Life Care Planning
By Lee Brinkley Bryan, MED, CRC, CVE
A life care planner is a specialist who has been trained to project the future cost and duration of medical and rehabilitative care associated with an injury or chronic health condition. He or she then prepares a document, called a life care plan, that outlines these required services and their costs.
WHO NEEDS A LIFE CARE PLAN?
If your burn injury results in litigation, your attorney may retain the services of a life care planner who can quantify the costs associated with any future care related to your injury. Increasingly, life care planners are also being utilized in divorce negotiations when disability issues make it necessary to identify care needs and related costs.
Outside the legal arena, a life care planner can help you by projecting your future expenses, both related and unrelated to your burn injury, as well as identify collateral resources that will offset your injury-related expenses. A life care plan can provide important information that can then be used to develop a financial plan.
SELECTING A LIFE CARE PLANNER
The academic training of a life care planner may vary. Many life care planners are rehabilitation practitioners; some are nurses specializing in rehabilitative care. An emerging area in life care planning is physician-driven planning that allows a treating physician or independent specialist to oversee the process. This allows the treating specialist who oversees your care or another medical specialist to have input into your life care plan and approve its content. In legal situations, this physician would, in turn, also be available to testify regarding not only your future care, but also the care and services outlined in the life care plan.
Prior to retaining the services of a life care planner, it is appropriate to inquire about their experience and areas of expertise. You should feel confident that the individual working with you is the appropriate professional to project your future needs.
UNDERSTANDING THE PROCESS
Your life care planner may ask that your first meeting take place in your home. This initial interview may last up to several hours in order for he or she to get to know you and learn as much about you as possible. The information obtained and data collected during this meeting is a crucial step in the evaluation process. Keep in mind that if, as a result of your injury, you need to have home renovations made, this meeting will provide an opportunity for your life care planner to see the issues firsthand.
It’s important that you prepare in advance of this meeting. Doing so will provide structure for you to consider the changes that have taken place in your health and life since your injury and will assist your life care planner in this important evaluation.
Gathering the answers to the following questions will help you to organize data that is important for the evaluation process:
- What are the names, specialty areas, and telephone numbers of your treating physician(s)?
- When was your last visit with each specialist and do you have follow-up visits scheduled in the future?
- Were you being seen by any of your specialists prior to your injury?
- What are your prescribed medications and dosages?
- What physician(s)prescribes each of your medications?
- What drug store is your source for prescriptions?
- Did you have health complications or medical conditions prior to your injury in which you received treatment or prescribed medication? (i.e., sinus problems, allergies, hypertension, etc.)
- Has your attorney already provided the life care planner with medical records? If not, you may need to provide dates of all hospitalizations and treatment interventions related to your injury?
- What recommendations have been made regarding your need for future medical or surgical interventions?
- Do you participate in therapeutic interventions, such as physical, occupational, or speech therapy? If so, what are the names and telephone numbers of your therapists?
- What special equipment has been necessary since your injury (for example, pressure garments, orthotics, prosthetics, ambulation aids, home care equipment)?
- What company or companies have provided your equipment?
Your life care planner will also ask you questions about your marital status, family support system, educational background, and insurance benefits. Don’t feel that you must prepare written documentation to answer these questions unless it would be helpful to you. You may be just as well prepared by simply thinking about responses to these potential questions, but do try to be organized for the meeting. Make sure you can easily access any business or appointment cards you have from your treating specialists, your prescriptions bottles, and your local phone book during this initial meeting. This preparation will help ensure that you are ready to provide the necessary information about yourself and will expedite the interview process.
TAKING A PERSONAL INVENTORY
As you prepare to meet with your life care planner, spend some time thinking about the changes that have occurred in your life since your injury. What are your chief complaints? Responses to this question may range from an immediate simple answer to “Where do I begin?” Start by thinking about the physical changes that have occurred since your injury and any physical limitations you may now experience. Do you experience itching, discomfort, or significant pain that affects your ability to participate in daily activities? Has your overall general health been affected? (During this initial interview burn survivors often report health problems or changes in their general health status that earlier in their recovery seemed minor or went unnoticed because of the severity of their burns, but have become more problematic as they attempt to return to daily activities.) Do problems with skin integrity affect your ability to perform activities of daily living or work activities? Are you now dependent on assistance from others for daily care that you did not require prior to your injury? Has your sleep quality or sleep habits been different since your injury? Do you tire easily and require daily rest periods? Are you no longer able to drive an automobile?
Sensory functioning can also change following a burn injury. Have you experienced changes in your sense of touch or other bodily sensations? Has your hearing or vision changed due to your injury? Is your sense of smell different now? Are you more sensitive to odors and, if so, do you have allergies or chronic sinus problems since your injury? Burn injuries often result in changes in how you receive information due to anxiety and depression.
If your injury involved an explosion, you are also at risk to have experienced a brain injury. Do you ever feel like you don’t remember information well or do you get lost in conversations? Do you have to re-read information or ask that information be repeated? Have you felt cognitively slower since your injury? Do you avoid social situations and crowds?
How would you describe yourself emotionally since your injury? How have your social personal relationships been affected by your burn injury? Has your injury resulted in sexual problems? Have you lost the ability to participate in past hobbies or recreational pursuits? What vocational implications have you experienced? How has your life been changed financially since your injury? Has your personality and temperament changed significantly since your injury? What are your goals or plans for the future? Are you receiving services from a case manager or other public or private assistance?
Thinking through these questions and presenting them to the life care planner may be a very emotional experience. A burn injury can affect every aspect of an individual’s life. Because it is also the life care planner’s job to accurately describe your life, he or she will need to identify your functional strengths and limitations and the resultant impact on your life activities. Be honest in sharing the changes you’ve experienced so that your life care planner can, in turn, accurately describe your life and identify your needs. A family member or friend who knows you well may also be able to offer additional input that can provide a valuable perspective for use in the evaluation process. You may want to ask that person to join you in the evaluation interview or you may prefer to provide his or her contact information to your life care planner so that they can speak later.
Your life care planner may ask to accompany you to your appointments with treating specialists as part of the life care planning process. He or she may also submit written questions to your treating specialists concerning your need for care and additional interventions. In some cases, your life care planner will identify additional specialists to evaluate your needs. He or she will coordinate these appointments with you, and, if litigation is involved, with your attorney.
PARTICIPATING IN VOCATIONAL ANALYSIS
Some life care planners are vocational specialists and may have also been asked to determine the impact of your burn injury on your future employability and earning potential. If your life care planner is not a vocational specialist, you may also meet with an additional professional who will focus his or her evaluation on the vocational implications of your injury. You will be asked about your work history, past work experiences, and the specific duties you have performed in your employment situations. You will also need to provide information about the schools you have attended in the past or about programs of study you may be attending currently. If you have prepared a resume, you should offer a copy to your life care planner and/or vocational specialist.
As part of the vocational analysis process, you may be asked to participate in vocational testing that may include intellectual, educational, vocational aptitude, and interest batteries. Your test results will help the practitioner determine your abilities, as well as potential for retraining, if that potential is in question. Your life care planner will also need to know whether you receive workers compensation or Social Security disability benefits related to your burn injury or any other condition and you will also need to provide copies of your tax records for documentation of your past earnings.
A life care plan is a comprehensive and dynamic case management tool. Its use in projecting future disability- related cost has become a powerful tool in both the litigation and nonlitigation arenas. As a “blueprint for care,” it provides burn survivors and their family members with a guide to optimum care and peace of mind that future needs have been identified and quantified from a financial perspective. For case managers and financial planners who may be charged with coordinating future services and care or managing investment funds, the life care plan is also an ideal blueprint for optimum care, identification of potential collateral resources, and budgeting.