Life Care Planning
The Multidimensionality of Life Care Planning
Understanding the concept that a life care plan is viewed as being multidimensional is critical for those taking on the task of plan development for the first time. Many rehabilitation professionals and case managers will undertake the life care plan as if they were constructing a building. First, they lay the foundation and then they construct each floor, one on top of the other. Or they may attempt to complete one page of the life care plan before moving on to the next page. This sounds logical, but it is fundamentally wrong and will inevitably lead to disaster on multiple levels. Every item or recommendation in a life care plan has the potential to influence every other recommendation in the plan. Any subsequent change in a recommendation, or any addition, has the potential to produce a “domino effect” in terms of its impact on the plan.
In this section, we will explore many of these pitfalls and discuss the concept of multidimensionality. The guiding principles may seem complex at first, but a simple exercise should help them become clear.
Principles of Multidimensionality in Life Care Planning
1. Each recommendation (driven by a specific deficit of dysfunction), will impact the life care plan pages both directly and indirectly.
For example, tube feeding may directly impact nursing services and therapies, but will also indirectly impact architectural renovations due to storage requirements.
2. Directly impacted items frequently crossover to influence other directly impacted items.
For example, both tube feeding and breakthrough seizure disorder management impact the level of nursing care required.
3. Directly impacted items may be affected by indirect recommendations.
For example, when a camp for children with special needs is recommended on the leisure page with no concomitant adjustment to the home care page, the result is an overlap in total care provided in the plan.
4. Directly impacted items may limit access to indirect items or pages forcing alternate recommendations.
For example, tube feeding cannot be accommodated at a local school program, which necessitates a homebound educational program. Many schools do not provide homebound educationally necessary therapy programs. This information would result in a change on your therapy page in relation to frequency and scheduling.
5. Directly impacted items may force recommendation changes by limiting time availability as well as access to an otherwise needed service. This situation often forces compromises. Such compromises are often the staple of an effective, credible, and efficient life care plan.
6. No one can complete a life care plan in a two-dimensional format. It is always multidimensional in its interaction and correlation.
Researching Costs
The moment a referral source contacts the life care planner, research begins. During intake, the file is opened, where at minimum, the basics of sex, age, disability, current location, and a general narrative will be recorded. The journey from referral to presentation of a life care plan can stall the practitioner in a potentially overwhelming congested roadway of facts, figures, and statistics. Without resources that are patient-specific, promptly accessible, easily understood, quickly verified, and regularly updated, the task of completing a competent, thorough, and accurate life care plan is nearly impossible.
Effective life care planners must cultivate a dynamic knowledge base in the ever-evolving and expansive field of rehabilitation. Each life care plan developed is a unique, patient-specific document. Because of the individualistic and comprehensive nature of a life care plan, it is essential for planners to develop an organized system in which to:
- Identify and define patient-specific information
- Cultivate effective resources to locate information
- Organize, store, and retrieve valuable information
Identifying and Defining Patient-Specific Information
Medical Records
When the client is referred and the file is opened, the life care planner will request a complete set of medical and health-related professionals’ records. It is important that these records include a detailed medical billing history.
Begin combing methodically through the recorded history outlining the patient’s experience. From this information, the life care planner will generate a germane medical summary.
Clinical Interview
Having researched and summarized the client’s medical records, it is now time to collect data from a clinical interview and history with the patient and family. To ensure that the client and caretakers come to the evaluation prepared, develop an initial contact packet to be mailed weeks in advance of the scheduled interview. Ask the patient to prepare and organize an inclusive list of all present medical treatments, supplies, services, and providers. The list should include all contact information the research will require.
Throughout the interview process, keep a vigilant watch for information needed to research the patient-specific plan. The more quality information is cultivated and recorded in the interview, the less footwork will be required later.
Narrowing the Scope
Once the medical summary is complete and the patient interview and history has been taken, the life care planner can look at the specific profile of the patient and begin to narrow the research scope.
Patient Specifics
Injury/disability
Environment/location
Patient needs based on the disability:
Medical services
Nursing/assistance
Residential needs
Education/vocation
Miscellaneous services
Supplies /equipment
Allied health services
By defining patient needs, you are simultaneously identifying those areas for inclusion in the life care plan.
Research Road Map
Having judiciously developed a complex understanding of the patient’s specific needs and abilities, the life care planner can now construct the research roadmap that will lead to the information needed to complete the plan.
Here is an example of one such roadmap: the area cost analysis form.
In using this or a similar form, the planner can begin to mentally construct the plan. By checking off those items requiring cost research, the planner is also identifying various recommendations contained within the plan and flagging the present treating professionals who will need to be contacted for consultation.
Area Cost Analysis
Patient name: DOB: ____ Sex: M F
Disability: Plaintiff: Defense:
City: Area code:____
Nearest metro area:
Allied health professionals:
__Dentist
__Gastroenterologist
__GP/Internist
__Neuroophthalmologist
__Neuropsychologist
__Neurosurgeon
__Neurologist
__Ophthalmologist
__Orthopedist
__Ortho Surgeon
__Otolaryngologist
__Pain Specialist
__Pediatrician
__Physiatrist
__Plastic surgeon
__Podiatrist
__Psychiatrist
__Psychologist
__Pulmonologist
__Rheumatologist
__Urologist
__Other
Home health:
Staffing:
HHA: per hour ____, per visit ____
LPN: per hour ____, per visit ____
RN: per hour ____, per visit ____
__Live-in (available/definition/last time staffed this level?)
__Request state regulations
Therapy:
__PT
__OT
__ST
__Respiratory
Invasive procedures required? (Yes/No) Such as:
__Catheter
__Suction
__IV therapy
__Trach care
__Tube feeding
__Bowel program
Facility-based outpatient therapy:
__PT
__OT
__ST
__Respiratory therapy
__Aquatic therapy
__Therapeutic riding
__Recreational therapy
__Work hardening program
__Disabled Driver: __Eval __ Training
__Augmentative communication: __Eval __ Training
__Assistive technology: __Eval __ Training
__Other:
Miscellaneous services:
__Handyman service
__Health club
__Home modification
__House cleaning
__Massage therapy
__Nutritionist
__Support group
__Other:
Educational programs:
__Public school
__Summer program
__Private school
__College aid
__Tutor
__Camp
__Vocational/technical:
__College: AA BA
Vocational services:
__Vocational evaluation
__Vocational counseling
__Job coaching
__Adult day training
__Supported work
Wage data research required (if providing a loss of earnings report):
Occupation:
Programs/facilities:
Facility care level required:
__Level of disability
__#Hrs supervision
__Activities of daily living (ADLs): cues (Yes/No)
__Aggressive
__Ambulatory
__Continent
__Verbal
__PVS
__Trach
__Vent
__Dependent
__Tube fed
__Bowel program
__Day program
__Work program
Type of program/facility:
__Adult daycare
__Day program __ABI __MR
__Assisted living facility (__ request state regulations)
__ICF/MR or group home
__Long-term head injury
__Skilled nursing facility
__Supported living
__Transitional living __SCI __ABI
__Neuro-behavioral inpatient
__Chronic pain: __inpatient __outpatient
__SCI rehab: __inpatient __outpatient
__SCI eval: __inpatient __outpatient
__Other
Diagnostics:
__EEG
__EKG
__Evoked potential audio
__Evoked potential visual
__Pulmonary functions
__Renal scan
__Renal ultrasound
__Sleep study
__Swallow study
__Urodynamic studies
__Broncoscopy
__Colonoscopy
__Cystoscopy
__Endoscopy
__CT:
__MRI:
__X-Ray:
Routine labs:
__Cardiac profile
__CBC (w/diff.)
__Comp metabolic panel
__Creatinine
__C & S
__LFT
__Lipid panel
__UA
__Chemical levels for medication:
Surgeries and procedures:
__Botox
__Bio-feedback
__FES
__Epidural block
__SCI
__Fertility program: M F
__Gastrostomy
__PEG Tube
__Trach revision
__Shunt revision
__Hip subluxation
__Hip replacement
__Knee replacement
__Baclofen pump
__Morphine pump
__Spinal stimulator
__Scoliosis surgery
__Diskectomy (cervical/thoracic/lumbar)
__Laminectomy (cervical/thoracic/lumbar)
__Spinal Fusion (cervical/thoracic/lumbar)
__Scar revision: Length of Scar:
__Stump revision:
__Arthroscopy:
__Contracture release:
__Tendon release:
__Hardware removal:
Equipment:
__ECU
__Standers
__Cushions
__Ramp/lift
__Van conversion
__Wheelchair (manual/power)
__Assistive technology
__Augmentative communication devices
__Pediatric equipment
__Orthotics
__Prosthetics
__Visual aids
__Specialized equipment:
Supplies:
Medications:
DME:
The above illustrates a sample form that can be used as a roadmap for life care plan research. With the Area Cost Analysis as your roadmap, it is time to drive the research vehicles.