Discussion: View Thread

Dear colleagues,

I have observed over the last several years an increased focus on life care planning costing. The recent discussion on the IALCP listserv is an example of this focus. I recognize that there are many practitioners who desire guidance on costing practices. I applaud those involved in a search for an empirically sound costing methodology. I would also like to add a voice that cautions each of us to keep our focus on what is important in our specialty practice. To do so, I must lay the foundation. 

In my research, the first definition of life care planning that I can find is below. 

The original definition, in the early 1980s, of life care planning was:

A consistent methodology for analyzing all of the needs dictated by the onset of a catastrophic disability through to the end-of-life expectancy. Consistency means that the methods of analysis remain the same from case to case and does not mean that the same services are provided to like disabilities (Deutsch & Raffa, 1982; Deutsch & Sawyer, 2002 as cited in Deutsch et al., 2003b, p. 5-7). 

Eventually, through consensus, the below definition was established in 1998 and remains the accepted definition in 2024: 

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. [Combined definition of the University of Florida and Intelicus annual life care planning conference and the American Academy of Nurse Life Care Planners (now known as the International Academy of Life Care Planners) presented at the Forensic Section meeting, NARPPS annual conference, Colorado Springs, Colorado, and agreed upon April 3, 1998].

The first definition consists of 49 words while the second definition consists of 47 words, so within 96 words the essence of our specialty practice of life care planning was captured. Of those words, the word "costs" appears one time. In contrast, both definitions emphasize the importance of methodologically sound practice based upon the concepts of standardization and consistency. These definitions remind us of the heterogeneity implicit in our work, hence the value of our empirically based and clinically informed professional judgment. In the 30 years I have been associated with life care planning, I have seen many concerns identified and most, with time, settled. However, this myopic focus on costing, in my humble opinion, is keeping us from focusing on more pressing matters. Those matters include adherence to existing standards, engagement in outcomes-based research, and unification in the identity of our profession. I think it would behoove all of us to "zoom out" on this costing focus and recognize the realities of most life care plans. These realities include the fact that upwards of 50% of the total cost of many life care plans is in attendant care, where percentile choice is not necessary. This is true for many other items in a life care plan including medications, most DME, architectural modifications, vehicle modifications, etc. The harsh reality also exists that attorney fees and litigation costs are subtracted from any award, thereby reducing the amount the individual with the disability will ultimately receive. While I have not tested this assumption, I suspect that comparing two life care plans containing identical items, one reflecting 50th percentile costs and one reflecting 75th percentile cost, the percentage difference in the two plans would be negligible, and likely would not overcome the amount that will be deducted for legal fees and expenses.

I am personally concerned that the professional splintering and divisiveness in the current life care planning community will handicap our ability to continue to meaningfully build upon the important work that people such as Dr. Paul Deutsch and Dr. Roger Weed did for so many decades. I invite all life care planners to consult the rich library of previously published documents in life care planning, as I believe you will find the guidance and information contained in those documents to be invaluable. I truly believe that such an endeavor will provide much more value than debating whether we should use the 50th or 75th percentile when costing medically related items in a life care plan.

Dear colleagues,

I have observed over the last several years an increased focus on life care planning costing. The recent discussion on the IALCP listserv is an example of this focus. I recognize that there are many practitioners who desire guidance on costing practices. I applaud those involved in a search for an empirically sound costing methodology. I would also like to add a voice that cautions each of us to keep our focus on what is important in our specialty practice. To do so, I must lay the foundation. 

In my research, the first definition of life care planning that I can find is below. 

The original definition, in the early 1980s, of life care planning was:

A consistent methodology for analyzing all of the needs dictated by the onset of a catastrophic disability through to the end-of-life expectancy. Consistency means that the methods of analysis remain the same from case to case and does not mean that the same services are provided to like disabilities (Deutsch & Raffa, 1982; Deutsch & Sawyer, 2002 as cited in Deutsch et al., 2003b, p. 5-7). 

Eventually, through consensus, the below definition was established in 1998 and remains the accepted definition in 2024: 

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. [Combined definition of the University of Florida and Intelicus annual life care planning conference and the American Academy of Nurse Life Care Planners (now known as the International Academy of Life Care Planners) presented at the Forensic Section meeting, NARPPS annual conference, Colorado Springs, Colorado, and agreed upon April 3, 1998].

The first definition consists of 49 words while the second definition consists of 47 words, so within 96 words the essence of our specialty practice of life care planning was captured. Of those words, the word "costs" appears one time. In contrast, both definitions emphasize the importance of methodologically sound practice based upon the concepts of standardization and consistency. These definitions remind us of the heterogeneity implicit in our work, hence the value of our empirically based and clinically informed professional judgment. In the 30 years I have been associated with life care planning, I have seen many concerns identified and most, with time, settled. However, this myopic focus on costing, in my humble opinion, is keeping us from focusing on more pressing matters. Those matters include adherence to existing standards, engagement in outcomes-based research, and unification in the identity of our profession. I think it would behoove all of us to "zoom out" on this costing focus and recognize the realities of most life care plans. These realities include the fact that upwards of 50% of the total cost of many life care plans is in attendant care, where percentile choice is not necessary. This is true for many other items in a life care plan including medications, most DME, architectural modifications, vehicle modifications, etc. The harsh reality also exists that attorney fees and litigation costs are subtracted from any award, thereby reducing the amount the individual with the disability will ultimately receive. While I have not tested this assumption, I suspect that comparing two life care plans containing identical items, one reflecting 50th percentile costs and one reflecting 75th percentile cost, the percentage difference in the two plans would be negligible, and likely would not overcome the amount that will be deducted for legal fees and expenses.

I am personally concerned that the professional splintering and divisiveness in the current life care planning community will handicap our ability to continue to meaningfully build upon the important work that people such as Dr. Paul Deutsch and Dr. Roger Weed did for so many decades. I invite all life care planners to consult the rich library of previously published documents in life care planning, as I believe you will find the guidance and information contained in those documents to be invaluable. I truly believe that such an endeavor will provide much more value than debating whether we should use the 50th or 75th percentile when costing medically related items in a life care plan.

Dear colleagues,

I have observed over the last several years an increased focus on life care planning costing. The recent discussion on the IALCP listserv is an example of this focus. I recognize that there are many practitioners who desire guidance on costing practices. I applaud those involved in a search for an empirically sound costing methodology. I would also like to add a voice that cautions each of us to keep our focus on what is important in our specialty practice. To do so, I must lay the foundation. 

In my research, the first definition of life care planning that I can find is below. 

The original definition, in the early 1980s, of life care planning was:

A consistent methodology for analyzing all of the needs dictated by the onset of a catastrophic disability through to the end-of-life expectancy. Consistency means that the methods of analysis remain the same from case to case and does not mean that the same services are provided to like disabilities (Deutsch & Raffa, 1982; Deutsch & Sawyer, 2002 as cited in Deutsch et al., 2003b, p. 5-7). 

Eventually, through consensus, the below definition was established in 1998 and remains the accepted definition in 2024: 

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. [Combined definition of the University of Florida and Intelicus annual life care planning conference and the American Academy of Nurse Life Care Planners (now known as the International Academy of Life Care Planners) presented at the Forensic Section meeting, NARPPS annual conference, Colorado Springs, Colorado, and agreed upon April 3, 1998].

The first definition consists of 49 words while the second definition consists of 47 words, so within 96 words the essence of our specialty practice of life care planning was captured. Of those words, the word "costs" appears one time. In contrast, both definitions emphasize the importance of methodologically sound practice based upon the concepts of standardization and consistency. These definitions remind us of the heterogeneity implicit in our work, hence the value of our empirically based and clinically informed professional judgment. In the 30 years I have been associated with life care planning, I have seen many concerns identified and most, with time, settled. However, this myopic focus on costing, in my humble opinion, is keeping us from focusing on more pressing matters. Those matters include adherence to existing standards, engagement in outcomes-based research, and unification in the identity of our profession. I think it would behoove all of us to "zoom out" on this costing focus and recognize the realities of most life care plans. These realities include the fact that upwards of 50% of the total cost of many life care plans is in attendant care, where percentile choice is not necessary. This is true for many other items in a life care plan including medications, most DME, architectural modifications, vehicle modifications, etc. The harsh reality also exists that attorney fees and litigation costs are subtracted from any award, thereby reducing the amount the individual with the disability will ultimately receive. While I have not tested this assumption, I suspect that comparing two life care plans containing identical items, one reflecting 50th percentile costs and one reflecting 75th percentile cost, the percentage difference in the two plans would be negligible, and likely would not overcome the amount that will be deducted for legal fees and expenses.

I am personally concerned that the professional splintering and divisiveness in the current life care planning community will handicap our ability to continue to meaningfully build upon the important work that people such as Dr. Paul Deutsch and Dr. Roger Weed did for so many decades. I invite all life care planners to consult the rich library of previously published documents in life care planning, as I believe you will find the guidance and information contained in those documents to be invaluable. I truly believe that such an endeavor will provide much more value than debating whether we should use the 50th or 75th percentile when costing medically related items in a life care plan.

Dear colleagues,

I have observed over the last several years an increased focus on life care planning costing. The recent discussion on the IALCP listserv is an example of this focus. I recognize that there are many practitioners who desire guidance on costing practices. I applaud those involved in a search for an empirically sound costing methodology. I would also like to add a voice that cautions each of us to keep our focus on what is important in our specialty practice. To do so, I must lay the foundation. 

In my research, the first definition of life care planning that I can find is below. 

The original definition, in the early 1980s, of life care planning was:

A consistent methodology for analyzing all of the needs dictated by the onset of a catastrophic disability through to the end-of-life expectancy. Consistency means that the methods of analysis remain the same from case to case and does not mean that the same services are provided to like disabilities (Deutsch & Raffa, 1982; Deutsch & Sawyer, 2002 as cited in Deutsch et al., 2003b, p. 5-7). 

Eventually, through consensus, the below definition was established in 1998 and remains the accepted definition in 2024: 

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. [Combined definition of the University of Florida and Intelicus annual life care planning conference and the American Academy of Nurse Life Care Planners (now known as the International Academy of Life Care Planners) presented at the Forensic Section meeting, NARPPS annual conference, Colorado Springs, Colorado, and agreed upon April 3, 1998].

The first definition consists of 49 words while the second definition consists of 47 words, so within 96 words the essence of our specialty practice of life care planning was captured. Of those words, the word "costs" appears one time. In contrast, both definitions emphasize the importance of methodologically sound practice based upon the concepts of standardization and consistency. These definitions remind us of the heterogeneity implicit in our work, hence the value of our empirically based and clinically informed professional judgment. In the 30 years I have been associated with life care planning, I have seen many concerns identified and most, with time, settled. However, this myopic focus on costing, in my humble opinion, is keeping us from focusing on more pressing matters. Those matters include adherence to existing standards, engagement in outcomes-based research, and unification in the identity of our profession. I think it would behoove all of us to "zoom out" on this costing focus and recognize the realities of most life care plans. These realities include the fact that upwards of 50% of the total cost of many life care plans is in attendant care, where percentile choice is not necessary. This is true for many other items in a life care plan including medications, most DME, architectural modifications, vehicle modifications, etc. The harsh reality also exists that attorney fees and litigation costs are subtracted from any award, thereby reducing the amount the individual with the disability will ultimately receive. While I have not tested this assumption, I suspect that comparing two life care plans containing identical items, one reflecting 50th percentile costs and one reflecting 75th percentile cost, the percentage difference in the two plans would be negligible, and likely would not overcome the amount that will be deducted for legal fees and expenses.

I am personally concerned that the professional splintering and divisiveness in the current life care planning community will handicap our ability to continue to meaningfully build upon the important work that people such as Dr. Paul Deutsch and Dr. Roger Weed did for so many decades. I invite all life care planners to consult the rich library of previously published documents in life care planning, as I believe you will find the guidance and information contained in those documents to be invaluable. I truly believe that such an endeavor will provide much more value than debating whether we should use the 50th or 75th percentile when costing medically related items in a life care plan.

Dear colleagues,

I have observed over the last several years an increased focus on life care planning costing. The recent discussion on the IALCP listserv is an example of this focus. I recognize that there are many practitioners who desire guidance on costing practices. I applaud those involved in a search for an empirically sound costing methodology. I would also like to add a voice that cautions each of us to keep our focus on what is important in our specialty practice. To do so, I must lay the foundation. 

In my research, the first definition of life care planning that I can find is below. 

The original definition, in the early 1980s, of life care planning was:

A consistent methodology for analyzing all of the needs dictated by the onset of a catastrophic disability through to the end-of-life expectancy. Consistency means that the methods of analysis remain the same from case to case and does not mean that the same services are provided to like disabilities (Deutsch & Raffa, 1982; Deutsch & Sawyer, 2002 as cited in Deutsch et al., 2003b, p. 5-7). 

Eventually, through consensus, the below definition was established in 1998 and remains the accepted definition in 2024: 

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. [Combined definition of the University of Florida and Intelicus annual life care planning conference and the American Academy of Nurse Life Care Planners (now known as the International Academy of Life Care Planners) presented at the Forensic Section meeting, NARPPS annual conference, Colorado Springs, Colorado, and agreed upon April 3, 1998].

The first definition consists of 49 words while the second definition consists of 47 words, so within 96 words the essence of our specialty practice of life care planning was captured. Of those words, the word "costs" appears one time. In contrast, both definitions emphasize the importance of methodologically sound practice based upon the concepts of standardization and consistency. These definitions remind us of the heterogeneity implicit in our work, hence the value of our empirically based and clinically informed professional judgment. In the 30 years I have been associated with life care planning, I have seen many concerns identified and most, with time, settled. However, this myopic focus on costing, in my humble opinion, is keeping us from focusing on more pressing matters. Those matters include adherence to existing standards, engagement in outcomes-based research, and unification in the identity of our profession. I think it would behoove all of us to "zoom out" on this costing focus and recognize the realities of most life care plans. These realities include the fact that upwards of 50% of the total cost of many life care plans is in attendant care, where percentile choice is not necessary. This is true for many other items in a life care plan including medications, most DME, architectural modifications, vehicle modifications, etc. The harsh reality also exists that attorney fees and litigation costs are subtracted from any award, thereby reducing the amount the individual with the disability will ultimately receive. While I have not tested this assumption, I suspect that comparing two life care plans containing identical items, one reflecting 50th percentile costs and one reflecting 75th percentile cost, the percentage difference in the two plans would be negligible, and likely would not overcome the amount that will be deducted for legal fees and expenses.

I am personally concerned that the professional splintering and divisiveness in the current life care planning community will handicap our ability to continue to meaningfully build upon the important work that people such as Dr. Paul Deutsch and Dr. Roger Weed did for so many decades. I invite all life care planners to consult the rich library of previously published documents in life care planning, as I believe you will find the guidance and information contained in those documents to be invaluable. I truly believe that such an endeavor will provide much more value than debating whether we should use the 50th or 75th percentile when costing medically related items in a life care plan.