Q&A on Life Care Plans

Q.What is a Certified Nurse Life Care Planner (CNLCP)?

A. Certified Nurse Life Care Planner (CNLCP) is a registered nurse who has met defined qualifications and passed a certification examination in Life Care Planning allowing them to utilize the designation “CNLCP”.

Q. What makes the Nurse Life Care Planner qualified to write Life Care Plans?

A. According to the American Association of Nurse Life Care Planners (AANLCP), the Nurse Life Care Planner has “extended experience, knowledge and education relevant to the life care planning process.” Nurse Life Care Planners are uniquely qualified because, as registered nurses, they approach the needs of the human being from a holistic perspective working within their licensed scope of practice.

Q. What’s a Life Care Plan?

A. 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 individuals who have experienced catastrophic injury or have chronic health care needs. A Life Care Plan is a tool used to estimate future medical and related costs for an individual who suffers from injuries and/or a chronic illness. The Life Care Plan identifies and projects the costs of reasonable and necessary services, supplies, and equipment over an estimated life expectancy.

The Life Care Plan helps support and validates the resources necessary to assure an individual is able to obtain and maintain a reasonable quality of life, with dignity and respect. The intention is to address the client as a whole using the team approach. The Life Care Plan should serve as a “road map” to ensure funds will be available to properly care for the client.

Q. What should an attorney look for when choosing a Nurse Life Care Planner?

A. Ask for proof of current, unrestricted registered nurse licensure. A registered nurse with a broad background in nursing, preferably with nursing degree(s) from an accredited college or university nursing program, is best to assess the injured person’s function, cognition, and current situation. A certified nurse life care planner has education and experience in case management and life care planning, and passed a national examination to demonstrate competence.

Q. How does a Nurse Life Care Planner prepare a Life Care Plan?

A. The first step is reviewing and summarizing all available medical records, including all hospital records. Then a personal visit with the injured person and family, at their home if possible, helps the preparer assess their knowledge of the injury and its treatment, the individual’s current function, adaptive technology in use, home modifications, transportation, home safety, resources, coping strategies, goals, and stress levels. The Life Care Planner reviews the literature on related standards of practice, available technology, recommendations for care and equipment, potential complications, changes expected with the diagnosis, and any other appropriate issues, to form a plan of care and develop recommendations. The Planner should always try to reach out to members of the treating team and others as appropriate (this generally isn’t possible with defense cases). Then all pricing for every recommendation is placed into easily-understood tables, with rationale/references; obtaining current accurate pricing can be very labor-intensive but there’s no substitute for detail-oriented work.

Q. What records does a Nurse Life Care Planner review?

A. The Nurse Life Care Planner will want to see all available records. Records compiled by a paralegal or other nonmedical person are often incomplete because the compiler may not recognize the significance of each piece of the puzzle.

For example, EMS and emergency department records describe initial findings and mechanism of injury. While admission and discharge summaries are useful, they are often dictated by residents who are not completely up to date on the range of care and responses during the admission; it isn’t surprising to see conflicts and errors in them carried forward from previous electronic records. Nurse Life Care Planners want to review all team progress notes, laboratory and diagnostic studies, physician and nursing order sheets, nursing records, medication administration records, consultant notes, and procedure notes (e.g., surgery, invasive testing) so the Nurse can identify errors there, too.

Outpatient therapy and orthotics/prosthetics records include periodic evaluations. Good information on problems, absences, and adherence to standard procedures can found here as well.

For a child, school records, IEP (individual education plan), and pediatrician’s notes help assess current developmental state and function.

Police accident reports help  to understand possible mechanisms of injury, and to assess for signs of disability that may not have been evident during initial hospitalization. Finally, billing records reveal valuable information on physicians and treatment plans that may need to continue in a Life Care Plan. Reconciling billing with medical records can disclose missing records, too.

Q. Nurses can’t prescribe, can they?

A. Yes, they can.  There’s no legal requirement in any state in the US for most medical goods and services for a patient’s care to be prescribed by a physician. It’s important not to confuse an insurance plan’s requirement to have a physician prescription for a billable product or service, or the legal requirement for physicians to prescribe medication, with the registered nurse life care planner’s ability to assess and recommend. The law requires some things (such as medications and surgery) to be prescribed or performed by physicians or advanced nurse practitioners. Insurance companies require that most goods and services be prescribed by physicians only for cost control purposes. The registered nurse professional licensure, certification, experience, education, standards of practice, and ethics are backed by nurse practice acts and the ANA Scope and Standards of Nursing Practice that apply to all RNs. Registered nurse life care planners are allowed to prescribe a plan of care after assessing the patient’s response to injury or illness. Through collaboration with members of the treating team, most Life Care Plan components won’t be involved with a health insurance contract and don’t require physician signature. The evaluations and other aspects of Life Care Plans are within the scope of professional licensure to prescribe.

Q. Are all Life Care Planners trained the same way?

A. No. At Caring Communities Life Care Planning, there is a Certified Nurse Life Care Planner, CNLCP, a professional registered nurse with education and expertise in catastrophic or chronic conditions. She has earned a national certification in Nurse Life Care Planning and practiced nursing since 1982.  As a registered nurse, she has based her independent practice on nursing processes and nursing diagnosis, backed by the nursing license and the Nurse Practice Act. We always collaborate with treating physicians to specify items requiring physician prescription by law, such as surgery, prescription medications, and some types of equipment. As a CNLCP, however, it’s within our scope of practice to prescribe the evaluations, equipment, consultations, and other interventions we specify in Life Care Plans.

Q. Why don’t I just ask the doctor what is needed?

A.The highest-cost items in most plans are for home nursing and escalating care levels with catastrophic conditions. Physicians aren’t licensed to prescribe nursing hours of care; RNs are. Physicians don’t do home visits to assess home-care needs; RNs do. When you consider that the biggest dollar values in Life Care Plans are for nursing care, it’s clear how important this is. And physicians are often not tuned into the other costs that insurance doesn’t cover.

When you have a case with long-term medical needs, you need an expert. We are the experts in medical damages over the life expectancy of the person.