Legal
Evaluation for Competency
Last Updated:
Life care planning began in the field of litigation, assisting attorneys to specify and clarify damages associated with long-term health problems. The intent was to provide costs for care, equipment, supplies and other needs resulting from the injury.
Today, the definition and use of life care plans has evolved beyond litigation. In 1998, the International Academy of Life Care Planners joined Intelicus, NARPPS Forensic Section and others to accept and publish the following definition:
A life care plan is a dynamic document based upon published standards, comprehensive assessment, data analysis and research, which provides an organized, concise plan for current and future needs, with associates costs for individuals who have experienced catastrophic injury or have chronic health care needs.
A life care plan is a method to manage information about the individual. Life care plans may be used by insurance or reinsurance companies to determine potential costs for persons with catastrophic injury. Families may use a life care plan as a guide to necessary services and resources. Life care planning may be used in elder care management and outcome evaluation.
Life care planning is a transdisciplinary practice, demonstrating advanced skill and knowledge about catastrophic injury or illness. Practitioners include nurses, physicians, vocational counselors, social workers or other rehabilitation professionals. The life care planner must have a thorough understanding of the individual’s diagnoses, medical treatment, costs of treatment and services, factors affecting care outcomes, psychosocial implications and ongoing health care needs. The life care planner must be knowledgeable about community resources and eligibility for these resources. Further, the professional must be able to identify and develop alternatives for care consistent with patient/family needs. A life care plan represents the integration of prevention, care/cure, and rehabilitation services into a plan to meet individual needs.
Life Care Plan Development
By definition, a life care plan is dynamic in nature. Therefore the plan is based upon five elements, which serve as the foundation for care and services, which will be affected by external influences:
1. Record Review
2. Assessment
3. Collaboration
4. Data Analysis
5. Research
Record Review
The process of life care planning begins with record review. Records may include medication information, school or military records, records of specialty evaluation or reports from community agencies or services. Review of records provides the life care planner with an initial understanding of the individual, the history of the catastrophic injury and treatment, and the current medical treatment plan. Members of the treatment team may be identified to promote the necessary collaboration.
Assessment
Assessment occurs through an on-site interview and includes the patient, family and/or care givers. If the patient and environment are not observed and assessed, then the document is not a life care plan, but simply a long-term cost projection based upon diagnosis and treatment records.
Data gathered during on-site assessment includes:
· History of the individual
· Health history
· Complications experienced since injury
· Current diagnosis
· Current treatment plan and compliance
· Current status
· Functional skills and abilities
· Psychosocial status including viability of the family unit
· Education and vocational history
· Financial status
· Current medications, supplies and durable medical equipment
· Adaptive devices
· Need for additional services
· Accessibility of the environment
· Understanding of the treatment plan
· Understanding and use of community resources
Collaboration
A life care plan is not developed in isolation. Collaboration with treating professionals is necessary to determine projected needs, frequency of care and services. This contact also promotes communication about the patient’s status, verification of the treatment plan and understanding about the patient’s application of learning to the home environment.
Collaboration must also occur with providers outside the treatment team, such as providers of durable equipment, supplies and pharmaceuticals.
Data Analysis
Data analysis is necessary for accuracy in formulating conclusions and long-term recommendations within the life care plan. Data analysis requires clinical knowledge regarding the patient’s medical diagnosis and status. If a strong knowledge base does not exist, there is the likelihood of poor planning, which could result in inappropriate care or services and inappropriate assessment of needs. Analysis of data involves comparison of medical records, assessment information and treatment team’s understanding of the individual’s needs with the life care planner’s identification of needs.
The outcome of data analysis is clear, concise documentation of needs, necessary care and services, the rationale for care and services, anticipated outcomes and variables that may impact care and costs.
Research
The need for research in life care planning for litigation has increased due to Supreme Court decisions (Daubert, Kumho Tire). At the same time, research requirements have increased for life care planning outside of litigation. As long-term needs are determined and costs identified, knowledge of actual costs, contracted costs, community alternatives and geographically specific data becomes imperative.
Costs may be researched by direct contact with providers, review of actual charges or access to databases that provide costs for supplies, equipment, medications and services. The research method must be identified within the life care plan and sources for information should be cited.
Geographic availability of services is a key area of research. A life care planner must learn about the local community and its resources to avoid making recommendations that cannot be met. A life care planner must know if community transportation exists, if “First Call for Help” is available, or if home care services will travel to a remote, rural area.
Research regarding currently accepted frequency of services or hospital lengths of stay must be carried out. For example, what professional group recommends neuropsychological evaluation annually or how has managed care impacted the length of stay following spinal cord injury?
Summary
Life care planning is a transdisciplinary process that is carried out by professionals in various settings. Initially developed for litigation, the process has expanded to workers’ compensation catastrophic cases, group health chronic diagnoses, patient/family education, elder care management and outcomes evaluation.
The process results in information management, using the elements of record review, assessment, collaboration, data analysis and research. A life care plan, completed by a professional with a strong clinical knowledge base, results in a clear, concise communication about an individual’s needs for appropriate care, goods and services, following catastrophic injury or diagnosis with chronic illness.
Patricia McCollom is president and nurse consultant of Management Consulting and Rehabilitation Services, Inc. and LifeCare Economics, Ltd., Ankeny, Iowa. She is CEO of the International Academy of Life Care Planners. Questions may be directed to McCollom at ialcp.com or by calling 515.964.3868.