Life Care Plan Development

When it is used

Life care planning is used in catastrophic injury, medical malpractice, and chronic disease cases to quantify future care costs for trial or settlement purposes.

Step-by-step

1. Review medical records and collaborate with treating team
2. Interview and, where appropriate, examine the evaluee
3. Identify categories of care (routine medical, therapies, durable medical equipment (DME), home modifications, attendant care, etc.)
4. Determine frequency and duration for each item based on physician recommendation and peer-reviewed literature (Weed & Berens, 2018)
5. Obtain geographically matched costs from local providers and published rate schedules
6. Compile the plan with itemized projections and total annualized cost

Data sources

• Treating physician recommendations
• IALCP / IARP life care planning standards
• Peer-reviewed duration and frequency literature
• Local provider cost quotations
• Published rate databases (Medicare, usual-and-customary compilations)

What the finished plan contains

A completed life care plan is a set of tables, one per category of care, in which each line names an item, the recommendation it rests on, its frequency, the age or period over which it is needed, its unit cost and the source of that cost. The categories typically run from physician follow-up, diagnostic testing and medications through therapies, durable equipment and supplies, home and vehicle modifications, attendant or facility care, and case management. A narrative introduces the evaluee's diagnoses, functional status and the treating recommendations the plan implements, and an appendix lists the records reviewed and the sources consulted. The tables are built so that a reader can trace every dollar to a recommendation and a cost source.

Sourcing the recommendations and the costs

Items within the scope of medical practice rest on a treating physician's recommendation, obtained from the records or through direct consultation and documented in the plan. Where the records are silent on an item the evaluee's condition ordinarily requires, the planner asks the treating physician rather than assuming the item, and the plan states which items rest on which source. Frequency and duration draw on the treating recommendation first and on the published literature for the condition where the recommendation does not specify them.

Costs are matched to the evaluee's geography. The planner obtains quotations from providers in the evaluee's area, published fee schedules and rate compilations for the region, and retail prices for equipment and supplies, and records each source with the date it was obtained so that the figures can be updated. A plan that prices care in the wrong market, or from an undated source, is the plan most easily challenged.

Reviewing an opposing plan

The same structure guides the review of a plan prepared by another planner. The reviewer checks that each item traces to a recommendation within the recommending professional's scope, that frequencies and durations match the recommendation or the literature, that costs are sourced to the evaluee's market and dated, that the plan neither duplicates items across categories nor omits a category the diagnoses call for, and that the life expectancy the totals rest on is stated and sourced. The review reports each discrepancy with its effect on the total rather than substituting the reviewer's own plan, unless a replacement plan has been requested.

Limitations

Life care plans reflect the best projection at a point in time. Costs, providers, and medical recommendations can change, which is why plans are typically updated periodically.

Admissibility

Life care planning methodology following IALCP / IARP standards (International Academy of Life Care Planners, 2022) is widely accepted when grounded in physician recommendations and documented cost data.