As published in VERDICT, Philadelphia Trial Lawyers Association,
Volume XII, Issue 10, June 1994

A comprehensive LifeCare Plan describes the injuries, costs and optimal long-term needs of a seriously injured person. It provides an explanation of the immediate physical injuries and the short and long-term impairments that have occurred and are likely to follow the traumatic event. The long-standing residual effects, anticipated complications, care needs and costs of care are projected -- and an itemized accounting of the costs of the injury over the course of the individual’s life are presented.

Any litigation which is pursued on behalf of a seriously injured client who may have residual disabilities and/or care needs requires a comprehensive LifeCare Plan prepared by a competent health care professional who is experienced in life care planning. This is especially true in cases of catastrophic injuries, such as spinal cord injury, head injury, severe burns, amputation and progressive neurological, respiratory or renal disease. However, a LifeCare Plan can be of benefit in any case in which your client may have long-term medical, nursing, attendant care, assistive or adaptive equipment, medication or supply needs.

While it may appear to be obvious that your client is injured, only a comprehensive LifeCare Plan can identify his/her multidisciplinary needs -- and put a dollar figure on those needs. Whatever the liability situation may be, it is important to accurately assess these costs in order to develop the true value of the case.

Many attorneys wait until a case nears the trial or settlement phase before requesting a LifeCare Plan. Often they learn that their initial estimate of the case’s value was far short of reality, and then they face the difficulty of increasing an initial demand. While “better late than never” certainly applies, the client often struggles to get by for a protracted period of time with sub-optimal services while the attorney mistakenly underestimates his/her needs and their “value.”

A LifeCare Plan should be requested at the time that you have determined that it is worth pursuing litigation. By the time a seriously injured person is discharged from the hospital or rehabilitation facility, preliminary life care planning can be completed in most cases. This is especially true in catastrophic injuries, such as spinal cord or brain injury.

It is important that a comprehensive LifeCare Plan be specifically developed for your client. “Boiler plate” plans which address your client’s needs merely as a typical person with a spinal cord injury, head injury, amputation, etc., will overlook the unique needs of your client as an individual. While knowledge and understanding of the nature and problems of the injury are essential, if the plan is addressed solely from that perspective, the nuances of each individual’s experience and situation is negated.

A comprehensive LifeCare Plan should address all of the issues and problems that your client encounters as a result of his/her injury. The immediate effects of the trauma, initial acute care and rehabilitation, complications encountered, medical-surgical interventions and initial disposition should be reviewed and explained. Current medical, nursing, therapy, and medical-surgical interventions should be reviewed and assessed. Future medical, surgical, nursing, attendant care, therapy and support needs should be projected. Future projections should also anticipate the need for ongoing testing, rehospitalizations and interventions to prevent and treat expected complications. A plan for optimal care should be recommended.

The client’s family and social support systems should be assessed in relation to his/her past, present and future social roles and needs. Especially in the case of catastrophic injury, the client’s family must also be considered as a victim of the trauma. A comprehensive LifeCare Plan considers the client as a part of a social/family unit that has needs beyond the individual.

Current living and care arrangements and concerns should be assessed and alternative recommendations should be made. This should include a review of the client’s activities of daily living (ADL) skills and needs. A description and explanation of the client’s level of independence and dependence must be included -- along with a written “Day In The Life” description. A comprehensive LifeCare Plan should also address the long-term effects of aging in relation to the client’s disabilities.

Clients with serious disabilities often depend on equipment such as hospital beds, wheelchairs, walkers, shower chairs, commode chairs, hydraulic lifts, etc. to facilitate increased independence in self-care activities. All equipment should be identified, evaluated and costed out. In the event that current equipment resources are found to be inadequate, alternative or additional equipment resources should be identified. Even “durable” equipment requires annual maintenance and replacement over time. Upgrading, maintenance and replacement costs must be included.

Medications and supplies should also be identified and costed out. While specific medication changes may be required over time, persons with long-term disabilities often have long-term needs that can be identified. The costs of medications and supplies (such as catheters, diapers, tube feeding supplies, wheelchair gloves, specialized clothing, etc.) are not insignificant and should not be overlooked.

Whenever it is possible, community-based living should be recommended and support services to ensure it should be identified. These recommendations may include the identification of attendant care resources, home modifications, and/or alternative housing. In some cases, a LifeCare Plan may recommend extended care facility placement as a possible alternative to community living if certain complications occur -- or if social support systems or community-based attendant care programs become unreliable or unavailable.

Educational and vocational experience, status and potential should be reviewed in relation to the client’s disability. The potential for retraining, education or employment should be considered in conjunction with appropriate vocational resources.

Finally, a LifeCare Plan should provide an itemized listing of all costs incurred and projected as a result of the disabling trauma. The projections should be based upon sound references of life expectancy, customary costs for each item, and reasonable care expectations. An overall cost of the injury should be identified.

Selecting a LifeCare planner presents various choices. If your client’s disability is primarily vocational, certainly a vocational expert can provide you with a plan that addresses those needs in detail. An economist can provide you with a projection of lost wages and can calculate the effects of inflation over the anticipated life expectancy. However, if your client is seriously injured and requires long-term medical, nursing and/or attendant care, assistive equipment, supplies and medications -- an experienced health care professional should prepare the LifeCare Plan.

The LifeCare planner who you select should have the educational background, professional experience and appropriate credentials to develop a comprehensive plan for your client. The ability to be certified as an indisputable expert witness at trial is also important. A professional rehabilitation nurse -- a registered nurse with an advanced degree in Rehabilitation Nursing -- is usually preferable.

The role of a rehabilitation nurse is traditionally that of a team coordinator. Thereby, he/she is experienced in assessing a person with chronic disability and in gathering input from the medical, surgical and allied health professional members of the rehabilitation team to ensure that each patient receives the multidisciplinary care he needs to achieve maximum functional potential and optimal care services. Indeed, coordination of services is a philosophical basis for rehabilitation nursing. With this experiential background, the rehabilitation nurse is far more prepared for LifeCare Planning than even many other professional healthcare disciplines.

It should be noted that a professional rehabilitation nurse is not synonymous with the commonly referred to “Rehab Nurse” who is often more appropriately called an “Insurance Rehabilitation Nurse.” The insurance rehabilitation nurse is primarily experienced in coordinating services on behalf of insurance carriers.

Advanced educational preparation in rehabilitation nursing adds the theoretical and knowledge bases for preparing a LifeCare Plan which recognizes the importance of the disabled person as an individual and as part of a larger societal unit. The impact of disability is viewed as a challenge that may often be overcome with appropriate education, care and support services. An advanced degree in rehabilitation nursing also adds credibility to the LifeCare planner’s expertise -- as does recognition as a published author in the field of rehabilitation nursing.

Certification by the Rehabilitation Nursing Certification Board of the Association of Rehabilitation Nurses as a Certified Rehabilitation Registered Nurse enhances credibility. However, in light of the fact that the certification examination is designed to acknowledge the basic knowledge and skills of rehabilitation nursing, it should not be regarded as the sole or determinative factor in selecting a LifeCare Planner. Indeed, the examination was designed originally for nurses who did not have an advanced degree in rehabilitation nursing.

Finally, the LifeCare planner you select should have experience as an expert witness and knowledge of legal nurse consulting. Testimony experience and at least a rudimentary understanding of the legal process are helpful in ensuring that the LifeCare planner can present herself as a credible witness. Affiliation with the American Association of Legal Nurse Consultants is one indication that the LifeCare planner is familiar with litigation issues. However, the experienced LifeCare planner should provide you with clinically competent input -- and not legal expertise. In other words, she should be a professional health resource and not a legal adjunct to the services you provide to your client.

Obviously, LifeCare Planning is an important cost of litigation on behalf of seriously injured clients. Most experienced planners charge on an hourly basis, plus out-of-pocket expenses, with a daily charge for out-of-town travel and testimony. Charges can be estimated up front. Appropriate communication with the planner can ensure that you are not negatively surprised by a bill for services which exceeds your expectations. Indeed, if your resources are limited, you should set a limit before committing yourself. Most experienced LifeCare planners require a modest retainer prior to commencing their work on the LifeCare Plan.

While the costs of LifeCare Planning are not insignificant, you can minimize your costs by providing all medical records, reports, and bills reflecting costs incurred to date in an organized fashion. While you should expect the LifeCare planner to research cost projections, you may not want to pay the planner to “reinvent the wheel” by having to research costs incurred for which you already have documentation. At the same time, it may be far more cost-effective to pay your office staff to organize the medical records, reports and bills than to pay the planner to collate all of the documentation. If you send the planner a box of uncollated invoices, you must realize that it is a time-consuming effort to organize the information for use in preparing the LifeCare Plan -- and you will be charged for that time.

It is also helpful to question the LifeCare planner about the specific documentation needed. Often there is no need for the planner to review every laboratory report and nurse’s note. The planner may advise you that only admission and discharge summaries are needed for the initial hospitalization. Again, the planner’s time (and bill) can be minimized.

A comprehensive LifeCare Plan is a vital piece of your presentation of damages. As previously mentioned, you may choose to augment the LifeCare Plan with a detailed vocational plan or you may have an economist report and testify regarding the impact of inflation over time. However, there is no economy in attempting to have a vocational or economic expert provide you with one catch-all plan that tries to answer all the questions -- especially if the specific issues which relate to disability are missed -- and are best developed by an experienced health care professional.