As the saying goes, “If you don't know where you are going, any road will get you there.” Those words were written by Lewis Carroll, an English Logician, Mathematician, Photographer and Novelist, especially remembered for Alice's Adventures in Wonderland. That saying was as true then as it is now. However, for those who have sustained a spinal cord injury, not knowing where you are going or what to expect now and in the foreseeable future can have dire and even catastrophic consequences.
Life Care Planning, or Lifetime Care Planning, as it is sometimes called, is the process of assessing an injured individual’s needs now and over their lifetime. In spinal cord and other catastrophic injuries those needs usually include but are not limited to rehabilitation needs, medical needs, and psychological needs and can include such things as:
A Life Care Plan is a written assessment, a document, or report that is often the most comprehensive head-to-toe evaluation that has been done or will occur for an injured individual.
For an individual who has sustained a spinal cord injury, where litigation or potential litigation exists, a life care plan can mean the difference between obtaining the necessary care and equipment or not. So often, an injured individual suffers needlessly while adversarial parties try to reach an agreement regarding the types and cost of care needed after a spinal cord injury. The goal of a life care plan is to answer questions, not to create more. There are several important goals of a life care plan which include but are not limited to;
Life care plans must be comprehensive, organized and easy to understand whether the reader is the lay public, such as might be the case with a jury, or an educated team member such as a treating physician or therapist, and everyone in between.
Life care plans are effective tools for communication and were originally developed out of a need for a case management tool so that injured individuals, their families, case managers, physicians, therapists, and other rehabilitation professionals can coordinate and anticipate care now and in the future and anticipate the associated costs. Life care plans are utilized in the litigation and non-litigation settings by anyone seeking the truth about the needs and costs of the care needed for an injured individual.
Many different clinical rehabilitation professionals have received the necessary training and possess the necessary experience to write or compose life care plans including nurses, vocational rehabilitation counselors, psychologist, neuropsychologist, occupational and physical therapists, as well as speech and language pathologists. The most recent group of medical professionals to join the ranks of life care planners include physicians, many of whom are trained in Physical Medicine and Rehabilitation, also known as PM&R or rehab doctors, or physiatrists. Physiatrists are a group of physician life care planners who are are uniquely qualified and trained to author life care plans.
Physiatrists are the specialists who possess the unique training, and experience in caring for individuals with the catastrophic functional challenges that arise after a spinal cord injury. This is not to say that professionals other than physicians do not possess the skill and experience to anticipate the long term needs of an individual. In fact, most non-physician life care planners collaborate with treating physicians who are often physiatrists. Physiatrists are usually willing contributors because of the nature of their profession. Physiatrist would typically make projections regarding life expectancy, and provide the medical basis for lifelong care needs, and much more.
Life care planning is a natural extension and the natural domain of most physiatrists, particularly once they are familiar with the methodology used to quantitate and reference the basis upon which to substantiate the costs of medically related expenses.
Recently, more and more physiatrists have gained the training, credentials, and experience to write or author life care plans. Physiatrist are by their nature and training team oriented and in many cases communicate and collaborate easily with the existing treatment team of doctors, nurses, therapists and case managers caring for a spinal cord injured patient.
In litigation related cases, the physiatrist life care planner can educate the judge, jury, and all interested parties about all aspects of the injured individual’s disabling condition and its implications, including the cost of care. Spinal cord injuries not only involve physical limitations, but can often have cognitive, emotional and psychological components which must be addressed. The physiatrist life care planner is uniquely qualified to do that and more.
The physiatrist life care planner often plays a key role in identifying the various team members that will be necessary to ensure the injured individual has an opportunity to reach their full rehab potential and quality of life. This means identifying and bringing together physical, occupational, and speech therapists; psychologists; vocational counselors; rehabilitation nurses, neurologists; psychiatrists; neurosurgeons; orthopedists; urologists; and others. The physiatrist life care planner is essential in developing a holistic approach and coordinating all of the necessary evaluations and therapies. Additionally, with the rapid advancement of applicable technology, the physiatrist life care planner would help the injured individual understand which technologies are available and appropriate for a given individual.
It is this author’s opinion that a physiatrist life care planner who possesses the training, clinical experience and compassion to care for catastrophically injured people, is perhaps the most qualified and credible professional to educate all interested parties about the long term consequences of spinal cord injuries and the associated costs. There is perhaps no other single medical professional who is in a better position to establish the medical foundation for care now and in the future. Non-physician life care planners are finding their opinions challenged more and more due to the lack of medical foundation of their opinions in court in some cases. Collaboration with the physiatrist life care planner and non-physician life care planner is encouraged and benefits all interested parties.
The physiatrist life care planner, due to their unique training and experience anticipates and answers questions that the injured individual, and their family, are likely to have. Many but certainly not all spinal cord injuries involve litigation or potential litigation. Physiatrist and physiatrist life care planners with rare exception are taught from the beginning of their training to be thorough in their evaluations and documentation.
The physiatrist life care planner is generally comfortable and knowledgeable regarding the litigation process including pre-litigation, mediation, discovery, depositions, and court testimony. While some physiatrist life care planners tend to be called upon more by the plaintiff counsel, others are sought more by the defense. Regardless it is this author’s experience that most physiatrist life care planners are effective communicators and are a valuable asset to whomever retains them or utilizes their professional services.
Answering critical questions and providing the medical foundation is an important function that the physiatrist life care planner must provide particularly in cases where the treatment team is not able or willing to opine what the short, medium and long range future needs for an injured individual will be. Recognizing and identifying the unique needs of a patient with a spinal cord injury is a regular part of the practice of most physiatrist life care planners.
The physiatrist life care planner may also be called upon to evaluate the plaintiff authored life care plan for medical accuracy and necessity and in doing so will determine independently whether the recommended services and procedures are in fact medically necessary and appropriate. Additionally, the physiatrist life care planner is often in the best position to opine and provide testimony regarding the medical basis for life expectancy determinations due to their medical training, and experience. More often than not, individuals who have sustained a spinal cord injury have comorbidities that may or may not affect life expectancy.
The International Association of Rehabilitation Professionals and the International Academy of Life Care Planners helps to develop curriculums, and basic standards of practice in an annual summit. More recently, the American Academy of Physician Life Care Planners is a professional organization of board certified physicians and other qualified clinical and forensic professionals dedicated to the practice and the advancement of life care planning. This organization whose inaugural meeting was in 2016 is committed to the advancement of life care planning methodology, standards of practice, research and publication, and training and education of qualified physicians. This author had the pleasure of attending the inaugural conference in San Antonio, Texas in 2016 where like-minded physician and other professionals met for the very first time.
While certification for a physiatrist life care planner is not a requirement, it is encouraged that a physiatrist life care planner obtain the necessary training regarding methodology, and standards of practice so as to be maximally effective. Currently the International Commission on Health Care is the body that governs certification.
In summary, an individual who has sustained a spinal cord injury is likely to benefit greatly from a well written life care plan, particularly one written by a physiatrist life care planner. By providing a road map for necessary care, and communicating the source and cost for such care, everyone involved benefits and better decision can then be made.
This information was written for SpinalCord.com by Dr. Santo Steven Bifulco
More about the author:
Dr. Santo Steven Bifulco is a Physical Medicine and Rehabilitation, and Pain Medicine specialist at Bifulco Medical Group. He has practiced medicine in Florida since 1990. Dr. BiFulco is a licensed physician in the State of Florida; he is certified in Interventional Pain Management and Radio-Frequency and Intra-Discal Therapies by Pain Management Training Seminars, and he is licensed by the United States Drug Enforcement Agency. Dr. BiFulco’s professional career includes decades of clinical practice treating patients with all manners of chronic and catastrophic injuries and illnesses. In addition, Dr. BiFulco has occupied numerous medical directorships and medically-oriented advisorship positions. As a medical professional, Dr. BiFulco founded and managed many successful clinical practices and medical centers.