Trial Magazine

Nearly a year ago, your client, Mrs. Jones, was severely injured in an auto collision. She continues to have difficulty walking, suffers from chronic neuropathic pain in her lower extremities, and has impaired memory and judgment. Her condition is so severe that her family is hesitant to leave her home alone, and she has not returned to work or driving.

An economist assesses Mrs. Jones’s economic damages and concludes that they are more complicated than merely lost wages and past medical bills. The economist suggests retaining a life care planner to develop a comprehensive plan for Mrs. Jones’s future care.

This is a common scenario in catastrophic personal injury cases and applies in this instance as well as ones involving birth injuries, traumatic brain and spinal cord injuries, and amputations. Life care plans also have been used for individuals with a delayed cancer diagnosis or who suffered a stroke, burns, abuse, chronic non-healing wounds, or other injuries that require long-term medical care, rehabilitation, or daily assistance.

In addition to medical needs, life care plans often account for other needs such as housing or vehicle modifications and household services.¹ More recently, life care plans have been used to quantify the household, child care, and counseling services surviving family members need when people die from their injuries.²

A life care plan is based on “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.”³ It should concisely and objectively present your client’s current and future needs and detail their associated costs. Its sources should be verifiable: The recommended services and their cost should be readily validated by another life care planner. And the plan’s recommendations should be consistent with both medical and community-based standards of care, such as current home-care and nursing regulations and practice standards. Here are some basics you should know before hiring a planner.

Although many life care planners are registered nurses or vocational rehabilitation counselors, other relevant backgrounds include social work, special education, rehabilitation therapy, or psychology.

Experience and Qualifications

Although many life care planners are registered nurses or vocational rehabilitation counselors, other relevant backgrounds include social work, special education, rehabilitation therapy, or psychology. Physicians, typically physiatrists, may also provide life care plans. When selecting a planner, make sure he or she has developed and defended life care plans for people like your client. A planner with experience implementing care management services in a rehabilitation facility or in the community can provide a plan solidly based on established standards of care—and can defend it in court.

Several organizations provide certifications to ensure consistency and credibility in life care planning. The International Commission of Health Care Certification⁴ offers health and allied health professionals the Certified Life Care Planner distinction, while the American Association of Nurse Life Planners⁵ offers registered nurses a Certified Nursing Life Care Planner certification.

These certifications do not guarantee a life care planner’s competency, but they indicate that the planner has completed certain basic training and testing requirements. To maintain these certifications, planners must avail themselves of continuing education opportunities on a consistent basis. Both organizations maintain a listing of certified life care planners for your reference.

Plan Basics

An experienced life care planner will use consistent methodology when evaluating each case. The planner likely will request a set of medical records to become familiar with your client’s past and current medical condition and will want to know any other expert opinions you anticipate obtaining during discovery.

The life care planner will visit your client—typically at his or her home. This visit helps the planner fully understand your client’s functional deficits, and the interplay between those deficits and your client’s family and home environment. For children, this may also include in-school observation and consulting education personnel. After these visits, the life care planner may request additional records or ­recommend additional evaluations. The planner will want to speak with the ­client’s current medical and rehabilitation providers before crafting the plan.

After gathering this information, the planner will complete his or her research into the cost of all services identified in the plan by consulting current medical billing records, making inquiries of current treating providers, and seeking out the cost of care from local providers appropriate to the client’s needs. The life care planner also may look online at verifiable sources and databases. He or she should be able to demonstrate both in the written plan and in testimony the sources for the identified costs and exactly how each cost was calculated.

Developing a comprehensive care plan takes time, so you should contact a life care planner as soon as you anticipate needing one. The planner typically requires four to six weeks to complete the plan—although some may take longer depending on the client’s ­status relative to ongoing treatment. For a client who has not yet reached the maximum level of improvement—such as someone suffering from a traumatic brain injury—the planner may need more time to determine the disability’s likely residual effects on the client’s future care needs.

Planners’ fees can vary widely—from $150 to more than $400 per hour, often depending on their location and level of experience. A life care plan typically requires at least 40 hours to complete, so you can anticipate spending between $6,000 and $16,000. And that does not include time the planner spends ­prepping for and giving testimony, reviewing depositions that were taken after submitting the report, or commenting on the defense’s life care plan.

Life care plans can be a fundamental part of your damages case. Therefore, it is important to retain a life care planner who is knowledgeable, professional, and experienced in both the development and execution of care plans.

Nancy Bond is the program director of the Medical Legal Services division of The Coordinating Center in Millersville, Md. She can be reached at nbond@coordinatingcenter.org.

Notes

1. Life care plans should consider every aspect of the client’s care, including physician and diagnostic services, medications and supplies, future surgical intervention including anticipated inpatient care, rehabilitation evaluations and services, therapeutic and adaptive equipment devices and their maintenance, daily care (both licensed and unlicensed), household services, home modifications including moving expenses that may be required, and transportation including vehicle modifications and maintenance.
2. Life care plans also can be useful in cases involving domestic matters, such as trusts and estates, mediations, divorces, and matters involving guardianship and futures planning.
3. Int’l Ass’n of Rehab. Prof’ls, Life Care Planning FAQ, connect.rehabpro.org/lcp/about/life-care-planning-faq. 
4. See  www.ichcc.org.
5. See  www.aanlcp.com.