Research Vehicles
For every recommendation in the life care plan there
must be support, and for every cost there must be verification.
The means planners use to obtain support and verification
range from the low-tech letter and conventional telephone
to the wide-open spaces of the Internet.
The Internet has developed into the most easily accessible
reference for up-to-date resources. As professionals,
we must keep abreast of technology in order to benefit
from what it can offer. This principle means being willing
to investigate new technology, new data storage, and
new retrieval systems. This approach does not mean planners
should discard a proven, successful method of data collection,
retrieval, and the like; however, they must keep an open
mind regarding the alternatives that are continually
being developed.
Although the Internet has certainly changed and shaped
the way we research, the telephone is still an important
link to specific information. Keep in mind, however,
that not everyone contacted by telephone will be forthcoming
and generous with time or information. The life care
planner with the competitive edge is the one who understands
how best to extract pertinent and beneficial data from
sometimes-unwilling sources.
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The Art of Obtaining Information by Telephone
First impressions count :
Be humble, not demanding. Convey the importance of your
call to the patient, yet be relaxed enough to avoid eliciting
cautious replies. Ask your questions with clarity and
sincerity. Have a rehearsed, ingratiating 30-second introduction
speech for the inevitable question "What is a life
care planner and why should I talk to you?"
Be optimistic and positive :
Do not let the person on the other end of the line try
to dismiss you by claiming that he or she does not know
the answer. If the person is unable to answer your question,
quickly regroup and ask it in a slightly different way.
Assume the person you are calling knows the answer, but
might not know he or she knows. Be persuasive, but kind
and optimistic.
Be complimentary : "I
understand you are the area expert on …"
Be persistent and patient :
Do not give up. Continue to follow-up on your contacts
and respect their time restrictions. Beg for their help,
when necessary, and return the favor, when possible.
Be personable : No one enjoys
talking to someone who is stiff and all business. To
make both of you feel at ease, throw in a bit of small
talk. If the other person can feel your "pain," so
to speak, you have a much better chance of acquiring
the needed information.
Be flexible : Go with the
flow. If you are referred to yet another number to call,
do so cheerfully. Eventually, you will be rewarded.
Now that we have reviewed the vehicles used to drive
the research and have our roadmap, in the form of an
Area Cost Analysis, let's look at some of the destinations
on the map.
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Locating Health Care Professionals
When preparing a comprehensive plan spanning the period
from the date of evaluation through to life expectancy,
it is best to have at least three sources for the major
cost items. Therefore, not only will you be using the
names and contacts for the patient's present sources,
you will also have to search out additional and corroborating
sources.
The first service referenced on the Area Cost Analysis
form is physicians. Locating common specialties such
as ophthalmologists, orthopedists, pediatricians, and
so on, is as simple as looking them up using the online
yellow pages. Here are two simple, yet effective websites:
Online Yellow Pages
Finding certain specificspecialists
sometimes requires more precise sites. Many medical disciplines
have a professional association. Locate specialists in
your patient's area of service through the association's
online member directory. Here are some commonly used
directory sites:
- Directory sites for medical specialties Physiatrists: The
American Academy of Physical Medicine and Rehabilitation http://www.aapmr.org/index.htm
-
-
- Nutritionists: The American Dietetic Association
http://www.webdietitians.org/Public/FindADiet.htm
- Pain specialists: The American Academy of Pain
Medicine
http://www.painmed.org/
- Rehab driver specialists: The Association for
Driver Rehabilitation Specialists http://www.driver-ed.org/
-
Therapeutic riding specialists:
North American
Riding for the Handicapped Association http://www.narha.org/
If you are unsure of the exact association, consult
the National Trade and Professional Associations journal.
This text provides detailed contact and background information
on more than 7,600 trade associations, professional societies,
technical organizations, and labor unions in the United
States.
The journal is available from:
Columbia Books, Inc.
P.O. Box 4668
Chestertown, MD 21690
Phone: (888) 265-0600
Fax: (410) 810-0911
Email: info@columbiabooks.com
Homepage: http://www.columbiabooks.com/books.cfm
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Locating Miscellaneous Services
Online yellow pages are also useful when attempting
to locate the following services:
- Handymen
- Health clubs
- House cleaning
- Massage therapy
Locating Schools/Educational Services
You can locate preschools, public schools, private
schools, and school boards easily through the online
yellow pages: http://www.infospace.com.
Colleges and universities typically have detailed websites
listing not only their current fees and tuition but also
degrees and certificate program requirements. To locate
a college by state, go to: http://www.newsdirectory.com/college.
A fast, nationwide resource for locating a tutor is Sylvan
Learning Centers, 1-800-Educate: http://www.educate.com.
Often a life care plan calls for a special needs camp. The
American Camping Association maintains a camp
locator at: http://www.acacamps.org.
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Home Health Care
Because of their quality of care and longevity of service,
national agencies are the first place you should look
when researching the cost of home health services and
providers. Home health providers are regulated by national,
state, and county agencies; therefore, it is important
to know not only the city and state but also the county
in which the patient resides. It is also advisable to
develop a home health service/needs checklist.
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Nursing Research Format
Provider:_______________________________________________________________
Telephone #_____________________________ Fax #________________________
Contact: ___________________________ Title _______________________
Areas of service (Counties):
HHA/Hr: $_____ $_____ $_____
HHA/Visit: $_____ $_____ $_____
LPN/Hr: $_____ $_____ $_____ $_____
LPN/Visit: $_____ $_____ $_____
RN/Hr: $_____ $_____ $_____
RN/Visit: $_____ $_____ $_____
Case manager: $_____/Hr.
Mileage charged in addition to hourly rate? ___Yes
___No. If Yes, ____/mile
Rates: (Private pay rate for all costs: ___Yes ___No)
Minimum # of hours per visit: _________
Live-in: ___Yes ___No Daily Rate: $_____
Number of hands-on care hours per day with a live-in:
_____
Number of uninterrupted sleep hours for a live-in per
night: _____
· Definition of live-in services as defined
by this specific agency:
________________________________________________________________________
· When was the last time this agency actually
supplied a live-in?
________________________________________________________________________
Therapies:
PT ___Yes ___No $_____/visit
OT ___Yes ___No $_____/visit
ST ___Yes ___No $_____/visit
Recreational therapy: ___Yes ___No $_____/visit
Transportation:
Can staff member transport patient? ___Yes ___No
Personal car? ___Yes ___No Or patient's car: ___Yes
___No
Skill responsibilities:
Can aide level:
· Administer medications: ___Yes ___No
· Perform bowel stimulation: ___Yes ___No
· Administer G-tube feeds: ___Yes ___No
· Insert catheter: ___Yes ___No
· Trim finger/toe nails: ___Yes ___No
Can LPN level:
· Perform trach care: ___Yes ___No
· Perform vent care: ___Yes ___No
· Trim finger/toe nails: ___Yes ___No
An agency may have a policy that aides, trained by
RNs, can do certain invasive procedures such as bowel
stimulation, catheter changes, and so on. Under this
arrangement, it is the specific RN training the aide
that is ultimately liable and responsible for the activities
of the aide. Therefore, in this agency, in practice,
are the aides performing such services in their day-to-day
activities?
Is RN supervision (included with):
· Live-in or aide care: One visit per _________(wk/month/qtr)
· LPN Care: One visit per _________(wk/month/qtr)
Is there an additional charge for the RN supervision
visit? ___Yes ___No
If Yes: $_____/visit
Comments: _____________________________________________________________________________
Research by: _________________ Date: _________________
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Locating Home Health Care
To locate national home health agencies that serve
a patient's geographic area, check the locators at these
websites:
Gentiva Home Health : http://www.gentiva.com
Interim Home Health : http://www.interimhealthcare.com
- Click on the map next to "Locations Coast to
Coast"
Kelly Assisted Living : http://www.kellyassistedliving.com
- Click "About Us", then choose "Our
Locations"
- Click on the link to perform a search
Maxim Home Health : http://www.maxhealth.com
- Click "Office Listing" to view the map
Nurse Finders : http://www.nursefinders.com
- Choose "home care" under Clients to view
general information
- Click "locations" to view the list of
staffing offices
If your search requires further resources, search the
databases at the Case Management Resource Guide website:
http://www.cmrg.com
This guide can provide information for a number of
programs and facilities, such as:
· Home care
· Rehabilitation
· Sub-acute care
· Nursing facilities
· Assisted living facilities
· Hospice
· Long-term acute care
· Hospitals
· Psychiatric and addiction care/facilities
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Locating Vocational Rehabilitation Services
You can locate venders for vocational evaluations,
job coaching, and other supportive work services through
the patient's local Department of Vocational Rehabilitation.
The Pennsylvania Rehabilitation Council website
offers a complete list of DVR offices by state at http://www.parac.org/svrp.html.
Geographically specific wage data can be downloaded
and printed from the
Bureau of Labor Statistics at http://stats.bls.gov/oes/2001/oessrcma.htm
The following publications are published on the Bureau's
website:
· Metropolitan Area Occupational Employment
and Wage Estimates :Employment
and wage estimates by occupation, divided into seven
tables: managerial, professional, sales, clerical,
service, agricultural, production.
· Occupational Outlook Handbook: Revised
every two years, the handbook describes what workers
do on the job, working conditions, the training and education
needed, earnings, and expected job prospects.
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Facilities and Programs
When you are researching availability and costs for
facilities and programs that offer services to catastrophically
injured patients, you may find the yellow pages online
or offline of little use. Many times, patients will be
forced to seek services outside of their geographic area.
Therefore, you may need to consult national databases:
Useful Websites for National Facilities and Services
· Commission on Accreditation of Rehabilitation
Facilities (CARF): http://www.carf.org
· Case Management Resource Guide: http://www.cmrg.com
· Miami Project: http://www.miami.edu/miami-project/resinfo.htm
· National Spinal Cord Injury Association: http://www.spinalcord.org
· Spinal Cord Rehab Centers: http://www.spinalcord.uab.edu/show.asp?durki=21810
· Shepherd Center (A Catastrophic Care Hospital):
http://www.shepherd.org
· Brain Injury Society of America:
http://www.biausa.org
· United Cerebral Palsy (UCP): http://www.ucp.org
To locate an intermediate care facility for the developmentally
disabled (ICF/DD) facility, visit the state regulations
and licensing site for the state in which your patient
resides. Here, you will find a complete listing of facilities
licensed and inspected by the state.
Assisted living facilities (ALFs) are also licensed
and regulated by the state. Because of the evolving demographics
served by ALFs, you may find it necessary to locate and
download the state's regulations. Become familiar with
the state government's websites in all the geographic
areas in which you work.
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Labs and Diagnostic Testing
It can be hard to keep track of all the abbreviations
used for labs and diagnostics. For example:
· ECG, EKG: Electrocardiogram
· ECHO: Echocardiography
· EEG: Electroencephalogram
· EGD: Esophagogastroduodenoscopy
The following website offers an easy chart to aid the
life care planner in deciphering various abbreviations:
Abbreviations for Diagnostic and Laboratory Tests :
http://www.mtio.com/lupus/proabbr.htm
For an explanation of specific diagnostic tests, go
to this website:
Harvard Medical Schools Guide to Diagnostic Tests
and Procedures :
http://www.health.harvard.edu/fhg/diagnostics.shtml
To better understand the many clinical lab tests that
are part of the diagnosis and treatment of a broad range
of conditions and diseases, go Lab Tests Online:
http://www.labtestsonline.org/understanding/
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Miscellaneous Links to Equipment and Suppliers
· Able Net Inc.: http://www.ablenetinc.com
· Adaptivation Inc.: http://www.adaptivation.com
· Assistive Technology Inc.: http://www.pvcdme.com
· Global Resource for Orthotics and Prosthetics:
http://www.OandP.com
· Invacare: http://www.invacaresupplygroup.com
· Mulholland Positioning Systems: http://www.mulhollandinc.com
· Prentke Romich Co.: http://www.prentrom.com
· Respiratory equipment: http://www.nelsonoxygen.com
· Ro Ho cushions: http://www.phc-online.com
· Scooters: http://www.scooterone.com
· Sunrise Medical One-Stop: http://www.sunrisemedicalonline.com
· Words Plus: http://www.words-plus.com
· Mattress systems and beds:
· Mellenair: http://www.mellenair.com
· Progressive Medical Inc.: http://www.progressivemedicalinc.com
· Select Comfort: http://www.selectcomfort.com
· Craftmatic: http://www.Craftmatic.com
· Adjustablebeds.com: http://www.1-Adjustablebeds.com
· National medication pricing resources:
· Eckerds: http://www.eckerds.com
· Walgreens: http://www.walgreens.com
· Drugstore.com: http://www.drugstore.com
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Links to Federal Information
· Federal government: http://www.firstgov.gov
· Medicaid phone numbers: http://cms.hhs.gov
· Social Security Administration: http://www.ssa.gov
· Federal government directory: http://www.lib.lsu.edu/gov/fedgov.html
· National Center for Dissemination of Disability
Research: http://www.ncddr.org
· National Clearinghouse of Rehabilitation
Training Materials: http://www.nchrtm.okstate.edu/
· National Library of Medicine, MEDLINE
database: http://www.nlm.nih.gov/databases
· U.S. government consumer health information
(Healthfinder): http://www.healthfinder.gov
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Storing and Retrieving Information
To present a life care plan that is indisputable and
succinct, you must document your research carefully.
To follow a strict, structured methodology of information
retrieval, collection, and storage, you will need to
create a life care plan database. Below are two products
available to assist you in this effort:
LCP STAT
Life Care Planning, Case Management software, by Randall
Thomas, Ph.D., P.O. Box 1347, Ridgeland, MS 39158; 601-991-0551,
Fax 601-952-0072, Email lcpstat595@aol.com.
This program comes in several modules or sizes, depending
on the needs of the rehabilitation professional. Some
of the highlights of the software's capabilities include:
· Tracks patient information
· External/internal case management
· Cost summaries
· Production reports
· Resource management
· Complications
· Life care tables
· Payments
· Invoice
Life Care Planning For the PC
This is a life care planning program designed to work
with Microsoft Word® and/or WordPerfect®, by
Ann Maniha, RN, CLCLP.
The program can be purchased from Ahab Press at:
http://www.ahabpress.com/lifecareplan.htm
The preceding discussion introduced the process of
researching costs and patient-specific information. Each
professional will develop his or her own system of organization
and presentation. However, it is important that all life
care planners adhere to the basic tenets and methodologies
of the planning process.
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Vocational Issues Related to Life Care Planning
This section will introduce readers to the role of
the vocational counselor in the life care planning process.
Work is highly valued in our society, and the presence
of a disability sometimes complicates rehabilitation
efforts to return patients to work. The life care planner
must be aware of evaluation strategies for identifying
job options, accommodations, or alternatives that offer
fulfillment and meaningful experiences when returning
to work is not a reasonable goal.
The Vocational Evaluation
A vocational evaluation is a comprehensive assessment
of a patient's interests, aptitudes, and physical abilities.
The evaluation is comprised of many components, which
may include a functional capacity evaluation, a transferable
skills analysis, interest surveys, personality inventories,
achievement tests, work samples, work site observations,
and other methods of determining whether a patient can
realistically expect to return to work. As a result of
this process, patients may be able to identify work categories
for which they are well suited. If a return to work is
not realistic, the patient may be able to identify activities
of interest that are within his or her physical capacity.
A functional capacity evaluation is generally completed
in a single day (sometimes two days) and measures the
ability of the patient to perform physical tasks. The
patient is asked to demonstrate the ability to stoop,
bend, walk, climb, push, and lift; performance of these
tasks is measured.
A transferable skills analysis is not a physical assessment,
but a study of the patient's previous educational/work
experience and current level of function. Residual capacities
may "transfer" into comparable work classifications
and help to establish realistic vocational goals.
The vocational counselor will determine whether a return
to work is feasible. If a patient is believed to be able
to return to work, the counselor will identify the extent
to which he or she may be expected to participate, the
associated costs, and the vocational damages. If a patient
is not able to return to work, the counselor will identify
costs associated with vocational pursuits in addition
to the vocational damages resulting from the injury.
In addition to the performance measures, the vocational
counselor also considers whether the patient would be
able to perform the assessed tasks over an extended period
of time (as may be required for certain jobs): the patient's
subjective complaints, limitations of the test instruments
used to assess the patient, and the possibility that
the patient may be receiving benefits by maintaining
his or her role as an individual with a disability (secondary
gains). The vocational counselor must judge whether the
results of the FCE are an accurate profile of the patient's
physical capacity.
The vocational counselor may begin his/her analysis
by establishing the patient's earnings at the time of
the injury. Next, the patient's earnings capacity is
determined by comparing the patient's level of functioning
pre-injury versus his or her present level of functioning.
From this comparison, the counselor can compare the patient's
levels of employability and an economist can project
the total lost earnings capacity over the life expectancy
of the patient.
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Employability vs. Placeability
Employability refers to a patient's access to the labor
market. For example, if the injury has eliminated the
patient from all work classifications, he or she would
have a very low probability of employability.
Placeability refers to the probability that the patient
will actually be hired into a position. For example,
even though patients may be able to perform the required
duties of a job, they may not be hired because they must
have a flexible schedule due to medical treatments or
because they experience sudden, severe headaches that
would result in frequent, unplanned absences.
References
Deutsch, P. (1990). A guide to rehabilitation testimony:
The expert’s role as an educator. Orlando,
FL: PMD Press.
Deutsch, P., & Raffa, F. (1981). Damages in
tort actions. New York, NY: Matthew Bender and
Company, Inc.
Deutsch, P., & Sawyer, H. (2002). A guide to
rehabilitation. White Plains, NY: Ahab Press,
Inc.
International Academy of Life Care Planners. (2003). Standards
of practice for life care planners. International
Academy of Life Care Planners. Available at: http://www.ialcp.org.
Merriam-Webster Dictionary. Available online at: http://www.m-w.com/home.htm.
Thomas, R., and Kitchen, J. (1996). Private hire: The
real costs. Inside Life Care Planning, 1(3),
3-4.
Weed, Roger O. (1998). Life care planning and case
management handbook. Boca Raton, FL, CRC Press.
Whiteneck, G., Charlifue, S, and Gerhart, K. (1993). Aging
with spinal cord injury. New York, NY: Demos Medical
Publishing, Inc.
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