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1. What is a life care plan?

"The life care plan is a dynamic document based upon published standards of practice, comprehensive assessment, data analysis, and research, which provides an organized, concise plan for current and future needs with associated costs for individuals who have experienced catastrophic injury or have chronic health care needs" (International Academy of Life Care Planners, 2003. Established during the 2000 Life Care Planning Summit ). Life care planning is a consistent process for evaluating the client in order to identify all future needs that will be necessary as a result of a debilitating injury. Because each person is a unique individual, "consistency" refers to the process used to develop a life care plan, and does not denote that life care plans for clients with the same disability will be identical. Careful consideration is given to the client's goals, needs and interest of the patient, the needs of the family, the geographic region in which the patient resides. The process is based on published standards, tenets, methodologies and principles. The life care planner carefully reviews medical records, the patient and family perspective, the treating interdisciplinary team, the clinical practice guidelines, relevant literature, and the carefully established best practices for medical, case management and rehabilitation intervention.

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2. How can a life care plan benefit an individual?

A life care plan is a tool of case management and can be used in consultation with patients, families, physicians, rehabilitation professionals, and catastrophic case managers. The life care plan specifies the long-term medical, psychological, and rehabilitation needs of an individual throughout his/her lifetime. It has application in multiple arenas including Workers Compensation, Long Term Disability, Medical Insurance, Litigation, and Government programs such as Medicare and Medicaid. In the insurance arena, a life care plan is utilized as a preventative plan for disability management and as a tool to set aside reserves. Within the legal arena, it is used to establish an accurate profile of the long term needs, recommendations and costs associated with the onset of a specific injury and subsequent disability.

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3. What is included in a life care plan?

Though the elements of life care plans are generally consistent, the content within each subheading is individualized to the needs of the patient and family. Each subheading includes the name of the service or device recommended in addition to each associated cost, replacement schedule, dates of implementation and suspension, and the name of the professional making the recommendation are clearly identified. Depending upon the specific needs of the patient, the following areas may be addressed within the life care plan:


  • Routine future medical evaluations and treatment
  • Surgical and/or Outpatient Procedures
  • Projected therapies; physical, occupational, speech, psychological, neuropsychological, etc.
  • Medication
  • Diagnostic testing and educational assessments
  • Supplies and Durable Medical Equipment, including replacement and maintenance schedules
  • Home care or facility-based care needs
  • Orthotic or prosthetic requirements
  • Transportation needs
  • Home renovations, furniture needs, and work accommodations
  • Aids for optimal independent function
  • Leisure or recreational accommodations and equipment

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4. What is the life care planner’s role in a legal case?

The role of the life care planner is that of educator, not advocate. A planner must maintain objectivity and base recommendations upon the medical records, clinical interview and history with the patient and family, interaction with the medical and health related professional treatment team, relevant clinical practice guidelines, relevant research literature as well as the opinions of consulting team members (physicians, therapists, etc.). The responsibility of the life care planner is to set forth attainable rehabilitation goals and to assure that all parties involved in the process understand why specific items are included, how/when services should be provided, and how the plan is best implemented. As an educator, the planner must be able to clearly communicate the nature of a patient's disability, the residual functional limitations, and the effects of the disability throughout the patient's life expectancy.

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5. Who is qualified to be a life care planner?

The role of the life care planner is that of educator, not advocate. A planner must maintain objectivity and base recommendations upon the medical records, clinical interview and history with the patient and family, interaction with the medical and health related professional treatment team, relevant clinical practice guidelines, relevant research literature as well as the opinions of consulting team members (physicians, therapists, etc.). The responsibility of the life care planner is to set forth attainable rehabilitation goals and to assure that all parties involved in the process understand why specific items are included, how/when services should be provided, and how the plan is best implemented. As an educator, the planner must be able to clearly communicate the nature of a patient's disability, the residual functional limitations, and the effects of the disability throughout the patient's life expectancy.

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6. Are life care planners certified?

In addition to achieving certification in their primary disciplines, a life care planning professional may elect to pursue board certification in life care planning through the International Commission on Health Care Certification (ICHCC) or, for nursing professionals, the American Association of Nurse Life Care Planners (AANLCP) . If certification is obtained through ICHCC, the professional is a Certified Life Care Planner (CLCP). If certification is obtained through AANLCP, the nurse is a Certified Nurse Life Care Planner (CNLCP). Both certifications require adherence to strict qualifications for eligibility and renewal of the certification.

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7. Are funding issues considered in a life care plan?

No. A life care plan reflects the needs of the individual and the recommendations necessary to fulfill those needs, irrelevant of the insurance or other funding that is currently available to the client. The costs assigned in a life care plan are based on the current cost of the services recommended in the area in which the client resides. Insurance fee schedules and discounts are not taken into consideration.

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8. Do life care planners collaborate with other professionals?

Absolutely. A life care plan addresses every aspect of a disability from onset through the end of life expectancy. By the nature of the task this requires developing information across the continuum of care, and includes medical, vocational, and recreational recommendations. Consequently, a life care plan cannot be developed in a vacuum. The life care planner consults with current and potential future providers to establish a realistic and appropriate plan of care.

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9. Is there a specific life care planning methodology?

Yes. The most respected life care planners follow a consistent approach to plan development with each and every case. These steps involve:

  • Comprehensive review of records and supportive documentation.
  • Clinical interview and history with the patient and whenever possible a family member or significant contact who knew the patient pre-morbidly as well as post-morbidly.
  • Interaction with the medical and health related treatment team to obtain answers to questions not established in the medical records review.
  • Research to develop relevant clinical practice guidelines to further establish needs and recommendations as well as support medical and case management foundation.
  • Research on relevant research literature to further establish needs and recommendations as well as support medical and case management foundation.
  • Where necessary establish further data through staffing with consulting specialists.

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10. Is a plaintiff life care plan different from a defense life care plan?

Absolutely not. Regardless of the referral source (e.g., plaintiff attorney, defense attorney, insurance company, private party, etc.), life care planners employ a systematic approach to analyze the client’s care needs and base their recommendations upon. This is not to say their won’t be variations between life care plans, even when clients have similar injuries. However, these variations will be a result of the uniqueness of the client as opposed to an inconsistent methodology.

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11. If a referral comes from a defense firm is the life care planning process different?

The fundamental process does not change when approaching the life care planning process from a defense perspective. However, because a life care planner is often not allowed to have access to the client, their family, or the treating providers, the life care planner can have limited information on which to base their opinions. If time permits, these issues can be overcome to some extent if the life care planner is provided the opportunity to prepare specifics questions that can be asked in the depositions of the client, the family, the plaintiff’s life care planner, and the medical and ancillary providers.

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12. What four areas of the life care plan require the development of a strong foundation?

The practice of life care planning has been influenced by extensive research that has taken place over the past several decades. This research has identified four critical areas of the life care plan where a strong Foundation must be established: Medical Foundation; Rehabilitation Foundation; Case Management Foundation; and Psychological Foundation.

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13. What steps are taken to develop a strong foundation?

A strong Medical Foundation is established by:

1. Drawing direct links between the medical records and recommendations in the plan.
2. Writing the Medical and Allied Health treatment team members with plan questions not answered in the existing records.
3. Utilizing consulting specialists.
4. Utilizing Clinical Practice Guidelines.

A strong Rehabilitation Foundation is established by:

1. Effective use of the medical and rehabilitation records through careful linking of this information to plan recommendations.
2. Writing the Medical and Allied Health treatment team members with plan questions not answered in the existing records.
3. Utilizing consulting specialists.
4. Utilizing Clinical Practice Guidelines.
5. Using Research Literature.

Strong Case Management and Psychological Foundations are established by:

1. Effective use of the medical and rehabilitation records through careful linking of this information to plan recommendations.
2. Writing the Medical and Allied Health treatment team members with plan questions not answered in the existing records.
3. Writing the current case manager on the file.
4. Utilizing consulting specialists.
5. Using Clinical Practice Guidelines.

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14. Why are and future technologies not included in the life care plan?

The costs and efficacy of future technologies cannot be accurately predicted. A life care planner can discuss the potential for future technologies in their narrative, but future costs are not assigned.

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15. How can a life care planner predict what an individual will need in the future?

A life care planner does not attempt to “predict” future events, but bases the plan upon all of the steps outlined in the process above. This includes but is not limited to review of the medical records, recommendations from members of the individual’s current treatment team, clinical practice guidelines, and evidence-based research relative to the individual’s disability and level of function. In addition, an extensive review of the medical records and clinical interview allow the planner to appreciate the individual’s medical and rehabilitation history while understanding current needs. Recommendations within the life care plan must have a basis in known medical, case management and rehabilitation outcomes as documented within the research literature.

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16. Can a life care planner withstand a Daubert challenge in federal court?

Paul M. Deutsch is one of the foremost leaders in the life care planning community. He has written extensively on the topic of life care planning, and many educational materials and text books for life care planners were written, at least in part, my Mr. Deutsch. Mr. Deutsch has outlined the following key components in answering the four questions under Daubert, (six if you are in Texas) or being prepared under Frye:

1. Always expect a challenge and be prepared to properly educate all parties on the life care planning process step by step.
2. Carefully educate your referral source so they are prepared to act as a first line of defense in answering the judge's questions. The most significant problems occur when the referral source is not sufficiently prepared for a challenge and cannot answer the questions.
3. Where possible have the testimony proffered, giving the Life Care Planner an opportunity to answer the questions that are being raised.
4. Always have extensive documentation. For example, do not just refer to the clinical practice guidelines, research literature, home health practice act for the particular state, Federal minimum standards for Home Health Practices or the Centers for Medicaid and Medicare standards for reimbursement on CNA's, LPN's and RN's. Instead, have the relevant materials with you at the time of testimony.
5. In addition to having the relevant materials, the life care planner should set up a bullet point chart outlining relevant points to go over for themselves and the referral source.
6. Documenting the acceptance of life care planning among the relevant scientific community is not difficult. Life care planning is endorsed by a number of professional associations and has been the focus of a broad range of peer reviewed journal articles. In addition, in 2004 a determination was made by CORE (Commission on Rehabilitation Education) stating that all State University Masters programs would be required to demonstrate relevant life care planning curriculum in order to qualify for certification.
7. In short be well informed, well prepared and know the relevant questions under Daubert and Frye and be prepared to answer them. Know the nature of the motion that has been filed and be prepared to answer that. Neither the referral source nor the life care planner should take this lightly. It is important to the case, to the referral source and it is critically important, to in its impact on the consulting career of the life care planner.

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17. How is validity related to life care planning?

Validity is case specific. If life care planning is a valid process, then a good life care plan will accomplish its mission: to decrease the frequency and severity of medical complications, avoid the need for crisis intervention, and improve the patient’s overall quality of life. Establishing the validity of the life care planning process shows that the basic tenets of life care planning are sound.

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