Life Care Plans...Who?, What, When, and Why?

Comp Clues
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:
  • Chronic Pain Traumatic Brain Injuries
  • Spinal Cord Injuries Cerebral Palsy
  • Severe Burns Reflex Sympathetic Dystrophy
  • Multiple Trauma Injuries Orthopedic Injuries
  • Amputations Electrical Injuries
  • Birth Injuries Toxic Exposure
  • 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.