Life Care Planning How To… A Saga …

What is a Life Care Plan (LCP) Individualized Comprehensive Plan of Action: – A tool or road map for the purpose of estimating Medical and Non-Medical Needs of a person with a catastrophic injury. – For Reasonable Care, Services, and Goods Necessary to achieve desired health outcomes. – Its underlying premise is that everyone benefits when clients* reach their optimum level of wellness, self-management, and functional capability

Who, What and Where Personal Injury and Medical Malpractice Attorneys Defense Attorneys Workers’ Compensation Divorce and Family Law Estate Planners

Who, What and Where (con’t) Life Care Planner: – American Association of Nurse Life Care Planners (AANLCP®)(CNLCP®) – Certified Life Care Planner (C-LCP)(IALCP)(LNCP)

Developing a Life Care Plan Systematic Process of Life Care Planning Planning Strategies and Resource Development Interview Procedures and Data Collection Utilization of Collateral Sources (e.g. Medi-Cal, Medicare, CCS etc)

Life Care Planning A Collaborative Process: – Physician Expert (s) – Treating Physicians – Therapists/Prosthetists – Vocational Expert – Economist

Guidelines Code of Ethics – Code of Ethics for Nurses, ANA CMSA – Standards of Practice for Case Management Nurse Life Care Planning – Scope and Standards of Practice, Ed 1.

Life Care Planning Process Preliminary Review of Records Home Visit – Assessing the client in their home environment, barriers, adaptive equipment, caregivers, community

Life Care Planning Process: Nurse Life Care Planners Nursing Diagnoses – NURSING DIAGNOSES: DEFINITIONS & CLASSIFICATION 2015–2017 (NANDA International, Inc. 10th ed., H. Herdman, S. Kamitsuru, (International iii), International, NANDA-. Nursing Diagnoses - Definitions and Classification Wiley-Blackwell, 08/13/2014., West Sussex, PO19 8SQ, UK, VitalBook file.)

NURSING DIAGNOSIS “The NANDA-I taxonomy provides a way to classify and categorize areas of concern to nursing (i.e., foci of the diagnoses).” – 234 nursing diagnoses grouped into 13 domains and 47 classes. Nurses deal with responses to health conditions and life responses to disease process. Nurses provide clinical judgments concerning an undesirable human response, assess vulnerabilities, promote health. Nurses have an understanding of critical areas of health concerns: – breathing, elimination, thermoregulation, physical comfort, self-care, and skin integrity.

Nursing Diagnoses and Life Care Planning Assessing Functional Needs of the Injured Party: Examples – Impaired Memory – Impaired Physical Mobility – Dressing Self Care Deficits – Risk for Falls

Life Care Planning Process Developing a DRAFT Consultation with other Experts and Treating Physicians/Prosthetists/Therapists

What is included? Medical Services Evaluation and Treatment Physician visits, diagnostics, rehabilitation and therapy, Pharmaceuticals, Supplies In-Home/Facility Care Emergency room visits/acute hospitalizations Equipment and Aids for Independent Function Orthotics and Prosthetics

What is included? (con’t) – Transportation – Architectural Renovations – Educational/Vocational needs – Leisure/Recreational/Productive Day activities

What is NOT Included Treatments which are not medically appropriate for the diagnosis or not related to the injury To be applied to the total cost of care the treatment must reach Reasonable Degree of Medical Certainty. – QUESTION? Can a Nurse provide this determination? – What about items that do not meet this threshold?

Life Care Planner as Consultant Analysis of Established Life Care Plans Medical/Legal Consultation – Providing Cost Projections

Preparation for Litigation Case Preparation: – Mediation, Settlement Conference Testimony: Depositions Trial

Litigation Testimony: Depositions – Defending the plan Trial: Educating the Jury

Litigation Cross Examination Process:

Case Study 19 year old woman (previously right hand dominant) (15 years old at injury) Traumatic Brain injury Passenger in vehicle (Extracted by EMTs) GCS of 3 No pre-existing health issues

Case Study MEDICAL DIAGNOSES: History of Motor Vehicle Accident with multiple trauma, skull fracture and subarachnoid hemorrhage, focal brain contusion, and tentorial subdural hemorrhage. s/p liver laceration, pulmonary contusion, cardiac contusion Hemiplegia, right side Dysarthria

Case Study (con’t) NURSING DIAGNOSES: Impaired Verbal Communication (00051) Interrupted Family Processes (00060) Risk for Caregiver Role Strain (00062) Risk for Situational Low Self-Esteem (00153) Impaired Physical Mobility (00085) Impaired Wheelchair Mobility (00089) Impaired Walking (00088) Self-Care Deficit, Feeding (00102), home maintenance (00098) Risk for disturbed personal identity (00225) Risk for Falls (00155)

Case Study Experts: – Physiatrist, – Neuropsychologist, – Economist – Nurse Life Care Planner