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Life-Care Planning for Patients After Catastrophic Injuries

Monday April 16, 2001
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Nurses and the care they give make a difference in the acute care and rehabilitation of a patient who has experienced a catastrophic injury. But the nursing involvement doesn't stop there; it continues with a process called life-care planning.
Valerie Parisi, RN, CRRN, CCM, is a life-care planner and rehabilitation nurse consultant. After working 14 years in a variety of nursing settings, she's putting her experience to work for her own business, ValPar Consultants. Her clients are law firms and insurance companies that seek her expertise for their clients, who have suffered catastrophic injuries.
So, what is a life-care plan? "Think of it as a big nursing care plan over the [patient's] life span, with associated costs," Parisi says.
When Parisi gets a new assignment, the patient has already completed rehab. She reviews their medical records and notes the details of the accident, such as the patient's status on the Glasgow Coma Scale, for relevance to their current needs. Then she makes an appointment for a home visit to the patient and family. There, she does a nursing assessment, gathering information about physicians, medications, and required therapies. A functional assessment includes safety, daily living activities, and the level of necessary supervision and home care. The visit typically takes 90 minutes to three hours, and Parisi considers future implications when assessing patient routines with caregivers. For example, an amputee at age 40 may be doing well, but Parisi must factor in the results of aging that will affect future healthcare needs. She uses the Functional Independence MeasureTM (FIM) to provide hard data. The FIM is an 18-item scale that measures independent performance in both cognitive and motor domains. It's used with all rehabilitation patient diagnoses, and is the most widely accepted functional assessment measure used in the rehab community.1
Next, Parisi contacts the treatment providers for their determination of future needs. She asks specific questions about the need for surgery, treatment, and hospitalization to calculate future costs. Then she researches costs, looking through medical supply catalogs and calling vendors in the patient's locale. She may even research the need for architectural renovations. Parisi also consults an expert to determine life expectancy, and works with an economist to come up with a total dollar figure, adjusted for inflation. When all this is done, Parisi writes the report, making sure that all of her determinations have a scientific and legal basis.
Her life-care plans are used by malpractice and personal injury attorneys, as well as by insurance companies that cover automobiles and worker's compensation claims. Parisi, however, doesn't lose sight of the patient. She says her goal is to make sure that the parties involved "manage resources wisely, so care can be available to maximize the patient's quality of life."