PUBLICATIONS - LIFE CARE PLANNING

The Multidimensionality of Life Care Planning

Principles of Multidimensionality in Life Care Planning

Researching Costs

Identifying and Defining Patient-Specific Information

Medical Records

Clinical Interview

Narrowing the Scope

Patient Specifics

Research Road Map

Area Cost Analysis


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.

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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.

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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

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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 day care

__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.


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Life Care Planning Education & Research Vocational Analysis