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By Nancy Fraser.
What is a Life Care Plan?
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.’
Life Care Plans are tailored to the patient’s unique current and anticipated needs through life expectancy. They address physical, developmental, cognitive, and psychosocial needs through collaboration with physicians and other professionals, patient and family interviews, resources and standards review, and empirical knowledge from rehabilitation experience. Care needs and frequency are calculated in present day value and are based on industry standards.
History
The history of life care planning is as impressive as its definition. This process arose from the field of Rehabilitation Counseling and was based on its foundational tenets. Initially, the rehabilitation counseling plan focused on assisting individuals who had disabilities and maximizing their potential quality of life and independence. Rehabilitation counselors assist individuals with various physical, mental and emotional disabilities, as defined in the Rehabilitation Act of 1973 and the 1998 Amendments to the Rehab Act, as well as in the Americans with Disabilities Act (ADA). This assistance was provided based on a systematic approach. This process included gathering client information, assessing rehabilitation and medical needs, and developing realistic plans to minimize complications, while maximizing functional independence and mitigating disability. As the field evolved, attorneys, utilizing expert testimony from Rehabilitation Counselors and their ‘plans’, became increasingly reliant upon this document as a tool to support their claims of damages and future care needs.
Soon, the graduates of these rehabilitation counseling programs entered the workforce. Their ‘plans’ were incorporated into their medical and vocational case management practice. The case management industry quickly recognized the value of these plans. The industry began marketing this plan to attorneys, families, and insurance companies. Registered nurses, physicians, psychologist, social workers and physical therapists began developing what is now known as Life Care Plans. Today, the profession is comprised of a variety of specialized disciplines and multiple perspectives.
Therefore, as a result of this variety, the industry created formal training, certification, and regulation of these practitioners and its practice. Formal training and certification programs address ethics, methodology, trends, and expert testimony through structured classes and continuing educational conferences. Today, there are hundreds of nationally-certified Life Care Planners, along with several formal university certificate programs governing the profession.
Benefits to the Patient
A Life Care Plan details how a patient’s long-term care, financial, physical, and psychological needs will be met. The purpose of a Plan is to maximize quality of life for the rest of the patient’s years, prevent possible complications, and provide assumptions that are needs appropriate, while giving the patient and their family the peace of mind that comes with financial consideration. With each Life Care Plan, the goal is to ease the burden of the injury and restore meaningful life to the injured party as they knew it prior to the injury.
Process and Work Product
In preparation for writing the Plan, Life Care Planners thoroughly review all records with a focus on the medical records, conduct a patient evaluation and medical provider interviews, review depositions and interrogatories of the patient, review expert reports, review depositions of medical providers, research and review supporting literature, and survey vendors. The Life Care Plan is comprised of a narrative report and a table format report detailing the cost projections. The detailed projections include the following:
*Home/Facility Care
*Procedures/Hospitalizations/Surgeries
*Medications
*Routine Medical Care
*Case Management
*Evaluations
*Therapies
*Diagnostic Testing
*Health and Strength Maintenance
*Transportation
*Equipment
*Supplies
*Orthotics/Prosthetics
*Wheelchairs
*Wheelchair Accessories and Maintenance
*Aids for Independent Living
*Home Furnishings and Accessories
*Architectural Renovations’
Inclusion of each of these considerations is based on the recommendations found in the medical records, clinical interview and history with the patient and family, treating physician and expert interviews, relevant clinical practice guidelines, relevant research literature, and the empirical knowledge of the Life Care Planner based on rehabilitative experience.
Throughout the process, the Life Care Planner stays in close communication with the patient or patient’s family and their legal representation to ensure a comprehensive and appropriate Plan that meets the needs of the individual.
Life Care Planner’s Role
The role of a Life Care Planner is that of an educator, not an advocate. Planners must maintain objectivity and set forth attainable rehabilitation goals and to assure that all parties involved in the process understand why specific items are included, how/when services should be provided, and how the plan is best implemented. As an educator, the Life Care Planner has a responsibility to educate others regarding the physical and psychosocial sequelae of the injury or illness, what can be expected when the effects of an injury or illness combine with the aging process, and the impact of the injury or illness on the family.
When selecting a Life Care Planner, clinical experience in creating Life Care Plans is critical. This Planner experience and expertise should be the foundation of all Life Care Plans so the resultant Plan is not superficial. A lack of clinical experience in creating Life Care Plans can lead to watered-down Plans, missing critical elements, or even impeachment.
Use in the Legal Arena
A Life Care Plan can be useful to more accurately identify and present the extent of damages arising as a consequence of the condition(s) in question. Benefits of Life Planning services include:
*Providing litigation consultation specific to settlement offers and/or demands
*Providing litigation consultation specific to witness preparation and/or cross examinations
*Presenting damage issues through a single witness in lieu of multiple experts
*Identifying the extent of damages through a standardized process that includes documented foundation
*Documenting ‘necessary’ versus ‘elective’ technologies and services
*Coordinating and/or facilitating ‘A Day-in-the-Life’ video
*Providing documented foundation for Medicare Set-Aside Trusts
A Plan provides valuable information regarding factors that can drastically impact the individual’s case, health care, and affect quality of life. Outside of the judicial arena, it can be used as a preventative Plan for disability management.
Abbreviated or more focused Plans can be useful for evaluating damages or projecting costs and can be effective in preparing for a fair settlement. Additionally, while Life Care Plans are typically designed for catastrophic cases, they can also be used for assessing damages for all levels of injuries to accurately identify and assess costs to any level of future care required.
Needs Based vs. Funding Based
Funding issues are not taken into consideration when developing a Life Care Plan. Instead of fitting a patient’s needs into the amount received as a result of litigation, a Life Care Plan takes the opposite approach. A Plan accurately assesses costs associated with necessary care and/or rehabilitation according to prevailing charges in the patient’s residing community and develops a foundation for the patient to receive appropriate funding that will allow their needs to be met.
Collaboration
Life Care Plans address every aspect of a disability from onset through the end of life expectancy. By the nature of the task, this requires developing information across a broad range of medical and health related professionals. No single Life Care Planner can do so on their own; however, an experienced Life Care Planner is the ideal professional to pull a team together to cover all aspects of the Plan thoroughly. The Life Care Plan is based on case management principles and medical foundations, including clinical practice guidelines, and relevant research literature. Having worked in the rehabilitation environment, experienced Life Care Planners are qualified to ask the appropriate questions, pull in the appropriate people, and cover the clinical aspects of the case. Regardless of their individual experience, Life Care Planners should be a part of a team effort, dependent on the knowledge of other professionals who are working with the patient to collaboratively determine the immediate and future needs of the patient. When choosing a Planner this may well be one of the first questions the referral source may wish to explore.
Methodology
In order to most effectively and accurately analyze the needs of patients, Life Care Planners must employ a consistent methodology and approach to the Plan. Life Care Planners deliberately and methodically organize, evaluate, and interpret patient-specific information. In each of the steps listed below, the goal is to link the recommendations to the supportive documentation.
Life Care Planners take a consistent approach to plan development with a qualified team of professionals on every case:
*Comprehensive review of records and supportive documentation.
*Clinical interview and history with the patient and, whenever possible, a family member or significant contact who knew the patient pre-morbidly as well as post-morbidly.
*Interaction with the medical and health related treatment team to obtain answers to questions not established in the medical records review.
*Research to identify relevant clinical practice guidelines to further establish needs and recommendations as well as support medical and case management foundation.
*Research of relevant literature to further establish needs and recommendations as well as support medical and case management foundation.
*Collaborate with other professionals to determine the patient’s needs.
Rebuttals
The same approach and methodology should be taken for all Life Care Plans, regardless of who is the requesting party, defense or plaintiff. The process and methodology does not change. Consistency in the approach is critical and should not be influenced by the referral source. It is important to note that some variation in Plans of patients with similar disabilities will occur because of unique case variables, but the process and methodology should remain consistent.
Med Legal’s Services
Med Legal Consulting Source’s Life Care Planning Services apply the foundation of our patented record review process by utilizing teams of certified Life Care Planners to review and assess the needs of each case. Our tiered review process assures high quality, reliable, and powerful reports tailored to specific needs. All of Med Legal’s highly qualified Life Care Planners meet our stringent standards for both clinical and legal certification. Every planner is thoroughly vetted and completes extensive training prior to becoming an active member of our team.
Med Legal’s Cost Projections quantify medical damages from a single injury and identify reasonable and necessary medical costs utilizing a consistent and scientific approach. This abbreviated Life Care Planning service can be useful for assessing damages, projecting costs, and reaching a fair settlement.
Med Legal’s Mini Life Care Plan is a projection and estimation of the costs of medical and non-medical needs of the person with a catastrophic injury or chronic health care needs, based on recommendations found in the medical records and through a phone interview with the patient and/or caregiver. The Mini Life Care Plan can be a powerful and effective tool in settlement, or can be used as a preliminary projection of costs before proceeding to a full Life Care Plan.
Med Legal’s full Life Care Plans expand upon the Mini. Evidentiary support for the Life Care Plan is provided in a narrative format with detailed tables for each recommendation, supplemented with summary tables annualizing costs and range of costs through the patient’s life expectancy. Prior to generating the Plan, the Planner strategizes with the Client and performs an assessment with the patient and family and/or caregivers. Med Legal’s Plans are consistent with standard care practices, recommend care, and produce reports from which all experts have collaborated and approved.
With all of Med Legal’s Life Care Planning services, our team of Life Care Planners performs at the highest level of experience, collaboration, and professionalism. The end result is a substantial, reliable work product that our Clients have come to expect.
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