Transcript No Slide Title

Life Care Planning
Process and Practice
CLOIE B. JOHNSON, MED,
ABVE, CCM
Life Care Planning:
State of the Art
AIDC 2012
Life Care Planning
 A. History
 B. What Is A Life Care Plan?
 C. Who Prepares A Life Care Plan?
 D. Practice Standards
 E. Tips
History
 McGowan and Porter (1967)
 The Rehabilitation Act of 1973
 Individual Written Rehabilitation Plan
(IWRP)
 Damages in Tort Action
 (Deutsch & Raffa, 1981)
What Is A Life Care Plan?
 A Life Care Plan is a dynamic document
based on published standards of practice,
comprehensive assessment, data analysis
and research, which provides an organized,
concise plan for current and future needs
with associated cost, for individuals who
experienced catastrophic injury or have
chronic health care needs.
 A Life Care Plan is a tool of Case
Management.
Who Utilizes Life Care Plans?
Patients
and Families
Treatment
Trust
Teams
Managers
Claims
Examiners
Attorneys
Economists
The
Court
What Areas Does a
Life Care Plan
Consider?
Categories
 Projected
Evaluations
 Wheelchair
/ Mobility Accessory and
Maintenance Needs
 Projected
Therapeutic Modalities
 Orthotic/Prosthetic
 Home/Facility
 Projected
Care
Routine Future Medical Care
 Diagnostic
Testing/Educational Assessment
 Architectural
Renovations
 Leisure
 Future
Time and/or Recreational Equipment
Routine Medical Care
 Future
Surgical Intervention, or Aggressive
Treatment Plan
 Transportation
 Identification
of Potential Complications
 Medication/Supply
Needs

to name a few…...
 Vocational
 Aids
Rehabilitation Assessments
for Independent Function
 Assessment
of Lost Earning Capacity (
Optional)
 Home
Furnishing and Accessories
 Orthopedic
Equipment

to name a few…...
Who Prepares A Life Care Plan?
 Rehabilitation
 Case
Counselors
Managers
 Nurses
 Therapists,
(PT, OT, SLP, Psychologists)
 Physicians
 Professionals
who have appropriate life care
planning training and experience.
Life Care Planners possess
 Education
 Experience
 Credentials
 Areas of Expertise (Specialized knowledge)
Rehabilitation Counselors/Case Managers
 Education:
Master's degree
 Experience:
Significant relevant experience in
Rehabilitation Counseling, Nursing and Case
Management.
 Certifications:
CRC, CCM, CDMS, ABVE, CLCP (not
all inclusive or all required)
 Areas
of Expertise: Specialized knowledge
Who Prepares a Life Care Plan?
Rule of Evidence vs. Professional Certifications: The
Real Basis for Establishing Admissible Testimony by
Rehabilitation Counselors and Case Managers,
Rehabilitation Professional Journal, Vol. 15, No. 3,
pps 7 – 16, Athens, GA: Elliott & Fitzpatrick, Inc., 2007
Summary of Rehabilitation Certifications
on Selected Variables
Minimum Minimum
Independent Year Education Experience
Accreditation Est. Required Required
Code
of Ethics
Standard
of
Exam
CEUs
NonPractice Required Required Profit
CRC
Yes
1975
Yes
Yes
Yes
Yes
Yes
Yes
CCM
Yes
1993
Yes
Yes
Yes
Yes
Yes
Yes
CDMS
Yes
1984
Yes
Yes
Yes
Yes
Yes
Yes
CLCP
No
1996
Yes
Yes
Yes
Yes
Yes
No
ABVE
No
1980
Yes
Yes
Yes
Yes
Yes
Yes
CNLCP
No
1999
Yes
Yes
Yes
Yes
Yes
Yes
CVE
No
1981
Yes
Yes
Yes
Yes
Yes
Yes
Who Prepares A Care Plan?
 Rehabilitation
Counselors and Case Managers
who have care planning training and
experience.
 The
professional should have advance
knowledge of specific disabilities, established
treatment care resources, and a consistent,
objective approach toward the practical and
functional elements involved in the treatment of
catastrophic injuries and diseases.
Life Care Plan Goals
Quality of Life
Least restrictive environment
Promote independence
Maintain dignity
Foundation and Role
 The medical community defines
the nature and extent of an
impairment. The Life Care
Planner translates what that
means for work and independent
living.

(Field, over the years)
Role and Function
 “…. emphasize the need to understand
the entire person and “look” at them
compared to themselves both pre and
post injury. The client is an N of 1.
While common approaches and
methodologies exist, clinical judgment
is required to determine the true effect
of injury or illness on an individual.”
(Choppa & Johnson, 2008)
Application of Data
“Often times, state data, federal data,
and/or research studies are used as
determining factors in an evaluation.
Practically speaking though, the client
as a whole, and all that is known about
them, should be applied to the data,
not simply applying the data to the
client.”
(Choppa & Johnson, 2008)
Round Pegs – Square Holes
 It is not Paint by Numbers
 It is not replicable by a layman
 “Economists deal in numbers or
things that can be converted into
numbers. The economist then,
expects the life care plan input to be
specific and capable of being
inserted into mathematical models.”
(Dillman, 2008)
Balance
 “The accuracy of the analysis is primarily based
upon the three factors of methodology, clinical
expertise and accurate application of the
available researched data”
 “The Life Care Planner is vulnerable to error in
the decision making process when they lack the
experience in evaluating a case and are overly
reliant upon the data.”
 “The experienced Life Care Planner is prone to
analysis error if they are overly reliant upon
their experience and ignore the data or fail to
evaluate how the data applies to a specific
individual.”
(Grimes, 2008)
Considerations
 The Life Care Planner must scratch
below the surface to understand the
practical real life implications for
the individual.
The Process
 Step-By-Step Process
 Consistent Methodology
 Generally accepted
 Peer reviewed
The Process of Coordinating a Life Care Plan
 “You’ve got to be very careful if
you don’t know where you are
going because you might not get
there.” Yogi
How is a Life Care Plan Prepared
 Referral
 Records
 Interview
 Coordination with Physicians and/or Providers
 Research
 Life Care Plan prepared
 Concurrence obtained
 Report completed
Process
 Case Intake/Referral
 Starts with accepting the referral

Discuss basic referral information:
 Purpose i.e., legal, reserves, private hire
 Timelines,
 Location of client,
 Financial issues, including retainer
 Request medical records
 Information release signed in advance
 Unique circumstances
Process
 Review Medical Records
 Are they sufficient (examples)..
Ambulance report
 Emergency room notes
 Admit and Discharge notes
 Nurses notes
 Doctors orders
 Therapy notes and reports
 Consultant reports
 Lab/X-ray reports
 Etc…

Process
 Additional documentation
 Depositions
 Videotapes
 School
records
 Employment records, including earnings
 Tax records
Process
 Initial Interview
 Educational
 Standardized forms
 Pre-functioning
 Post-Functioning
 Current treatment
 Impact on all roles
Process
 Initial Interview Materials
 Informed
Consent
 Release of information
 Intake outline
 Related checklists
 Sample plan
Process
 Consulting and Communicating with Team Members
 Physician
 Consulting specialists
 Client and family
 Foundational requirements:

Medical, Psychological, Case Management and Vocational
Process
 There are five components to establishing the medical





foundation for the life care plan .
A. Utilizing the Medical Records.
B. Coordinating with the treatment team.
C. Utilizing consulting specialists.
D. Utilizing of Clinical Practice Guidelines.
E. Utilizing of Research Literature.
Process
 A psychological foundation is also established with
the similar steps noted above, however may also
include coordinating with the psychologist or
mental health counselor.
 Case Management foundation

Similar steps are utilized in establishing case management
foundation although consultation with the current case manager
would also be utilized.
 Rehabilitation foundation

Establishing a rehabilitation foundation may also include utilizing
personal expertise, training, and clinical judgment
Process
 Preparing the Preliminary Plan
Item
Purpose
Providers
Duration
Frequency
Base
Cost
PRELIMINARY CARE PLAN
NAME: MALE
DOB: 3/5/80
DOI: 1/14/02
ITEM
PURPOSE
PROVIDER
AGE/INITIATED
AGE/SUSPENDED
REPLACEMENT
RATE
BASE
COST
What
Why
Who
When
How often
How Much
CARE PLAN
Life Care Plan Coordination
 Filling in the Holes
Missing
information
Additional evaluations
Realistically implementable
Have you thought through the missing
issues
Life time road map
Life Care Plan Coordination
 Researching Costs and Sources
 Actual
providers
 Internet
 Prior medical records
 Catalogues
 Documentation
Life Care Plan Coordination
 Finalize the Plan and share
 Physician/treatment
 Client
 Vocational
Expert
 Economist
 Referral
source
team
ITEM
PURPOSE
PROVIDER
Physical Medicine
and Rehabilitation
Evaluation,
Monitoring and
Treatment
Ongoing evaluation, monitoring and treatment of
sequelae of T7 paraplegia Make necessary
rehabilitation referrals regarding musculoskeletal,
neurogenic bowel/bladder and other related
complications.
Primary Care
Physician Evaluation
Monitoring and
Treatment
Urological Evaluation
Monitoring and
Treatment
Orthopedic
Evaluation,
Monitoring and
Treatment
Dr. PM&R or
Local Provider
AGE/INITIATED
AGE/SUSPENDED
Current Age to Life
Expectancy
REPLACEMENT
RATE
Average 1 visit per
year minimum
Ongoing evaluation, monitoring and treatment of
spinal cord injury. Provide future treatment
recommendations as needed.
Dr. PCP or Local
Provider
Current Age to Life
Expectancy
Ongoing evaluation, monitoring and treatment of
neurogenic bladder due the sequelae of Mr. Doe’s
spinal cord injury. Provide future treatment
recommendations, as needed.
Dr. P or Local
Provider
Current Age to Life
Expectancy
Average 6 visits per
year above and
beyond routine and
pre-existing needs
Average 1 visits per
year minimum
Ongoing evaluation, monitoring and treatment of
orthopedic needs as Mr. Doe is at risk for
developing: upper and lower extremity contractures
and deformities; he is more likely than not going to
experience one fracture minimum in his lifetime and
require surgical intervention with follow up. Provide
future treatment recommendations, as needed.
Dr. Bone or Local
Provider
Current Age to Life
Expectancy
PROJECTED EVALUATIONS/TREATMENT
Evaluation one time
minimum, timing to
be determined by
PM&R or PCP
BASE
COST
Evaluation:
$177.00 $217.00
Follow-up:
$119.00 –
176.00
$158.00 212.00 per visi
Evaluation:
$147.00 $211.00
Follow-up:
$158.00 212.00
Evaluation:
$147.00 $211.00
Follow-up:
$158.00 212.00
VOCATIONAL ASSESSMENT AND
LIFE CARE PLANNING
•Vocational Assessment
•Vocational Recommendations
•Rehabilitation Plan
•Educational Capacity
•Wage Earning Capacity
•Life Care Plan
Tips
•O B T A I N A P P R O P R I A T E E D U C A T I O N A N D
CREDENTIALS
•B E K N O W L E D G E A B L E A B O U T T H E
DISABILITY(IES).
•O B T A I N R E L E V A N T S P E C I A L I Z E D L C P
TRAINING
•B E L O N G T O A N D , E V E N B E T T E R , B E A C T I V E
IN APPROPRIATE ORGANIZATIONS
Tips
(continued)
42
•D E V E L O P L I F E C A R E P L A N S A C C O R D I N G
TO ESTABLISHED AND ACCEPTED
STANDARDS OF PRACTICE, ETHICS AND
P U B L I S H E D M E T H O D OL O G I E S
•M A K E S U R E T H A T L I F E C A R E P L A N S
INCLUDE PROPER FOUNDATION
•S T A Y C U R R E N T W I T H T H E P A R A M E T E R S
OF THE PROFESSION
Tips
43
•B E F A M I L I A R W I T H R E L E V A N T
LITERATURE
•B E F A M I L I A R W I T H T H E R U L E S O F T H E
JURISDICTIONS IN WHICH ONE PRACTICES
•B E K N O W L E D G E A B L E A B O U T A P P L I C A B L E
FEDERAL RULES OF EVIDENCE WHEN
TESTIFYING IN PERSONAL INJURY
LITIGATION
Tips
(continued)
•L I F E C A R E P L A N N E R S A R E N O T S I M P L Y
SCRIVENERS OR SECRETARIES SIMPLY
WRITING DOWN WHATEVER SOMEONE
ELSE RECOMMENDS NOR DO THEY “KNOW
IT ALL”
•S T A Y W I T H I N O N E S A R E A O F E X P E R T I S E
OR SCOPE OF PRACTICE
•U T I L I Z E A L L O F Y O U R S K I L L S A N D
UNDERSTAND THE PREMISE IN WHICH
YOU COORDINATE A LIFE CARE PLAN
Standards of Practice in Life
Care Planning
IALCP - THE PURPOSE OF THE IALCP IS TO PROVIDE
EDUCATION AND LEADERSHIP FOR PROFESSIONALS WHO
CONDUCT LIFE CARE PLANNING AND TO CONTRIBUTE TO
THE DEVELOPMENT OF LIFE CARE PLANNING STANDARDS,
POLICIES AND PRACTICE.
INTERNATIONAL ACADEMY OF LIFE CARE PLANNERS. (2006
REV). STANDARDS OF PRACTICE FOR LIFE CARE PLANNERS.
JOURNAL OF LIFE CARE PLANNING, 5(3), 75-81.
99 CONSENSUS AND MAJORITY STATEMENTS FROM SUMMITS
SINCE 2000 (PRESTON, K & JOHNSON, C., JOURNAL OF LIFE
CARE PLANNING, 11(2), 9-14