What Goes Into a Life Care Plan?

A life care plan is a document that projects the medical care, equipment, services and support a person with a serious injury or chronic condition will need for the rest of their life, with how often, for how long and at what cost. It turns a diagnosis into a list of future needs a jury can follow. A good plan is built on the records, an assessment of the person and medical support for each recommendation, and every line can be traced back to one of those.

Who prepares it, and with whom

Life care plans are often prepared by nurses, and many nurse planners hold a life care planning credential such as the CNLCP or CLCP. Rehabilitation counselors and physicians also prepare them. On a life care planning engagement, the planner works with:

• Treating providers and retained physicians, who supply the medical foundation for care the planner is not licensed to prescribe: surgeries, specialist follow-up, medications, imaging. A physician expert often fills this role when treaters will not.
• Therapists, for the frequency and duration of physical, occupational and speech therapy.
• A vocational expert, if lost earning capacity is part of the damages.
• An economist, who takes the planner's costs and the life expectancy and calculates present value. The planner does not do the discounting.

Life expectancy usually comes from a physician or another qualified expert, not from the planner.

The process behind the plan

1. Record review. The planner reads the full medical history, including pre-injury records, so the plan covers needs caused by the injury rather than conditions that already existed. A medical chronology or record summary speeds this up.
2. Interview and assessment. The person and family describe daily routines, who provides care now, and what is not getting done. Many planners visit the home.
3. Provider input. The planner sends written questions to treating or retained physicians and documents their answers.
4. Cost research. Each item is priced from identified sources in the person's area, such as local vendors and providers.
5. The written plan. Tables of items with frequency, duration, unit cost and the basis for each.

The categories in a typical plan

Each item should show when it starts, when it stops (or that it continues for life), how often it recurs, the unit cost and the source. Equipment lines also show a replacement interval.

Where nursing judgment matters most

The home care line is often the largest category and the most contested. A nurse planner looks at what the person needs across a full day: transfers, bowel and bladder care, skin checks and repositioning, tube feedings, tracheostomy care, medication administration, supervision for safety. The next question is the skill level each task requires and whether a trained aide may perform it, which depends on state rules and on the task.

Other places a nursing eye helps:

• Complications. Pressure injuries, urinary tract infections, contractures and respiratory infections are foreseeable with some conditions. Plans handle them differently: some include them, some note them separately. Either way the support for the approach should be stated.
• Duplicates. The same supply priced under both home care and supplies, or one therapy listed twice under two names.
• Consistency with the records. A plan that calls for a power wheelchair when the therapy notes show independent walking will be attacked.

These questions come up most in catastrophic injury cases, such as brain and spinal cord injuries and birth injuries, where the plan may run for decades. Our article on legal nurse consultants in personal injury cases covers the earlier record work that feeds into it.

How the other side tests a plan

Expect a rebuttal plan or a critique that goes line by line. Common points:

• No medical foundation for an item, or a physician who was never asked.
• Care hours that exceed what the records show the person needs.
• Costs priced from charges rather than amounts actually paid. How courts treat billed versus paid amounts varies by state.
• Items unrelated to the injury, such as care for a condition that predated it.
• Life expectancy that does not match the medical evidence.
• Methodology. Life care planning organizations publish standards of practice, and a plan that departs from its own stated method invites a challenge. The admissibility points in Daubert and Frye challenges to nurse experts apply to planners too.

For the defense, a nurse reviewer can audit the plaintiff's plan against the records before a rebuttal planner is retained, which narrows the dispute to the items that matter.

What to send the planner

• The complete medical records, before and after the injury
• Billing records and current medication lists
• Therapy evaluations and progress notes
• Depositions of treating providers, if taken
• Any prior life care plan, vocational report or economic report
• Contact details for the family and the treating physicians, if the planner may reach out to them

Next step

Request a life care plan: describe the injury without names, and nurse life care planners send proposals. Records stay private until you hire.

General information for legal professionals, not legal advice. Rules and deadlines vary by state; check the statute and local rules that govern your case.