Oklahoma Bar Journal
The History and Evolution of Life Care Planning
By Sherry A. Latham
What is a life care plan? By definition, “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 costs for individuals who have experienced catastrophic injury or have chronic health care needs.”1
Traditionally, life care plans have been used in a variety of settings using case management principles. Since the early days of life care planning, the role and arena in which the life care planner and life care plan has evolved to additional areas of law, such as family law, criminal law and private trusts in estate planning for long-term care of those with injuries or chronic illnesses.
According to Weed and Berens, the care plan has been used in setting reserves for insurance companies, assisting workers’ compensation companies with assessing future care costs associated with work-related disabilities, the cost of future care for health insurance companies, assisting Trusts with prioritizing and managing funds and providing the client and family with an outline of future care. have been used primarily as a litigation tool to outline medical damages.2
The first time the concept of life care planning was formalized, it appeared in a legal publication, Damages in Tort Actions by Deutsch and Raffa.3This publication described a life care plan and its appropriateness for tort litigation cases, particularly as helpful in case management of catastrophic injuries. The first generation of authors of these expert reports generally came from either vocational rehabilitation or nursing backgrounds. Over the years, it has become apparent the most comprehensive setting in which a life care plan is used is that of litigation due to the necessity of qualifying an expert in relation to Daubert, Kumho Tire and other rulings regarding expert witnesses.
CREDENTIALS AND PROFESSIONAL ORGANIZATIONS
Since life care planning started as a specialty and the specialty-wide agreement upon a definition of life care planning, subsequent training programs were developed to meet the criteria required to become a Certified Life Care Planner (CLCP), a credential offered by the International Commission on Health Care Certification (ICHCC) that is often referred to as the gold standard. These training programs established the minimum requirements of education, experience and background of specialties to qualify entry not only into the training programs, but also to sit for the CLCP examination. Eventually, the practice of life care planning became an interdisciplinary specialty of experts beyond that of vocational rehabilitation and nursing fields. While the minimum standards to qualify to sit for the certification exam have remained the same, the field of life care planning has continued to emerge to become an evidence-based practice to meet the criteria needed to withstand scrutiny within legal jurisdictions.4
There are professionals who practice as experts in life care planning without certification. Yet, these professionals are held to the same standards of practice and expectations of conformity to the consensus and majority statements5 6 and the role and functions study outcomes developed through evidence-based research.7 8 9 The lack of certification by a life care planner negates the protective value to the public a certification signifies or the expectation that the expert has met a minimum standard of education, experience, training and competency in the field of life care planning and catastrophic case management to perform the role of a life care planner.
Since the initial CLCP credential, the specialty of life care planning has grown with two additional certifications for life care planners: the Certified Nurse Life Care Planner (CNLCP), which is the same qualifications as the CLCP but available only to nurses, and the Physician Life Care Planner (PLCP), which is available only to board-certified physiatrists who have already completed the CLCP certification. It is not uncommon to have some experts who are dually credentialed, as they have achieved the requirements of more than one of the certifying bodies. Even still, the totality of certified life care planners by one or more of the certifying bodies equates to approximately 2,000 professionals internationally.
With growth, the importance and ultimately a sense of requirement came forth regarding involvement in professional organizations specific to life care planning by mention in the standards, consensus and majority statements as well as identified in the role and function studies of life care planners by the field of life care planning. The International Academy of Life Care Planners (IALCP), now under the formal umbrella of the International Association of Rehabilitation Professionals (IARP), provides opportunities for life care planners to be involved in the field and emergence of life care planning. For example, Standards of Practice for life care planning is now in its development stage for the fourth edition. Both IACLP and IARP provide continuing education opportunities and venues for the life care planner to stay abreast of new developments and continue to meet the set standards established by the field of life care planning. Two additional professional organizations are available to life care planners coming from specific disciplines, the American Association of Nurse Life Care Planners (AANLCP) as well as the Academy of Physician Life Care Planner (APLCP).
All organizations provide ongoing continuing education and annual conferences. The IALCP also has a professional designation, the Fellow of International Academy of Life Care Planners. Its purpose is to recognize expertise, experience and contribution to the field of life care planning.10 The program recognizes those life care planners who have achieved a high level of skill and use their skills and knowledge to promote the advancement of life care planning.
RETAINING LIFE CARE PLANNERS
The education, training and experience have metamorphosized into making life care planning a unique specialty and the expert a valued member of the damages team in multiple venues and roles. Life care planners were traditionally retained as one of the last few needed experts and often given a short discovery timeline to prepare their reports. Within this last decade, attorneys nationwide have become more knowledgeable of not only the talent but the foresight life care planners can bring in prelitigation for their firm in the following areas:
- Educating the attorneys and injured party of the mechanisms of the injuries and anticipated future needs.
- Reviewing and identifying missing records.
- Assisting in preparing demand packages by preparing a life care plan that provides real documentation of costs as to the needs of the claimant rather than an estimate of the dollar value or in excess of value (marginal costs) routinely utilized. This individualized life care plan for the injured party establishes an evidence-based view of the future of not only the needs but also the costs associated with those needs due to the injuries sustained within their geographical area. This pre-suit report ultimately saves those involved in the matter time and money, resolving the case perhaps prior to engaging the litigation system.
- Assisting with identifying the appropriate experts by specialty according to the injured party’s injuries and/or referrals for ongoing care (e., neuropsychological assessment for a traumatic or acquired brain injury). A seasoned life care planner, typically one with a national practice, has a database established over the years for specialty experts, which reduces the costs normally associated with expert location services.
- Assisting and input into settlement conferences.
- Presenting the life care plan to the injured party and family for their input and fielding questions to ensure they understand future needs and locating those within their geographical area, as identified in the life care plan.
- Reviewing the opposing life care planner’s report against standards, methodology, consensus and majority statements, and the role and functions of the life care planning expert.
- Developing appropriate deposition or trial line of questions for opposing experts.
- Preparing attorneys for deposing the opposing life care planner.
- Identifying potential areas of challenge for exclusions.
- Identifying inclusion of trial exhibits.
- Collaborating with Day in the Life videography to ensure the videos are consistent with the life care plan projected needs.
- Assisting with special needs trust disbursement and oversight.
- Identifying appropriate candidates in the geographical area as sources of services to meet the needs of ongoing implementation of the life care plan, who will provide advocacy and assistance to the injured party post-litigation as a case manager.
FROM THE DEFENSE
The life care planner on the defense side of a case can work either as a consultant or as a designated expert retained for testimony. The roles on the defense differ only if the life care planner is asked to critique or provide peer review of the plaintiff expert’s life care plan based only on the injuries sustained in the incident that is the subject of the case and in accordance with the standards and methodologies established in the field. Specifically, Gunn notes, “A defendant’s life care planning consultant can be of great assistance in helping defense counsel to identify any weaknesses in the plaintiff’s proposed expert’s qualifications to testify regarding the need for any given treatment element in the plan.”11
A common defense tactical error is waiting to retain a life care planner until after the plaintiff life care plan has been received. There are certain types of catastrophic injuries the defense attorney should anticipate the plaintiff will retain a life care plan for (i.e., traumatic brain injury, spinal cord injury, amputation, birth injury case). For cases dealing with these catastrophic injuries, the defense should retain a life care planning expert early in the litigation process, rather than waiting until they have received the plaintiff life care plan. Retention of a life care planner should come earlier in the litigation process. Then, a determination should be made closer to discovery deadlines as to whether the life care planning expert should provide only consultation or become a testifying expert.
Gunn adds, in order to be properly prepared to rebut the plaintiff’s plan and determine whether to present a defense plan, it is vital that much of the groundwork be laid in the early portions of case discovery.12 A defense consultant can provide early assistance by suggesting the various records that should be requested and identifying persons to be deposed in order to make the determinations necessary to evaluate the injured party’s life care needs. Retaining a life care planner after the plaintiff life care plan is received inflates costs to the defense and increases the stress level of the defense expert, negating the positive benefits of having the expertise available as the case develops instead of at the final hour of the litigation process.
BEYOND PERSONAL INJURY: OTHER VENUES FOR THE LIFE CARE PLANNER
Beyond the use of life care planners in personal injury, there have been other legal or service arenas where their expertise and reports are beneficial. These include:
- Family law
- Issues related to alimony support for a spouse with a catastrophic injury or chronic health care needs.
- Child support, often through life expectancy for a child with special needs.
- Criminal law
- An individual under arrest has a catastrophic injury or chronic health care need that needs to be tended to while incarcerated.
- Private trusts for families with long-term medical needs to establish funding needed.
- Plan of care for chronic illnesses such as multiple sclerosis or severe autism.
THE FUTURE OF LIFE CARE PLANNING
As life care planning research continues to develop through the Foundation for Life Care Planning and Rehabilitation Research or other sources, thus developing additional evidence-based practice resources, this will evolve the practice of life care planning in legal and medical settings. Consequently, ongoing education to both the legal and life care planning fields of the ongoing development of roles and venues in which life care planners can provide consultation and expertise should result in the integration of life care planners into more disciplines of both law and medicine. One would anticipate the specialty of life care planning to be more commonplace in the future.
ABOUT THE AUTHOR
Sherry A. Latham is an RN, a Certified Life Care Planner and a Fellow of the International Academy of Life Care Planning. She is active in professional organizations, leadership and published in peer-reviewed journals. She co-authored the Capital Law School Life Care Planning Program and is the lead instructor. She was honored with the 2020 Outstanding Educator Award from the International Academy of Life Care Planners.
- International Conference on Life Care Planning and the International Academy of Life Care Planners, adopted April 1998.
- Weed, R. (2018). Life Care Planning and Case Management, 4th edition (4th ed.). New York, NY: Routludge, p. 609.
- Deutsch, P., & Raffa, F. 1981. Damages in Tort Action (Vols. 8 & 9), New York: Matthew Bender, p. 3.
- Id., p. 3.
- Johnson, C., (2015), Consensus and Majority Statements Derived from Life Care Planning Summits, held in 2000, 2002, 2004, 2006, 2008, 2010, 2012, 2015. Life Care Planning Journal, 13, (4), 35-38.
- Johnson, C., Pomeranz, J., and Stetton, N. (2018). Life Care Planning Consensus and Majority Statements, 2000- 2018: Are they Still Relevant and Reliable? A Delphi Study, Journal of Life Care Planning, 16 (4), 5-14.
- Neulicht, A. T., Riddick-Grisham, S., & Goodrich, W. R. (2010). Life Care Plan Survey 2009: Process, Methods and Protocols. Journal of Life Care Planning, 9(4), 131-200.
- Johnson, C., Pomeranz, J., & Stetton, N. (2018). Life Care Planning Consensus and Majority Statements, 2000-2018: Are they Still Relevant and Reliable? A Delphi Study, Journal of Life Care Planning, 16(4), 5-14.
- May, V. R., III, & MoradiRekabdarkolaee, H. (2020). The International Commission on Health Care Certification Life Care Planner Role and Function Investigation (1155100642 868009957 T. R. Owen, Ed.). Retrieved Jan. 13, 2021.
- IARP, para. 1; https://connect.rehabpro.org/lcp/fellow/fellow-program.
- Gunn, T. R. (2018), Chapter 24 “A Defense Attorney's Perspective on Life Care Planning,” in 1155055160 867982494 R. Weed & 1155055161 867982494 D. Berens (Eds.), Life Care Planning and Case Management Handbook, (4th Edition ed., pp. 1-940), New York, NY: Routludge, pp. 655-668.
- Id., p. 666.
Originally published in the Oklahoma Bar Journal – OBJ 92 Vol 6 (August 2021)