. Additionally, when retained by the defense, the planner is typically asked to critique, and/or rebut, the plaintiff Life Care Plan, rather than prepare a defense Life Care Plan, although the latter is also done in appropriate circumstances.