A. Life care planning is a program established for the management of the care, resources, and services required by the catastrophically injured or disabled or the person suffering from a complex chronic health condition.

B. Life care planning focuses on promoting the client’s independence and empowerment, as well as the enhancement of the quality of care to ensure safety and a meaningful life for the chronically or catastrophically ill.

C. According to the International Academy of Life Care Planners (IALCP), life care planning is defined as an advanced and collaborative transdisciplinary practice that includes the patient (client), family (client’s support system), varied health care providers, and other parties who are concerned in coordinating, accessing, evaluating, and monitoring the necessary services required for the care of a catastrophically injured or chronically ill client.

D. The American Association of Nurse Life Care Planners (AANLCP) defines life care planning specialty in nursing practice as “the protection, promotion, and optimization of health and abilities for individuals and families affected by catastrophic injuries, and chronic and complex health conditions” (AANLCP, 2014, p. 5).

E. Deutsch describes life care planning as “a consistent methodology for analyzing all of the needs dictated by the onset of a catastrophic disability through to the end of life expectancy. Consistency means that the methods of analysis remain the same from case to case and does not mean that the same services are provided to like disabilities” (Deutsch, 2010, pp. 4-5). Case managers and/or life care planners:

F. Life care planning is a transdisciplinary specialty practice. Each professional, including rehabilitation specialists, nurses, case managers, physicians, social workers, and other allied health personnel, involved in life care planning brings his or her expertise and specialization to the life care planning process and to the life care plan for the ultimate benefit of the client/patient.

G. Life care planning has experienced tremendous growth in the last three decades. This growth is due to the use and benefit of life care plans within the rehabilitation, insurance, and legal professions. It has primarily emerged from combining case management and catastrophic disability.

H. The standards of practice for life care planning are developed based on the standards of practice of the individual disciplines that constitute the life care planning team such as nursing, medicine, case management, and rehabilitation.

I. The International Academy of Life Care Planners (IALCP) is the professional organization responsible for the development, maintenance, and promotion of life care planning standards. IALCP is sponsored and supported by the International Association of Rehabilitation Professionals (IARP). AANLCP also is involved in the development and promotion of life care planning standards; however, these apply only to nurses who function as life care planners.

J. When as a health care professional and case manager you find yourself wondering about the extent of the client’s injury or disability and the cost of future care, it is time to consider a life care plan for the client:

K. The life care plan is a team effort that uses the opinions of the client’s physicians, therapists, counselors, specialty providers, other involved health care professionals, and client’s support system.

L. According to Deutsch (2010), life care planning has its philosophical roots in three distinct fields of practice: experimental analysis of behavior, developmental psychology, and case management (Box 26-1). With catastrophic injuries, complex illnesses, and long-term disabilities, clients experience behavioral changes and limitations in function, coupled with the complex needs based on the developmental life stage of the client. These factors make life care planning a beneficial option. It then assures the delivery of quality and cost-effective care and facilitates improvement in condition.

A. Accessible—A term used to denote buildings/environments that are barrier free, thus allowing all members of society safe entry and exit.

B. Actionable tort—A legal duty imposed by statute or otherwise, owing by a defendant to the person injured.

C. Assessment—The process of collecting in-depth information about a person’s situation, family, and functioning to identify an individual’s needs in order to develop a comprehensive life care plan. Information should be gathered from all relevant sources (patient, family, caregivers, employers, medical records, etc.).

D. Clinical practice guidelines—Systematically developed statements on medical or nursing practices that assist a practitioner in making decisions about appropriate diagnostic and therapeutic health care services. Practice guidelines are usually developed by authoritative professional societies and organizations.

E. Deposition—The testimony of an individual taken under oath, but not in open court, on the subject at hand, reduced to writing, and authenticated, which may be used in court.

F. Efficacy of care—The potential, capacity, or capability to produce the desired outcome through evidence-based findings.

G. Expert witness—An expert qualified to provide court testimony by virtue of knowledge, skill, experience, training, or education.

H. Exposure—The amount of money for goods, care, and services an insurance company owes, when there is liability for the injured/ill person.

I. Life care plan—A dynamic document based on published standards of practice, comprehensive assessment, research, and data analysis, which 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 (IALCP, 2009).

J. Life care planner—A health care professional specifically educated regarding the methodology for life care planning. Professionals engaged in this specialty practice may be nurses, vocational rehabilitation counselors, rehabilitation psychologists, disability management specialists, physicians, occupational therapists, social workers, physical therapists, and speech/language pathologists.

K. Outcome—The result and consequence of a health care process. In life care planning, an outcome is used to describe the result of the expected care or services.

A. The Case Management Society of America (CMSA) describes in its standards of practice for case management that case management practice extends across all health care settings, including payer, provider, government, employer, community, and home environment (CMSA, 2010):

B. Case managers as life care planners are embedded in life care planning programs. They apply the CMSA standards of practice, in addition to the life care planning standards, in their work settings and as appropriate to the client population they serve.

C. In some organizations, case managers are the life care planners for their clients; in some others, they are not. Regardless, however, they collaborate with life care planners as part of their professional roles. Therefore, being knowledgeable of the CMSA standards of practice and how they relate to life care planning is essential. It is also necessary for case managers who are not life care planners to understand this specialty practice to facilitate timely access to care and services and the achievement of desired outcomes for both the clients and providers of care.

D. The case management process described in the CMSA standards of practice for case management is similar in focus and purpose to the life care planning process. These two processes align well. Although, in life care planning, the case manager or life care planner is often involved in testimony about the client’s care and actual or projected cost of interventions and needed resources included the life care plan, such involvement is an uncommon practice in other work settings or specialties.

A. The aims of life care planning are similar to those of case management and focus on meeting the client’s/support system’s needs, interests, and care preferences while addressing the client’s health condition, disability, or complex illness and coordinating the life care plan (Box 26-2).

B. Life care planners assist clients and their support systems in achieving optimal outcomes by developing appropriate life care plans. These plans include prevention of complications and restoration of health and well-being while assuring client safety and cost-effectiveness. The plans also recommend evaluations, interventions, services, and treatments that contribute to the client’s level of wellness and restoration of function and provide information regarding care and resource requirements.

C. Life care planners communicate the plan of care. Goals and objectives of the treatment and interventions and expected outcomes to their clients, support systems, and involved members of the health care team. They also use comprehensive assessment tools to monitor and evaluate the client’s condition, progress toward achieving the goals, and identify situations where modification of the life care plan are necessary.

D. Initially, life care planning was known as a specialty within rehabilitation. However, as its “standards and methods gained acceptance outside of the general rehabilitation circle, insurance carriers, worker’s compensation judges, circuit … [and] federal court judges, attorneys, and others involved in litigation have called upon life care planners as experts in long-term disability management… [As a result, life care planners are sought after for their] specialized knowledge… to understand the long-term effects of catastrophic injuries and the associated economic damages of such cases” (Deutsch, 2010, p. 4).

A. The life care planning process is similar to that of case management. IALCP describes the process based on the functions of the life care planner, which include the following (IALCP, 2009):

A. Case managers in a life care planning program are called life care planners. Those who are nurses are referred to as nurse life care planners. They use tools such as the life care plan to provide individualized and comprehensive life care services for clients with catastrophic illnesses and/or disabilities. In their roles, they project current and future longterm care needs and potential costs that are congruent with the level of disability evident in the condition of the catastrophically injured or chronically ill individual.

B. Life care planners must possess appropriate educational and licensure requirements and knowledge as defined by their professional discipline and its associated standards and scope of practice.

C. Life care planners must have a foundation of knowledge and appropriate experience in a specialty such as rehabilitation and/or nursing. According to IALCP (2009), they:

D. With its foundation in rehabilitation, it is natural that health professionals interested in the role of a life care planner are those from rehabilitation-related clinical specialty (Box 26-3).

E. Health professionals who function as life care planners are usually licensed or certified in a primary health discipline such as rehabilitation counseling. Many also hold either of the following certifications: