Planning for current and future needs
Life Care Planning
The International Academy of Life Care Planners (IALCP) adopted the following definition of a life care plan:
A 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 cost for individuals who have experienced a catastrophic injury or have chronic health care needs.
A life care plan may be further described as follows (IALCP):
The life care plan is a document that provides accurate and timely information which can be followed by the evaluee (the person who is the subject of the life care plan) and relevant parties. It is a detailed document that can serve as a lifelong guide to assist in the delivery of health care services. The life care plan reflects a collaborative effort among the various parties, when possible, and the goals that are preventative, habilitative, palliative, and rehabilitative in nature and should optimize outcomes. As a dynamic document, the life care plan may require periodic updating to accommodate changes.
Future Costs of Care Reports:
Projecting Evidence-Based Needs into Financial Value
In Canada, life care plans are commonly referred to as Future Costs of Care Reports. In a forensic context, extraordinary needs are linked to a specific causative event such as a motor vehicle collision, a professional error, or an assault. The costs associated with the identified evidence-based needs are represented using current day prices. A financial professional can then project these costs into the future to determine the value of the identified needs.
Foundational Principles
Dr. Paul Deutsch
Over 20 years ago, Dr. Paul Deutsch, widely considered the father of life care planning, provided the following description a life care plan:
A consistent methodology for analyzing all of the needs dictated by the onset of a catastrophic disability through to the end of life expectancy.
While this definition has been revised and updated as presented above, Dr. Deutsch long ago emphasized principles that remain vital today: the importance of establishing a standardized methodology aligned with current practice standards; distinction of impairments caused by the inciting event in contrast to pre-existing or unrelated conditions.
Codified Principles of Life Care Planning
Life care planners are supported by a wealth of guiding tenets, consensus and majority statements, handbooks, and peer-reviewed research in the area of life care planning, as well as Standards of Practice (SOP) for Life Care Planners, now in their fourth edition. Each life care planner is expected to adhere to these standards, which evolve to reflect current best practice. The standards outline performance and practice expectations of practising life care planners.
Failure to adhere to standards of practice can adversely affect the utility and admissibility of the life care plan
Maintaining compliance with standards of practice ensures that the plan remains credible, defensible, reliable, and valid.
Board Certification
A board-certified life care planner or an International Certified Cost of Care Professional has completed the necessary training, board examination, and peer review of a completed life care plan indicative of their training and exposure to the expectations and standards of life care planning. Thus, these certified professionals are best equipped to provide expert testimony.
Life Care Planning Standards and Methodology
To create an evidence-based and defensible life care plan, all professionals engaged in practising life care planning or future costs of care analyses are expected to use a methodically rigorous process grounded in published Standards of Practice. This iterative process includes:
Case Initiation
- The life care planner facilitates understanding of the life care planning process and establishes clear expectations with the referring party.
Assessment and evaluation of the evaluee
- The life care planner performs a comprehensive assessment of all primary and secondary data from multiple sources.
- Most commonly, there is an in-person interview and functional testing of the evaluee within their natural home environment.
Analysis and synthesis to identify functioning, disability, and health
- The life care planner analyzes all available data using a consistent, valid, and reliable process.
- In addition to a thorough review and analysis of the available secondary data from the clinical records, the life care planner considers the primary data collected from the evaluee, any objective data collected during their evaluation, and interview of a collateral source such as a friend or family member.
Delineating future care recommendations
- The life care planner uses a consistent, valid, and reliable approach to determining evaluee’s needs.
- The life care planner seeks to collaborate with professionals for recommendations that fall outside of the life care planner’s specific evaluation and their scope of practice.
- The life care planner triangulates all data sources to formulate defensible needs and recommendations.
Delineating costs
- The life care planner uses a consistent, valid, and reliable approach to costing of the identified needs.
- The life care planner applies a transparent, evidence-based methodology, sourcing multiple verifiable, accessible, and geographically relevant costs.
Work product creation
- The life care planner produces a clear, well-supported, and defensible report.
- An appropriate evidence-based foundation is provided for all identified needs, quantified and costed for the full duration of disability.
Evaluation for consistency within the life care plan and adherence to standards of practice
- The life care planner verifies the internal and external consistency of the life care plan by confirming that opinions and findings align with accepted methodological standards.
Education of consumers/users of life care plans
- The life care planner serves as an educator to help clients, legal professionals, and other stakeholders understand the life care planning process and its findings.
Forensic application
- The life care planner may engage in forensic applications, including:
- acting as a legal or expert consultant
- providing sworn testimony
- maintaining records in compliance with jurisdictional/regulator body requirements
- seeking clarity regarding applicable legal and procedural standards
Commonly Included Needs
Needs are often grouped according to commonalities and routinely include:
- Health care services (e.g., medical, therapies, counselling, vocational support)
- Maintenance of health and residual function
- Attendant/personal care needs and long-term living options
- Assistive devices, equipment, technology
- Medications and supplies
- Extraordinary transportation costs
- Indoor and outdoor home maintenance
- Home renovations and vehicle modifications
- Extraordinary support required for community, leisure, family participation