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Life Care Planning: An Exciting Option for RNs

Monday January 13, 2003
Debra Blyth, RN, JD, believes that RNs have unique skills that transfer easily to the role of a 
life care planner. 
Photo by CJ Gunther.
Debra Blyth, RN, JD, believes that RNs have unique skills that transfer easily to the role of a life care planner. Photo by CJ Gunther.
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Diane Smith, RN,* is a case manager in the greater Boston area. Recently, Smith was contacted by Thomas Brown,* a well-known local attorney. Brown wants to hire Smith to assist him with one of his cases that is close to settlement. Brown's client, a 23-year-old man, was injured while diving into a swimming pool. He was diagnosed with a C3 fracture and is currently ventilator-dependent and in a wheelchair. Brown filed suit against the owners of the pool, and the defendant's insurance company has offered to settle the case for $500,000.00.
Before deciding whether this amount is sufficient for a settlement, Brown needs a comprehensive list of all the services and equipment the young man is likely to need for the rest of his life. He also needs to know what all these will cost to be able to come up with a dollar figure to be used in his settlement negotiations. Will the amount offered by the defense be sufficient to cover his care for the rest of his life? Can Smith help him? Yes, because in addition to being an RN and a case manager, she is also a certified life care planner.
A 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 people who have experienced catastrophic injury or have chronic healthcare needs. To put it simply, a life care plan is a road map of care that a particular patient will require over the course of his lifetime.
In the above example, Smith will detail the care the young man will require for the course of his lifetime. As he will most likely always be ventilator dependent, he will need skilled care, whether at home or in a facility. He will also need certain supplies, including those for his ventilator.
What about his wheelchair? Should the plan allow for a manual chair or a power chair, or both? What about medications he is currently taking and will require for the rest of his life? What about doctor visits, referrals to specialists, physical and occupational therapy? What about adaptive equipment to foster his independence and self-sufficiency? The plan will have to account for all these areas and more, then detail the costs for each of these elements.
Life care planning is an exciting new field of opportunity for medical professionals. It is a specialized subset of case management, dealing with catastrophically injured or chronically ill people. Historically, the first life care plan was published in rehabilitation literature in 1985. Since then, the concept has grown and has come to represent the most effective case management tool within the industry. Currently, there are approximately 500 certified life care planners nationwide. The need for life care planners is expected to grow exponentially over the next 10 years.
Although not all life care planners are nurses, as RNs, we are uniquely qualified to succeed in this field. We are taught in nursing school the value of seeing the whole person, and the complete picture of their life - the psychosocial aspects as well as the physical. We are also taught to anticipate the needs of patients and to teach them and their families about their illness and care.
In additional to being used in a financial setting, a life care plan is also an educational and communication tool for the patient and all third parties. In the above example, by referring to the life care plan, the young man's caregivers know how often they need to schedule his medical appointments, what to expect in terms of rehabilitation, and what they can expect the course of his medical care to look like.
Many life care planners are independent practitioners. Others work for hospitals or rehabilitation facilities, law firms, managed care organizations, or insurance companies. One thing is for certain, armed with the knowledge and certification in this newly burgeoning field, nurse life care planners will be positioned more than ever for success and for making a difference.