Life care planners and CMs should collaborate

Each can draw on the other’s expertise

By Patricia McCollom

In a complex and often confusing health care arena, case managers are an important resource for patients who need access to the right care at the right time. As they provide services for catastrophically ill or injured individuals or those with chronic illnesses, including elderly patients, case managers may be working more frequently with another group of specialty practitioners: life care planners.

A life care planner may draw upon the expertise of a case manager as a detailed life care plan is developed. A life care plan is a dynamic document based upon published standards of practice, comprehensive assessments, data analysis, and research. It provides an organized, concise plan for current and future needs with associated costs for individuals who have experienced catastrophic injury or who have chronic health care needs (from IALCP Standards of Practice). The case manager must contribute to and act in accordance with the treatment plan that is going to be the foundation for the life care plan. Or case managers may pursue this area of specialty themselves, bringing their vital case management skills to the field of life care planning.

With the aging of the population, the collaboration between life care planners and case managers likely will occur more frequently. Elder care services are being utilized by the so-called "sandwich generation," those with dependent children and aging parents to care for. Working together — with good communication and mutual respect — life care planners and case managers will be able to provide quality, comprehensive care plans that include treatment, ongoing care, and access to care and community resources.

Optimizing the partnership

To optimize this partnership, life care planners and case managers need to be aware of the ethical questions and issues that can arise in life care planning. For both professionals, being an advocate on behalf of the patient is paramount. Providing a fair, equitable and comprehensive life care plan for a catastrophically ill or injured individual requires objectivity and clinical expertise. Within the elder care segment of life care planning, the emphasis is on educating the patient and family to allow them to make informed decisions.

Admittedly, there are times when this is difficult and emotionally challenging. The ethics of the life care planning, however, demand compassion and impartiality, advocacy, and empowerment.

For example, I worked as a life care planner for a patient who suffered from amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease. After this diagnosis, the patient decided that, when he could no longer breathe on his own, he would not go on a ventilator. I knew that a great number of people can live for extended periods with ALS, but this was the patient’s decision. In my mind, this bright, articulate man died too soon, but I respected his decision. As his life care planner, my role was to educate him about possible options, not to interfere in his decision-making process.

Life Care Planning and Personal Injury Cases

Objectivity is one of the tenets of life care planning, given its roots in providing litigation support services in personal injury cases. In these situations, the role of the life care planner is more paternalistic, making decisions as a third party hired by an attorney. The ethical challenge is to determine an accurate and honest life care plan whether the plaintiff’s attorney or the defense’s attorney pays for the services. While this may be difficult at times due to outside pressures, the life care planner cannot be swayed by the interests of the customer — the attorney.

The life care planner and case manager involved in a personal injury case also need to be aware of a significant challenge in developing a life care plan. The plaintiff’s attorney only has one chance in court to secure reimbursement for the care that a catastrophically ill or injured person will require for the rest of his or her life. There is no second chance or update allowed. Thus, if the patient is a 3-year-old child with cerebral palsy, the life care planner must conduct extensive research to develop the foundation on which to base the treatment that will be necessary over the life of this individual.

Life Care Planning in Elder Care Management

Life care planning has branched out, beyond services for catastrophically ill or injured patients, to the area of elder care management. As the population ages, there will be greater demand for these services.

According to population projections, 22% of the U.S. population will be older than 65 by 2020. With aging comes an increase in chronic diseases, as well as a greater likelihood for catastrophic injuries suffered by older adults. For example, auto accident injuries suffered by an older adult with osteoporosis are far more severe than similar injuries sustained by a younger adult. Overall, there will be an increased use of health care dollars by this segment of the population.

Life care planning, working in conjunction with case management, will help ensure that the health care dollars are spent in the patient’s best interest.

In elder care, it is not the planner’s role to make choices on behalf of the patient. Rather, the life care planner educates the patient and/or the family so that they may make the best, informed choices for their needs.

I worked with an elderly patient with cancer who chose to live with his 80-year-old brother as his primary caregiver. As his life care planner, I could offer support and access to resources to make this arrangement work as well as possible. For example, when it became apparent that the patient was not eating well, I presented several options for meals. What he wanted was fresh, home-prepared food, something his brother could not provide. A solution was found through the community. A local church group volunteered to prepare and deliver fresh meals every day.

Through their daily interactions with patients and families, life care planners and case managers encounter ethical dilemmas and challenges. It can be a fine line to walk at times. Understanding the importance of their roles as educators and advocates, working on behalf of patients and their families, life care planners and case managers can make a world of difference for patients and their families.

Ethics Tips:

  • As a life care planner working on a personal injury or liability case, keep in mind that your role is as an impartial third party. Regardless of whether you have been hired by an attorney for the plaintiff or the defense, your life care plan should be honest, accurate, and fair.
  • As a life care planner providing elder care services, your responsibility is to educate and empower the patient and the family. No matter what your opinion or preference might be, your role is to provide information on all available options so that the patient and/or family can make the right decisions to meet their demands, needs and preferences.
  • Working together, case managers and life care planners bring valuable perspectives and expertise to the collaboration. Rather than being territorial, these professionals need to communicate openly and act cooperatively.

[Editor’s note: Patricia McCollom, RN, MS, CRRN, CCM, CDMS, CLCP, is a past chair of the CCMC, the first certifying body for case management professionals to be accredited by the National Commission for Certifying Agencies.

URAC also has determined that the CCM credential is a recognized case management certification. For more information or to obtain an application for the CCM, contact the CCMC at (847) 818-0292 or see the web site at www.ccmcertification.org.

McCollom also is President and Nurse Consultant for LifeCare Economics LTD and Management Consulting & Rehabilitation Services Inc., and is CEO of International Academy of Life Care Planners in Ankeny, IA.]

By Patricia McCollom, RN, MS, CRRN, CCM, CDMS, CLCP, Past Chair, Commission for Case Manager Certification (CCMC), Member, CCMC Research and Exam Committee, Rolling Meadows, IL.