Life Care Planner
The nursing license can be used in so many different facets of the healthcare community. One such facet is life care planning. This field of life care planning is a niche area of nursing, which seems to require an amazing amount of critical thinking, and analytical skills, which many nurses tend to have in abundance. It’s interesting to see how nurses use the great abilities and strengths that are acquired in their education and work experience .
Wendie Howland is an expert life care planner, with an established consultancy practice in Massachusetts. We asked Wendie to come on the site and give us a rundown of what working as a life care planner is really like, how she uses her skill set, and how if interested you could follow the same path.
How did you transition from being a Nurse to a Life Care Planner?
There is no transition– I am first, last, and always a nurse. As a matter of fact, the nursing process is integral to nurse life care planning methodology.
A brief description of life care planning is… it’s a way to estimate and document the medical and nonmedical needs of someone with a catastrophic injury or illness over the expected life span, with associated costs. This involves research, assessment, and extensive communication with the patient, family, and treating team, in most cases.
What kind of education is required to be a Life Care Planner?
To sit for the certification examination to be a certified nurse life care planner, CNLCP, you must hold an active and unrestricted RN license, have 120 hours of formal education in nurse life care planning (obtainable by attending one of two excellent courses offered by Kelynco or FIG Services; links atwww.aanlcp.org) OR five years of experience as a case manager, and prepare a life care plan for review. In practical terms, it’s extremely beneficial to have had a broad and deep nursing career with experience in critical care or other specialty area, rehabilitation, case management, or all of the above. As my assistant says after seeing me at work, “This isn’t a game for rookies.” There’s a lot of great help out here, but you have to bring a good bit to the table.
Can you describe the schooling process and your experience in that program?
I went to college right from high school and earned a BS in Nursing. I spent the next 8 years in critical care, along the way learning that I wanted to be able to get a teaching job because I was always being asked to orient, precept, and instruct, and I liked it. To do that I needed a master’s degree, and that took me about two years. Although a BSN and MN are NOT required for certification in life care planning, the more education and experience you have, the more valuable you will be in any setting, particularly in this one. After six years as a critical care clinical specialist I fell into a case management position in the worker’s compensation insurance industry, learning an entirely new specialty (case management is part of legal nursing according to the ANA) and earning certifications in rehabilitation nursing and case management. This experience gave me invaluable exposure to the legal and insurance side of health care, essential parts of life care planning (and a good part of the certification examination).
In a nutshell, then, preparation for this role includes a broad clinical base (mine is a decades-long mix of critical care, field case management, and education– a great combination), specific education and continuing education in life care planning, and the ability to work independently. Excellent writing and verbal communication skills with the ability to translate medical concepts into lay English are essential. The average life care plan is about 40 pages long and includes tables with current costs of goods and services.
Once you have that License where are the best places to start looking for jobs? And what is the job market like currently?
CNLCP is not a license, it’s a certification. Most CNLCPs are independent practitioners like me, in our own consulting businesses, although some work in-house for law firms or insurance companies. Three general groups want my services and expertise.
Plaintiff attorneys need to understand the medical records to understand how to proceed with their cases. They need to know what kind of care will be needed for a victim of an accident or illness and how much this will cost over the person’s life expectancy. They use this information at trial to explain the damages and in negotiations for settlement. A CNLCP may be called to testify at trial to explain the effects of medical evidence as a fact witness, and to explain how this resulted in the elements of the life care plan.
Defense attorneys want to know what kind of financial exposure their clients will have as a result of plaintiff injury. They and their clients need to have a clear understanding of the medical evidence and its effects on the plaintiff. They also usually request a critique of plaintiff life care plans to see if they are excessive or unjustified. Interestingly, sometimes they are, and sometimes they aren’t.
Last, after the legal system has run its course, trust officers need a roadmap to help them know how to spend the money appropriately for the benefit of the individual. They want to know about equipment costs, maintenance, repair, and replacement; services; need for home nursing or respite care; and other aspects of lifetime care, so they can make the money last.
Many CNLCPs advertise in various hire-an-expert websites or the find-a-nurse page at our professional organizations’ websites. Most of us have our own websites optimized to help potential clients find us. The most reliable source of clients is repeat business and word of mouth referrals from satisfied former clients. When you become known for the quality of your work, clients follow.
The demand for CNLCPs is increasing as they add value to the attorneys’ cases. In an increasingly litigious society with work environments where catastrophic injury can be common, people need what we can do.
Can you give us a bit of a 9-5 day in the day of a life care planner?
What does my day look like? Well, one of the things I love about being a nurse life care planner is that I rarely do the same thing every day. Every case is different. I may be reviewing medical records to find out what the mechanism of injury was for a catastrophic case, like a spinal cord injury or brain injury, and then what the person’s functional ability is, so I can start thinking about levels of care, or home modification, or adaptive equipment. I might be on a conference call with an attorney and client to explain what the medical findings are and what they mean. I might be traveling to a patient’s home to do an assessment and some patient teaching. I might be attending a team meeting at a rehabilitation facility. I might be being deposed, to explain how I decided what provisions to make for components in my plan, or be asked to testify at trial to explain why the elements of the plan are necessary for the health and safety of the ill or injured person if mediations don’t produce a settlement. I might be at an educational offering, learning about a new technology for adaptive communication or the latest in computerized prostheses. I might be reviewing a plan from a plaintiff’s life care planner to be sure it’s accurate and that the numbers add up. I might be collaborating with a colleague on a thorny issue. Or I might be sitting at my desk in the office in my house, comfortably dressed with a cup of tea and some pleasant music in the headphones, researching, writing, and editing a life care plan before I send it to the client for review.
What are some of your favorite things about your job? Are there aspects of it that sometimes seem difficult that someone getting into life care planning should be prepared for?
Every job has difficult aspects or moments. The ones that frustrate me the most are the unforeseen delays– I can’t get a physician to reply to a letter asking for the current treatment plan, or an attorney office wants my work done yesterday but hasn’t sent me the materials I need to do a good job– or doesn’t care that the physician isn’t helping. Being an independent business means being sure the bills get paid even while I am dealing with clients who pay me late. Never knowing when another case will come in makes office budgeting a challenge sometimes. Sometimes the outcome of a legal case seems unfair, or a patient doesn’t get what is necessary for health and safety, and there’s nothing I can do about it; this is hard for a nurse to see in any work setting. And for many cases, a CNLCP never finds out how, or even whether, that plan is ever implemented.
However, the benefits far outweigh these. My favorite thing is that my work allows me to use everything I have learned and done in my career as a nurse. Although many people think that if you’re not wearing scrubs you’re not a real nurse, the basis for my assessments and planning is the nursing process. I rely on it to explain and justify my plan elements in many settings, notably at deposition when I hear, “Nurse Howland, you can’t prescribe these things in your plan because you aren’t a DOCTOR, right?” No, this is incorrect. It’s important not to confuse an insurance plan’s requirement to have a physician prescription for a billable product or service, or the legal requirement for physicians to prescribe medication, with the nursing ability to assess that something is appropriate and indicated by nursing diagnosis. Medical plans of care are developed by physicians; nursing plans of care are developed by registered nurses. Prescribing a nursing plan of care is precisely what nurse life care planners do. Most of my plaintiff clients will be private-pay as they win their cases; medical equipment companies and therapy centers will be happy to provide for them without physician prescriptions if a health insurance company is not the payor.
In many ways, I’m more of a nurse since I left bedside care than I was before, because I understand more that nursing isn’t just facility-based bedside tasks– we really can have far-reaching influence.
Could you possibly share a story with us about being a life care planner that inspired you or excited you to be in the industry you are in?
I can’t tell too many stories because so many of my cases are under confidentiality orders. However, I once wrote a description of what NYHA IV cardiac failure meant, defining the terms in the medical record, and, specifically, how this physically affected the daily life of woman whose legal case was put before a judge. After the case was concluded I got a note from the judge thanking me for the clear and understandable explanation, saying that he planned to keep my explanation on hand and refer to it when other cases like this came before him. While this is a small example, it’s exciting to know that the work I do may be used by others to help people in ways I’ll never know. And isn’t all nursing like that?
I have also been very involved in my professional organization, the American Association of Nurse Life Care Planners, helping to write the standards and scope of practice that, when approved by the ANA, will apply to every nurse doing life care planning. I collaborate with a group of exceptional people who are excited about our roles and responsibilities in building a new profession. As a group, CNLCPs exemplify nursing’s collaborative and supportive approach to problems; I get up happy to be working in this field every single day.
Any Final words to nurses looking to go down this career path?
Get all the experience you can. Get all the education you can. Read widely and learn to be a good writer; nurses naturally do patient teaching, and much of what I do really is like that. Although I might find myself teaching attorneys, judges, and juries, it’s all the same: making medical concepts clear to the people who really have to understand. Never hesitate to ask someone more experienced than you are; never hesitate to help someone who needs your knowledge and experience. And remember: If you love what you do, you’ll never work a day in your life. Love what you do.