cloie b. johnson, med, abve, ccm life care planning process and practice life care planning: state...
TRANSCRIPT
CLOIE B. JOHNSON, MED, ABVE, CCM
Life Care Planning Process and Practice
Life Care Planning: State of the Art
AIDC 2012
Life Care Planning
A. History B. What Is A Life Care Plan? C. Who Prepares A Life Care Plan?D. Practice StandardsE. Tips
History
McGowan and Porter (1967)
The Rehabilitation Act of 1973
Individual Written Rehabilitation Plan (IWRP)
Damages in Tort Action (Deutsch & Raffa, 1981)
What Is A Life Care Plan?
A Life Care Plan is a dynamic document based on 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 experienced catastrophic injury or have chronic health care needs.
A Life Care Plan is a tool of Case Management.
Who Utilizes Life Care Plans?
Patients and FamiliesTreatment TeamsTrust ManagersClaims ExaminersAttorneysEconomistsThe Court
What Areas Does a Life Care Plan
Consider?
Categories
Projected Evaluations Wheelchair / Mobility Accessory and
Maintenance Needs Projected Therapeutic Modalities Orthotic/Prosthetic Home/Facility Care Projected Routine Future Medical Care Diagnostic Testing/Educational Assessment Architectural Renovations
Leisure Time and/or Recreational Equipment Future Routine Medical Care Future Surgical Intervention, or Aggressive
Treatment Plan Transportation Identification of Potential Complications Medication/Supply Needs
to name a few…...
Vocational Rehabilitation Assessments Aids for Independent Function Assessment of Lost Earning Capacity
( Optional) Home Furnishing and Accessories Orthopedic Equipment
to name a few…...
Who Prepares A Life Care Plan?
Rehabilitation Counselors Case Managers NursesTherapists, (PT, OT, SLP, Psychologists)PhysiciansProfessionals who have appropriate life care
planning training and experience.
Life Care Planners possess
EducationExperienceCredentialsAreas of Expertise (Specialized
knowledge)
Rehabilitation Counselors/Case Managers
Education: Master's degree Experience: Significant relevant experience in
Rehabilitation Counseling, Nursing and Case Management.
Certifications: CRC, CCM, CDMS, ABVE, CLCP (not all inclusive or all required)
Areas of Expertise: Specialized knowledge
Who Prepares a Life Care Plan?
Rule of Evidence vs. Professional Certifications: The Real Basis for Establishing Admissible Testimony by Rehabilitation Counselors and Case Managers,
Rehabilitation Professional Journal, Vol. 15, No. 3, pps 7 – 16, Athens, GA: Elliott & Fitzpatrick, Inc., 2007
Summary of Rehabilitation Certifications on Selected Variables
Independent
Accreditation
YearEst.
MinimumEducationRequired
MinimumExperienc
eRequired
Codeof EthicsStandardof Practice
ExamRequire
dCEUs
RequiredNon-Profit
CRC Yes197
5Yes Yes Yes Yes Yes Yes
CCM Yes199
3Yes Yes Yes Yes Yes Yes
CDMS Yes198
4Yes Yes Yes Yes Yes Yes
CLCP No199
6Yes Yes Yes Yes Yes No
ABVE No198
0Yes Yes Yes Yes Yes Yes
CNLCP
No199
9Yes Yes Yes Yes Yes Yes
CVE No198
1Yes Yes Yes Yes Yes Yes
Who Prepares A Care Plan?
Rehabilitation Counselors and Case Managers who have care planning training and experience.
The professional should have advance knowledge of specific disabilities, established treatment care resources, and a consistent, objective approach toward the practical and functional elements involved in the treatment of catastrophic injuries and diseases.
Life Care Plan Goals
Quality of LifeLeast restrictive environment
Promote independenceMaintain dignity
Foundation and Role
The medical community defines the nature and extent of an impairment. The Life Care Planner translates what that means for work and independent living.
(Field, over the years)
Role and Function
“…. emphasize the need to understand the entire person and “look” at them compared to themselves both pre and post injury. The client is an N of 1. While common approaches and methodologies exist, clinical judgment is required to determine the true effect of injury or illness on an individual.”
(Choppa & Johnson, 2008)
Application of Data
“Often times, state data, federal data, and/or research studies are used as determining factors in an evaluation. Practically speaking though, the client as a whole, and all that is known about them, should be applied to the data, not simply applying the data to the client.”
(Choppa & Johnson, 2008)
Round Pegs – Square Holes
It is not Paint by NumbersIt is not replicable by a layman“Economists deal in numbers or things that can be converted into numbers. The economist then, expects the life care plan input to be specific and capable of being inserted into mathematical models.”
(Dillman, 2008)
Balance
“The accuracy of the analysis is primarily based upon the three factors of methodology, clinical expertise and accurate application of the available researched data”
“The Life Care Planner is vulnerable to error in the decision making process when they lack the experience in evaluating a case and are overly reliant upon the data.”
“The experienced Life Care Planner is prone to analysis error if they are overly reliant upon their experience and ignore the data or fail to evaluate how the data applies to a specific individual.” (Grimes, 2008)
Considerations
The Life Care Planner must scratch below the surface to understand the practical real life implications for the individual.
The Process
Step-By-Step Process Consistent MethodologyGenerally acceptedPeer reviewed
The Process of Coordinating a Life Care Plan
“You’ve got to be very careful if you don’t know where you are going because you might not get there.” Yogi
How is a Life Care Plan Prepared
ReferralRecordsInterviewCoordination with Physicians and/or
ProvidersResearchLife Care Plan preparedConcurrence obtainedReport completed
Process
Case Intake/Referral Starts with accepting the referral
Discuss basic referral information: Purpose i.e., legal, reserves, private hire Timelines, Location of client, Financial issues, including retainer Request medical records Information release signed in advance Unique circumstances
Process
Review Medical Records Are they sufficient (examples)..
Ambulance report Emergency room notes Admit and Discharge notes Nurses notes Doctors orders Therapy notes and reports Consultant reports Lab/X-ray reports Etc…
Process
Additional documentation Depositions Videotapes School records Employment records, including earnings Tax records
Process
Initial Interview EducationalStandardized forms
Pre-functioning Post-Functioning Current treatment Impact on all roles
Process
Initial Interview Materials Informed Consent Release of information Intake outline Related checklists Sample plan
Process
Consulting and Communicating with Team Members Physician Consulting specialists Client and family Foundational requirements:
Medical, Psychological, Case Management and Vocational
Process
There are five components to establishing the medical foundation for the life care plan .
A. Utilizing the Medical Records.B. Coordinating with the treatment team.C. Utilizing consulting specialists.D. Utilizing of Clinical Practice Guidelines.E. Utilizing of Research Literature.
Process
A psychological foundation is also established with the similar steps noted above, however may also include coordinating with the psychologist or mental health counselor.
Case Management foundation Similar steps are utilized in establishing case management
foundation although consultation with the current case manager would also be utilized.
Rehabilitation foundation Establishing a rehabilitation foundation may also include
utilizing personal expertise, training, and clinical judgment
Process
Preparing the Preliminary PlanItemPurposeProvidersDurationFrequency Base Cost
PRELIMINARY CARE PLANNAME: MALE
DOB: 3/5/80DOI: 1/14/02
ITEM PURPOSE PROVIDER AGE/INITIATEDAGE/SUSPENDED
REPLACEMENTRATE
BASECOST
What Why Who When How often How Much
CARE PLAN
Life Care Plan Coordination
Filling in the HolesMissing informationAdditional evaluationsRealistically implementableHave you thought through the missing
issuesLife time road map
Life Care Plan Coordination
Researching Costs and SourcesActual providersInternet Prior medical recordsCataloguesDocumentation
Life Care Plan Coordination
Finalize the Plan and sharePhysician/treatment teamClientVocational ExpertEconomistReferral source
ITEM
PURPOSE
PROVIDER
AGE/INITIATED
AGE/SUSPENDED
REPLACEMENT
RATE
BASE COST
Physical Medicine and Rehabilitation
Evaluation, Monitoring and
Treatment
Ongoing evaluation, monitoring and treatment of sequelae of T7 paraplegia Make necessary
rehabilitation referrals regarding musculoskeletal, neurogenic bowel/bladder and other related
complications.
Dr. PM&R or Local Provider
Current Age to Life Expectancy
Average 1 visit per year minimum
Evaluation: $177.00 - $217.00
Follow-up: $119.00 –
176.00 Primary Care
Physician Evaluation Monitoring and
Treatment
Ongoing evaluation, monitoring and treatment of spinal cord injury. Provide future treatment
recommendations as needed.
Dr. PCP or Local Provider
Current Age to Life Expectancy
Average 6 visits per year above and
beyond routine and pre-existing needs
$158.00 - 212.00 per visit
Urological Evaluation Monitoring and
Treatment
Ongoing evaluation, monitoring and treatment of neurogenic bladder due the sequelae of Mr. Doe’s
spinal cord injury. Provide future treatment recommendations, as needed.
Dr. P or Local Provider
Current Age to Life Expectancy
Average 1 visits per year minimum
Evaluation: $147.00 - $211.00
Follow-up: $158.00 -
212.00 Orthopedic Evaluation,
Monitoring and Treatment
Ongoing evaluation, monitoring and treatment of orthopedic needs as Mr. Doe is at risk for
developing: upper and lower extremity contractures and deformities; he is more likely than not going to experience one fracture minimum in his lifetime and require surgical intervention with follow up. Provide
future treatment recommendations, as needed.
Dr. Bone or Local Provider
Current Age to Life Expectancy
Evaluation one time minimum, timing to
be determined by PM&R or PCP
Evaluation: $147.00 - $211.00
Follow-up: $158.00 -
212.00
PROJECTED EVALUATIONS/TREATMENT
VOCATIONAL ASSESSMENT AND LIFE CARE PLANNING
•Vocational Assessment•Vocational Recommendations
•Rehabilitation Plan•Educational Capacity
•Wage Earning Capacity •Life Care Plan
•OBTAIN APPROPRIATE EDUCATION AND CREDENTIALS •BE KNOWLEDGEABLE ABOUT THE DISABILITY(IES).•OBTAIN RELEVANT SPECIALIZED LCP TRAINING •BELONG TO AND, EVEN BETTER, BE ACTIVE IN APPROPRIATE ORGANIZATIONS
Tips
•DEVELOP LIFE CARE PLANS ACCORDING TO ESTABLISHED AND ACCEPTED STANDARDS OF PRACTICE, ETHICS AND PUBLISHED METHODOLOGIES •MAKE SURE THAT LIFE CARE PLANS INCLUDE PROPER FOUNDATION •STAY CURRENT WITH THE PARAMETERS OF THE PROFESSION
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Tips (continued)
•BE FAMILIAR WITH RELEVANT LITERATURE •BE FAMILIAR WITH THE RULES OF THE JURISDICTIONS IN WHICH ONE PRACTICES •BE KNOWLEDGEABLE ABOUT APPLICABLE FEDERAL RULES OF EVIDENCE WHEN TESTIFYING IN PERSONAL INJURY LITIGATION
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Tips
•LIFE CARE PLANNERS ARE NOT SIMPLY SCRIVENERS OR SECRETARIES SIMPLY WRITING DOWN WHATEVER SOMEONE ELSE RECOMMENDS NOR DO THEY “KNOW IT ALL” •STAY WITHIN ONES AREA OF EXPERTISE OR SCOPE OF PRACTICE•UTILIZE ALL OF YOUR SKILLS AND UNDERSTAND THE PREMISE IN WHICH YOU COORDINATE A LIFE CARE PLAN
Tips (continued)
IALCP - THE PURPOSE OF THE IALCP IS TO PROVIDE EDUCATION AND LEADERSHIP FOR PROFESSIONALS WHO CONDUCT LIFE CARE
PLANNING AND TO CONTRIBUTE TO THE DEVELOPMENT OF LIFE CARE PLANNING STANDARDS, POLICIES AND PRACTICE.
INTERNATIONAL ACADEMY OF LIFE CARE PLANNERS. (2006 REV). STANDARDS OF PRACTICE FOR LIFE CARE PLANNERS. JOURNAL OF
LIFE CARE PLANNING, 5(3), 75-81.
99 CONSENSUS AND MAJORITY STATEMENTS FROM SUMMITS SINCE 2000 (PRESTON, K & JOHNSON, C., JOURNAL OF LIFE CARE
PLANNING, 11(2), 9-14
Standards of Practice in Life Care Planning