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By Nicki Bradley,
RN, BS, CCM, DOL, CNLCP, Bradley Consulting and Management
Life Care
Plans are becoming an integral part of estimating future medical needs.
The estimation of future medical needs is not a new concept. In fact,
attempting to predict the future is what medical-related litigation has
always been about. Formal Life Care Planning, on the other hand, is
moving to the forefront as an organized method for making medically
probable predictions and then using that information to set aside
appropriate dollar reserves.
What
is a Life Care Plan?
The Life Care Plan is an estimation or
projection based on published standards of practice, research and data
analysis as well as a comprehensive assessment and medical records
review. Necessary information is collected by using a team approach. The
estimate of needs is prepared in collaboration with each healthcare
professional involved in the client’s care. The plan is unique and based
on the specific needs of the individual. Issues addressed in the plan
include physical, developmental, cognitive and psychosocial aspects.
The intent of the Life
Care Plan is to allow the client to be as independent as possible. The
plan is a guide which ensures that funds will be available to properly
care for the client throughout his lifetime. The Plan is an estimate of
medical care and costs and may also include a vocational assessment.
Contents of the Plan are comprehensive but can be modified according to
the needs of the requestor.
Who
would utilize a Life Care Plan?
For
insurance purposes, adjusters use the Life Care Plan to set reserves.
In litigation, typically, a plaintiff’s attorney will retain the
services of a Life Care Planner to research the financial issues of an
injured client. When a defense attorney notes that a Life Care Planner
has been retained, he will do the same. It is essential that a Life Care
Planner be employed who has worked on both sides and has a reputation
for being ethical and consistent with the type of evaluations that she
performs. Once both sides have developed a plan, these plans are usually
compared in a litigation setting and through arbitration, mediation or
trial, a settlement is agreed upon and money becomes available to care
for the ill or injured individual.
Who
needs a Life Care Plan?
Life Care
Plans provide an estimate of the medical and non-medical needs of
persons with catastrophic or chronic debilitating injuries or
illnesses. Any individual with a severe injury or illness with life
long on-going needs is appropriate for a Life Care Plan.
Appropriate patient referrals include:
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Chronic Pain Traumatic Brain Injuries
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Spinal Cord Injuries Cerebral Palsy
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Severe Burns Reflex Sympathetic Dystrophy
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Multiple Trauma Injuries Orthopedic Injuries
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Amputations Electrical Injuries
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Birth Injuries Toxic Exposure
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Vision/Hearing Loss Injuries HIV/AIDS
-
Medicare Settlements
Who
is qualified to complete a Life Care Plan?
An appropriately skilled
professional certified as a Life Care Planner should lead the team of
professionals in developing the Plan. Unique to the registered nurse
credentialed as a Life Care Planner is the fact that according to the
Nurse Practice Act, the nurse is licensed to complete a medical
assessment. This fact is substantiated and recognized in a court of law.
The Life Care Planner works in close collaboration with the treating
physicians, therapists, vocational experts, equipment and care
providers, and economists.
What
is included in a Life Care Plan?
Needed equipment,
replacement schedules, and maintenance will be included in each plan and
will vary according to the individual interests and use of the
equipment. The costs projections are based on interviews with
suppliers, facilities, pharmacies, and other health care providers. If
the product is unavailable in the local area, shipping is included in
the cost of the product. Inflationary trends in the industry are not
reflected in the costs. An economist is consulted to determine
allowances for inflationary medical care trends.
The Life Care Plan is
accompanied by a narrative report that outlines activities of daily
living, treatment history, employability if indicated and loss of
earning capacity.
How is the Life Care
Plan implemented?
Once the money is made
available, it is highly recommended that a case manager be retained to
implement and continue the Life Care Plan. The money must be available
and guaranteed for use by the ill or injured individual whether the
money is put into a structured settlement or set aside in reserves. The
cost of the case manager is usually included in the Life Care Plan,
therefore the expense is already paid for and available. The case
manager will keep the plan in place and determine when new needs arise.
A Life Care Plan should be updated and adjusted every six months or as
needed based on the individual’s medical needs.
Nicki Bradley, RN, BS,
CCM, DOL, CNLCP is a Certified Nurse Life Care Planner. Please call
Nicki at 800-467-7331 ext. 200 or e-mail
nbradley@bradleycm.com with
any questions about Life Care Plans.
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