Terri S. Patterson, RN, MSN, CRRN
President, Nursing Consultation Services
Norristown PA
The role of the rehabilitation nurse has expanded in recent years in the area of life care planning. We are now going beyond traditional, episodic case management to life management; beyond disease management to life care prevention; beyond critical pathways to life pathways of maintenance. As managed care continues to permeate health care markets, the responsibility of managed care organizations and providers to address life care needs of their populations intensifies. Many organizations now have the exposure for costs of clients from birth to death, and having a comprehensive life care plan becomes an essential case management tool. Certainly the insurance industry has addressed an aspect of this issue in the past in order to establish reserves for clients with catastrophic injuries and/or illnesses. Now it is critical for all health care providers and funders to determine life care needs so that prevention, health maintenance and disease/injury management can be accomplished in the most cost effective manner, while securing the best value for their health care dollar.
A solid, philosophical framework in regard to life care issues is critical to the life care planner. It is paramount to be consistent, precise, and comprehensive in the preparation of a life care plan. Life care plans should address areas of medical care, therapeutic modalities, diagnostics, hospitalizations, procedures, safety, home modifications, academics, vocational issues, placements, residential care and case management. The differences in the life care plans need to reflect the individuality of the client, their family system and their response to the injury/illness. It is critical that the life care plan be presented within the scope of practice of the preparer of the care plan. Therefore a life care plan prepared by a nurse needs to inherently reflect the nursing process and Standards of Practice for Rehabilitation Nursing and remain within the parameters of the Nurse Practice Act. The life care planner is responsible and accountable for their care recommendations, costs and resources within the plan. In addition, the life care planner needs to be aware of the professional standards within the specific medical diagnoses of injury/illness such as federal and state regulations, professional organizations task forces, protocols, best practices, evidence based care delivery and outcomes. The life care planner must familiarize themselves with the present research and literature and realize that the utilization of current resources in order to be comprehensive is essential. It is paramount to access research projects, publications, literature searches, catalogs, conferences, internet and a multitude of professional organizations thereby incorporating the most recent protocols, technology and anticipated treatment available.
Initially, the rehabilitation nurse should evaluate the current level of care and make appropriate referrals for additional evaluation and treatment if indicated. Appropriate referrals to specialty physicians, therapists, or educators are often made to further delineate the future care needs. Often the rehabilitation nurse will need to determine and recommend rehabilitation care which has previously not been initiated. Frequently, the client has been discharged from the acute care setting and has not had the opportunity for comprehensive inpatient rehabilitation or for continued rehabilitation in the community. Another role for the rehabilitation nurse is to identify appropriate costs for services/care and identify corresponding resources. Providing quality resources benefits both the funder and provider, and contributes to the best quality of life for the client.
Critical evaluation of the case initially by the life care planner facilitates the total process. In order to accept or deny a case, the life care planner needs to be acquainted with the "Best Practices" of the catastrophic event or illness, as well as their own philosophy of life care management of the individual. On site evaluation of a client prior to preparation of a life care plan is recommended. If this is not possible, appropriate discussion of the limitations of the care plan must be stated within the context of the plan. Making recommendations for treatments and protocols after an independent clinical evaluation by the life care planner needs to be prepared with the interaction of numerous professionals who are presently or in the past have treated the client as well as all significant participants in their daily life. For example, for a child, a school visit to meet with the school teacher, therapists, nurse, education director, and administrator is advantageous in preparation of a life care plan to incorporate their recommendations. Also, telephone conversations and when necessary appointments for discussion with the treating professionals (physicians, therapists, psychologists, counselors, employers, funding representatives) lends support in the preparation of the care plan. In this manner, the life care planner is able to coordinate all recommendations as well as collaborate between professionals for life care plan projections. Also, either meetings or telephone interaction with the other professionals involved in the care of the client provides a sounding board and a systematic collegial approach to determine future care needs. Often many of the participants of care delivery are not aware of each others’ recommendations and therefore a comprehensive problem solving opportunity arises. The life care planner can be critical in facilitating and coordinating future care as well as identifying outcomes for ongoing case management.
The life care planner needs to be cognizant of their responsibility to their professional practice, and liability exposure. It is critical that the life care planner have the educational preparation, the clinical experience, and the professional organization involvement to substantiate their expertise. It is advantageous for the life care planner to demonstrate their expertise in a variety of arenas, not just being an employee in one facility with exposure to one diagnostic group or rehabilitation program. As a life care planner, you present yourself as an expert in care management and therefore will be held accountable for the content of the life care plan. In essence you are accountable to yourself, to your profession, and most importantly to the individual client for whom you are designing a life care plan.
Nursing Consultation Services, Ltd.
www.nursingconsultation.com
1000 Germantown Pike, Suite D-1, Plymouth Meeting, PA 19462
Phone: 610-279-1122 / Fax: 610-279-1136 / E-mail: ncsltd@aol.com