This article discusses the history and evolution of what is now known as a life care plan. The qualifications of professionals who perform the specialty practice of life care planning are reviewed. The standards of practice for life care planning have been a long-standing guide for the practitioner and its core components are discussed.
Key points
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A life care plan is a tool of case management.
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A life care plan is based on proper medical, psychological, case management, and rehabilitation foundation.
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The development of a life care plan requires following generally accepted and peer-reviewed methodology and standards of practice.
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Life care planning is a transdisciplinary specialty practice.
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A life care plan is a dynamic document based on published standards of practice, comprehensive assessment, data analysis, and research that 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.
Introduction
A life care plan is a tool of case management, used for medical treatment planning and management purposes in many venues. Understanding what a life care plan is, how it is created, and the various roles of the rehabilitation counselor, case manager, or other professional coordinating a life care plan along with his or her integral role in compiling a life care plan are the focus of this article. A life care plan is based on proper medical, psychological, case management, and rehabilitation foundation. Life care plans require consistently applied methodology, combined with professional clinical judgment.
Clinical judgment is the embodiment of a clinician’s experiences, and throughout the process of coordinating and implementing a life care plan clinical judgment is used to ensure that the life care plan is specific and appropriate to the individual. This article outlines the methodology, standards, and process to assist in educating readers if they are requested to provide a foundation for a life care plan.
Introduction
A life care plan is a tool of case management, used for medical treatment planning and management purposes in many venues. Understanding what a life care plan is, how it is created, and the various roles of the rehabilitation counselor, case manager, or other professional coordinating a life care plan along with his or her integral role in compiling a life care plan are the focus of this article. A life care plan is based on proper medical, psychological, case management, and rehabilitation foundation. Life care plans require consistently applied methodology, combined with professional clinical judgment.
Clinical judgment is the embodiment of a clinician’s experiences, and throughout the process of coordinating and implementing a life care plan clinical judgment is used to ensure that the life care plan is specific and appropriate to the individual. This article outlines the methodology, standards, and process to assist in educating readers if they are requested to provide a foundation for a life care plan.
History
Life care plans have evolved over time for multiple purposes. Rehabilitation planning had its genesis in legislation beginning primarily in 1917 (Smith-Hughes Act), and it has continued to develop into the 1960s and 1970s as a result of major legislation that provided services for all people with disabilities. In their seminal 1967 publication, McGowan and Porter noted that the range of “modern day” rehabilitation services included full evaluation, counseling and guidance, medical services and care, prosthetics, vocational training, services through rehabilitation facilities, maintenance and transportation, tools and equipment, and placement services.
The major functions of the counselor require assuming responsibility to evaluate the client; planning with the individual from the initial counseling interview and diagnostic services to the establishment of eligibility, planning, and arranging the supervision of services; and being responsible for final job adjustment. Also included in these functions is responsibility for effective management of the caseload, case records, correspondence, reports, and workflow.
Deutsch and Raffa first established the guidelines to determine damages in civil litigation cases. By 1985, the Guide to Rehabilitation had introduced the life care plan to the health care industry. Since 1985, when the life care plan first emerged in the rehabilitation literature, the concept has grown immensely and it is now the most effective case management method used within the industry, particularly with regard to complex and medically challenging cases.
Life care plans have historically been used in a variety of settings, including managed care; workers’ compensation claims; Medicare set-aside plans; in response to the Federal Employees Liability Act, Jones Act, Longshore and Harbor Workers’ Compensation Act, and in Office of Workers Compensation Programs cases; and for dissolution litigation, personal injury litigation, employment litigation, mediation, reserve setting for insurance companies, federal vaccine injury fund cases, and family trusts. Each venue has special life care planning considerations that are beyond the scope of this article.
The development of a comprehensive plan of care has always been an integral part of the medical and rehabilitation process. This type of plan has been used historically by multiple medically related disciplines. Rehabilitation professionals create a rehabilitation plan, nurses develop a nursing care plan, physicians define a medical treatment plan, and other professions develop plans specific to their practice. Because of rapid growth in medical technology and an increased emphasis on the cost of care, including concepts of managed care, information on the specific cost of care has become an increasingly important aspect of health care. The process of developing a comprehensive plan and delineating costs has evolved over an extensive period and it is now used by case managers, counselors, and other professionals in many sectors. The life care plan represents an acceptable and pragmatic approach to the delivery of services within myriad sectors of the health care delivery system.
Rehabilitation or life care plans have been used in a variety of health care and legal settings to provide information and documentation on the cost of services related to long-term care. These plans are also provided as valuable tools for such areas as rehabilitation planning; geriatric services implementation; and management of health care resources, discharge planning, educational planning, and long-term managed care.
Transdisciplinary perspective
Life care planning is a transdisciplinary specialty practice. Each profession brings to the process of life care planning practice standards that must be adhered to by the individual professional, and these standards remain applicable while the practitioner engages in life care planning activities. Each professional works within specific standards and scope of practice for their discipline to ensure accountability, provide direction, and mandate responsibility for the standards for which they are accountable. These include, but are not limited to, activities related to quality of care, qualifications, collaboration, law, ethics, advocacy, resource use, and research.
In addition, individual practitioners must examine their qualifications as applied to each individual case. Therefore, thorough knowledge of the medical diagnosis, disability, and long-term care considerations, by virtue of education and experience, is a necessary component of the practitioner’s competency for each case. Moreover, each practitioner is responsible for following the standards of practice for life care planning in addition to the standards for the practitioner’s qualifying profession.
Definition
A life care plan is a dynamic document based on published standards of practice, comprehensive assessment, data analysis, and research that 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. This combined definition was derived from the University of Florida and Intellicus annual life care planning conference, and the American Academy of Nurse Life Care Planners (now known as the International Academy of Life Care Planners [IALCP]), presented at the Forensic Section meeting, National Association of Rehabilitation Professionals in the Private Sector annual conference, Colorado Springs, Colorado, and agreed on April 3, 1998, as cited in the IALCP Standards of Practice.
The life care plan is developed in many instances to identify damages in civil cases involving liability. However, the general content of the plan prepared by the coordinator and by the professional completing a life care plan are essentially the same: they detail what maintenance services and support items a person with a disability would need to achieve optimal recovery during the postinjury period.
The life care plan should be a working document that provides accurate and timely information that can be easily used by the client and interested parties. The plan should be updated as needed and serve as a lifelong guide to assist in the delivery of health care services in a managed format.
If possible, the life care plan should be a collaborative effort among the various parties and it should reflect preventive and rehabilitative goals. As a dynamic document, the life care plan requires periodic updating to accommodate changes and should have as its goal quality outcomes.
In accordance with professional standards and codes of ethics for the various practitioners and clinicians who perform life care planning, the client (also known as the evaluee; see later) is considered the person with a disability or illness who receives services. In life care planning, the client is defined as the person who is the subject of the life care plan. In the forensic or litigation setting, the individual for whom the life care plan is being prepared is considered the evaluee because the professional involved in life care planning is acting as a consultant rather than one who provides treatment.
Furthermore, the individual with an injury, illness, or impairment is assessed individually with respect to findings reported in the literature. The client is a study unto itself. It is important to apply the individual’s specific and unique circumstances to the data and research available in the literature, not the research and data in the literature to the individual. It needs to be understood that the entire person must be examined and compared preinjury and postinjury. Although common approaches and methodologies exist, clinical judgment is required to determine the true effect of injury or illness on an individual.
The following are the goals of a life care plan :
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To assist the client in achieving optimal outcomes by developing an appropriate plan to prevent complications and to restore function. This may include recommendations for evaluations or treatment that may contribute to the client’s level of wellness or provide information regarding treatment requirements.
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To provide health education to the client and interested parties, when appropriate.
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To develop accurate and timely cost information and specificity of service allocations easily used by the client and interested parties.
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To develop options for care that may be necessary for other situations.
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To communicate the life care plan and its objectives to the client and interested parties, when appropriate.
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To develop measurement tools used to analyze outcomes.
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To routinely develop comprehensive assessments of the projected goals of the life care plan, whenever possible.
Training, education, and certification
The life care planner must have skill and knowledge in understanding the health care needs addressed in a life care plan. Consultation with others and obtaining education are expected when the life care planner must address new or unfamiliar health care needs. The life care planner must be able to locate appropriate resources when necessary. The life care planner provides a consistent, objective, and thorough methodology for constructing the life care plan, while relying on appropriate medical and other health-related information, resources, and personal expertise to develop its content. The life care planner relies on state-of-the-art knowledge and resources to develop a life care plan.
Specialized skills are required to successfully develop a life care plan, such as the ability to research, critically analyze data, manage and interpret large volumes of information, attend to details, demonstrate clear and thorough written and verbal communication skills, develop positive relationships, create and use networks for gathering information, work autonomously, and demonstrate a professional demeanor and appearance.
According to the standards of practice developed through the IALCP (revised 2006), the life care planner must
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Possess the appropriate educational requirements as defined by their professional standards (eg, nurses should possess the requirements to acquire licensure, rehabilitation counselors should possess the requisite master’s degree, and other health professionals should possess the required degree for their fields).
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Maintain current professional licensure or national board certification within a professional health care discipline.
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Demonstrate completion of an accredited program in nursing or a baccalaureate or higher-level educational program in a professional health care field. Fields may include nursing, rehabilitation counseling, medicine, physical, occupational or speech therapy, and psychology.
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Demonstrate that professional discipline provides sufficient education and training to ensure that the life care planner has an understanding of human anatomy and physiology, pathophysiology, the health care delivery system, the role and function of various health care professionals, and clinical practice guidelines and standards of care.
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Participate in specific continuing education required to maintain the individual practitioner’s licensure or certification within his or her profession.
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Obtain continuing education or training to remain current in the knowledge and skills in the field.
Who prepares life care plans?
In addition to rehabilitation counselors, allied health professionals (eg, occupational therapists, physical therapists, speech language pathologists, nurses, dietitians, counselors, psychologists, dentists, audiologists, and so forth) also develop projected care based on published formats used in life care planning. Although it is important that the various participants have a rehabilitation education and relevant certification in their area of specialty before engaging in the life care planning process, this by itself is insufficient; additional education and experience are necessary. A qualified life care planner must be a collaborator, participant, and author of the life care plan.
Seven certifications prevalent in the practice of rehabilitation counseling, life care planning, and case management were researched on the following descriptive variables: inception; financial (profit) status; accreditation ; eligibility; examination; continuing education requirements; and code of ethics/standards of practice ( Table 1 ). Often individuals with one or more of these certifications are involved in preparing a life care plan.
| Type of Certification Program | Independent Accreditation | Year Established | Minimum Education Required | Minimum Experience Required | Code of Ethics/Standards of Practice | Examination Required | CEUs Required | Nonprofit |
|---|---|---|---|---|---|---|---|---|
| Certified Rehabilitation Counselor | Yes | 1975 | Yes | Yes | Yes | Yes | Yes | Yes |
| Certified Case Manager | Yes | 1993 | Yes | Yes | Yes | Yes | Yes | Yes |
| Certified Disability Management Specialist | Yes | 1984 | Yes | Yes | Yes | Yes | Yes | Yes |
| Certified Life Care Planner | No | 1996 | Yes | Yes | Yes | Yes | Yes | No |
| American Board of Vocational Experts | No | 1980 | Yes | Yes | Yes | Yes | Yes | Yes |
| Certified Nurse Life Care Planner | No | 1999 | Yes | Yes | Yes | Yes | Yes | Yes |
| Certified Vocational Evaluator | No | 1981 | Yes | Yes | Yes | Yes | Yes | Yes |
Descriptions of certification programs
The descriptive paragraphs that follow are excerpted from the Web sites of various certification accreditation bodies, on which are described the requirements for each type of certification. The reader is encouraged to review the full information for each certification program on the respective Web sites.
Certified Rehabilitation Counselor
The Commission on Rehabilitation Counselor Certification (CRCC) sets the standard for quality rehabilitation counseling services in the U.S. and Canada. As an independent, not-for- profit organization, the CRCC has certified more than 30,000 counselors with its widely recognized Certified Rehabilitation Counselor (CRC) and Canadian Certified Rehabilitation Counselor (CCRC) designations.
Certified Case Manager
Case management is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet the client’s health and human service needs. It is characterized by advocacy, communication, and resource management and promotes quality and cost-effective interventions and outcomes. … Certification as a Certified Case Manager (CCM) is a voluntary professional credential sponsored by the Commission for Case Manager Certification (CCMC).
Certified Disability Management Specialists
The current Certification of Disability Management Specialists Commission (CDMSC) was established in 1984 as the Certification of Insurance Rehabilitation Specialists Commission; in 1996 the Certification of Insurance Rehabilitation Specialists Commission changed to its name to CDMSC. “The CDMSC is the only nationally accredited and independent organization that certifies disability management specialists. Disability management specialists analyze, prevent and mitigate the human and economic impact of disability for employees and employers ….”
CDMSC’s mission is to “advance the field of disability management through the utilization of certified practitioners; evaluate and respond to the trends in disability management; promote continuing education while identifying key strategies, skills, and collaboration to ensure best practices in disability management.”
Certified Life Care Planner
At time of original writing, the Web site was not functional on this issue stating “This section of the CHCC website is near completion for updating, but more time is needed. Thank you for your patience.” In an e-mail memo sent to “All Members of the life care planning Community,” information released indicates that ICHCC in “the Spring of 2002 was restructured to S-Corp for profit,” and the NCCA application “is completed, and following final review by the Board of Commissioners within the next few days, it will be made available to you” implying that CHCC will refile the required papers for accreditation.
As of November 15, 2012, however, the following development was noted at the International Commission on Health Certification’s Web site:
We are pleased and excited about our application to the National Commission for Certifying Agencies (NCCA). We are working hard to ensure that your credential remains above and beyond approach and that the ICHCC becomes an accredited agency that is in itself above and beyond question or approach. We have engaged two outside consultants to work with us in preparing the extensive application of the NCCA for review. We have received their input and are now revising out a two-volume application so that the field will have an accredited testing agency by the Fall of 2012.
American Board of Vocational Experts
The American Board of Vocational Experts is a professional credentialing body established as a not-for-profit organization. Its Diplomats and Fellows have academic preparation in several disciplines (rehabilitation, psychology, economics and various aligned disciplines) and in assessment, counseling and consulting. Prior to completion of the certification process, professionals may be associate or student members of ABVE.
Certified Nurse Life Care Planner
The American Association of Nurse Life Care Planners Certification Board (AANLCPCB) provides oversight of the certification exam for nurse life care planners. This oversight includes item writing and test development, tracking of certificants, quality assurance of the exam, and update of exam content based on industry changes. A passing score on the certification exam allows a nursing professional to utilize the designation Certified Nurse Life Care Planner (CNLCP). The Certification Board is a voluntary organization comprised of six Registered Nurses specializing in life care planning who have earned the designation of CNLCP as well as one public member with an interest in the field.
The mission of the AANLCP Certification Board “is to promote expertise and professionalism in the nurse life care planning by recognizing practitioners who have met defined qualifications and demonstrated knowledge through a certification examination in the specialty.”
Certified Vocational Evaluator
CCWAVES [the Commission on Certification of Work Adjustment and Vocational Evaluation Specialists] is a nationally-recognized certifying body that sets, maintains and promotes high standards consistently and responsively for persons who practice vocational evaluation, work adjustment, and career assessment. Certified Vocational Evaluation Specialist (CVE): Persons who earn the designation of a Certified Vocational Evaluation Specialist (CVE) have demonstrated that they possess at least an acceptable minimum level of knowledge (as determined by the Commission) with regard to the practice of their profession. It is intended to help achieve widespread acceptance of the CVE designation by legislators, employers, consumers, peers, other human service professionals and the general public. The primary purpose of this certification process is to provide assurance that those professionals engaged in vocational evaluation meet acceptable standards of quality. Work in the community is foundational to the practices of vocational evaluation and work adjustment. The absence of work, real or simulated, indicates that the service provided is not vocational evaluation or work adjustment.
The Certified Vocational Evaluator certificate that was available through the Commission on Certification of Work Adjustment and Vocational Evaluation Specialists ended with the dissolution of Commission on Certification of Work Adjustment and Vocational Evaluation Specialists in 2009.
Many life care planners are asked at deposition if they are board certified in this professional specialty. Many explain they are not, then justify why it is not required. Several explain that they have been doing the work for years and do not see the need to complete yet another certification examination. Some portray that being a Certified Rehabilitation Counselor prepares them for life care planning and it is a board certification in rehabilitation (The Council on Rehabilitation Education requires basic life care planning education as part of the master’s program in rehabilitation counseling [see standard C-10–12]). Life care planning is a tool of advanced case management, so certification as a case manager may be adequate. Elements of all of these arguments may be true. No state requires that an individual be a Certified Life Care Planner (nor a Certified Rehabilitation Counselor, Certified Case Manager, or Certified Disability Management Specialist, and so forth) to testify as an expert. Moreover, some have criticized that the board for life care planning is a private for-profit organization. Additionally, most people on a jury are familiar with board certification as it relates to medicine, which can serve to increase the credibility of a life care planner.
Other professions have individuals who have elected to be part of the subspecialty of life care planning. Physicians, physical therapists, occupational therapists, speech language pathologists, and psychologists have undergone the requisite training and certification, and follow the standards of practice for life care planning.
Recommendations for life care planners and those who seek to use the services of life care planners include the following :
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Appropriate education and credentials
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Knowledgeable about the medical aspect of disability or disabilities
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Relevant specialized training
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Belong to and, better yet, are active in appropriate organizations (eg, International Association of Rehabilitation Professionals [IARP], Case Management Society of America, IALCP, and American Association of Nurse Life Care Planners)
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Life care plans are developed according to established and accepted standards of practice, ethics, and published methodologies
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Life care plans include proper foundation (including medical)
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Life care plans include up-to-date and current knowledge within the parameters of the profession
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Life care planners must be familiar with relevant literature
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Life care planners must be familiar with the rules of the jurisdictions in which they practice
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Life care planners must be knowledgeable about applicable Federal Rules of Evidence when testifying in personal injury litigation
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Life care planners are not scriveners or secretaries, who simply write down whatever someone else recommends; conversely, neither do life care planners know it all
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Life care planners must stay within their area of expertise or scope of practice
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Life care planners use all skills and understand the premise in which to coordinate a life care plan
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The professional should consider certification as a life care planner
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Life care planners need to be aware of the intangible
Related posts:
Life Care Planning After Traumatic Brain Injury
The Person with a Spinal Cord Injury
The Person with Amputation and Their Life Care Plan
Life Care Planning for the Child with Cerebral Palsy
Published Research and Physiatric Opinion in Life Care Planning
Vocational Rehabilitation Process and Work Life
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