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Introduction to Life Care Planning
Gerrie Springston, B.S.N., R.N., C.N.L.C.P., L.N.C.C., C.C.M.
Objectives
1. State the definition of a Life Care Plan.
2. Name at least one life care planning certification.
3. Be able to discuss when a Life Care Plan is needed.
4. Discuss at least two keys to look for in a Life Care
Plan.
Definition of Nurse Life Care Planning “The protection, promotion, and optimization of health and
abilities for individual and families affected by catastrophic
injuries, and chronic and complex health conditions; Nurse Life
Care Planners apply advocacy, judgment, and critical thinking
skills using the nursing process to develop long‐term or lifetime
plans of care. These plans include the future cost of identified
interventions and associated costs for health maintenance,
health promotion, and optimization of physical and psychological
abilities for the life expectancy of the individual.” (American
Association of Nurse Life Care Planners®, Nurse Life Care
Planning Scope and Standards of Practice, 2015)
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Definition of a Life Care Plan “The 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 catastrophic injury or have chronic health care
needs.” (International Academy of Life Care Planners, Standards
of Practice for Life Care Planners, 3rd Ed., 2015)
When is a Life Care Plan Needed?







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Catastrophic cases: Spinal cord injury (SCI)
Traumatic brain injury (TBI)
Amputation
Burns
Chronic pain
Birth injuries
Injuries to the brachial plexus (nerves that conduct signals to the shoulder, arm, and hand)
 Etc. Life Care Planning Certifications
 Certified Nurse Life Care Planner (CNLCP)
certification is administered by the American
Association of Nurse Life Care Planners (AANLCP).
(www.aanlcp.org)
 Certified Life Care Planner (CLCP) certification is
administered by the International Commission on
Health
Care
Certification
(ICHCC).
(www.ichcc.org)
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Keys of a Life Care Plan

Methodology
 Foundation
 Data Sources
 Reliability
“Will you please answer the question, and this time, without the smoke and mirrors?  Life care planning methodology should be
consistent with peer reviewed, published life care
planning standards of care.
 Methodology includes assessment, data analysis,
cost research and development of an individual
specific plan.
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Methodology
Assessment begins with the collection of data:
 Review of records ‐ medical and nonmedical  Clinical interview of the person (if allowed)
 Collaboration with appropriate treating or consulting medical and nonmedical experts
 Research The data collected helps provide foundation for the
Life Care Plan.
Methodology
Data Analysis
Identify the evaluee’s current and future care needs
made necessary by injuries claimed to have been
sustained in the subject accident/incident.
Cost Research
 Cost data sources documented
 Geographic specific costs
 Providers/vendors reasonably available to the
evaluee
Methodology
Development of a Plan
The content of a Life Care Plan should be reasonable
and individual specific.
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“We have incomplete data, so I’ll need to use my intuition and experience to make the decision.” Foundation
 Items and services in the Life Care Plan must be
supported by the records reviewed, information
obtained during the clinical interview, information
obtained during consultation with other treating
or consulting experts, and/or the literature.
 A life care planner’s recommendations must be
consistent with their individual scope of practice.
Foundation
 Goals of the Life Care Plan include enabling the
subject to be as independent as possible,
prevention of complications when possible, and
safety.
 Pre‐existing conditions,
subsequent injuries
co‐morbidities,
and
 Annualized costs vs. non‐annualized costs
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Cost for Future Technology Luke Skywalker’s Robotic Hand (Episode 5 ‐ Empire Strikes Back) Life Care Plan Tables
 The sources of foundation should be documented
in a Life Care Plan, with further discussion in the
narrative report as needed.
 The purpose for the items and services should be
stated in the Life Care Plan.
 A beginning date and an end date, as well as the
frequency of replacement, should be included.
Life Care Plan Tables
 The costs should be clearly noted and cost
data sources should be identified.
 Typically, a forensic economist performs
present value calculations of the costs
presented by the life care planner.
 Concise and organized
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“They tell me it’s the latest breakthrough –
the nonsurgical pacemaker.” LIFE CARE PLAN SUMMARY TABLES
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REBUTTAL TO LIFE CARE PLAN
Subtotals by Category
Cost Per VDI
Cost Per Opposing Life Care Planner
Projected Evaluations
$
6,676.85 - $
13,312.85
$
0.00
Future Medical Care – Routine
$ 134,872.00 – $ 351,860.00
$ 3,012.71 - $ 4,219.81
Future Medical Care – Surgical
$
84,448.00 – $ 493,623.00
$ 7,717.27
Projected Therapeutic Modalities
$
33,207.00 – $
58,729.00
$
Diagnostic and Laboratory Needs
$
9,683.00 – $
26,895.00
$ 3,064.36
DME / Aids for Independent Function
$
842.00 – $
991.00
Prosthetics and Orthotics
$
0 .00 - $
1,025.00
Home Furnishings
$ 14,479.00
$
0.00
0.00
$
0.00
$
0.00
Medications
$ 86,529.00
$ 9,902.92
Home Care
$ 476,483.00 – $1,022,099.00
$
0.00
Transportation
$
$
0.00
Grand Total:
$ 850,841.85 - $2,073,164.85
3,622.00
$23,697.26 - $24,904.36
Note: These charges do not include present value calculations. GAF = Geographical Adjustment Factor. Item/Service
Speech Therapy Evaluation
Note:
CPT 92521 Evaluation of
speech fluency (e.g.,
stuttering);
CPT 92610 - Evaluation of
oral and pharyngeal
swallowing function
Cost Per Opposing
Life Care Planner
CPT
92521: $266.85
92610: $217.67
----------------------Subtotal: $484.52
Data Source: not noted
Cost Per VDI
CPT (per Opposing Life Care
Planner)
92521: $211
92610: $158
----------------------Subtotal: $369 x 0.988 GAF
= $364.57
Comment
No foundation in the records available
for review
Jim Neuron, M.D., Neurologist,
03/02/17 telephone conference: Speech
therapy is not needed for injuries
sustained in the subject accident.
Data Source: Medical Fees
2017, 50th%, GAF for AZ =
0.988
Total: 0.00 (no foundation)
Item/Service
Cardiac Workup
Cost Per Opposing
Life Care Planner
CPT 99245: $367.85 –
Cost Per VDI
CPT 99243 (Consult): $267 x
0.988 GAF = $263.80
Comment
N. Love, M.D., Cardiologist, cardiac
evaluation done on 01/07/17.
Total: 0.00
(evaluation completed)
Orthopedic Hand Surgeon
CPT 99213: $130 x 6 = $780
CPT 99213: $125 x 0.988
GAF = $123.50 x 6 = $741
No foundation in the records available
for review
Data Source: Medical Fees
2017, 50th%, GAF for AZ =
0.988
01/03/17, Dem Bones, M.D.,
Orthopedic Hand Surgeon, Progress
Notes: Dr. Bones documented that
there was no surgical intervention that
would benefit the patient.
Total: 0.00
(no foundation)
Mileage
2017 to life expectancy
215 miles/year
@ $0.535/mile
$115.03/year
17 cents per mile driven for
medical or moving purposes
Source: www.irs.gov
$0.17 x 215 miles (for
comparison only) =
$36.55/year
All of Mr. Walker’s providers are less
than 20 miles from his residence.
Opposing Life Care Planner used the
business mileage rate, 53.5 cents a
mile, instead of the medical mileage
rate, 17 cents a mile. (Source: irs.gov)
Total: 0.00 (no foundation)
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THANK YOU! 11