By Dorajane Apuna, BSN, MA, RN, CCM, CNLCP
Understanding the value and need for life care plans is an important step to being an expert in the medical-legal field. In very simplistic forms, each life care plan is a research project.
Substantiating the information presented in a life care plan is the focus of the life care planner when developing the life care plan. Use basic research techniques in the development of the plan to reduce the number of problems faced when being deposed. The basic premise is to provide a plan that allows a catastrophically injured person to maintain a quality life with the needed supplies, equipment and medical care for his future.
Where does this research begin?
1: It is necessary to ask for a full set of medical records for the client when preparing the plan. In this treasure trove is information that will be included in the plan. The medical records give a foundation of what care has been completed, the client’s reaction to the treatments and the functional status of the client at this time. Footnoting the usable items in the plan will strengthen your plan. The physicians’ reports often give the treatment plans, the future needs, and at times, what the doctors’ felt the client would need from their perspective. Research then turns to the life care planner’s observations.
2: Using a designed form relating to the individual’s injuries, the life care planner meets face-to-face with the client. In this stage the planner has the opportunity to assess not only the client, but the client’s relationships with family members, and also completes a home assessment of needs. For instance, what kind of equipment does the client already have and what types of equipment would help the client to have more function or ease in activities of daily living? If the planner is a nurse, the nurse formulates the nursing diagnoses used at this stage. It is important to document these findings in the plan as a basis for your opinions.
3: To secure more credibility for the plan, the life care planner needs to show documentation for his opinions concerning the disease process, the medical needs and the supportive literature. Research improves the process and validates the needs and support for assessing quality of life issues.
Where do you start? Research can be done through different web sites relating to the injury, or also on Google Scholar. It is important that the research be current so that it demonstrates a more recent opinion.
For an example, when writing a plan for a spinal cord injury client, one of the more popular research sites is the paralyzed veteran’s web site, www.pva.org, University of Birmingham’s spinal cord site, www.spinalcord.uba.edu and the government site at www.guideline.gov/summary/summary.aspx?ss=15&doc_id=2588&nbr=1814 – 42k -. These types of sites provide information concerning the national standards for the different levels of spinal cord injuries and their needs. Using the Google Scholar search engine allows you to look up recent research concerning problems with skin breakdowns, bladder infections and ongoing problems related to outcomes.
4: Another source of research for this project is costing or pricing for the plan. It is expected for the life care planner to use “local prices” for the client. This means calling three or more local vendors for pricing related to the item, then averaging the price. Discounts or HMO pricing is not used because the client may not have access to them once the litigation is completed. The sourcing can be identified through footnotes, lists in the appendix or in the tables. The life care planner expert is questioned most in this area during depositions. Web sites can be used, but are not felt to be as strong of a resource as the local vendors. If you have access to the “paid medicals” for the client to this time, then those prices can be used because they are already established.
The Foundation for Life Care Planning Research is a new entity that has been independently developed to provide funding for life care planning research. I would recommend going to the research site to learn more on how research is developed and used is this practice area, (www.flcpr.org). •
Dorajane Apuna, BSN, MA, RN, CCM, CNLCP is a nurse consultant and life care planner based in Sacramento, Calif.; firstname.lastname@example.org.
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