All the Right Moves
Nurse life care planners help patients with long-term needs navigate insurance and medical systems, and design a 'road map' for the future

By John Leighty
December 23, 2003

Richard Hess Jr., RN, CNLCP, said he's poised on the "cutting edge" of a health care practice that is exciting, creative and challenges his clinical and case management skills: that of a certified life care planner for people who have suffered catastrophic injuries or illnesses. "It's a great career track, it's a new frontier," said Hess, a former critical care nurse and case manager. Hess, who launched a business offering LCP 2½ years ago in Middlebury, Ind., said the emerging field is full of rewarding opportunities for advanced practice nurses who have strong entrepreneurial and reasoning skills.

Hess is one of an estimated 1,000 board-certified life care planners in the country-about 60 percent of them nurses. The life care planners are especially qualified to document the present and future medical, psychosocial and economic needs of individuals with catastrophic disability or long-term health care needs. Like Hess, many planners are in independent practice, creating the complex life care "road maps" for disabled individuals' medical care and claims payments.

For Carol Jacobs, RN, CNLCP, going into life care planning was a natural evolution after 25 years of case management work with a workers compensation insurance firm. Two years ago, she became an independent contractor, accepting case management from her home office in San Diego and becoming certified in LCP. "Being independent is so nice, I should have done it sooner," said Jacobs, who received her nursing diploma in 1965 from Allegheny General Hospital School of Nursing in Pennsylvania. She later moved to Southern California for further education and experience, working in various hospital ICUs for about 12 years before going into insurance. Since becoming certified in LCP, that area of her business has steadily grown.

A typical life care plan takes Jacobs about 40 hours to prepare and involves meeting with the patient and visiting the home environment. She confers with all the physicians involved with the patient's care, as well as therapists and others. "I have to look into the future to anticipate complications and to discuss those with the primary doctor," she said. She also has to estimate life expectancy and outline all the costs involved for home modification, specially equipped vans or vehicles, wheelchairs, special beds, braces, medication, therapy, lab work, X-rays, hospitalization and other needs.

Both the patient and his or her insurance company must accept the life care plan. If the insurance company rejects it, the company's lawyer can subpoena the life care planner, who then must defend his or her cost projections for patient care, services and equipment in court. "It takes a lot of years of experience," Jacobs said. "You have to feel comfortable in your shoes and with what you're recommending."

"An LCP has to be specific to a particular patient, but you need to support every nickel allocated for that person," said Sherry Ficklin, RN, CNLCP, an Oklahoma City nurse who consults nationally in catastrophic case management. Ficklin's work is about 30 percent LCP. "Once you're impeached, the LCP becomes public record, so your entire career can depend on how well you write your plans."

Hess, Jacobs and Ficklin opted to become board-certified LCPs by taking an intense seven-day course offered by the Draper, Utah-based American Association of Nurse Life Care Planners. The course averages $2,500 and is offered at various locations. It prepares nurses for the three-hour certification test that costs $250. The test can be taken only by RNs with a valid license, a minimum of two years' case management experience and either 60.6 continuing education units from an approved LCP course, such as the AANLCP course, or evidence of 500 hours of life care planning experience within two years of application.

In addition to nurses, LCP is practiced by rehabilitation counselors, physicians, chiropractors, social workers, psychologists, occupational therapists, physical therapists and special education professionals. About 600 life care planners, 50 percent of them nurses, have been officially certified by the Commission on Health Care Certification in Midlothian, Va., which screens applicants for the $350 exam. "There's a range of specialty backgrounds with one thing in common-they meet the standards set by us to be certified," said Virgil May, CEO of the organization and a former rehab counselor. "Believe me, we turn a lot of people away."

LCP evolved in the 1980s from the field of vocational rehab counseling. A pioneer in developing standards used by certification organizations is Paul Deutsch, Ph.D., CLCP, who runs a consulting business in Ovieda, Fla. "When I started, there was no such thing as life care planning or certification," Deutsch said. "There were case managers working with the catastrophic disabled who tried to do planning, but there were no tools to aid them in that process. I recognized the need to come up with a consistent methodology not only to analyze the disability but to pull together all the components of care associated with the disability."

Deutsch said the LCP concept was adopted quickly by the legal system and insurance companies as an effective way to chart the projected cost of care in catastrophic cases for juries and others. As he saw the field of LCP growing, Deutsch began authoring guides in 1981 for the insurance and legal communities on innovations in rehabilitation for various injuries.

For health care professionals interested in pursuing LCP, Deutsch has helped develop-and is an instructor for-a comprehensive 12-month online study program launched by Kaplan College in June. A series of seven courses is designed as a pathway to becoming a certified life care planner for a cost of $3,250. "I will be frank in saying I came into the project a little skeptical of how to adapt what I've always taught in a traditional setting to the online environment," Deutsch said. "The Kaplan system made that simple and I'm now an enthusiastic supporter."

Tricia Johnson, MSN, NP, RN, a pediatrics nurse practitioner in San Diego, said she signed up for the Kaplan course because she is looking for a new challenge. "Life care planning seems like a perfect fit for me, for my personality," she said. "I needed an educational program that was flexible and was drawn to Kaplan when I realized Paul Deutsch was instrumental in developing the curriculum."

Johnson said the course is user-friendly, has a live chat room for interaction, a virtual classroom and a message board where questions can be answered by instructors and other students. She also has sent private e-mail questions to the instructors and received personal replies from Deutsch. "It's been a really helpful learning process for me-like a real classroom," Johnson said.

Barbara Sonderling, RN, executive director of Kaplan's Health Care Pathways online certificate programs, said that cyber-learning works for LCP because students already have clinical skills but need the academic knowledge base to enter the field. Kaplan's Health Care Pathways online certificate programs, which are run from Kaplan's Boca Raton, Fla., campus, include LCP, forensic nursing and legal nurse consulting.

"The wonderful thing about online education is you can work at your own pace within the 12-month time frame, so it lends itself to the lifestyle of a working professional or someone with family responsibilities," Sonderling said.

Deutsch said the field of LCP can bring rewards far greater than monetary ones. He remains available to patients he's helped in the past, including James Tuttle of Lenoir, N.C., who at age 15 broke his neck in a diving accident. "I met Deutsch when I first got hurt and we still stay in touch," said Tuttle, a quadriplegic who for 20 years has relied on the comprehensive LCP that Deutsch developed.

Tuttle said Deutsch helped him get the support and equipment he needed as he progressed at home and even showed up for a community fund-raising event. "He's supported me a lot," Tuttle said. "He's a wonderful man."

Deutsch said that because Tuttle had no large sums of money from litigation to administer a LCP, he had to be creative and organize community, church and state resources for basic medical care and equipment needs. "When his high school put on a fund-raising wrestling match, we were fully supportive and participated," Deutsch said. "When those kind of events took place, we were able to guide those organized events to raise funds where they were most needed and most effective and to make sure nothing was done during fund raising that would interfere with or jeopardize state or federal resources."

Gary and Kim Juliana of Ocala, Fla., said that Deutsch developed and administered an integrated LCP for their son, Gary Jr. At age 7, the youngster was left with severe brain damage and cerebral palsy when a machine malfunctioned during a surgical procedure and resulted in the loss of oxygenated blood flow to his brain. "Before the life care plan, we didn't have any idea what the future held," the father said. "What Paul did was provide a road map that gives us a sense of direction for both the near future and the long-term future."

Deutsch said he's preparing a new version of his 30-volume "Guide to Rehabilitation" series. One of his favorite activities has been meeting with a group of the top 150 life care planners in the country to exchange information and brainstorm on the challenges ahead.

Hess, too, said the support network of life care planners has been an important element in the success of his Indiana business. More than 100 nurses who were energetic and charged up about the LCP process attended this year's annual conference in Las Vegas, he said.

"It was enriching and enthralling to be surrounded by such high-energy individuals who have a zest and zeal for life care planning and who are nurses who are collaborative-everybody offers to help everyone else," Hess said. "It's a great support system that's really neat and is the perfect representation of what nursing is all about."

Contact John Leighty at johnsan@aol.com