The Life Care Plan: An Overview

Lynn Karfomenos RN BSN CCM CNLCP

Richard Hess RN CCM CNLCP

A Life Care Plan (LCP) is a tool used for the purpose of projecting and estimating medical and non-medical needs of the person with a catastrophic injury utilizing a consistent and scientific approach.  The Life Care Plan addresses and projects the costs and frequency of needed goods and services over the estimated lifespan.[i] It is a guide for the patient, family, caregivers, and payor source to follow to ensure that funds will be available over the patient’s lifetime.

The Certified Nurse Life Care Planner (CNLCP) is uniquely qualified to develop the Life Care Plan due to his/her extended experience, knowledge, and education of the nursing process, which forms the foundation of the Life Care Plan. To become certified, a professional nurse must complete advanced course work as well as pass the national certification examination with 78% or higher raw score. The Certified Nurse Life Care Planner collaborates with other members of the healthcare team to formulate an individualized plan to meet the needs of the patient.

Life Care Plans are utilized by a variety of referral sources for several reasons. Insurance carriers or third party administrators may utilize the Life Care Plan for accurate reserve setting on catastrophic claims and as a guide for the authorization of appropriate and medically necessary treatment. Personal injury, medical malpractice, divorce and family law attorneys use the Life Care Plan to assess damages for settlement.  Defense attorneys often request that the Certified Nurse Life Care Planner review and critique the plaintiff’s Life Care Plan for accuracy prior to settlement. Advocacy groups and rehabilitation centers are among other groups that utilize the Life Care Plan as a roadmap to ensure the adequacy and availability of services for a patient.

The most common conditions requiring a Life Care Plan include but are not limited to, catastrophic injuries, spinal cord injuries, traumatic brain injuries, amputations, burns, chronic pain conditions, neonatal and pediatric conditions such as cerebral palsy, and conditions affecting the geriatric populations.

The Life Care Plan is developed by a trained Certified Nurse Life Care Planner, utilizing the nursing process as well as employing research and case management skills. A patient assessment is performed via review of the medical record, thorough medical research, and an inperson interview with the patient. Additional interviews with the family, caregiver, employer, or teachers, are conducted if necessary to obtain a complete patient assessment. The collected data is then analyzed to identify health issues and formulate nursing diagnoses.  The Certified Nurse Life Care Planner may recommend that the patient be evaluated by additional provider specialties to more accurately assess the patient’s needs. An individualized, comprehensive plan of action is developed and associated costs of care, services, and goods are calculated. Following completion of the Life Care Plan, the life care planner will evaluate the effectiveness of the plan for optimal outcomes.  In-person evaluation however, is not always possible if the plan is used solely for the purposes of reserve setting or settlement. The plan should be reviewed and updated every six months.

The average time required to complete a thorough Life Care Plan varies depending on the complexity and number of medical issues and the expedience of data collection. From the time of referral to its completion, the Life Care Plan may require anywhere from 2 to 4 months and involve 30 to 50+ hours of intensive development. Due to the time intensity of the plan development, it is therefore crucial that the referral be made as soon as possible to the Certified Nurse Life Care Planner.

The Life Care Plan is more than a “snapshot” of medical care and associated costs.  It is more than a mere cost-projection of care.  Rather, the Life Care Plan is an individualized, comprehensive, and thorough analysis of the patient’s needs over his/her remaining lifespan, specific to the medical condition.  The Life Care Plan is an invaluable tool for claims professionals, attorneys, patients, families, and providers to ensure that the patient obtains and maintains the highest level of functionality and quality of life all the while utilizing the allocated resources identified and outlined in the individualized plan.

Ms Karfomenos and Mr. Hess are the principle partners of Hess, Karfomenos and Associates LLC, a firm whose business focus is Medical Case Management, Life Care Planning and Legal Nurse Consulting. Both Ms. Karfomenos and Mr. Hess sit on the Certification Board of the American Association of Nurse Life Care Planners and are nationally certified as Nurse Life Care Planners as well as Case Managers. The firm has extensive Worker's Compensation experience in multiple state jurisdictions. Their offices are located physically in North Central Indiana. They may be contacted by visiting their website; www.hkamedlegal.com

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