Transcript Slide 1

FUTURE CARE COSTING FOR
CATASTROPHIC BRAIN INJURY
PUTTING IT ALL TOGETHER
Respect, Learning, Independence
OUTLINE
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What is it?
Why do it?
When to do it?
Who should do it?
Overview of the process
Foundation for future care costing
Case study
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WHAT IS IT?
Future Cost of Care Analysis (aka life care
plans) is used to predict the impact of disability
on the individual.
The impact is detailed in relation to the future
goods and services and related costs, needed
to restore the disabled party to pre-injury
status insofar as is reasonably possible.
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WHY DO A FCC?
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To assist insurance companies to set
reserves for fiscal management of the file.
2.
To determine settlements which set aside
sufficient reserves to meet the lifetime needs
of the injured or chronically disabled person.
3.
To provide a template of care for family/
caregivers to assist them in making
informed decisions regarding care and
expenditures.
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WHEN TO DO IT?
Early completion:
Acknowledging that full functional prognosis
may not yet be know.
 Assists in setting appropriate reserves
Later completion:
Based on clearer understanding of functional
status and potential.
 Assists in settlement of file.
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WHO SHOULD DO IT?
Expertise and experience in the field of
Rehabilitation.
Credentials (Certified Life Care Planner):
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Should have an understanding of the medical,
physical, emotional, cognitive and behavioural
sequelae of the impairment and disability.
Should have an understanding of the functional
impact of the particular impairment.
Should have an understanding of the
interdisciplinary approach to rehabilitation.
Should have an understanding of case law.
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FOUNDATION FOR FUTURE
CARE COSTING
Entitlement for Future Care based on:
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Is the particular need attributable to the
accident?
Is there a reasonable probability that the
costs will be incurred in the future?
Are the costs extraordinary?
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CASE LAW
1.
If the plaintiff established a real and
substantial risk of future loss, (s)he is
entitled to compensation. Graham v. Rourke
(1990).
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Entitlement to compensation will depend in
part on the degree of risk established.
Graham v. Rourke (1990).
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CASE LAW
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Con’t.
The paramount concern for the courts when
awarding damages for personal injuries hould
be to assure that there will be adequate
future care. Andrew v Grand and Toy
Alberta Limited (1978).
To the extent, within reason, that money
can be used to sustain or improve the mental
or physical health of the injured person it
may properly form part of a claim. Andrew v.
Grand and Toy “Alberta Limited (1978)
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WHAT MAKES A GOOD PLAN?
Clarity and Consistency:
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A clear description of pre-accident and
post status, consistent with documentation.
Clearly laid out theory regarding the most
probable life course for the client.
Consistent with medical prognosis.
Consistent with rehabilitation team’s view
and experience of the client.
Clarity in the presentation of costs.
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OVERVIEW OF THE PROCESS
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Referral
Data gathering
 Review of documentation
 Interview and functional assessment
 Consultation with providers –
multidisciplinary approach
 Collateral information from friends and family.
Analysis of lifelong needs
Client specific research for resources and costs
Formulation of Table of Costs
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DEVELOPING THE PLAN
Understand the functional impact of the
injury on the ability to manage:
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Personal care and activities of daily living.
Homemaking and property maintenance.
Community mobility.
Financial Management.
Parenting.
Education or employment.
Leisure and recreation.
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HOLISTIC APPROACH
Person
Life roles
Environment
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CASE STUDY
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Person
28-years-old
Cantonese male
DOL: winter 1999 – (age 17)
Presentation: Behavioural and cognitive
deficits, including communication
impairment, aggressive and self-injurious
behaviours.
Seizure disorder, addressed with medications
Assessed at or below the 1st percentile using
the Adaptive Behaviour Assessment System
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CASE STUDY
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Environment
Lives at home with his parents and maternal
grandparents.
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Two bedroom apartment in Toronto.
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No external services in place for care giving.
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Has worked with a case manager, an O.T.
and a physio.
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CASE STUDY
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Life Roles
Completed grade 9 and had been considered
an excellent student.
Efforts to enroll him in Bloorview MacMillan
Centre and school setting unsuccessful.
No noted program and/or productive role
currently established.
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THEORY OF CASE
Pre-accident assumptions:
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Client would have completed education and
proceeded to independent living, a family, and
remunerative employment.
Post-accident assumptions:
 No improvement expected in neurological
condition.
 Will require full-time caregiver support over
lifetime.
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THEORY OF CASE
Con’t.
Post-accident assumptions:
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Improvement in daily function may be realized
through the introduction and training of
compensatory and behavioural strategies for the
client and caregivers.
Will require assistance for home and property
tasks.
Will require legal guardian for fiscal matters.
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THE NEEDS
Productivity
Maximum
function for
daily living
Safety
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THE NEEDS
Safe Environment:
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Physical dwelling-home modifications.
Ensure home safety through provision of
assistive devices.
Suitable caregiver support throughout the
day to ensure safety.
Medications to manage behaviour and
seizures.
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THE NEEDS
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Medical and Rehabilitation Services:
Case management.
Medical management for seizures and
general health.
Intensive behavioural management.
Occupational therapy.
Speech language pathology.
Individual and family counselling/support.
Rehabilitation Support Worker.
Transportation.
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THE NEEDS
Productive Role:
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Education.
Rehabilitation Support Worker for
community outings to promote quality of
life.
For long term introduction of community
based day programming.
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PROFESSIONAL SERVICES
Name:
_______________
Date of Birth:
_______________
Date of Loss:
_______________
TOTAL Fixed Cost
Per Instance:
$ 91,708.24
TOTAL: Fixed Cost:
$3,441,004.16
TOTAL Annual Recurring
Cost:
$ 224,930.40
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PROFESSIONAL SERVICES
Con’t.
Please Note: The timing and frequency of treatment
set out in this report approximates requirements over
a lifetime. Although the overall estimates are
reasonable. I expect XXXX to resort to treatment to
the degree and with the frequency that circumstances
require from time to time
Case Note:
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PROFESSIONAL SERVICES
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PROFESSIONAL SERVICES
Con’t.
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PROFESSIONAL SERVICES
Con’t
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COST OF CARE
TOTAL Fixed Term:
$ 92,824.00
TOTAL Annual Recurring Cost
$286,725.50
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COMPLEX VS. MILD
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Attendant care/support
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Attendant care/support
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Attendant care/support
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MAKING THE DOLLARS LAST
Attendant Care – Considerations:
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If family and friends were taken out of
consideration, could client live alone?
If the client requires “intermittent” care is this
predictable?
If a recommendation is made for privately hired
services – who will manage implementing
resources?
Practically what is available to purchase at market
rates – per hour, live in model, minimum blocks of
hours
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MAKING THE DOLLARS LAST
Rehabilitation Services Considerations:
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Use of RSW services (under direction of
professional) to implement treatment.
Reducing attendant care for hours when
RSW is in place.
Looking at community resources for suitable
programs
Examining cost effective transportation.
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SUMMARY
Ensuring that an individual and his or her
family have access to necessary services
will increase the individual’s opportunity to
return as closely as possible to his or her
pre-accident roles and responsibilities and
to achieve reasonable dignity and quality
of life
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Thank you
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