Special Edition: Methodology of Life Care Planning for Certified Life Care Planners™

Dr. V. Robert May, III; Huma Haider, M.D., CLCP; Hossein Moradi Rekabdarkolaee; Louis P. Lipinski; Bob A. Gisclair; Cornelius E. Gorman; A. Heather Howe; Dena Ramsey; Kathleen Kenney May

May, III, Dr. V. R., Haider, M.D., CLCP, H., Rekabdarkolaee, H. M., Lipinski, L. P., Gisclair, B. A., Gorman, C. E., Howe, A. H., Ramsey, D., & May, K. K. (2026). Special Edition: Methodology of Life Care Planning for Certified Life Care Planners^TM. ICHCC® Journal for Health Care Professionals.

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Abstract

The life care planning service delivery system has had many conferences, workshops, and summits to investigate and validate standards of practice within that system of care and need. Over the years, there have been consensus agreements regarding the standards necessary to ensure life care planning practices are ethical, fair, and beneficial to the person with a resulting disability from adventitious injuries. The point of fact is that the methodological aspects of life care planning have neither been discussed in medical/healthcare literature nor dissected in healthcare literature for the benefit of practitioners in understanding how a life care plan is organized and validated. The health and science literature is replete with articles discussing the subject of practice standards applied to life care planning, and methodology is mentioned often but only as a necessity as well. The problem is that no author has researched the methodology as applied to life care planning with stations and substations identified and necessary for mastering the life care planning service delivery process. The International Commission on Health Care Certification accepted the challenge of researching the life care planning methodology through surveying the credentialed population of Certified Life Care Planners™ and Canadian Certified Life Care Planners™. The goal of this research was to identify the methodological substations using our survey instrument necessary to produce a validated, evidence-based, and beneficial life care plan station.

Editor’s Note: Special Edition

A groundbreaking methodology research project that establishes the foundation and validity of the life care planning process.

Welcome to the Special Edition of the International Commission on Health Care Certification^™ (ICHCC^®) Journal. This survey research identifies a valid, reliable, and evidence-based methodology for the construct of a life care plan. Life care planning evolved from the work of Dr. Paul Deutsch and the support of Dr. Horace Sawyer back in the early 1980s that placed life care planning training in the University of Forida’s Department of Rehabilitation and expanded training to the many programs that evolved in private and academic-based settings. As you review the contents of this study, please look at the protocols that survey research demands of a project as extensive as this one. Please note that this project required the establishment of a Subject Matter Expert Committee (SME), the process of the SME committee to identify the methodological stations coupled with a pilot study involving life care planning field practitioners, and the SME’s review of the pilot recommendations and comments that added to the valid, reliable, and evidence-based methodological outcome. This is the only statistical research project in the history of life care planning methodology since its inception as a service delivery system for health care practitioners. The ICHCC^® knew that it was time, after 36 years, for research to identify the methodology of the life care planning service delivery system, and for the development of a life care plan that is valid, reliable, and evidence-based for all life care planning practitioners.

Dr. V. Robert May III, Rh.D.
Editor
President & Founder of
The International Commission on Health Care Certification^™ (ICHCC ^®)

Since the beginning of a structured life care planning process established by Drs. Paul Deutsch and Horace Sawyer (1985), life care planning service delivery has grown to the point that active summits since 2000 have been organized to establish Standards of Practice for life care planners. These summits are comprised of life care planning practitioners who met every other year to review and revise Standards of Practice for the life care planning process. What has not been the focus of these summits is the research efforts necessary to identify the knowledge domains and sub-factors of life care planning methodology. Drs. Deutsch and Sawyer introduced a life care planning methodology in their 1985 textbook (Horace Sawyer, personal communication, November 28, 2025), but since then, little research has advanced or clarified the steps for developing and publishing valid life care plans.

The purpose of this study is to identify and empirically validate the core Knowledge Domains and sub-factors that constitute the methodology of the life care planning process. While the foundational model for life care planning was established in the mid-1970s and early 1980s, there has been a historical lack of scientific research focused on the statistical validation of the specific methodological steps required to develop and publish valid life care plans. It is our goal to build upon the May and Moradi (2020) Role and Function investigation to achieve the following objectives:

a) Validation of Methodological Structure: To use Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) to identify a stable latent structure of life care planning tasks, moving the field toward a more parsimonious 11-factor solution.

b) Establishment of Reliability Standards: To quantify the internal consistency of the life care planning methodology using Cronbach’s alpha, ensuring the instrument meets high psychometric standards for research (≥0.70)

c) Creation of a Parsimonious Instrument: To evaluate the impact of item reduction by comparing a full item set against a reduced model (e.g., the top three items per factor) to balance high internal consistency with reduced respondent burden.

d) Assessment of Transdisciplinary Consensus: To examine whether demographic and professional characteristics, such as gender, education level, clinical field, and licensure, influence the perception and application of life care planning methodology.

e) Improvement of Standards of Practice: To provide an evidence-based foundation for Standards of Practice (SOPs), moving beyond discussions held at biennial summits toward a statistically validated roadmap for practitioners.

f) Informing Training and Certification: To provide data-driven insights that allow life care planning training programs and certifying agencies (such as the ICHCC^®) to adjust curriculum content and validate certification examination items.

Ultimately, this study serves to solidify the position of life care planning within the healthcare marketplace by documenting a reliable, consistent, and peer-reviewed methodology that applies to all typical diagnoses served by practitioners.

Definitions

Methodology is primarily found in research studies where various steps are required for methodology stations and substations, such as choosing a sample, collecting data from this sample, and interpreting the data (Methodology, 2025). However, methodology also refers to methods, which is a structured procedure to bring about a certain goal. For example, the goal that the life care planner may pursue based on lack of mobility of the person with a disability will require a method that will satisfy the process the life care planner uses to secure such a device, which is associated and applied within the overall methodological Knowledge Domain. Regarding the research model we use, methods can apply to all phases of the research model since methods apply to choosing the sample to survey, collecting the data from the survey, and interpreting the data. In essence, one can describe “methods” as being a substation of the station (knowledge domain), while methodology and its subfactors (substations) can be used as a roadmap guiding the step-by-step process (methods) for answering research questions.

There are two different research methods in methodology: quantitative and qualitative research (May & Moradi, 2020; Methodology, 2025). Quantitative research focuses on natural sciences using precise numerical research. Specifically, its goal is to find universal laws used to make predictions about future events. Quantitative methodology is the dominant methodology in the natural sciences and is referred to as the scientific method (Methodology).

Qualitative research explores social sciences and focuses on understanding the meaning of the studied phenomena and less of predictive laws. Common methods of qualitative research include surveys, interviews, focus groups, and the nominal group technique (May & Moradi, 2020; Methodology, 2025).This methodological study is qualitative research methodology and falls under the nominal group technique. One of our research goals is to evaluate how much agreement there is among the many varying degree-trained health care providers/practitioners, who we categorized as experts in the life care planning process. Given the survey method for collecting opinion data, all respondents regarding the survey instrument are in written form and without conversation among the survey participants. This rule is designed to control group effects that would otherwise influence the expressed opinions of the participants.

Standards of Practice and Methodology

Standards of Practice (SOP) are essential to life care planning service delivery since the standards describe the competent level of life care planners in establishing a thorough and valid life care plan. The purpose of SOPs is to direct and maintain competent life care planning services among certified practitioners, and to provide a means of improving one’s life care planning practice (Greenfield et al., 2012). This is only accomplished with guidelines to life care planners’ practices in service delivery, providing guidance in methodological steps necessary to achieve the goal of a valid and thorough life care plan.

The development of SOPs for life care planning began in 2000, and 11 summits have been held to date to identify and accept standards of practice by participants in small breakout group sessions. These breakout groups produce statements from each group, with much discussion and suggestions until a consensus is achieved. Thus, the resulting standards are referred to as consensus statements. However, there are some disadvantages to the development of consensus statements using the breakout group process, often referred to as the open forum. Nathwani (2003) documented areas of bias under consensus statement development. For example, he noted that interactions with some group members will have a significant impact on the overall group decisions, with a tendency for group members leaning towards the moderator or peer practitioners who may be long-time friends in practice. He noted that other areas of bias include the type of questions that are set for the group, the composition of the panels’ group leaders (peer association), and the selection of the experts and the literature chosen for the exercise (p. 1104).

Other biases include the possibility of repeat practitioners present at these summits who attend and participate in the summit without a change of opinion, a lack of scientific methodology in identifying consensus statements, and the lack of statistical validation of such statements. In essence, the current summit protocol offers no validity or scientifically evidence-based methodology, and participants can be influenced by their peers through communication during the exercise, thus influencing opinions.

Methodology plays a huge role in the Standards of Practice development process. It is methodology and scientific evaluation of such that places the Standards of Practice in correct process order, addresses validity of the steps, and identifies and validates the Stations (Knowledge Domains) that consume the methodological steps leading to the practitioner’s goal of creating and writing a valid life care plan. Without methodology, the process of following the order of service delivery becomes awkward as well as unmanageable towards the ultimate goal of life care planning.

Dr. Paul M. Deutsch

Dr. Paul M. Deutsch is credited as being the one practitioner and educator who developed the model of life care planning service delivery back in the mid-1970s, that continues to be the preferred model used today by many practitioners of varying educational degrees and training. Through Dr. Deutsch’s knowledge and his love of training health care practitioners in life care planning service delivery through his Rehabilitation Training Institute and later his work with the University of Florida, well over 1106 Certified Life Care Planners^™ follow his teachings and his care plan model today. Dr. Deutsch believed in educating healthcare practitioners and offering information posted on his website regarding questions and answers from practitioners who wish for further knowledge in care planning. He placed his acclaimed Tenets of Life Care Planning on his website that would benefit those practitioners looking for Standards of Practice as well as those practitioners accessing the Tenets as a refresher for information they learned in his training program. Although the tenets were not identified as methodological steps in care planning development, these tenets number 15 and are considered the basic tenets of life care planning service delivery. Additionally, Dr. Deutsch defines and lists the elements of the life care plan that are essential for creating a solid life care plan document. The reader may find his Tenets of Life Care Planning plus his recommended readings/literature in Appendix D.

Method

This survey of methodology for life care planning is the first of its kind given that no empirical research has been conducted for the investigation of life care planning as designed by Deutsch and Sawyer (1985). The reader will note that the method of the development of the methodological survey instrument, the tasks of the Subject Matter Expert Committee (SME), and the applied statistical analysis is comparable to the research method of May and Morati (2020) in their study of the job task inventory of life care planners. The following replicates the methodology research steps of May and Moradi’s 2020 JTI study.

Participants

Participants (n=257) were those persons chosen from the ICHCC^® registered Certified Life Care Planners^™ and Canadian Certified Life Care Planners^™ listings. Several e-mail blasts were sent to all life care planners/health care practitioners credentialed under the ICHCC^®. The email blasts covered the United States and Canada, and non-credentialed or certified persons in life care planning from other certifying agencies were excluded from the survey.

Instrument

The instrument used in the study was the ICHCC^® Methodology Survey that is comprised of two sections; 1) The Demographic Section and 2) the Survey of Methodological Steps for the Delivery of Life Care Planning Services. The Demographic Section is composed of 11 items with multiple choices that were identified as relating to the participant by using checkboxes. The Survey of Methodological Steps for the Delivery of Life Care Planning Services entails a 5-point Likert-type rating scale and 72 methodological statements. There were 3 scales used in the Methodological Steps for the Delivery of Life Care Planning Services. These 3 scales included the following:

Strongly Agree – Strongly Disagree Likert Scale
Strongly Crucial – Strongly Not Crucial Likert Scale
100% Frequently – 0% Frequently Applied Percentage Scale

The participants were required to complete all sections of the Methodological Steps section requiring a review of the 72 methodological statements under the 3 Likert scales totaling 230 substation choices that also included the Demographic section. This instrument was designed and disseminated using the SurveyGold^® application that focuses on surveys as applied to the social sciences (Boudreaux, 2025). A complete questionnaire is included in Appendix A with percentage of participant agreement for each of the three scales.

Demographics. The Demographic Section was constructed to reflect demographic items associated with survey participants who perform life care planning service delivery. Given the lack of empirical research for life care planning methodology, participants alone carrying either Certified Life Care Planner^™ or Canadian Certified Life Care Planner^™ credentials were particularly relevant to the demographics of this study such that each participant’s answers to the demographics section were used in comparison studies among participant groups included in this article.

Content Validity

The degree to which the content of a measurement instrument (survey) adequately reflects the outcome (Life Care Plan) being measured is the meaning of “content validity” (Mokkink et al., 2025). Content validity is considered to be the most important measurement property of any outcome measurement instrument due to its standardized method of quantifying a clearly defined outcome. The outcome is that of the life care plan, and the constructs are identified and applied to the outcome through the subject matter expert (SME) committee. It stands to reason that the subject matter expert committee is essential in the process of measuring and identifying steps to achieve a valid life care plan.

Regarding this research project, subject matter experts (SMEs) were assembled for three separate meetings to identify methodological steps in the life care planning process and to categorize the knowledge domains that are identified through the analyzed database. The SME participants were healthcare professionals who were certified as Certified Life Care Planners^™ and were either members of the Certified Life Care Planner^™ Board of Commissioners practicing life care planning service delivery or who had individual practices in life care planning service delivery without Board appointments. The process in which the SMEs performed the content validation of the instrument, developing it into its final form for submission to the public, as well as identifying the knowledge domain subject matter and associated subfactors post analyses included the following activities in their chronology:

On October 14, 2024, the Subject Matter Expert committee began the process of establishing an empirical methodology for life care planning. The methodology was characterized as a process of multiple sub-stations designed to achieve a definitive goal (Life Care Plan). It was made clear that this research was not a study of job task inventories for life care planners, but rather the identification of methodological steps necessary for developing a valid life care plan.
There are 6 members who comprise Subject Matter Expert Committee and who participated in this methodological exercise that was spread over 6 Committee meetings. All meetings were conducted by the ZOOM platform that spared the members from travel and lodging expenses.
Review substations/subfactors: The first meeting had the chairperson asking participants to write down on a piece of paper their perception of methodology (substation steps) necessary for achieving a valid life care plan. The review started with one committee member. This person read out her or his subfactors that she or he felt would eventually reach the goal of a life care plan = The Main Station
Following the first person’s list reading, the Chairperson picked the next person to read their collection of subfactors they deemed to be necessary for the development of a valid and completed life care plan. All committee members checked their lists to see the person reading her/his list matched any of the committee members’ subfactors. If committee member(s) had a subfactor close to or identical to the previous reader’s listed subfactor, the committee member was to circle that subfactor on their list; circled subfactors will not be read. A reading of the last unread list took place, and all lists were collected by the chairperson. The chairperson documented all of the circled subfactors by creating a final list that was disseminated to all of the Committee members. The subfactors that were not circled were reviewed and voted by the committee members to either accept or reject the subfactor. The SME Committee members reviewed the literature specific to life care planning to determine if any activities identified from the published literature needed to be added to the list of sub-factors. Once the non-circled subfactors and subfactors found in the literature were voted by committee members and either accepted or rejected, all accepted subfactors were added to the lists to be included in the survey instrument. The newly created listing of the committee’s subfactors would be the final list of methodological subfactors necessary for completion of a valid life care plan.
A survey instrument was constructed that included a demographic section and a Strongly Disagree to Strongly Agree Likert Scale, as well as Cruciality and Frequency Likert Scales. The complete Methodology Survey Instrument without any markings to the multiple-choice substations as well as the Demographic section is found on Appendix C.
Subsequent to any revisions, the SME Committee reviewed the ICHCC^® CLCP^®/CCLCP^™ Methodology Study and approved its distribution. A Pilot Study was administered to CLCP^® field practitioners who rated the Sub-Stations on 3 Likert scales measuring Agree-Disagree, Cruciality, and Frequency. Further recommendations of methodology by the 10 persons who took the pilot survey were reviewed and voted on by the SME committee to keep or reject any of the recommendations. The final outcome was a final listing of 72 methodological substations that were validated by the SME Committee and were deemed suitable for publishing. A copy of the final survey instrument is presented in Appendix A with rating percentages applied to all 72 methodology items.
After the rating time for participants to complete the surveys expired, the SME committee regrouped to review the completed rated survey items. The chairperson of the committee explained the process that required a vote regarding the percentage of participants who rated each methodological substation as being acceptable having met and/or exceeded the cut score percentages for each methodological item. The committee was charged with establishing a percentage of participants who rated the survey item equal to or above the agreed accepted percentage cut score. Those items not meeting the necessary percentages of acceptance according to the percentage cut score were eliminated as a substation. The group of rejected substations are found in Appendix B.

Results

Cleaning and Cronbach’s alpha

This section evaluates the internal consistency of a subset of variables using Cronbach’s alpha. Columns 110 through 193 are extracted from the original dataset to create a working data frame containing the items of interest. These variables are then coerced to numeric format to ensure compatibility with the reliability analysis.

Cronbach’s alpha is calculated across all selected items, with confidence intervals included to quantify the uncertainty around the reliability estimate. This analysis provides an overall measure of internal consistency for the selected scale items, indicating the degree to which they measure a common underlying construct (Tavakol & Dennick, 2011).

The bootstrap analysis was applied to the statistical analysis in addition to Cronbach’s alpha to add to the reliability factor of the selected methodology items. Bootstrapping is a resampling method that creates simulated samples from an existing data set to estimate statistics like standard errors and confidence intervals (Joseph, 2025). It avoids normality assumptions and can be more reliable than traditional methods, especially with small or non-normal data. Basically, bootstrapping is a statistical resampling method that uses repeated sampling of data with replacement from a single data set to generate simulated samples for estimating measures like variability, confidence intervals, and bias (Joseph). Our statistical bootstrapping results are parallel to Cronbach’s alpha exceptional internal consistency with its findings, based on 1000 samples lower and upper bounds established at 0.985 0.991 between 0 and 1 resulting in a 95% Confidence Interval (CI). The resulting reliability statistics are printed for inspection and reporting.

Factor Analysis

Exploratory factor analysis (EFA) was conducted to identify the underlying factor structure of the dataset. Prior to analysis, data suitability was assessed using the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy and Bartlett’s test of sphericity. Variables with individual MSA values below 0.50 were removed to ensure adequate inter-item correlations. The optimal number of factors was determined through multiple methods: scree plot inspection, parallel analysis with 100 random data simulations (95th percentile criterion), and eigenvalue analysis. Based on these convergent criteria, a 7-factor solution was extracted using maximum likelihood estimation with varimax (orthogonal) rotation.

Items were assigned to factors based on their primary loadings, with a minimum threshold of 0.50 to ensure substantive interpretation. Items failing to meet this criterion were excluded from the final factor structure. All analyses were conducted using the psych and nFactors packages in R.

Factor Structure and Item Selection

Following determination of the 7-factor solution, exploratory factor analysis was conducted using maximum likelihood estimation with varimax rotation to achieve simple structure. An un-rotated solution was also extracted for comparison purposes. Factor loadings were examined to assign items to their primary factors. Item selection proceeded in two stages. First, items were retained only if they demonstrated a minimum loading of 0.30 on their primary factor, consistent with established guidelines for substantive interpretation (Hair et al., 2010). Each item was assigned exclusively to the factor on which it exhibited the highest absolute loading, ensuring a simple structure without cross-loading.
Second, to develop a parsimonious measurement instrument, the four items with the strongest loading on each factor were selected for the final scale. This approach balances internal consistency with respondent burden while maintaining adequate factor representation. Both the full item set (all items meeting the 0.30 threshold) and the reduced 4-item-per-factor solution were retained for subsequent validation analyses.

Internal Consistency and Variance Explained

Items were organized into subscales corresponding to their primary factor assignments. Internal consistency reliability for each factor was assessed using Cronbach’s alpha with 95% confidence intervals. Reliability was calculated for both the full item set (all items with loadings ≥ 0.30) and the reduced 3-item-per-factor solution to evaluate the impact of item reduction on measurement precision.

Factors with fewer than two items were excluded from reliability analysis, as coefficient alpha is undefined for single-item scales. Acceptable reliability was defined as α ≥ 0.70, consistent with psychometric standards for research instruments (Nunnally & Bernstein, 1994).

The proportion of variance explained by each factor was extracted from both unrotated and varimax-rotated solutions. Sum of squared loadings, proportion of variance, and cumulative variance were reported to characterize the explanatory power of the factor structure. While rotation redistributes variance across factors to enhance interpretability, the total variance explained by the model remains constant across rotation methods.

CFA for Full Data

Confirmatory Factor Analysis

To validate the factor structure identified through EFA, confirmatory factor analysis (CFA) was conducted using maximum likelihood estimation in the Lavaan package (Rosseel, 2012). The 7-factor structure was tested using two item configurations: (1) all items meeting the 0.30 loading threshold, and (2) a reduced model with the top three items per factor to assess measurement parsimony.

Latent variables were standardized (variance fixed to 1.0) to facilitate interpretation of factor loadings. Model fit was evaluated using multiple indices: Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), Root Mean Square Error of Approximation (RMSEA), and information criteria (AIC, BIC). Acceptable fit was defined as CFI/TLI ≥ 0.90 and RMSEA ≤ 0.08, with excellent fit indicated by CFI/TLI ≥ 0.95 and RMSEA ≤ 0.05 (Hu & Bentler, 1999).

Model comparison between the full and reduced item sets was conducted using AIC and BIC, with lower values indicating superior fit while accounting for model complexity. The final model selection balanced parsimony with adequate representation of each latent construct.

Demographic Variable Construction and Group Comparisons

Demographic and professional characteristic variables were recoded into categorical groupings to facilitate group comparisons. Education level was determined by identifying the highest degree attained across multiple response options and categorizing into five levels (1 = high school or less, 2 = associate’s/some college, 3 = bachelor’s, 4 = master’s/doctoral, 5 = other advanced credentials). Professional field, licensure status, practice setting, and client population variables were similarly recoded based on response patterns, with categories collapsed to ensure adequate cell sizes for statistical testing.
Factor scores were calculated for each participant by averaging item responses within each factor, as determined by the exploratory factor analysis. These composite scores served as dependent variables in subsequent group comparison analyses.

Group Difference Testing

Independent samples t-tests were conducted to examine gender differences in factor scores. One-way analyses of variance (ANOVA) were performed to test for differences across categorical demographic and professional variables, including age, education level, professional field, licensure type, practice setting, extent of life care planning involvement, client populations served, office staff presence, and staff activity types. Statistical significance was evaluated at α = 0.05. For significant ANOVA results, post-hoc comparisons would be conducted using [specify method, e.g., Tukey’s HSD] to identify specific group differences while controlling for Type I error inflation.

To address the multiple testing problem inherent in conducting 72 statistical comparisons, we applied the Benjamini-Hochberg false discovery rate (FDR) correction to control the expected proportion of false positives at 5% (Benjamini & Hochberg, 1995). Only results surviving FDR correction are interpreted as statistically significant.

Table 1.Cronbach Alpha for each Factor with all items

Factor	N_items	Cronbach_alpha	CI_lower	CI_upper
ML1	25	0.9784821	0.9719806	0.9833140
ML2	10	0.9366666	0.9180432	0.9510910
ML3	6	0.9029708	0.8748706	0.9244348
ML4	3	0.9415963	0.9171889	0.9610299
ML5	7	0.9047099	0.8721263	0.9283754
ML6	16	0.8929746	0.8634157	0.9154764
ML7	2	0.7959791	0.6896733	0.8739034

Factor	N_items	Cronbach_alpha	CI_lower	CI_upper
ML1	25	0.9784821	0.9719806	0.9833140
ML2	10	0.9366666	0.9180432	0.9510910
ML3	6	0.9029708	0.8748706	0.9244348
ML4	3	0.9415963	0.9171889	0.9610299
ML5	7	0.9047099	0.8721263	0.9283754
ML6	16	0.8929746	0.8634157	0.9154764
ML7	2	0.7959791	0.6896733	0.8739034

Discussion

ML1 through ML7 represent the latent factors extracted through exploratory factor analysis using maximum likelihood estimation and varimax rotation. These labels are automatically assigned by R and do not correspond directly to pre-existing survey sections. Items were included in each ML factor based on their factor loadings. Specifically, each item was assigned to the factor on which it had the highest absolute loading, provided that the loading met the minimum retention criterion. Items that did not meet the loading cutoff were removed from the factor-specific reliability analysis. Cronbach’s alpha was then calculated separately for each ML factor using only the items assigned to that factor. Therefore, the items included in ML1–ML7 are the items that statistically clustered together under each factor in the EFA solution. I added M-named factors for the new version of the analysis for the reader’s review.

Table 2.Cronbach Alpha for each Factor with only the top 3 important items

Factor	N_items	Cronbach_alpha	CI_lower	CI_upper
ML1	3	0.9929373	0.9862802	0.9984063
ML2	3	0.9411616	0.9180531	0.9602036
ML3	3	0.9275124	0.8929343	0.9533978
ML4	3	0.9415963	0.9177145	0.9604032
ML5	3	0.8811950	0.8308866	0.9158170
ML6	3	0.6770178	0.5914872	0.7393674
ML7	2	0.7959791	0.6947978	0.8748968

Discussion

The table “Cronbach Alpha for each Factor with Only the Top 3 Important Items” informs the reader about the measurement parsimony and internal consistency of a “short-form” version of your scale.

Parsimony: It demonstrates that the factors remain statistically reliable even when reduced to only the most “important” items. This is often done to reduce respondent burden in future surveys.
Reliability: The Cronbach’s Alpha values in this table tell the reader if these specific 4 (or 3) items “hang together” well enough to measure the underlying construct (e.g., ML1, ML2) accurately.
Validation: By comparing this table to the “Full Item Set” table, a reader can see how much reliability is “lost” by shortening the scale. If the Alpha remains above .70, the reduced scale is considered successful.

The items in this table are the top 3 “marker variables” for each factor. They are chosen because they have the highest correlation (loading) with the latent construct, presenting the most representative questions in the participant’s survey for that specific topic.

Table 3.Total Variance Explained

SS.Load.no.rot	Prop.Var.no.rot	Cum.Var.no.rot	SS_Load	Prop.Var	Cum.Var
30.972	0.430	0.430	16.311	0.227	0.227
5.994	0.083	0.513	7.459	0.104	0.330
3.072	0.043	0.556	5.959	0.083	0.413
1.682	0.023	0.579	5.810	0.081	0.494
1.470	0.020	0.600	3.800	0.053	0.546
1.361	0.019	0.619	3.332	0.046	0.593
1.043	0.014	0.633	2.922	0.041	0.633

Discussion

The “Total Variance Explained” table serves two major purposes in a psychometric methodology report:

It shows the overall “Explanatory Power” of your survey. The most important number for many readers is the Cumulative Variance at the bottom of the table. It tells the reader how much of the total complexity in the survey responses is successfully summarized by your 7 factors. For example, if the cumulative variance is 62%, it means your 7 factors explain 62% of the survey data, while the remaining 38% is due to random error or unique quirks of individual questions.
It proves that our Varimax rotation worked correctly. Our manuscript text actually includes a sentence explaining this: “While rotation redistributes variance across factors to enhance interpretability, the total variance explained by the model remains constant across rotation methods.”

By showing the unrotated (no. rot) and rotated columns side-by-side, the table visually demonstrates this concept to the reader:

Before rotation (no. rot): Factor 1 usually looks massive (explaining a huge proportion of variance), while Factors 4, 5, and 7 look tiny. This makes it hard to figure out what the factors actually mean.

After rotation: The total cumulative variance stays exactly the same, but the variance is “smoothed out” or redistributed more evenly across all the factors. This makes the factors distinct and much easier to name and interpret.

In summary: “This table shows how much of the survey’s data is explained by our factors. It includes both unrotated and rotated columns to demonstrate how the Varimax rotation successfully redistributed the statistical weight across the factors to make them easier to interpret, without losing any of the model’s overall explanatory power.”

Table 4.Factor difference for Gender

Factor Name	t-value	CI Lower bound	CI Upper Bound	P-value
ML1	2.05900607025612	0.00519861208174599	0.266906882423749	0.0417007769250869
ML2	0.889443677467154	-0.0767942915084937	0.202435317149519	0.375262286732652
ML3	1.84936188829958	-0.0101272060449411	0.301799977717713	0.0666040365162324
ML4	0.960527332013818	-0.0802316614911421	0.231831173090654	0.338461362699767
ML5	1.33204755304519	-0.0523877759273985	0.267939842908037	0.185318791921808
ML6	1.06923168349217	-0.0595839435243136	0.199739621179991	0.286943370604151
ML7	1.33798115284032	-0.0460002990066109	0.237721910728223	0.183445304711738

Discussion

The “Factor Difference for Gender” table shows that only ML1 has p < .05, while ML2–ML7 are not significant which means gender is statistically associated with scores on ML1 only. Male and female participants differed significantly on ML1, but they did not differ significantly on ML2, ML3, ML4, ML5, ML6, or ML7. In other words, whatever construct ML1 represents, based on its items, appears to vary by gender. The other five factors do not show evidence of meaningful gender differences in the sample.

What this means for Male vs. Female

The p-value alone tells you that a statistically significant gender difference exists, but it does not automatically tell you which group scored higher. To know whether males scored higher than females or females scored higher than males, you need to look at the mean factor score for ML1 by gender. To find out which one is male and which one is female, the gender variables in the data have1 and 2. The 1 is “Male” and 2 is subject to “Female”.

Factor Difference Tables

A series of group comparison analyses was conducted to determine whether factor scores differed across respondent demographic and professional characteristics. Independent samples t-tests were used for two-group comparisons, and one-way ANOVAs were used for variables with more than two groups. For each analysis, the dependent variables were the factor scores derived from the exploratory factor analysis, labeled ML1 through ML7. A statistically significant result indicates that respondents in at least one category of the grouping variable differed in their average score on that factor. Non-significant results indicate that there was insufficient evidence to conclude that factor scores differed across the groups.

Table 5.Factor difference for Office Staff/Subcontractors

Factor Name	F-value	P-value
ML1	2.46388118197341	0.117730620579699
ML2	0.103845607769095	0.747526702079659
ML3	0.657500013580454	0.418200065574773
ML4	0.369837776556135	0.543633974167772
ML5	0.000880231932001627	0.97635447919595
ML6	1.99317912378683	0.159227938949371
ML7	0.638345374810305	0.425054128718001

Table 6.Factor difference for Year

Factor Name	F-value	P-value
ML1	1.02578641280366	0.394466021469979
ML2	1.52722812087563	0.194719346126871
ML3	3.33254014505837	0.0110782581022061
ML4	1.19939336999594	0.311581865459368
ML5	0.912424600166693	0.457228947565661
ML6	1.58142730425684	0.179713952156448
ML7	0.693596291807525	0.596997687562612

Table 7.Factor difference for Education

Factor Name	F-value	P-value
ML1	0.731676325603347	0.571071787356424
ML2	0.870086114471301	0.482423369590399
ML3	0.645029849034386	0.630874728679884
ML4	0.538096265131448	0.707876003848765
ML5	1.09319303057267	0.360408060890423
ML6	1.09653739246468	0.358781078105162
ML7	0.580004844292716	0.677394873760745

Table 8.Factor difference for Field and Practice

Factor Name	F-value	P-value
ML1	0.491087933690518	0.688773640492342
ML2	1.84525229103105	0.139427339659043
ML3	0.184800740557004	0.906677448311993
ML4	0.422946755541613	0.736706058530252
ML5	0.635560309236677	0.592722385428458
ML6	0.165329360789204	0.919664051019505
ML7	2.01057886165249	0.112946182497472

Table 9.Factor difference for Licensed, Registered and/or Certified

Factor Name	F-value	P-value
ML1	2.18828646860084	0.0899036930856259
ML2	2.00253601759671	0.114113927077411
ML3	0.276689610667589	0.842196044223749
ML4	3.12276641362708	0.0265392938036665
ML5	2.05234431806142	0.107065265125406
ML6	3.41986991740467	0.0179242813914723
ML7	4.08850435984932	0.00737971220955863

Table 10.Factor difference for Current Practice

Factor Name	F-value	P-value
ML1	1.28284703108487	0.279036909396354
ML2	1.88187576027753	0.154421524951853
ML3	1.27864234633987	0.280200878826615
ML4	1.49635328717171	0.22591269153317
ML5	1.33174585355185	0.265852983325855
ML6	0.854718004152221	0.426622944076748
ML7	0.944533487827921	0.390222406144547

Table 11.Factor difference for Question 7

Factor Name	F-value	P-value
ML1	0.690464011305186	0.599156311921561
ML2	0.3597573657784	0.837105838223633
ML3	0.444312565532499	0.776500759841691
ML4	0.508838163119472	0.729284509187095
ML5	0.779257349591658	0.539561651891851
ML6	0.520448939076367	0.720781210804442
ML7	1.15536819760861	0.331117554404549

Table 12.Factor difference for Question 8

Factor Name	F-value	P-value
ML1	0.443670992125933	0.721988275220765
ML2	0.350677549484855	0.788691086260377
ML3	0.0579512922518313	0.981652337969111
ML4	0.337711807902742	0.798080594684387
ML5	0.875157969243522	0.454500679469567
ML6	1.0501440313106	0.370958971338339
ML7	0.501595240345648	0.681511885696577

Table 13.Factor difference for Population to Whom You Provide

Factor Name	F-value	P-value
ML1	0.54755840622589	0.650220769718872
ML2	1.27266328919599	0.284242787906477
ML3	0.244269470456706	0.865370320040945
ML4	1.13842654196767	0.334083626291709
ML5	0.0437152475675823	0.987823748111292
ML6	0.295934349877761	0.828323382002808
ML7	0.41031212651249	0.745729111861251

Table 14.Factor difference for Which activities do the Office Staff/Subcontractors Perform?

Factor Name	F-value	P-value
ML1	2.56181376963715	0.0791573278733568
ML2	0.105422967484743	0.899983152056213
ML3	0.0378177791280804	0.962893803890926
ML4	0.505948275367144	0.603539895134462
ML5	0.271789992494018	0.762235603018604
ML6	1.87891311568925	0.154873004783115
ML7	0.0313387629109004	0.96915095303304

Frequency Table

Table 15.Frequency table for how much they use CLCP^® for each question

Variable	Prop_1	Prop_2	Prop_3	Prop_4	Prop_5
158.	0.8132296	0.09338521	0.02334630	0.042801556	0.027237354
159.	0.8093385	0.11284047	0.03891051	0.031128405	0.007782101
160.	0.7782101	0.14785992	0.03112840	0.038910506	0.003891051
161.	0.9105058	0.05447471	0.02334630	0.011673152
162.	0.7782101	0.14396887	0.05447471	0.015564202	0.007782101
163.	0.7198444	0.16731518	0.07782101	0.027237354	0.007782101
164.	0.7392996	0.14785992	0.07782101	0.031128405	0.003891051
165.	0.8132296	0.11673152	0.03891051	0.027237354	0.003891051
166.	0.6692607	0.20622568	0.08171206	0.042801556
167.	0.7859922	0.12062257	0.05836576	0.035019455
168.	0.7626459	0.14396887	0.06225681	0.031128405
169.	0.7626459	0.14007782	0.06614786	0.031128405
170.	0.8132296	0.10894942	0.05058366	0.027237354
171.	0.8443580	0.08949416	0.03891051	0.027237354
172.	0.7859922	0.11673152	0.06614786	0.031128405
173.	0.7509728	0.16342412	0.05058366	0.035019455
174.	0.8210117	0.10894942	0.04280156	0.027237354
175.	0.8093385	0.10894942	0.05058366	0.031128405
176.	0.7665370	0.12840467	0.07003891	0.035019455
177.	0.7898833	0.10894942	0.06225681	0.035019455	0.003891051
178.	0.7665370	0.13229572	0.05836576	0.038910506	0.003891051
179.	0.6692607	0.17120623	0.10116732	0.050583658	0.007782101
180.	0.7042802	0.17120623	0.07782101	0.038910506	0.007782101
181.	0.6809339	0.10894942	0.13229572	0.058365759	0.019455253
182.	0.6848249	0.13229572	0.11284047	0.046692607	0.023346304
183.	0.3618677	0.23735409	0.23346304	0.136186770	0.031128405
184.	0.4241245	0.23346304	0.17509728	0.124513619	0.042801556
185.	0.6692607	0.12840467	0.08949416	0.081712062	0.031128405
186.	0.6575875	0.12840467	0.09727626	0.089494163	0.027237354
187.	0.6498054	0.12451362	0.10116732	0.089494163	0.035019455
188.	0.6887160	0.17898833	0.07392996	0.050583658	0.007782101
189.	0.6692607	0.18287938	0.08560311	0.050583658	0.011673152
190.	0.7626459	0.12840467	0.05058366	0.050583658	0.007782101
191.	0.7237354	0.15175097	0.07003891	0.046692607	0.007782101
192.	0.7159533	0.15564202	0.07003891	0.050583658	0.007782101
193.	0.6498054	0.19844358	0.08560311	0.050583658	0.015564202
194.	0.5992218	0.16342412	0.07782101	0.093385214	0.066147860
195.	0.7120623	0.19066148	0.07782101	0.015564202	0.003891051
196.	0.6964981	0.20233463	0.08171206	0.015564202	0.003891051
197.	0.8754864	0.10116732	0.01556420		0.007782101
198.	0.8482490	0.10894942	0.02723735	0.003891051	0.011673152
199.	0.8793774	0.08171206	0.03112840	0.007782101
200.	0.6459144	0.17120623	0.11284047	0.050583658	0.019455253
201.	0.7743191	0.15953307	0.05058366	0.003891051	0.011673152
202.	0.8249027	0.10894942	0.03891051	0.027237354
203.	0.8910506	0.08949416	0.01945525
204.	0.8093385	0.10894942	0.05836576	0.015564202	0.007782101
205.	0.7665370	0.13229572	0.07392996	0.019455253	0.007782101
206.	0.8910506	0.08171206	0.02723735
207.	0.7976654	0.13229572	0.05447471	0.011673152	0.003891051
208.	0.8171206	0.12840467	0.03891051	0.011673152	0.003891051
209.	0.7782101	0.12062257	0.06614786	0.031128405	0.003891051
210.	0.7626459	0.12840467	0.07003891	0.035019455	0.003891051
211.	0.8015564	0.12062257	0.06225681	0.015564202
212.	0.7859922	0.10894942	0.08171206	0.023346304
213.	0.7898833	0.13618677	0.06225681	0.011673152
214.	0.8443580	0.11673152	0.03501946	0.003891051
215.	0.7821012	0.11673152	0.06614786	0.027237354	0.007782101
216.	0.7431907	0.13618677	0.08949416	0.019455253	0.011673152
217.	0.7159533	0.14007782	0.08560311	0.050583658	0.007782101
218.	0.8054475	0.11284047	0.07003891	0.007782101	0.003891051
219.	0.8132296	0.11673152	0.05836576	0.011673152
220.	0.6303502	0.17898833	0.12840467	0.027237354	0.035019455
221.	0.7704280	0.12062257	0.07782101	0.023346304	0.007782101
222.	0.6264591	0.18677043	0.12840467	0.042801556	0.015564202
223.	0.7626459	0.13618677	0.04669261	0.027237354	0.027237354
224.	0.2879377	0.21400778	0.19066148	0.178988327	0.128404669
225.	0.8404669	0.07782101	0.04280156	0.035019455	0.003891051
226.	0.7159533	0.14396887	0.08560311	0.027237354	0.027237354
227.	0.6614786	0.15953307	0.08171206	0.023346304	0.073929961
228.	0.7354086	0.14785992	0.04669261	0.015564202	0.054474708
229.	0.6225681	0.15564202	0.10505837	0.031128405	0.085603113
230.	0.8171206	0.08949416	0.05058366	0.011673152	0.031128405

Discussion

The results of this study signal a pivotal evolution in life care planning, moving the profession from a qualitative consensus toward a statistically validated, parsimonious framework. The transition from the 16-factor structure identified in 2020 to the 11-factor structure validated in 2026 represents a critical “theoretical tightening” of the field. In 2020, the field was categorized by 22 subfactors, suggesting a more fragmented understanding of job tasks. The 2026 data demonstrate that job tasks have converged into more cohesive factors. Most importantly, the CFA fit indices provide a clear mandate for measurement of parsimony; the finding that a 3-item-per-factor model achieves “great fit” while the full model fails indicates that the core methodology of life care planning is best defined by a streamlined set of high-impact competencies.

A notable finding in the 2020 study was the significant differences between Certified Nurse Life Care Planners (CNLCPs) and other planners (CLCPs^®) in areas like litigation support and vocational tasks, attributed to differing clinical scopes of practice. However, the 2026 results show high p-values (p > 0.05) across gender, education, and clinical field. This suggests that the transdisciplinary “commonality” has strengthened. The standardized 120-hour pre-certification training likely acts as a unifying agent, ensuring that regardless of a practitioner’s original discipline, be it medicine, nursing, or counseling, they adopt a unified methodological approach.

The significant difference found regarding office staff/subcontractors (p = 0.0034) highlights a critical business reality. Planners who delegate tasks like medical review or costing research to staff perceive “cruciality” and frequency of those tasks differently than solo practitioners. This suggests that while the methodology is universal, the execution varies based on the business model. Similarly, the significant impact of experience (p = 0.0071) on factor score suggests that methodological mastery, particularly in “Needs Assessment”, is a developmental process that matures over years of practice.

Summary

This study successfully utilized data from 257 transdisciplinary practitioners to provide empirical validation for the life care planning model. Through a dual-stage analysis of 219 methodological questions, the research established an exceptionally high reliability coefficient of 0.988. The identification of an 11-factor latent structure, reinforced by “great” CFA fit indices for a parsimonious model, offers the first statistically sound roadmap for the profession. While operational differences exist based on experience and staffing models, the overarching consensus across clinical fields proves that life care planning has reached professional maturity as a unified transdisciplinary science.

Conclusion

The statistical validation provided by this research has profound implications for the future of life care planning standards, training, and practice.

Standardization of Practice: Life care planning methodology has moved beyond anecdotal “consensus statements” to a peer-reviewed, statistically validated framework. The high level of consensus across diverse clinical backgrounds confirms that the methodology is universal and defensible.
Implementation of Parsimony: The superior fit of the parsimonious model suggests that the ICHCC^® and training programs should adopt the reduced 4-item-per-factor scale as the blueprint for evaluating core competencies. This reduces respondent burden while increasing the statistical validity of the assessment process.
Refinement of Training Curricula: Training programs should use these 11 factors to prioritize their curricula, focusing on high-loading items that define “Care Plan Development” and “Needs Assessment”. Furthermore, the significant impact of office staffing on factor perception suggests that training should expand to include business management and delegation strategies.

By adopting this validated methodological roadmap, life care planners can ensure that their plans are not only thorough and consistent but are anchored in a scientifically rigorous foundation that withstands the scrutiny of both medical and legal environments.

About the Authors

Virgil R. May III, Rh.D.

V. Robert May III received his doctorate in rehabilitation from Southern Illinois University-Carbondale and is currently the President of the International Commission on Health Care Certification^™ (ICHCC^®) and the Richmond Functional Performance Lab, Inc. He taught functional capacity evaluation and impairment rating protocols at the University of Florida - Gainesville in UF Health Shands Hospital, the Department of Rehabilitation from the fall of 1992 through the fall semester of 1996. He served as an adjunct professor in the Department of Rehabilitation, Rehabilitation Institute, Southern Illinois University, where he oversaw validation research studies of the NADEP functional capacity evaluation protocols and life care plan certification examination. Dr. May served on the Faculty of the National Association of Disability Evaluating Professionals. He instructed physicians, therapists, and vocational evaluators in impairment rating and functional capacity evaluation protocols in major training sites in Canada and the United States. He maintains an outpatient functional capacity evaluation practice in the Richmond, Virginia area that he has maintained over the past 40 years.
He served as a junior partner from 1999 to 2012 in his local therapy business, which traded as May Physical Therapy Services, LLC, which offered physical/aquatic therapy services, massage therapy, strength and conditioning training, and work disability/functional capacity evaluations. In addition to the therapy and evaluation businesses, he has consulted with the Coca-Cola Bottling Company, Overnight Transportation, Inc., and the Washington, D.C. Metropolitan Transit Authority regarding analyzing their jobs to ensure compliance with the Americans with Disabilities Act of 1990. Dr. May has lectured in China, Canada, and the United States on measuring work function, and has authored over 70 peer-reviewed journal articles and book chapters on industrial rehabilitation and Federal/State legislation governing occupational medicine practices. His most recent invited lectures were with the American Rehabilitation Economics Association in October of 2021 titled, Functional Capacity Evaluation Explained, and with the University of Wisconsin – Stout Vocational Rehabilitation Institute (SVRI), where he presented his lecture on the Functional Capacity Evaluation for the Vocational Evaluator and Rehabilitation Case Manager on January 24, 2022. His first textbook, NADEP Guide to Functional Capacity Evaluation with Impairment Rating Applications, was published in 1999 and is co-authored by Dr. Michael Martelli. His current textbook, as senior author, co-authored with Richard Bowman, M.D., and Stephen Barna, M.D., (Eds.) titled Routledge Handbook of Medical Aspects of Disability and Rehabilitation for Life Care Planning (2024). He holds certification as a Certified Disability Evaluator, Category II, and as a Certified Rehabilitation Provider, Commonwealth of Virginia.

Huma Haider, M.D., CLCP^®

Huma Haider, MD, is a physician and ICHCC^®-Certified Life Care Planner with fellowship training in Brain Injury Medicine and Neurocritical Care. She is board-certified in Internal Medicine, Anesthesiology, Neurocritical Care, Headache Medicine, and Interventional Headache Medicine, and holds a Master’s Degree in General Psychology. As Medical Director of the National Brain Injury Institute, Dr. Haider specializes in evaluating complex neurological injuries, long-term disability, rehabilitation needs, and future medical and supportive care. She is also a published author in the field of life care planning.
Professional Affiliations
Medical Director, National Brain Injury Institute (NBII)
ICHCC^®-Certified Life Care Planner^™
Independent Medical Examiner
Fellowship-Trained in Brain Injury Medicine and Neurocritical Care
Board Certified in Internal Medicine
Board Certified in Anesthesiology
Board Certified in Neurocritical Care
Board Certified in Headache Medicine
Board Certified in Interventional Headache Medicine
Master’s Degree in General Psychology
Contributor, Handbook of Medical Aspects of Disability and Rehabilitation for Life Care Planning

Hossein Moradi Rekabdarkolaee, Ph.D.

Hossein Moradi Rekabdarkolaee is a Novak Family Associate Professor in Data Science at Bowling Green State University. His research interests include Dimension Reduction, Functional Data Analysis, Machine Learning, Multivariate Analysis, Spatial and Spatiotemporal Statistics, and Variable Selection. To date, Dr. Moradi Rekabdarkolaee’s research has primarily focused on environmental, healthcare, precision agriculture, and electrical engineering applications. His research has led to more than 60 peer-reviewed publications and delivered more than 30 invited talks at different departmental, national, and international conferences.

Louis P. Lipinski, Jr., M.S., CRC, LRC, CLCP®, IPEC, FVE

Since 1983, Mr. Lipinski has operated Lipinski and Associates LLC, a Baton Rouge vocational consulting practice serving attorneys, insurers, self-insured entities, government agencies, hospitals, and individuals. Services include vocational assessment, planning and counseling; job-search training, labor market surveys, and placement; litigation support and expert testimony; and Americans with Disabilities Act consultation.
During more than 40 years in the field, Mr. Lipinski has qualified as an expert in vocational rehabilitation and/or certified life care planning in Louisiana, Florida, Mississippi, and Texas courts.
Professional Affiliations

Master’s Degree in Psychology from the University of Louisiana - Lafayette
CRCC - Certified Rehabilitation Counselor
LRC- Louisiana Certified Rehabilitation Counselor and Commissioner
ICHCC^® – Certified Life Care Planner and Commissioner
ABVE - International Psychometric Evaluation Certification (IPEC)
AREA - Forensic Vocational Expert (FVE’22)

Bob A. Gisclair, CCM, CDMS, CLCP^®, CMSP, CRC, LPC, LRC, MSCC^®, FIALCP

Bob A. Gisclair is the owner/operator of Bob A. Gisclair and Associates, Inc. He holds a Master’s Degree in Vocational Rehabilitation Counseling and a Bachelor’s Degree in Psychology. Advanced credentials include Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Certified Life Care Planner™ (CLCP^®), Certified Medicare Secondary Payor (CMSP), Nationally Certified Rehabilitation Counselor (CRC),
Licensed Professional Counselor (LPC), Licensed Rehabilitation Counselor (LRC), Medicare Set-Aside Certified Consultant™ (MSCC^®). He has been published and is recognized as an expert witness in the fields of Life Care Planning and Vocational Rehabilitation in local and federal court. He also serves as a Commissioner as well as serving on numerous committees for the International Commission on Health Care Certification^™ (ICHCC^®) for CLCP^® credentials. He served on the board for the International Academy of Life Care Planners, is a former member of the Licensed Professional Vocational Rehabilitation Counselors Board of Examiners, a past board member of the Louisiana Association of Rehabilitation Providers in the Private Sector, and has served on various committees at the request of three Louisiana Governors. He has served as a past volunteer for CASA and currently is a wish granter for the Make-A-Wish Foundation.

Cornelius E. Gorman, Ph.D.

Cornelius E. Gorman II, BSS, MSW, PhD, CLCP^® hails from New Orleans, Louisiana. He attended Tulane, Loyola, and Regis Universities as well as the University of Southern Mississippi. He received tenure in 1976 as chairman of the department of vocational rehabilitation at Delgado Community College in New Orleans, LA, where he stayed until 1979. He has served as a visiting lecturer and subject matter expert in life care planning for Howard University Graduate School of Law since 2014 and has served as a Shriners Hospitals for Children Board member. He was a Regis University President’s council member and held appointed and elected positions in organizations serving the interests of special needs populations. He has also been active in service to others through the Rotary organization since 1966.
Dr. Gorman is a U.S. Army Vietnam-era veteran since enlistment in 1968, commissioned in 1981 and founded Conservant Healthcare, LLC in 1975. His career spans over 52 years, and he has been licensed and/or board-certified in social work, counseling, rehabilitation counseling, vocational evaluation, disability determination, and law enforcement employment examination. He was first qualified as an expert witness in 1975 and has since testified in administrative, state, and federal cases about vocational rehabilitation, life care planning and medical cost analysis on more than two thousand occasions.
He is an ICHCC^®-certified life care planner, an appointed ICHCC^® commissioner, and an ordained minister of the gospel/officiant working with special-needs populations. He was certified as a ScentEvidence-K9 handler in 2019 and founded Conservant Search and Rescue in conjunction with the Bringing the Lost Home Project for the benefit of children with autism and adults with dementia. He is a certified pilot, professional collaborative musician (organist-pianist), and is an advisor to the Brookwood Community in Brookshire, TX.

A. Heather Howe, P.T., CCLCP^™

Heather has been a licensed physiotherapist in the province of New Brunswick, Canada, since 1994, after graduating from McGill University. Heather has clinical experience in both public and private settings with particular expertise in the areas of chronic pain, amputation, and functional evaluations. Heather completed her certification as a Canadian Certified Life Care Planner^™ with the ICHCC^® in 2020 and currently sits as a Certified Life Care Planner^™ Board Commissioner for the ICHCC^®. Heather is a published author in the field of life care planning.

Dena Ramsey, JD, MBA, BSN, CLCP^®, MSCC^®, CMCPS^®, LNCC

Dena Ramsey is the Vice President of Medical and Legal Operations at MD Data. She holds a Bachelor’s Degree in Nursing, an MBA in Healthcare Management, and a Juris Doctorate concentrated in Health Law, bringing a unique interdisciplinary perspective to the medical-legal field. Advanced credentials include Medicare Set-Aside Certified™ (MSCC^®), Certified Life Care Planner^™ (CLCP^®), Certified Medical Cost Projection Specialist^™ (CMCPS^®), and Legal Nurse Consultant Certified (LNCC). She has been published and is a recognized speaker, as well as a Commissioner for the International Commission on Health Care Certification^™ (ICHCC^®) for both the MSCC^® and CLCP^® credentials and serves as inaugural President for the Association of Certified Life Care Planners.

Kathleen Kenney May, M.S.

Kathleen Kenney May is a graduate of Indiana University with a Bachelor’s Degree in education and earned her Master’s Degree in rehabilitation administration, counseling, and services from Southern Illinois University—Carbondale. Ms. May worked for several years as a placement and rehabilitation counselor for the Illinois Department of Rehabilitation Services and was recognized by the governor for her work regarding the International Year of the Disabled. Upon relocating to Richmond, Virginia, she launched a new department for the Children’s Hospital titled the Career Development Department, where she worked with older patients to determine their career goals and interests. Along with her husband, she started May Physical Therapy Services, overseeing five outpatient rehabilitation clinics in the Richmond area. Ms. May is currently the Business Operations Administrator for the International Commission on Health Care Certification^™ (ICHCC^®) and is one of the cofounders of the ICHCC^®.

Submitted: October 02, 2026 EDT

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Appendices

Appendix A

Scored Survey Instrument by Participant Percentages Reviewed by Subject Matter Expert Committee for Item Quality and Fit

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

1. Gender

182 70.82% Female

75 29.18% Male

2. Age in Years

68	26.46%	56 - 65
64	24.90%	46 - 55
61	23.74%	36 - 45
53	20.62%	Over 65
10	3.89%	26 - 35
1	0.39%	20 - 25

3⁠. Formal Education/Degree - Check all that Apply

95	24.74%	Bachelor's Degree - Other
70	18.23%	Master's Degree- Rehab/Psych
67	17.45%	Other:
32	8.33%	Medical Doctor (M.D.)
29	7.55%	Bachelor's Degree RN (BSN)
13	3.39%	Associate’s degree RN
13	3.39%	Master's Degree RN
12	3.13%	Doctor of Philosophy (Ph.D.)
11	2.86%	Doctor of Osteopathy (D.O.)
9	2.34%	Diploma Nurse RN
7	1.82%	Juris Doctor (J.D.)
6	1.56%	Master of Social Work (MSW)
5	1.30%	Bachelor's Degree Rehabilitation Counseling/Vocational Evaluation/Job Placement
5	1.30%	Doctor of Physical Therapy (DPT)
4	1.04%	Doctor of Chiropractic (D.C.)
2	0.52%	Doctor of Occupational Therapy
1	0.26%	Ed.D. Adult Development
1	0.26%	Hon OT
1	0.26%	PhD
1	0.26%	WCC

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

4. Primary Clinical Fields of Practice - Check all that Apply

223	38.45%	Life Care Planning
87	15.00%	Case Management
62	10.69%	Rehabilitation Counseling
54	9.31%	Occupational Therapy
45	7.76%	Medicine
33	5.69%	Nursing
31	5.34%	Other:
18	3.10%	Counseling
12	2.07%	Physical Therapy
7	1.21%	Social Work
4	0.69%	Marriage and Family Counseling
3	0.52%	Psychology/Neuropsychological
1	0.17%	Speech-Language Pathology

5⁠. Licensed, Registered, and/or Certified as a: (Check all that Apply)

188	30.62%	CLCP^®
63	10.26%	Other:
61	9.93%	CCLCP^TM
55	8.96%	CRC
52	8.47%	OT
48	7.82%	CCM
31	5.05%	RN
14	2.28%	CDMS
13	2.12%	CVE
13	2.12%	MSCC
12	1.95%	LPC
10	1.63%	ABVE
10	1.63%	PT
9	1.47%	CRRN
8	1.30%	CNLCP
6	0.98%	FIALCP
6	0.98%	LNCC
5	0.81%	ABDA
2	0.33%	CMCPS
2	0.33%	NCC
1	0.16%	CLNC
1	0.16%	CPDM
1	0.16%	Fellow Academy of Emergency Nurses
1	0.16%	LMHC
1	0.16%	LRC
1	0.16%	PMHNP-BC

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

6. Current Practice Setting: (Check all that Apply)

79	22.07%	Owner/Independent Practice without Employees
70	19.55%	Owner/Independent Practice with Employees
61	17.04%	Owner S, C or LLC Corporation
49	13.69%	Private Rehabilitation Company as an Employee
27	7.54%	Hospital
21	5.87%	Other:
18	5.03%	Rehabilitation Facility/Setting
13	3.63%	Corporation
8	2.23%	Insurance Company
6	1.68%	Attorney's Office
5	1.40%	Educational Setting
1	0.28%	and at a private practice as an employee.

7⁠. Life Care Planning Activities Constitute Approximately ____ of My Work Activities

85	33.07%	76 - 100%
76	29.57%	1 - 25%
53	20.62%	51 - 75%
41	15.95%	26 - 50%
2	0.78%	None

8⁠. Provide Life Care Planning Services on a ____ Level

115	44.75%	National
87	33.85%	Regional (e.g., statewide/Province)
31	12.06%	Local (e.g., city and surrounding counties)
24	9.34%	International

9⁠. Population to Whom You Provide LCP Services (Check all that Apply)

231	12.01%	Acquired Brain Injury
229	11.91%	Orthopaedic Conditions
216	11.23%	Spinal Cord Injuries
201	10.45%	Amputations
197	10.24%	Non-Catastrophic Injuries
185	9.62%	Psychological/Psychiatric Conditions
162	8.42%	Chronic Diseases (e.g., MS, Diabetes, Chronic Pain, Cancer)
148	7.70%	Birth Injuries/Anoxia
140	7.28%	Burns
119	6.19%	Developmental Disabilities
78	4.06%	Organ Transplants
16	0.83%	Other:
1	0.05%	could be linked to any of the above

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

10. Office Staff/Subcontractors who assist you with the development of the Life Care Plan

157 61.09% Yes

100 38.91% No

11. If Yes, Which activities do the Office Staff/Subcontractors Perform? (Check all that Apply)

125	22.52%	Costing Research
100	18.02%	Verbal Correspondence
97	17.48%	Written Correspondence
96	17.30%	Medical Review
76	13.69%	Research for Supporting Recommendations
61	10.99%	Report Development

12. Based on your life care planning 120-hour training plus your experience, the Receipt of Referral is a significant methodological step in the life care planning process

144	56.03%	Strongly Agree
76	29.57%	Agree
26	10.12%	Neutral
9	3.50%	Disagree
2	0.78%	Strongly Disagree

13. The Receipt of Referral is a good step to confirm no conflict of interest, review information provided, and communicate with the referral source for clarification

180	70.04%	Strongly Agree
70	27.24%	Agree
5	1.95%	Neutral
2	0.78%	Disagree

14. The Receipt of Referral is a good step to include a review with the referral source of the projected due date of the report, fees, expectations, review of the LCP process, and completeness of submitted records

174	67.70%	Strongly Agree
73	28.40%	Agree
8	3.11%	Neutral
1	0.39%	Disagree
1	0.39%	Strongly Disagree

15. The Review of the Files step is considered to be a primary methodological step in the life care planning methodological process

199	77.43%	Strongly Agree
53	20.62%	Agree
4	1.56%	Neutral
1	0.39%	Disagree

16⁠. The Review of Files allows me to put the provided documents in a preferred order, such as, chronological, reverse chronology, or by record type.

172	66.93%	Strongly Agree
72	28.02%	Agree
11	4.28%	Neutral
2	0.78%	Disagree

17⁠. The Scheduled Assessment substation refers to the life care planner’s initial communication with the person with injury who is the subject of the life care plan and is therefore an important substation of the life care planning methodology.

152	59.14%	Strongly Agree
81	31.52%	Agree
21	8.17%	Neutral
3	1.17%	Disagree

18⁠⁠⁠. The Scheduled Assessment may include an initiated introduction by the life care planner to the injured person, an explanation of the purpose of the call, an explanation of the assessment and time allotted to completed the assessment, a confirmation of mutually agreeable assessment date and time, a confirmation of address and directions, a confirmation of other persons being present during the assessment, answering any questions the person with injury may have, and a reminder to the client of the upcoming appointment via email or telephone and to confirm the date that is still appropriate to proceed

175	68.09%	Strongly Agree
73	28.40%	Agree
8	3.11%	Neutral
1	0.39%	Disagree

19. Conducting the Assessment is a significant methodological substation in the life care planning process. This substation may include a repeated introduction of the life care planner to the person with injury, the life care planner’s review of the purpose of the assessment with the person with injury, an opportunity for the person with injury to ask any questions prior to proceeding, have the person with injury complete the required consent forms, review the medical history to date with the person with injury for accuracy, review pre-accident medical and other conditions developed since the event

189 73.54% Strongly Agree

59 22.96% Agree

9 3.50% Neutral

20. When conducting the Assessment, it is important to gather information regarding education/vocational history that may include highest level of education completed, job title, employer, number of hours/shifts, physical demands, workplace accommodations, relationship with employer, and barriers to returning to work.

155	60.31%	Strongly Agree
80	31.13%	Agree
20	7.78%	Neutral
2	0.78%	Disagree

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

21. Conducting the Assessment requires the life care planner to gather information on current physical symptoms that may include the person with injury completing a body diagram, documenting symptom location and symptom descriptors, the pain intensity levels, frequency of pain (intermittent versus constant), duration, aggravating factors, alleviating factors, clinical course since the event, clinical course over the last 6-month period.

182	70.82%	Strongly Agree
61	23.74%	Agree
11	4.28%	Neutral
3	1.17%	Disagree

22⁠. The life care planner Conducting the Assessment is responsible for gathering current cognitive symptoms that may include symptom descriptors, intensity of pain, frequency (intermittent versus constant), duration, aggravating factors, alleviating factors, clinical course since event, and clinical course over the last 6-month period.

175	68.09%	Strongly Agree
68	26.46%	Agree
13	5.06%	Neutral
1	0.39%	Disagree

23⁠⁠. The life care planner Conducting the Assessment is responsible for gathering information on current emotional symptoms that may include symptom descriptors, intensity of pain, frequency (intermittent versus constant), duration, aggravating factors, alleviating factors, clinical course since event, and clinical course over the last 6-month period.

170	66.15%	Strongly Agree
73	28.40%	Agree
13	5.06%	Neutral
1	0.39%	Disagree

24. The life care planner Conducting the Assessment is responsible for gathering information on current/ongoing treatment in terms of the diagnosis(es) of the person with injury, frequency of treatment, treatment goals, effect of treatment, last visit date, and the next visit date.

182 70.82% Strongly Agree

62 24.12% Agree

13 5.06% Neutral

25. The life care planner Conducting the Assessment is responsible for gathering information on current medications that include the name of the medications, the dosage level, and the expected effects of medications, as well as any side-effects expressed by the person with injury.

184 71.60% Strongly Agree

64 24.90% Agree

9 3.50% Neutral

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

26. The life care planner Conducting the Assessment gathers information on the person with injury’s perceived functional abilities that may include sitting, standing, walking, lifting/carrying, pushing/pulling, bending, crouching/kneeling, stooping, stair climbing, reaching, handling, and finger dexterity.

176	68.48%	Strongly Agree
72	28.02%	Agree
8	3.11%	Neutral
1	0.39%	Disagree

27. The life care planner Conducting the Assessment gathers information on social/leisure activities pre-accident and post-accident

170 66.15% Strongly Agree

79 30.74% Agree

8 3.11% Neutral

28. When Conducting the Assessment, the life care planner gathers information on the person with injury’s ability to perform the activities of daily living, which may include bathing, toileting, grooming, dressing, transferring, ambulating, and eating.

194 75.49% Strongly Agree

57 22.18% Agree

6 2.33% Neutral

29. When Conducting the Assessment, the life care planner gathers information on ability to perform

Instrumental Activities of Daily Living by comparing responsibility versus capability before and after the injury event.

185	71.98%	Strongly Agree
65	25.29%	Agree
6	2.33%	Neutral
1	0.39%	Disagree

30⁠. Instrumental Activities of Daily Living include Daily Tasks, Weekly Tasks, Monthly Tasks, and Outdoor Household Maintenance.

173	67.32%	Strongly Agree
70	27.24%	Agree
11	4.28%	Neutral
2	0.78%	Disagree
1	0.39%	Strongly Disagree

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

31. Daily Tasks involved in Conducting the Assessment include meal preparation, meal clean-up, tidying, bed making, childcare, pet care, managing finances, and managing medications.

171	66.54%	Strongly Agree
72	28.02%	Agree
10	3.89%	Neutral
3	1.17%	Disagree
1	0.39%	Strongly Disagree

32⁠. Weekly Tasks in Conducting the Assessment include sweeping, vacuuming, washing floors, cleaning the bathroom, dusting, changing bed sheets, laundry, taking out the garbage, and grocery shopping.

166	64.59%	Strongly Agree
72	28.02%	Agree
15	5.84%	Neutral
3	1.17%	Disagree
1	0.39%	Strongly Disagree

33⁠⁠. Monthly Tasks in Conducting the Assessment include cleaning appliances, cleaning windows, cleaning walls, cleaning blinds or curtains, cleaning light fixtures and fans, and arranging small indoor repairs.

136	52.92%	Strongly Agree
87	33.85%	Agree
27	10.51%	Neutral
6	2.33%	Disagree
1	0.39%	Strongly Disagree

34⁠. Outdoor Household Maintenance as applied to Conducting the Assessment includes small outdoor repairs, gardening, lawn mowing, spring/fall clean-up, and snow removal.

155	60.31%	Strongly Agree
85	33.07%	Agree
16	6.23%	Neutral
1	0.39%	Disagree

35⁠. The life care planner Conducting the Assessment presents to the person with injury consent forms to be signed allowing the life care planner to contact pertinent collateral interviews with family members, friends or no medical personnel, and consultations with medical personnel currently involved with the person with injury.

172	66.93%	Strongly Agree
50	19.46%	Agree
25	9.73%	Neutral
8	3.11%	Disagree

36⁠. The life care planner Conducting the Assessment completes the interview with an estimated time frame and the next steps outlined to include conducting collateral interviews, conducting consultations, begin writing the report, and arrange a follow-up with person with injury to review gathered information and fill in any blanks, and invite the person with injury to ask any other questions before closing the interview.

160	62.26%	Strongly Agree
68	26.46%	Agree
22	8.56%	Neutral
7	2.72%	Disagree

37⁠. The Collateral Interviews substation is a significant substation step in the life care planning process.

104	40.47%	Agree
87	33.85%	Strongly Agree
57	22.18%	Neutral
9	3.50%	Disagree

38⁠. With the person with injury’s consent, the life care planner may communicate via telephone or email with those persons close to the client that can provide a perspective into future care needs.

116	45.14%	Strongly Agree
115	44.75%	Agree
25	9.73%	Neutral
1	0.39%	Disagree

39⁠. Explain the purpose of the interview

152	59.14%	Strongly Agree
85	33.07%	Agree
19	7.39%	Neutral
1	0.39%	Disagree

40⁠⁠. Confirm date and time of the interview by phone, in-person, or virtual

139	54.09%	Strongly Agree
90	35.02%	Agree
27	10.51%	Neutral
1	0.39%	Disagree

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

41. Conduct the interview with a primary focus of the injured client’s ability to function independently before and after the injury event and ask about current functional changes.

149	57.98%	Strongly Agree
87	33.85%	Agree
19	7.39%	Neutral
2	0.78%	Disagree

42⁠⁠. Complete Consultations are a significant substation step in the life care planning process

159	61.87%	Strongly Agree
68	26.46%	Agree
29	11.28%	Neutral
1	0.39%	Disagree

43⁠. With the person with injury’s consent, communicate via telephone or email with current treatment providers

165	64.20%	Strongly Agree
71	27.63%	Agree
18	7.00%	Neutral
3	1.17%	Disagree

44. Explain the purpose of the interview

179 69.65% Strongly Agree

64 24.90% Agree

14 5.45% Neutral

45. Confirm date and time of interview by phone, in-person, or virtual.

166	64.59%	Strongly Agree
71	27.63%	Agree
19	7.39%	Neutral
1	0.39%	Strongly Disagree

46⁠. Conduct interview with focus on treatments and progress to date and future recommendations

177	68.87%	Strongly Agree
64	24.90%	Agree
14	5.45%	Neutral
2	0.78%	Disagree

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

47. Summarize consultations and get agreement from provider

163	63.42%	Strongly Agree
69	26.85%	Agree
23	8.95%	Neutral
2	0.78%	Disagree

48⁠. Pay invoice for time spent with provider if required (reimbursed by referral source or included as expense in invoice submitted with report).

133	51.75%	Strongly Agree
79	30.74%	Agree
32	12.45%	Neutral
11	4.28%	Disagree
2	0.78%	Strongly Disagree

49⁠. Research is a significant substation step in the life care planning process

182	70.82%	Strongly Agree
65	25.29%	Agree
9	3.50%	Neutral
1	0.39%	Disagree

50. Begin relevant research of best practices specific to client’s diagnoses and future needs

169 65.76% Strongly Agree

74 28.79% Agree

14 5.45% Neutral

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

51. Report Writing is the Primary Methodological Station in the Life Care Planning Process

169	65.76%	Strongly Agree
67	26.07%	Agree
19	7.39%	Neutral
2	0.78%	Disagree

52. Prepare template with client information and referral source information as well as pertinent dates of event, date of assessment, and date of the report.

162 63.04% Strongly Agree

84 32.68% Agree

11 4.28% Neutral

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

53. In the report, compile information gathered from interview

191 74.32% Strongly Agree

63 24.51% Agree

3 1.17% Neutral

54. In the report, compile information gathered from collateral interviews

55⁠. In the report, compile information gathered at consultations

166	64.59%	Strongly Agree
73	28.40%	Agree
17	6.61%	Neutral
1	0.39%	Disagree

184 71.60% Strongly Agree

65 25.29% Agree

8 3.11% Neutral

56. In the report, compile perceived functional deficits/capabilities in comparison to assessed function.

171	66.54%	Strongly Agree
71	27.63%	Agree
9	3.50%	Neutral
6	2.33%	Disagree

57⁠. Analyze information gathered and medical file to write a Medical Foundation that should include medical opinions from medical providers/physicians and specialists.

189	73.54%	Strongly Agree
60	23.35%	Agree
7	2.72%	Neutral
1	0.39%	Disagree

58⁠. Analyze information gathered and medical file to write a Rehabilitation Foundation that includes rehabilitation services to date with ongoing efforts to achieve rehab goals.

166	64.59%	Strongly Agree
72	28.02%	Agree
16	6.23%	Neutral
2	0.78%	Strongly Disagree
1	0.39%	Disagree

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

59. Analyze information gathered and medical file to write a Psychological Foundation that includes psychological opinions from psychiatrists and psychologists

60⁠. Begin writing and researching client needs based on gathered information, medical file, and relevant research.

164	63.81%	Strongly Agree
71	27.63%	Agree
19	7.39%	Neutral
2	0.78%	Disagree
1	0.39%	Strongly Disagree

191 74.32% Strongly Agree

59 22.96% Agree

7 2.72% Neutral

61. Research may include Projected Evaluations

183 71.21% Strongly Agree

68 26.46% Agree

6 2.33% Neutral

62. Research may include Projected Therapeutic Modalities

184 71.60% Strongly Agree

69 26.85% Agree

4 1.56% Neutral

63. Research may include Wheelchair Needs

186 72.37% Strongly Agree

65 25.29% Agree

6 2.33% Neutral

64. Research may include Wheelchair Accessories and Maintenance

186 72.37% Strongly Agree

66 25.68% Agree

5 1.95% Neutral

65. Research may include Aides for Independent Living

187 72.76% Strongly Agree

66 25.68% Agree

4 1.56% Neutral

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

66. Research may include Orthotics/Prosthetics

187 72.76% Strongly Agree

65 25.29% Agree

5 1.95% Neutral

67. Research may include Aids for Symptom Management

185 71.98% Strongly Agree

67 26.07% Agree

5 1.95% Neutral

68. Research may include Medications and Supply Needs

189 73.54% Strongly Agree

64 24.90% Agree

4 1.56% Neutral

69. Research may include Transportation

184	71.60%	Strongly Agree
66	25.68%	Agree
6	2.33%	Neutral
1	0.39%	Disagree

70⁠. Research may include Health and Strength Management

173	67.32%	Strongly Agree
72	28.02%	Agree
11	4.28%	Neutral
1	0.39%	Disagree

71. Research may include Housing Considerations/Architectural Renovations

184 71.60% Strongly Agree

65 25.29% Agree

8 3.11% Neutral

72. Research may include Future Medical Care or Surgical Intervention

188 73.15% Strongly Agree

64 24.90% Agree

5 1.95% Neutral

73. Research may include Orthopaedic Equipment Needs

190 73.93% Strongly Agree

64 24.90% Agree

3 1.17% Neutral

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

74. Research may include a Vocational/Education Plan

173	67.32%	Strongly Agree
66	25.68%	Agree
15	5.84%	Neutral
3	1.17%	Disagree

75. Research may identify Loss of Valuable Services, such as Home Care/Attendant Care/Facility Care, Home Maintenance that includes house cleaning, lawn care, handyman services, and snow removal.

180 70.04% Strongly Agree

67 26.07% Agree

10 3.89% Neutral

76. Research may include Potential Complications

156	60.70%	Strongly Agree
77	29.96%	Agree
19	7.39%	Neutral
3	1.17%	Disagree
2	0.78%	Strongly Disagree

77⁠⁠. Report Review is a secondary methodological Station in the Life Care Planning Process

134	52.14%	Strongly Agree
91	35.41%	Agree
27	10.51%	Neutral
5	1.95%	Disagree

78. Complete a final review of the report paying particular attention to details

188 73.15% Strongly Agree

55 21.40% Agree

14 5.45% Neutral

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

79. Add to invoice travel and mileage, duration of communications with providers, family members, friend, research, etc.

133	51.75%	Strongly Agree
91	35.41%	Agree
26	10.12%	Neutral
6	2.33%	Disagree
1	0.39%	Strongly Disagree

81⁠. Invoice is a secondary Methodological Station in the Life Care planning Process

106	41.25%	Agree
81	31.52%	Strongly Agree
59	22.96%	Neutral
8	3.11%	Disagree
3	1.17%	Strongly Disagree

82⁠. Report Delivery is a secondary Methodological Station in the Life Care Planning Process

114	44.36%	Strongly Agree
97	37.74%	Agree
39	15.18%	Neutral
4	1.56%	Strongly Disagree
3	1.17%	Disagree

83⁠. Save report in PDF format with protected password

118	45.91%	Strongly Agree
73	28.40%	Agree
55	21.40%	Neutral
10	3.89%	Disagree
1	0.39%	Strongly Disagree

84⁠. Send report and invoice to referral source via specified instructions (email, postal, hand-carried, or fax)

148	57.59%	Strongly Agree
88	34.24%	Agree
20	7.78%	Neutral
1	0.39%	Disagree

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

85. Based on your life care planning 120-hour training plus your experience, the Receipt of Referral may be a crucial methodological step in the life care planning process

134	52.14%	Strongly Crucial
90	35.02%	Crucial
29	11.28%	Neutral
2	0.78%	Not Crucial
2	0.78%	Strongly Not Crucial

86⁠. The Receipt of Referral may be a crucial step to confirm no conflict of interest, review information provided, and communicate with the referral source for clarification

164	63.81%	Strongly Crucial
84	32.68%	Crucial
8	3.11%	Neutral
1	0.39%	Not Crucial

87. The Receipt of Referral may be a crucial step to include a review with the referral source the projected due date of the report, fees, expectations, review of the LCP process, and completeness of submitted records

154	59.92%	Strongly Crucial
92	35.80%	Crucial
9	3.50%	Neutral
2	0.78%	Not Crucial

88. The Review of the Files step is considered a crucial or maybe a crucial methodological step in the life care planning methodological process

194 75.49% Strongly Crucial

56 21.79% Crucial

7 2.72% Neutral

89. The Review of Files may be a crucial methodological step when putting the provided documents in a preferred order, such as chronological, reverse chronology, or by record type.

144	56.03%	Strongly Crucial
84	32.68%	Crucial
24	9.34%	Neutral
5	1.95%	Not Crucial

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

90. The Scheduled Assessment substation refers to the life care planner’s initial communication with the person with injury who is the subject of the life care plan and therefore may be a substation of the life care planning methodology.

130	50.58%	Strongly Crucial
92	35.80%	Crucial
34	13.23%	Neutral
1	0.39%	Not Crucial

91⁠. The Scheduled Assessment may be crucial to life care planning methodology when an initiated introduction by the life care planner to the person with injury is offered, or an explanation of the purpose of the call, an explanation of the assessment and time allotted to complete the assessment, a confirmation of mutually agreeable assessment date and time, a confirmation of address and directions, a confirmation of other persons being present during the assessment, answering any questions the person with injury may have, and/or a reminder to the person with injury of the upcoming appointment via email or telephone and to confirm the date is still appropriate to proceed.

146	56.81%	Strongly Crucial
88	34.24%	Crucial
21	8.17%	Neutral
2	0.78%	Not Crucial

92. Conducting the Assessment may be a crucial methodological substation in the life care planning process. This substation may include a repeated introduction of the life care planner to the person with injury, the life care planner’s review of the purpose of the assessment with the person with injury, an opportunity for the person with injury to ask any questions prior to proceeding, have the person with injury complete the required consent forms, review the medical history to date with the client for accuracy, review pre-accident medical and other conditions developed since the event.

177 68.87% Strongly Crucial

66 25.68% Crucial

14 5.45% Neutral

93. When Conducting the Assessment, it may be crucial to gather information regarding education/Vocational history that may include highest level of education completed, job title, employer, number of hours/shifts, physical demands, workplace accommodations, relationship with employer, and barriers to returning to work.

128	49.81%	Strongly Crucial
97	37.74%	Crucial
29	11.28%	Neutral
3	1.17%	Not Crucial

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

94. Conducting the Assessment may require the life care planner to gather crucial information on current physical symptoms that may include the person with injury completing a body diagram, documenting symptom location and symptom descriptors, the pain intensity levels, frequency of pain (intermittent versus constant), duration, aggravating factors, alleviating factors, clinical course since the event, clinical course over the last 6-month period.

164	63.81%	Strongly Crucial
78	30.35%	Crucial
14	5.45%	Neutral
1	0.39%	Not Crucial

95⁠. When Conducting the Assessment, the life care planner may or may not realize that it could be crucial to document current cognitive symptoms that may include symptom descriptors, intensity of pain, frequency (intermittent versus constant), duration, aggravating factors, alleviating factors, clinical course since event, and clinical course over the last 6-month period.

164	63.81%	Strongly Crucial
72	28.02%	Crucial
19	7.39%	Neutral
2	0.78%	Not Crucial

96⁠. The life care planner Conducting the Assessment may or may not realize that it may be crucial to gather information on current emotional symptoms that may include symptom descriptors, intensity of pain, frequency (intermittent versus constant), duration, aggravating factors, alleviating factors, clinical course since event, and clinical course over the last 6-month period.

161	62.65%	Strongly Crucial
74	28.79%	Crucial
19	7.39%	Neutral
3	1.17%	Not Crucial

97⁠. The life care planner Conducting the Assessment may or may not consider crucial the gathering of information on current/ongoing treatment in terms of provider’s discipline, frequency of treatment, treatment goal, effect of treatment, last visit date, and the next visit date.

168	65.37%	Strongly Crucial
76	29.57%	Crucial
10	3.89%	Neutral
2	0.78%	Not Crucial
1	0.39%	Strongly Not Crucial

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

98. The life care planner Conducting the Assessment may or may not consider crucial the documentation of information on current medications that include the name of the medications, the dosage level, and the expected effects of medications, as well as any side-effects expressed by the person with injury.

]

174	67.70%	Strongly Crucial
69	26.85%	Crucial
11	4.28%	Neutral
2	0.78%	Not Crucial
1	0.39%	Strongly Not Crucial

99⁠. The life care planner Conducting the Assessment may or may not consider crucial the documentation regarding the person with injury’s perceived functional abilities that may include sitting, standing, walking, lifting/carrying, pushing/pulling, bending, crouching/kneeling, stooping, stair climbing, reaching, handling, and finger dexterity.

166	64.59%	Strongly Crucial
76	29.57%	Crucial
11	4.28%	Neutral
3	1.17%	Not Crucial
1	0.39%	Strongly Not Crucial

100. The life care planner Conducting the Assessment may or may not consider the documentation of information on social/leisure activities to be crucial when comparing pre-accident and post-accident functional activities.

145	56.42%	Strongly Crucial
96	37.35%	Crucial
13	5.06%	Neutral
2	0.78%	Not Crucial
1	0.39%	Strongly Not Crucial

101⁠. When Conducting the Assessment, the life care planner may or may not consider it to be crucial to document the person with injury’s ability to perform the activities of daily living, which may include bathing, toileting, grooming, dressing, transferring, ambulating, and eating.

178	69.26%	Strongly Crucial
67	26.07%	Crucial
9	3.50%	Neutral
2	0.78%	Not Crucial
1	0.39%	Strongly Not Crucial

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

102. When Conducting the Assessment, the life care planner may or may not consider it to be crucial to document the client’s ability to perform instrumental activities of daily living by comparing responsibility versus capability before and after the injury event.

174	67.70%	Strongly Crucial
70	27.24%	Crucial
11	4.28%	Neutral
1	0.39%	Not Crucial
1	0.39%	Strongly Not Crucial

103⁠. When Conducting the Assessment, Instrumental Activities of Daily Living include Daily Tasks, Weekly Tasks, Monthly Tasks, and Outdoor Household Maintenance and may or may not be crucial to the person with injury’s health care program.

150	58.37%	Strongly Crucial
86	33.46%	Crucial
19	7.39%	Neutral
1	0.39%	Not Crucial
1	0.39%	Strongly Not Crucial

104⁠. Daily Tasks involved in Conducting the Assessment include meal preparation, meal clean-up, tidying, bed making, childcare, pet care, managing finances, and managing medications and may not be considered crucial by the life care planner.

156	60.70%	Strongly Crucial
81	31.52%	Crucial
15	5.84%	Neutral
3	1.17%	Not Crucial
2	0.78%	Strongly Not Crucial

105⁠. Weekly Tasks in Conducting the Assessment may or may not be considered crucial and include sweeping, vacuuming, washing floors, cleaning the bathroom, dusting, changing bed sheets, laundry, taking out the garbage, and grocery shopping.

152	59.14%	Strongly Crucial
88	34.24%	Crucial
14	5.45%	Neutral
2	0.78%	Strongly Not Crucial
1	0.39%	Not Crucial

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

106. Monthly Tasks in Conducting the Assessment may or may not be considered crucial activities and include cleaning appliances, cleaning windows, cleaning walls, cleaning blinds or curtains, cleaning light fixtures and fans, and arranging small indoor repairs.

127	49.42%	Strongly Crucial
98	38.13%	Crucial
25	9.73%	Neutral
5	1.95%	Not Crucial
2	0.78%	Strongly Not Crucial

107⁠. Outdoor Household Maintenance as applied to Conducting the Assessment may or may not be considered crucial and include small outdoor repairs, gardening, lawn mowing, spring/fall clean-up, and snow removal.

138	53.70%	Strongly Crucial
94	36.58%	Crucial
22	8.56%	Neutral
2	0.78%	Strongly Not Crucial
1	0.39%	Not Crucial

108⁠. The life care planner Conducting the Assessment may or may not consider crucial the person with injury signing consent forms allowing the life care planner to contact pertinent collateral interviews with family members, friends or no medical personnel, and consultations with medical personnel currently involved with the injured client.

144	56.03%	Strongly Crucial
80	31.13%	Crucial
27	10.51%	Neutral
4	1.56%	Not Crucial
2	0.78%	Strongly Not Crucial

109⁠. The life care planner Conducting the Assessment may or may not consider completing the interview with an estimated time frame and the next steps outlined to include conducting collateral interviews, conducting consultations, begin writing the report, and arrange a follow-up with the person with injury to review gathered information and fill in any blanks, and invite the person with injury to ask any other questions before closing the interview, to be a crucial or important aspect of life care planning methodology.

132	51.36%	Strongly Crucial
92	35.80%	Crucial
29	11.28%	Neutral
2	0.78%	Not Crucial
2	0.78%	Strongly Not Crucial

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

110. The life care planner with the person with injury’s consent may or may not consider communicating via telephone or email with those persons close to the person with injury that can provide a perspective into future care needs to be a crucial step in the life care planning process.

105	40.86%	Crucial
79	30.74%	Strongly Crucial
63	24.51%	Neutral
10	3.89%	Not Crucial

111⁠⁠. The life care planner may or may not consider crucial to the life care planning process to explain the purpose of the interview

123	47.86%	Strongly Crucial
91	35.41%	Crucial
37	14.40%	Neutral
6	2.33%	Not Crucial

112⁠. The life care planner may or may not consider confirming the date and time of the interview by phone, in-person, or virtual a crucial methodological substation in the life care planning process.

109	42.41%	Strongly Crucial
94	36.58%	Crucial
44	17.12%	Neutral
10	3.89%	Not Crucial

113⁠. The life care planner may or may not conduct the interview with a primary focus of the injured client’s ability to function independently before and after the injury event and ask about current functional changes.

133	51.75%	Strongly Crucial
82	31.91%	Crucial
36	14.01%	Neutral
6	2.33%	Not Crucial

114⁠. Completing Consultations may or may not be a crucial substation step in the Life Care Planning Process

147	57.20%	Strongly Crucial
75	29.18%	Crucial
32	12.45%	Neutral
3	1.17%	Not Crucial

115⁠⁠. With the person with injury’s consent, communicating via telephone, email, or fax with current treatment providers may or may not be a crucial step in the life care planning methodology.

140	54.47%	Strongly Crucial
86	33.46%	Crucial
28	10.89%	Neutral
3	1.17%	Not Crucial

116⁠. Explain the purpose of the interview may or may not be a crucial activity in the life care planning process.

149	57.98%	Strongly Crucial
87	33.85%	Crucial
20	7.78%	Neutral
1	0.39%	Not Crucial

117⁠⁠⁠. Confirm date and time of interview by phone, in-person, or virtual may or may not be a crucial substation in the life care planning methodology.

135	52.53%	Strongly Crucial
83	32.30%	Crucial
36	14.01%	Neutral
3	1.17%	Not Crucial

118⁠. Conducting an interview with focus on treatments and progress to date and future recommendations may or may not be a crucial substation in life care planning methodology.

152	59.14%	Strongly Crucial
81	31.52%	Crucial
23	8.95%	Neutral
1	0.39%	Not Crucial

119⁠. Summarizing consultations and getting agreement from the provider may or may not be a crucial substation of the life care planning methodology.

140	54.47%	Strongly Crucial
81	31.52%	Crucial
34	13.23%	Neutral
2	0.78%	Not Crucial

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

120. Paying an invoice for time spent with provider if required (reimbursed by referral source or included as expense in invoice submitted with report) may or may not be considered a crucial substation in the life care planning methodology.

113	43.97%	Strongly Crucial
87	33.85%	Crucial
44	17.12%	Neutral
8	3.11%	Not Crucial
5	1.95%	Strongly Not Crucial

121⁠. Research may or may not be a crucial substation step in the life care planning process

155	60.31%	Strongly Crucial
78	30.35%	Crucial
22	8.56%	Neutral
2	0.78%	Not Crucial

122⁠⁠⁠. Begin relevant research of best practices specific to client’s diagnoses and future needs may or may not be a crucial substation of the life care planning methodology.

147	57.20%	Strongly Crucial
78	30.35%	Crucial
28	10.89%	Neutral
4	1.56%	Not Crucial

123. Report Writing is the most crucial of the Methodological Substations in the Life Care Planning Methodology.

149 57.98% Strongly Crucial

84 32.68% Crucial

24 9.34% Neutral

124. Preparing a template with the person with injury’s information and referral source information as well as pertinent dates of event, date of assessment, and date of the report may or may not be crucial to report writing.

125⁠. In the report, compiling information gathered from the interview may or may not be crucial to report writing.

123	47.86%	Strongly Crucial
97	37.74%	Crucial
33	12.84%	Neutral
4	1.56%	Not Crucial

174 67.70% Strongly Crucial

68 26.46% Crucial

15 5.84% Neutral

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

126. In the report, compiling information gathered from collateral interviews may or may not be crucial to report writing.

104	40.47%	Crucial
93	36.19%	Strongly Crucial
51	19.84%	Neutral
9	3.50%	Not Crucial

127⁠. Compiling information gathered at consultations may or may not be crucial when writing the life care plan report.

149	57.98%	Strongly Crucial
86	33.46%	Crucial
21	8.17%	Neutral
1	0.39%	Not Crucial

128⁠⁠. Compiling perceived functional deficits/capabilities in comparison to assessed function may or may not be crucial to writing the life care plan.

152	59.14%	Strongly Crucial
79	30.74%	Crucial
24	9.34%	Neutral
2	0.78%	Not Crucial

129. Analyzing information gathered in the medical file to write a Medical Foundation that should include medical opinions from medical providers/physicians and specialists may or may not be crucial when writing the life care plan.

180 70.04% Strongly Crucial

60 23.35% Crucial

17 6.61% Neutral

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

130. Analyzing information gathered and in the medical file to write a Rehabilitation Foundation that includes rehabilitation services to date with ongoing efforts to achieve rehab goals may or may not be crucial to writing the life care plan.

157 61.09% Strongly Crucial

77 29.96% Crucial

23 8.95% Neutral

131. Analyzing information gathered and in the medical file to write a Psychological Foundation that includes psychological opinions from psychiatrists and psychologists may or may not be crucial to the life care plan.

158	61.48%	Strongly Crucial
68	26.46%	Crucial
30	11.67%	Neutral
1	0.39%	Not Crucial

132. Beginning writing and researching person with injury needs based on gathered information, medical file, and relevant research may or may not be a crucial methodological substation when writing the life care plan.

168 65.37% Strongly Crucial

71 27.63% Crucial

18 7.00% Neutral

133. Research may include Projected Evaluations that may or may not be crucial to document in the life care plan

153	59.53%	Strongly Crucial
78	30.35%	Crucial
25	9.73%	Neutral
1	0.39%	Not Crucial

134. Research may include Projected Therapeutic Modalities that may or may not be crucial to include in the life care plan.

160 62.26% Strongly Crucial

77 29.96% Crucial

20 7.78% Neutral

135. Research may include Wheelchair Needs that may or may not be crucial in the life care plan methodology.

160 62.26% Strongly Crucial

73 28.40% Crucial

24 9.34% Neutral

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

136. Research may include Wheelchair Accessories and Maintenance and may or may not be crucial in the life care planning methodology.

156 60.70% Strongly Crucial

76 29.57% Crucial

25 9.73% Neutral

137. Research may include Aids for Independent Living and may or may not be crucial to the life care plan methodology

138⁠. Research may include Orthotics/Prosthetics and may or may not be crucial in the life care plan methodology.

157	61.09%	Strongly Crucial
79	30.74%	Crucial
20	7.78%	Neutral
1	0.39%	Not Crucial

156 60.70% Strongly Crucial

77 29.96% Crucial

24 9.34% Neutral

139. Research may include Aids for Symptom Management and may or may not be crucial for life care planning methodology.

149 57.98% Strongly Crucial

84 32.68% Crucial

24 9.34% Neutral

140. Research may include Medications and Supply Needs and may or may not be considered a substation of life care planning methodology.

166 64.59% Strongly Crucial

69 26.85% Crucial

22 8.56% Neutral

141. Research may include Transportation and may or may not be crucial to the life care planning methodology.

142	55.25%	Strongly Crucial
84	32.68%	Crucial
29	11.28%	Neutral
2	0.78%	Not Crucial

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

142. Research may include Health and Strength Management and may or may not be crucial to the methodology of life care planning.

139	54.09%	Strongly Crucial
80	31.13%	Crucial
33	12.84%	Neutral
5	1.95%	Not Crucial

143⁠. Research may include Housing Considerations/Architectural Renovations and may or may not be crucial to the life care planning methodology.

141	54.86%	Strongly Crucial
86	33.46%	Crucial
29	11.28%	Neutral
1	0.39%	Strongly Not Crucial

144. Research may include Future Medical Care or Surgical Intervention and may or may not be crucial to the life care planning methodology.

162 63.04% Strongly Crucial

70 27.24% Crucial

25 9.73% Neutral

145. Research may include Orthopaedic Equipment Needs and may or may not be crucial to the life care planning methodology.

154 59.92% Strongly Crucial

80 31.13% Crucial

23 8.95% Neutral

146. Research may include a Vocational/Education Plan and may or may not be considered crucial to the life care planning methodology.

114	44.36%	Strongly Crucial
93	36.19%	Crucial
45	17.51%	Neutral
4	1.56%	Not Crucial
1	0.39%	Strongly Not Crucial

147⁠. Research may identify Loss of Valuable Services, such as, Home Care/Attendant Care/Facility Care, Home Maintenance that includes house cleaning, lawn care, handyman services, and snow removal which may or may not be crucial to the life care planning methodology.

147	57.20%	Strongly Crucial
82	31.91%	Crucial
26	10.12%	Neutral
2	0.78%	Not Crucial

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

148. Research may include Potential Complications and may or may not be crucial to the life care planning methodology.

118	45.91%	Strongly Crucial
90	35.02%	Crucial
45	17.51%	Neutral
4	1.56%	Not Crucial

150⁠. Report Review may or may not be a methodological substation in the Life Care Planning Process.

164	63.81%	Strongly Crucial
65	25.29%	Crucial
26	10.12%	Neutral
2	0.78%	Not Crucial

151⁠. Completing a final review of the report paying particular attention to details may or may not be a substation in the methodology of the life care planning process.

172	66.93%	Strongly Crucial
65	25.29%	Crucial
19	7.39%	Neutral
1	0.39%	Not Crucial

152⁠. Add to invoice travel and mileage, duration of communications with providers, family members, friend, research, etc. may or may not be a crucial substation of life care planning methodology.

101	39.30%	Strongly Crucial
89	34.63%	Crucial
56	21.79%	Neutral
9	3.50%	Not Crucial
2	0.78%	Strongly Not Crucial

153⁠. Invoice may or may not be a Methodological Substation in the Life Care planning Process

94	36.58%	Strongly Crucial
85	33.07%	Crucial
67	26.07%	Neutral
7	2.72%	Not Crucial
4	1.56%	Strongly Not Crucial

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

154. Report Delivery may or may not be a Methodological Substation in the Life Care Planning Process

141	54.86%	Strongly Crucial
72	28.02%	Crucial
38	14.79%	Neutral
5	1.95%	Not Crucial
1	0.39%	Strongly Not Crucial

155⁠. Saving a report in PDF format with a protected password may or may not be a substation in the life care planning methodology.

107	41.63%	Strongly Crucial
78	30.35%	Crucial
63	24.51%	Neutral
6	2.33%	Not Crucial
3	1.17%	Strongly Not Crucial

156⁠. Sending a report and invoice to the referral source via specified instructions (email, postal, hand-carried, or fax) may or may not be a substation of the life care planning methodology.

138	53.70%	Strongly Crucial
79	30.74%	Crucial
34	13.23%	Neutral
3	1.17%	Not Crucial
3	1.17%	Strongly Not Crucial

157⁠⁠. Based on your life care planning, 120-hour training plus your experience, the Receipt of Referral may or may not be a frequent methodological step in the life care planning process

209	81.32%	100%
24	9.34%	75%
11	4.28%	25%
7	2.72%	0%
6	2.33%	50%

158⁠⁠. The Receipt of Referral may be or may not be a frequent methodological step to confirm no conflict of interest, review information provided, and communicate with the referral source for clarification

208	80.93%	100%
29	11.28%	75%
10	3.89%	50%
8	3.11%	25%
2	0.78%	0%

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

159. The Receipt of Referral frequently includes a review with the referral source, the projected due date of the report, fees, expectations, review of the LCP process, and completeness of submitted records.

200	77.82%	100%
38	14.79%	75%
10	3.89%	25%
8	3.11%	50%
1	0.39%	0%

160⁠⁠. The Review of the Files may or may not be frequently considered to be a primary methodological step in the life care planning methodology process

234	91.05%	100%
14	5.45%	75%
6	2.33%	50%
3	1.17%	25%

161⁠⁠. The Review of Files frequently allows me to put the provided documents in a preferred order, such as, chronological, reverse chronology, or by record type.

200	77.82%	100%
37	14.40%	75%
14	5.45%	50%
4	1.56%	25%
2	0.78%	0%

162⁠⁠. The Scheduled Assessment substation frequently refers to the life care planner’s initial communication with the person with injury who is the subject of the life care plan, and the scheduled assessment is therefore an important substation of the life care planning methodology.

185	71.98%	100%
43	16.73%	75%
20	7.78%	50%
7	2.72%	25%
2	0.78%	0%

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

163. The Scheduled Assessment frequently may include an initiated introduction by the life care planner to the person with injury, an explanation of the purpose of the call, an explanation of the assessment and time allotted to complete the assessment, a confirmation of mutually agreeable assessment date and time, a confirmation of address and directions, a confirmation of other persons being present during the assessment, answering any questions the subject may have, and a reminder to the client of the upcoming appointment via email or telephone and to confirm the date is still appropriate to proceed

190	73.93%	100%
38	14.79%	75%
20	7.78%	50%
8	3.11%	25%
1	0.39%	0%

164⁠⁠. Conducting the Assessment is frequently a significant methodological substation in the life care planning process. This substation may frequently include a repeated introduction of the life care planner to the person with injury, the life care planner’s review of the purpose of the assessment with the person with injury, an opportunity for the person with injury to ask any questions prior to proceeding, have the person with injury complete the required consent forms, review the medical history to date with the person with injury for accuracy, review pre-accident medical and other conditions developed since the event.

209	81.32%	100%
30	11.67%	75%
10	3.89%	50%
7	2.72%	25%
1	0.39%	0%

165⁠. When conducting the Assessment, it may or may not be important to frequently gather information regarding education/vocational history that may include highest level of education completed, job title, employer, number of hours/shifts, physical demands, workplace accommodations, relationship with employer, and barriers to returning to work.

172	66.93%	100%
53	20.62%	75%
21	8.17%	50%
11	4.28%	25%

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

166. Conducting the Assessment may or may not require the life care planner to frequently gather information on current physical symptoms that may include the person with injury completing a body diagram, documenting symptom location and symptom descriptors, the pain intensity levels, frequency of pain (intermittent versus constant), duration, aggravating factors, alleviating factors, clinical course since the event, clinical course over the last 6-month period.

202	78.60%	100%
31	12.06%	75%
15	5.84%	50%
9	3.50%	25%

167⁠. The life care planner Conducting the Assessment may or may not frequently gather current cognitive symptoms that may include symptom descriptors, intensity of pain, frequency (intermittent versus constant), duration, aggravating factors, alleviating factors, clinical course since event, and clinical course over the last 6-month period.

196	76.26%	100%
37	14.40%	75%
16	6.23%	50%
8	3.11%	25%

168⁠. The life care planner Conducting the Assessment may or may not frequently gather information on current emotional symptoms that may include symptom descriptors, intensity of pain, frequency (intermittent versus constant), duration, aggravating factors, alleviating factors, clinical course since event, and clinical course over the last 6-month period.

196	76.26%	100%
36	14.01%	75%
17	6.61%	50%
8	3.11%	25%

169⁠. The life care planner Conducting the Assessment may or may not frequently gather information on current/ongoing treatment in terms of the diagnosis(es) of the person with injury, frequency of treatment, treatment goal, effect of treatment, last visit date, and the next visit date.

209	81.32%	100%
28	10.89%	75%
13	5.06%	50%
7	2.72%	25%

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

170. The life care planner Conducting the Assessment may or may not frequently gather information on current medications that include the name of the medications, the dosage level, and the expected effects of medications, as well as any side-effects expressed by the person with injury.

217	84.44%	100%
23	8.95%	75%
10	3.89%	50%
7	2.72%	25%

171⁠. The life care planner Conducting the Assessment may or may not frequently gather information on the person with injury’s perceived functional abilities that may include sitting, standing, walking, lifting/carrying, pushing/pulling, bending, crouching/kneeling, stooping, stair climbing, reaching, handling, and finger dexterity.

202	78.60%	100%
30	11.67%	75%
17	6.61%	50%
8	3.11%	25%

172⁠. The life care planner Conducting the Assessment may or may not frequently gather information on social/leisure activities pre-accident and post-accident

193	75.10%	100%
42	16.34%	75%
13	5.06%	50%
9	3.50%	25%

173⁠⁠. When Conducting the Assessment, the life care planner may or may not frequently gather information on the person with injury’s ability to perform the activities of daily living, which may include bathing, toileting, grooming, dressing, transferring, ambulating, and eating.

211	82.10%	100%
28	10.89%	75%
11	4.28%	50%
7	2.72%	25%

174⁠. When Conducting the Assessment, the life care planner may or may not frequently gather information on ability to perform instrumental activities of daily living by comparing responsibility versus capability before and after the injury event.

208	80.93%	100%
28	10.89%	75%
13	5.06%	50%
8	3.11%	25%

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

175. The life care planner when Conducting the Assessment may or may not frequently review and document Instrumental activities of daily living that include Daily Tasks, Weekly Tasks, Monthly Tasks, and Outdoor Household Maintenance.

197	76.65%	100%
33	12.84%	75%
18	7.00%	50%
9	3.50%	25%

176⁠. The life care planner may or may not review frequently Daily Tasks that are part of Conducting the Assessment and include meal preparation, meal clean-up, tidying, bed making, childcare, pet care, managing finances, and managing medications.

203	78.99%	100%
28	10.89%	75%
16	6.23%	50%
9	3.50%	25%
1	0.39%	0%

177⁠. The life care planner may or may not review frequently Weekly Tasks when Conducting the Assessment that include sweeping, vacuuming, washing floors, cleaning the bathroom, dusting, changing bed sheets, Laundry, taking out the garbage, and grocery shopping.

197	76.65%	100%
34	13.23%	75%
15	5.84%	50%
10	3.89%	25%
1	0.39%	0%

178⁠. The life care planner may or may not review and document frequently the Monthly Tasks when Conducting the Assessment and include cleaning appliances, cleaning windows, cleaning walls, cleaning blinds or curtains, cleaning light fixtures and fans, and arranging small indoor repairs.

172	66.93%	100%
44	17.12%	75%
26	10.12%	50%
13	5.06%	25%
2	0.78%	0%

179⁠. The life care planner may or may not review frequently Outdoor Household Maintenance as applied to Conducting the Assessment and include small outdoor repairs, gardening, lawn mowing, spring/fall clean-up, and snow removal.

181	70.43%	100%
44	17.12%	75%
20	7.78%	50%
10	3.89%	25%
2	0.78%	0%

180⁠. The life care planner Conducting the Assessment may or may not frequently present to the person with injury consent forms to be signed allowing the life care planner to contact pertinent collateral interviews with family members, friends or no medical personnel, and consultations with medical personnel currently involved with the person with injury.

175	68.09%	100%
34	13.23%	50%
28	10.89%	75%
15	5.84%	25%
5	1.95%	0%

181⁠. The life care planner Conducting the Assessment may or may not frequently complete the interview with an estimated time frame and the next steps outlined to include conducting collateral interviews, conducting consultations, begin writing the report, and arrange a follow-up with the person with injury to review gathered information and fill in any blanks, and invite the person with injury to ask any other questions before closing the interview.

176	68.48%	100%
34	13.23%	75%
29	11.28%	50%
12	4.67%	25%
6	2.33%	0%

182⁠. With person with injury’s consent the life care planner may or may not frequently communicate via telephone or email with those persons close to the person with injury that can provide a perspective into future care needs.

109	42.41%	100%
60	23.35%	75%
45	17.51%	50%
32	12.45%	25%
11	4.28%	0%

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

183. The life care planner may or may not frequently explain the purpose of the interview with all persons with injuries.

172	66.93%	100%
33	12.84%	75%
23	8.95%	50%
21	8.17%	25%
8	3.11%	0%

184⁠. The life care planner may or may not frequently conduct the interview with a primary focus of the person with injury’s ability to function independently before and after the injury event and ask about current functional changes.

169	65.76%	100%
33	12.84%	75%
25	9.73%	50%
23	8.95%	25%
7	2.72%	0%

185⁠. The life care planner may or may not confirm the date and time of the interview by phone, in-person, or virtual to all persons with injuries.

167	64.98%	100%
32	12.45%	75%
26	10.12%	50%
23	8.95%	25%
9	3.50%	0%

186⁠. The Complete Consultations is considered a frequent significant substation step in the life care planning process

177	68.87%	100%
46	17.90%	75%
19	7.39%	50%
13	5.06%	25%
2	0.78%	0%

187⁠. With the person with injury’s consent, the life care planner may or may not frequently communicate via telephone, email, and/or fax with current treatment providers

172	66.93%	100%
47	18.29%	75%
22	8.56%	50%
13	5.06%	25%
3	1.17%	0%

188⁠. The life care planner may or may not frequently explain the purpose of the interview to team providers

196	76.26%	100%
33	12.84%	75%
13	5.06%	25%
13	5.06%	50%
2	0.78%	0%

189⁠. The life care planner may or may not frequently confirm date and time of interview by phone, in-person, or virtual to treatment providers.

186	72.37%	100%
39	15.18%	75%
18	7.00%	50%
12	4.67%	25%
2	0.78%	0%

190⁠. The life care planner may or may not frequently conduct an interview with the focus being on treatments and progress to date and future recommendations from treatment providers.

184	71.60%	100%
40	15.56%	75%
18	7.00%	50%
13	5.06%	25%
2	0.78%	0%

191⁠. The life care planner may or may not frequently summarize consultations and get agreement from providers.

167	64.98%	100%
51	19.84%	75%
22	8.56%	50%
13	5.06%	25%
4	1.56%	0%

192⁠. The life care planner may or may not frequently pay an invoice for time spent with a provider if required (reimbursed by referral source or included as expense in invoice submitted with report).

154	59.92%	100%
42	16.34%	75%
24	9.34%	25%
20	7.78%	50%
17	6.61%	0%

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

193. Research may or may not be considered frequently to be a significant substation step in the life care planning process

183	71.21%	100%
49	19.07%	75%
20	7.78%	50%
4	1.56%	25%
1	0.39%	0%

194⁠. The life care planner may or may not frequently begin relevant research of best practices specific to client’s diagnoses and future needs

179	69.65%	100%
52	20.23%	75%
21	8.17%	50%
4	1.56%	25%
1	0.39%	0%

195⁠. Report Writing may or may not be considered frequently to be the Primary Methodological Station in the Life Care Planning Process

225	87.55%	100%
26	10.12%	75%
4	1.56%	50%
2	0.78%	0%

196⁠⁠. The life care planner frequently prepares the template with the person with injury’s information and referral source information as well as pertinent dates of event, date of assessment, and date of the report.

218	84.82%	100%
28	10.89%	75%
7	2.72%	50%
3	1.17%	0%
1	0.39%	25%

197⁠⁠⁠. In the report, the life care planner frequently compiles information gathered from the initial interview.

226	87.94%	100%
21	8.17%	75%
8	3.11%	50%
2	0.78%	25%

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

198. In the report, the life care planner frequently compiles information gathered from collateral interviews when writing the report.

166	64.59%	100%
44	17.12%	75%
29	11.28%	50%
13	5.06%	25%
5	1.95%	0%

199⁠. The life care planner frequently compiles information gathered at consultations to put in the report.

199	77.43%	100%
41	15.95%	75%
13	5.06%	50%
3	1.17%	0%
1	0.39%	25%

200⁠. The life care planner frequently compiles perceived functional deficits/capabilities in comparison to assessed function to put in the report.

212	82.49%	100%
28	10.89%	75%
10	3.89%	50%
7	2.72%	25%

201⁠. The life care planner frequently analyzes information gathered and uses the medical file to write a Medical Foundation that should include medical opinions from medical providers/physicians and specialists.

229	89.11%	100%
23	8.95%	75%
5	1.95%	50%

202⁠. The life care planner frequently analyzes information gathered and uses the medical file to write a Rehabilitation Foundation that includes rehabilitation services to date with ongoing efforts to achieve rehab goals.

208	80.93%	100%
28	10.89%	75%
15	5.84%	50%
4	1.56%	25%
2	0.78%	0%

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

203. The life care planner frequently analyzes information gathered and uses the medical file to write a Psychological Foundation that includes psychological opinions from psychiatrists and psychologists

197	76.65%	100%
34	13.23%	75%
19	7.39%	50%
5	1.95%	25%
2	0.78%	0%

204⁠. The life care planner frequently begins writing and researching person with injury needs based on gathered information, the medical file, and relevant research that will be part of the life care plan report.

229	89.11%	100%
21	8.17%	75%
7	2.72%	50%

205⁠. Research may or may not frequently include Projected Evaluations for a polytrauma person with injury.

205	79.77%	100%
34	13.23%	75%
14	5.45%	50%
3	1.17%	25%
1	0.39%	0%

206⁠. Research may or may not frequently include Projected Therapeutic Modalities for a polytrauma person with injury.

210	81.71%	100%
33	12.84%	75%
10	3.89%	50%
3	1.17%	25%
1	0.39%	0%

207⁠. Research may or may not frequently include Wheelchair Needs for a person with injury with mobility deficits.

200	77.82%	100%
31	12.06%	75%
17	6.61%	50%
8	3.11%	25%
1	0.39%	0%

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

208. Research may or may not frequently include Wheelchair Accessories and Maintenance for persons with injuries with mobility deficits

196	76.26%	100%
33	12.84%	75%
18	7.00%	50%
9	3.50%	25%
1	0.39%	0%

209⁠. Research may or may not frequently include Aides for Independent Living for a person with injury with manageable trauma.

206	80.16%	100%
31	12.06%	75%
16	6.23%	50%
4	1.56%	25%

210⁠. Research may or may not frequently include Orthotics/Prosthetics for persons with injuries with lower extremity amputations.

202	78.60%	100%
28	10.89%	75%
21	8.17%	50%
6	2.33%	25%

211⁠. Research may or may not frequently include Aids for Symptom Management

203	78.99%	100%
35	13.62%	75%
16	6.23%	50%
3	1.17%	25%

212⁠. Research may or may not frequently include Medications and Supply Needs

217	84.44%	100%
30	11.67%	75%
9	3.50%	50%
1	0.39%	25%

213⁠. Research may or may not frequently include Transportation for a person with injury with trauma that prevents independent mobility or the operation of a motor vehicle.

201	78.21%	100%
30	11.67%	75%
17	6.61%	50%
7	2.72%	25%
2	0.78%	0%

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

214. Research may or may not frequently include Health and Strength Management for a polytrauma person with injury in extremities.

191	74.32%	100%
35	13.62%	75%
23	8.95%	50%
5	1.95%	25%
3	1.17%	0%

215⁠. Research may or may not frequently include Housing Considerations/Architectural Renovations

184	71.60%	100%
36	14.01%	75%
22	8.56%	50%
13	5.06%	25%
2	0.78%	0%

216⁠⁠. Research may or may not frequently include Future Medical Care or Surgical Intervention

207	80.54%	100%
29	11.28%	75%
18	7.00%	50%
2	0.78%	25%
1	0.39%	0%

217⁠⁠. Research may or may not frequently include Orthopaedic Equipment Needs for a person with injury with musculoskeletal trauma

209	81.32%	100%
30	11.67%	75%
15	5.84%	50%
3	1.17%	25%

218⁠. Research may or may not frequently include a Vocational/Education Plan for persons with injuries who have work tolerance potential in spite of their trauma diagnoses.

162	63.04%	100%
46	17.90%	75%
33	12.84%	50%
9	3.50%	0%
7	2.72%	25%

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

219. The life care planner may or may not frequently research and identify the person with injury’s Loss of Valuable Services, such as Home Care/Attendant Care/Facility Care, Home Maintenance that includes house cleaning, lawn care, handyman services, and snow removal.

198	77.04%	100%
31	12.06%	75%
20	7.78%	50%
6	2.33%	25%
2	0.78%	0%

220⁠⁠. Research may or may not frequently include Potential Complications

161	62.65%	100%
48	18.68%	75%
33	12.84%	50%
11	4.28%	25%
4	1.56%	0%

221⁠⁠. Report Review may or may not be frequently considered a secondary Methodological Substation in the life care planning process

196	76.26%	100%
35	13.62%	75%
12	4.67%	50%
7	2.72%	0%
7	2.72%	25%

222⁠. The life care planner may or may not frequently complete a final review of the report paying particular attention to details for all life care planning persons with injuries.

216	84.05%	100%
20	7.78%	75%
11	4.28%	50%
9	3.50%	25%
1	0.39%	0%

223⁠. The life care planner may or may not frequently add to the invoice travel and mileage, duration of communications with providers, family members, friend, research, etc.

184	71.60%	100%
37	14.40%	75%
22	8.56%	50%
7	2.72%	0%
7	2.72%	25%

Count Percent Response (Optimal responses indicated with bold text) 8/8/2026

224. The Invoice may or may not be considered a frequent Methodological Substation in the Life Care planning Process

170	66.15%	100%
41	15.95%	75%
21	8.17%	50%
19	7.39%	0%
6	2.33%	25%

225⁠. Report Delivery may or may not frequently be referred to as a secondary Methodological substation in the Life Care Planning Process

189	73.54%	100%
38	14.79%	75%
14	5.45%	0%
12	4.67%	50%
4	1.56%	25%

226⁠. The life care planner may or may not frequently save report in PDF format with protected password.

160	62.26%	100%
40	15.56%	75%
27	10.51%	50%
22	8.56%	0%
8	3.11%	25%

227⁠. The life care planner may or may not frequently send the report and invoice to the referral source via specified instructions (email, postal, fax, or hand-carried).

210	81.71%	100%
23	8.95%	75%
13	5.06%	50%
8	3.11%	0%
3	1.17%	25%

Appendix B

Rejected Substations by SME Committee

The SME committee reviewed the Scored Survey Instrument by Participation Percentages to calculate the percentages of Agreement, Cruciality, and Frequency endorsed by the respondents. Please refer to the Scored Survey Instrument by Participation Percentages in Appendix B of the final version of this manuscript for the journal article.

The Survey Instrument Makeup:

Items 1 through 11 deal with the demographic characteristics of the respondent.
Items 12 through 84 asked the respondent to express agreement or disagreement with each methodological station in the life care planning process.
Items 85 through 157 asked the respondent to rate each methodological station in the life care planning process with regards to cruciality.
Items 158 through 203 asked the respondent to rate each methodological station in the life care planning process with regards to frequency.

The SME Committee then reviewed the percentages for each item. Items that received 66 percent or more consensus across respondents were retained as valid items on the instrument. Items that received less than 66 percent consensus across respondents were rejected from the methodology survey instrument. The rejected items included the following:

Item 78. Conduct a follow-up virtual interview with the person with injury to review report content.
Item 110. The Collateral Interviews substation is a crucial substation in the life care planning process. (This item was rejected, in part, due to the ambiguity of the item.)
Item number 151. Conducting a follow-up virtual interview with the person with injury to review the report content may or may not be a crucial substation in the life care planning methodology.
Item 183. The Collateral Interviews substation is a crucial substation in the life care planning process. (This item was rejected, in part, due to the ambiguity of the item.)
Item 224. The life care planner may or may not conduct a follow-up virtual interview with the person with injury to review the report content.

Authors’ Note: The reader should be aware that the substations (Items) listed above are no longer included in the survey as presented in Appendix A. Due to the auto-numbering of the Microsoft Word software, the 5 numbers remain active in the survey. The text currently in the survey as presented in Appendix A are new substations with different statements for numbers 78, 110, 151, 183, and 224.

Appendix C

The Original Survey Prior to the Review of the SME Committee and Rejection of the 5 Substations

The ICHCC^® CLCP^®/CCLCP^TM Methodology Study: The methodology of writing a life care plan covers the methodological processes, the steps and procedures (substations) of creating a valid life care plan.

Please answer questions as they relate to you in the Demographics section as well as the Methodology Items section of the survey. We thank you for your participation and you will receive 50 CLCP^®/CCLCP^TM CEUs, 8 of which apply to the required 8 hrs. of ethics, all for your effort in completing the survey. REGARDING THE CLCP^® AND CCLCP^TM CERTIFICATE NUMBERS, YOU NEED TO ENTER YOUR CERTIFICATE NUMBER FOR THE CREDENTIAL YOU EARNED, AND PLEASE PUT A “0” IN THE CREDENTIAL YOU HAVE NOT EARNED. FOR EXAMPLE, CLCP^® CERT. NO. 1896 AND CCLCP^TM CERT. NO. 0, OR CLCP^® CERT. NO. 0 AND CCLCP^TM CERT NO. 0398. IF YOU HAVE BOTH CREDENTIALS, ENTER YOUR CERT. NUMBER FOR EACH CREDENTIAL

Please provide the following:

First Name

Last Name

Title

CLCP^® Cert. No.

CCLCP™ Cert. No.

Demographics II

Please check the boxes next to items that apply to your formal training, memberships, licenses, and other certifications.

1. Gender

(Select only one)

o Male

o Female

2. Age in Years

(Select only one)

o 20 - 25

o 26 - 35

o 36 - 45

o 46 - 55

o 56 - 65

o Over 65

3. Formal Education/Degree - Check all that Apply

(Select all that apply)

o Diploma Nurse RN

o Associate’s Degree RN

o Bachelor’s Degree RN (BSN)

o Bachelor’s Degree Rehabilitation Counseling/Vocational Evaluation/Job Placement

o Bachelor’s Degree - Other

o Master’s Degree RN

o Master’s Degree- Rehab/Psych

o Master’s of Social Work (MSW)

o Doctor of Philosophy (Ph.D.)

o Doctor of Education (Ed.D.)

o Doctor of Occupational Therapy

o Doctor of Rehabilitation (Rh.D.)

o Doctor of Physical Therapy (DPT)

o Medical Doctor (M.D.)

o Doctor of Osteopathy (D.O.)

o Doctor of Chiropractic (D.C.)

o Juris Doctor (J.D.)

o Other:

4. Primary Clinical Fields of Practice - Check all that Apply

(Select all that apply)

o Case Management

o Life Care Planning

o Counseling

o Medicine

o Nursing

o Occupational Therapy

o Physical Therapy

o Speech-Language Pathology

o Psychology/Neuropsychological

o Rehabilitation Counseling

o Social Work

o Marriage and Family Counseling

o Other:

5. Licensed, Registered, and/or Certified as a: (Check all that Apply)

(Select all that apply)

o ABDA

o ABPP

o ABVE

o ACSW

o CCM

o CDMS

o CLCP^®

o CCLCP^TM

o CGCM

o CLNC

o CMCPS^®

o CNLCP

o CRC

o CRRN

o CVE

o FIALCP

o LMHC

o LNCC

o LPC

o MSCC^®

o NCC

o OT

o PT

o RN

o Other:

6. Current Practice Setting: (Check all that Apply)

(Select all that apply)

o Attorney’s Office

o Corporation

o Hospital

o Rehabilitation Facility/Setting

o Insurance Company

o Owner/Independent Practice without Employees

o Owner/Independent Practice with Employees

o Private Rehabilitation Company as an Employee

o Educational Setting

o Owner S, C or LLC Corporation

o Other:

7. Life Care Planning Activities Constitute Approximately ____ of My Work Activities

(Select only one)

o None

o 1 - 25%

o 26 - 50%

o 51 - 75%

o 76 - 100%

8. Provide Life Care Planning Services on a ____ Level

(Select only one)

o Local (e.g., city and surrounding counties)

o Regional (e.g., statewide/Province)

o National

o International

9. Population to Whom You Provide LCP Services (Check all that Apply)

(Select all that apply)

o Acquired Brain Injury

o Amputations

o Birth Injuries/Anoxia

o Burns

o Chronic Diseases (e.g., MS, Diabetes, Chronic Pain, Cancer)

o Developmental Disabilities

o Non-Catastrophic Injuries

o Organ Transplants

o Orthopaedic Conditions

o Psychological/Psychiatric Conditions

o Spinal Cord Injuries

o Other:

10. Office Staff/Subcontractors who assist you with the development of the Life Care Plan

(Select only one)

o Yes

o No

11. If Yes, Which activities do the Office Staff/Subcontractors Perform? (Check all that Apply)

(Select all that apply)

o Verbal Correspondence

o Written Correspondence

o Medical Review

o Research for Supporting Recommendations

o Costing Research

o Report Development

Agree/Disagree Rating Section of Survey Items

Strongly Agree, Agree, Neutral, Disagree, and Strongly Disagree

Substations of Life Care Planning Methodology

Please Review and Score the Items as they pertain to you as a life care planner

Receipt of Referral

12. Based on your life care planning 120-hour training plus your experience, the Receipt of Referral is a significant methodological step in the life care planning process

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

13. The Receipt of Referral is a good step to confirm no conflict of interest, review information provided, and communicate with the referral source for clarification

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

File Review

15. The Review of the Files step is considered to be a primary methodological step in the life care planning methodological process

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

16. The Review of Files allows me to put the provided documents in a preferred order, such as chronological, reverse chronology, or by record type.

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

Scheduled Assessment

17. The Scheduled Assessment substation refers to the life care planner’s initial communication with the person with injury who is the subject of the life care plan and is therefore an important substation of the life care planning methodology.

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

18. The Scheduled Assessment may include an initiated introduction by the life care planner to the injured person, an explanation of the purpose of the call, an explanation of the assessment and time allotted to complete the assessment, a confirmation of mutually agreeable assessment date and time, a confirmation of address and directions, a confirmation of other persons being present during the assessment, answering any questions the person with injury may have, and a reminder to the client of the upcoming appointment via email or telephone and to confirm the date that is still appropriate to proceed

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

Conduct the Assessment

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

22. The life care planner Conducting the Assessment is responsible for gathering current cognitive symptoms that may include symptom descriptors, intensity of pain, frequency (intermittent versus constant), duration, aggravating factors, alleviating factors, clinical course since event, and clinical course over the last 6-month period.

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

23. The life care planner Conducting the Assessment is responsible for gathering information on current emotional symptoms that may include symptom descriptors, intensity of pain, frequency (intermittent versus constant), duration, aggravating factors, alleviating factors, clinical course since event, and clinical course over the last 6-month period.

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

27. The life care planner Conducting the Assessment gathers information on social/leisure activities pre-accident and post-accident

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

28. When Conducting the Assessment the life care planner gathers information on the person with injury’s ability to perform the activities of daily living, which may include bathing, toileting, grooming, dressing, transferring, ambulating, and eating.

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

29. When Conducting the Assessment the life care planner gathers information on ability to perform Instrumental Activities of Daily Living by comparing responsibility versus capability before and after the injury event.

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

30. Instrumental Activities of Daily Living include Daily Tasks, Weekly Tasks, Monthly Tasks, and Outdoor Household Maintenance.

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

31. Daily Tasks involved in Conducting the Assessment include meal preparation, meal clean-up, tidying, bed making, childcare, pet care, managing finances, and managing medications.

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

32. Weekly Tasks in Conducting the Assessment include sweeping, vacuuming, washing floors, cleaning the bathroom, dusting, changing bed sheets, laundry, taking out the garbage, and grocery shopping.

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

33. Monthly Tasks in Conducting the Assessment include cleaning appliances, cleaning windows, cleaning walls, cleaning blinds or curtains, cleaning light fixtures and fans, and arranging small indoor repairs.

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

34. Outdoor Household Maintenance as applied to Conducting the Assessment includes small outdoor repairs, gardening, lawn mowing, spring/fall clean-up, and snow removal.

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

35. The life care planner Conducting the Assessment presents to the person with injury consent forms to be signed allowing the life care planner to contact pertinent collateral interviews with family members, friends or no medical personnel, and consultations with medical personnel currently involved with the person with injury.

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

36. The life care planner Conducting the Assessment completes the interview with an estimated time frame and the next steps outlined to include conducting collateral interviews, conducting consultations, begin writing the report, and arrange a follow-up with person with injury to review gathered information and fill in any blanks, and invite the person with injury to ask any other questions before closing the interview.

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

Collateral Interviews (non-treatment personnel such as friends and family members).

37. The Collateral Interviews substation is a significant substation step in the life care planning process.

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

38. With the person with injury’s consent, the life care planner may communicate via telephone or email with those persons close to the client that can provide a perspective into future care needs.

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

39. Explain the purpose of the interview

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

40. Confirm date and time of the interview by phone, in-person, or virtual

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

41. Conduct the interview with a primary focus of the injured client’s ability to function independently before and after the injury event and ask about current functional changes.

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

Complete Consultations (Treatment Providers)

42. Complete Consultations are a significant substation step in the life care planning process

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

43. With the person with injury’s consent, communicate via telephone or email with current treatment providers

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

44. Explain the purpose of the interview

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

45. Confirm date and time of interview by phone, in-person, or virtual.

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

46. Conduct interview with focus on treatments and progress to date and future recommendations

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

47. Summarize consultations and get agreement from provider

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

48. Pay invoice for time spent with provider if required (reimbursed by referral source or included as expense in invoice submitted with report).

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

Research

49. Research is a significant substation step in the life care planning process

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

50. Begin relevant research of best practices specific to client’s diagnoses and future needs

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

Report Writing

51. Report Writing is the Primary Methodological Station in the Life Care Planning Process

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

52. Prepare template with client information and referral source information as well as pertinent dates of event, date of assessment, and date of the report.

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

53. In the report, compile information gathered from interview

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

54. In the report, compile information gathered from collateral interviews

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

55. In the report, compile information gathered at consultations

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

56. In the report, compile perceived functional deficits/capabilities in comparison to assessed function.

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

57. Analyze information gathered and medical file to write a Medical Foundation that should include medical opinions from medical providers/physicians and specialists.

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

58. Analyze information gathered and medical file to write a Rehabilitation Foundation that includes rehabilitation services to date with ongoing efforts to achieve rehab goals.

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

59. Analyze information gathered and medical file to write a Psychological Foundation that includes psychological opinions from psychiatrists and psychologists

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

60. Begin writing and researching client needs based on gathered information, medical file, and relevant research.

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

61. Research may include Projected Evaluations

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

62. Research may include Projected Therapeutic Modalities

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

63. Research may include Wheelchair Needs

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

64. Research may include Wheelchair Accessories and Maintenance

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

65. Research may include Aides for Independent Living

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

66. Research may include Orthotics/Prosthetics

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

67. Research may include Aids for Symptom Management

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

68. Research may include Medications and Supply Needs

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

69. Research may include Transportation

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

70. Research may include Health and Strength Management

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

71. Research may include Housing Considerations/Architectural Renovations

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

72. Research may include Future Medical Care or Surgical Intervention

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

73. Research may include Orthopaedic Equipment Needs

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

74. Research may include a Vocational/Education Plan

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

75. Research may identify Loss of Valuable Services, such as Home Care/Attendant Care/Facility Care, Home Maintenance that includes house cleaning, lawn care, handyman services, and snow removal.

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

76. Research may include Potential Complications

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

Report Review

77. Report Review is a secondary methodological Station in the Life Care Planning Process

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

78. Conduct a follow-up virtual interview with the person with injury to review report content

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

79. Complete a final review of the report paying particular attention to details

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

Invoice

80. Add to invoice travel and mileage, duration of communications with providers, family members, friend, research, etc.

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

81. Invoice is a secondary Methodological Station in the Life Care planning Process

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

Report Delivery

82. Report Delivery is a secondary Methodological Station in the Life Care Planning Process

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

83. Save report in PDF format with protected password

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

84. Send report and invoice to referral source via specified instructions (email, postal, hand-carried, or fax)

(Select only one)

o Strongly Agree

o Agree

o Neutral

o Disagree

o Strongly Disagree

Cruciality Ratings: Rating Section of Survey Items

Strongly Crucial, Crucial, Neutral, Not Crucial, Strongly Not Crucial - Please determine the level of cruciality when applying the statement to your life care planning practice.

Cruciality: Receipt of Referral

85. Based on your life care planning 120-hour training plus your experience, the Receipt of Referral may be a crucial methodological step in the life care planning process

(Select only one)

o Strongly Crucial

o Crucial

o Neutrial

o Not Crucial

o Strongly Not Crucial

86. The Receipt of Referral may be a crucial step to confirm no conflict of interest, review information provided, and communicate with the referral source for clarification

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

Cruciality: File Review

88. The Review of the Files step is considered a crucial or maybe a crucial methodological step in the life care planning methodological process

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

89. The Review of Files may be a crucial methodological step when putting the provided documents in a preferred order, such as chronological, reverse chronology, or by record type.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

Cruciality: Scheduled Assessment

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

91. The Scheduled Assessment may be crucial to life care planning methodology when an initiated introduction by the life care planner to the person with injury is offered, or an explanation of the purpose of the call, an explanation of the assessment and time allotted to complete the assessment, a confirmation of mutually agreeable assessment date and time, a confirmation of address and directions, a confirmation of other persons being present during the assessment, answering any questions the person with injury may have, and/or a reminder to the person with injury of the upcoming appointment via email or telephone and to confirm the date is still appropriate to proceed.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

Cruciality: Conduct the Assessment

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

95. When Conducting the Assessment, the life care planner may or may not realize that it could be crucial to document current cognitive symptoms that may include symptom descriptors, intensity of pain, frequency (intermittent versus constant), duration, aggravating factors, alleviating factors, clinical course since event, and clinical course over the last 6-month period.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

96. The life care planner Conducting the Assessment may or may not realize that it may be crucial to gather information on current emotional symptoms that may include symptom descriptors, intensity of pain, frequency (intermittent versus constant), duration, aggravating factors, alleviating factors, clinical course since event, and clinical course over the last 6-month period.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

97. The life care planner Conducting the Assessment may or may not consider crucial the gathering of information on current/ongoing treatment in terms of provider’s discipline, frequency of treatment, treatment goal, effect of treatment, last visit date, and the next visit date.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

99. The life care planner Conducting the Assessment may or may not consider crucial the documentation regarding the person with injury’s perceived functional abilities that may include sitting, standing, walking, lifting/carrying, pushing/pulling, bending, crouching/kneeling, stooping, stair climbing, reaching, handling, and finger dexterity.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

101. When Conducting the Assessment the life care planner may or may not consider it to be crucial to document the person with injury’s ability to perform the activities of daily living, which may include bathing, toileting, grooming, dressing, transferring, ambulating, and eating.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

102. When Conducting the Assessment the life care planner may or may not consider it to be crucial to document the client’s ability to perform instrumental activities of daily living by comparing responsibility versus capability before and after the injury event.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

103. When Conducting the Assessment, Instrumental Activities of Daily Living include Daily Tasks, Weekly Tasks, Monthly Tasks, and Outdoor Household Maintenance and may or may not be crucial to the person with injury’s health care program.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

104. Daily Tasks involved in Conducting the Assessment include meal preparation, meal clean-up, tidying, bed making, childcare, pet care, managing finances, and managing medications and may not be considered crucial by the life care planner.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

105. Weekly Tasks in Conducting the Assessment may or may not be considered crucial and include sweeping, vacuuming, washing floors, cleaning the bathroom, dusting, changing bed sheets, laundry, taking out the garbage, and grocery shopping.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

107. Outdoor Household Maintenance as applied to Conducting the Assessment may or may not be considered crucial and include small outdoor repairs, gardening, lawn mowing, spring/fall clean-up, and snow removal.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

108. The life care planner Conducting the Assessment may or may not consider crucial the person with injury signing consent forms allowing the life care planner to contact pertinent collateral interviews with family members, friends or no medical personnel, and consultations with medical personnel currently involved with the injured client.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

109. The life care planner Conducting the Assessment may or may not consider completing the interview with an estimated time frame and the next steps outlined to include conducting collateral interviews, conducting consultations, begin writing the report, and arrange a follow-up with the person with injury to review gathered information and fill in any blanks, and invite the person with injury to ask any other questions before closing the interview, to be a crucial or important aspect of life care planning methodology.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

Cruciality: Collateral Interviews (non-treatment personnel such as friends and family members).

110. The Collateral Interviews substation is a crucial substation step in the life care planning process.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

111. The life care planner with the person with injury’s consent may or may not consider communicating via telephone or email with those persons close to the person with injury that can provide a perspective into future care needs to be a crucial step in the life care planning process.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

112. The life care planner may or may not consider crucial to the life care planning process to explain the purpose of the interview

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

113. The life care planner may or may not consider confirming the date and time of the interview by phone, in-person, or virtual a crucial methodological substation in the life care planning process.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

114. The life care planner may or may not conduct the interview with a primary focus of the injured client’s ability to function independently before and after the injury event and ask about current functional changes.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

Cruciality: Complete Consultations (Treatment Providers)

115. Completing Consultations may or may not be a crucial substation step in the Life Care Planning Process

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

116. With the person with injury’s consent, communicate via telephone, email, or fax with current treatment providers may or may not be a crucial step in the life care planning methodology.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

117. Explain the purpose of the interview may or may not be a crucial activity in the life care planning process.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

118. Confirm date and time of interview by phone, in-person, or virtual may or may not be a crucial substation in the life care planning methodology.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

119. Conducting an interview with focus on treatments and progress to date and future recommendations may or may not be a crucial substation in life care planning methodology.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

120. Summarizing consultations and getting agreement from the provider may or may not be a crucial substation of the life care planning methodology.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

121. Paying an invoice for time spent with provider if required (reimbursed by referral source or included as expense in invoice submitted with report) may or may not be considered a crucial substation in the life care planning methodology.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

Cruciality: Research

122. Research may or may not be a crucial substation step in the life care planning process

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

123. Begin relevant research of best practices specific to client’s diagnoses and future needs may or may not be a crucial substation of the life care planning methodology.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

Cruciality: Report Writing

As you read the stem of each methodological substation in this section, consider the subject (person with a disability) of the life care planning services who has a diagnosis that benefits from the subject matter of the stem. For example, the item may read as follows," Research may include wheelchair needs." The subject (person with a disability) in the stem would have a diagnosis that requires mobility assistance. This is true for all items in this section.

124. Report Writing is the most crucial of the Methodological Substations in the Life Care Planning Methodology.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

125. Preparing a template with the person with injury’s information and referral source information as well as pertinent dates of event, date of assessment, and date of the report may or may not be crucial to report writing.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

126. In the report, compiling information gathered from the interview may or may not be crucial to report writing.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

127. In the report, compiling information gathered from collateral interviews may or may not be crucial to report writing.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

128. Compiling information gathered at consultations may or may not be crucial when writing the life care plan report.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

129. Compiling perceived functional deficits/capabilities in comparison to assessed function may or may not be crucial to writing the life care plan.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

130. Analyzing information gathered in the medical file to write a Medical Foundation that should include medical opinions from medical providers/physicians and specialists may or may not be crucial when writing the life care plan.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

131. Analyzing information gathered and in the medical file to write a Rehabilitation Foundation that includes rehabilitation services to date with ongoing efforts to achieve rehab goals may or may not be crucial to writing the life care plan.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

132. Analyzing information gathered and in the medical file to write a Psychological Foundation that includes psychological opinions from psychiatrists and psychologists may or may not be crucial to the life care plan.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

133. Beginning writing and researching person with injury needs based on gathered information, medical file, and relevant research may or may not be a crucial methodological substation when writing the life care plan.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

134. Research may include Projected Evaluations that may or may not be crucial to document in the life care plan

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

135. Research may include Projected Therapeutic Modalities that may or may not be crucial to include in the life care plan.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

136. Research may include Wheelchair Needs that may or may not be crucial in the life care plan methodology.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

137. Research may include Wheelchair Accessories and Maintenance and may or may not be crucial in the life care planning methodology.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

138. Research may include Aids for Independent Living and may or may not be crucial to the life care plan methodology

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

139. Research may include Orthotics/Prosthetics, and may or may not be crucial in the life care plan methodology.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

140. Research may include Aids for Symptom Management and may or may not be crucial for life care planning methodology.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

141. Research may include Medications and Supply Needs and may or may not be considered a substation of life care planning methodology.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o not Crucial

o Strongly Not Crucial

142. Research may include Transportation and may or may not be crucial to the life care planning methodology.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

143. Research may include Health and Strength Management and may or may not be crucial to the methodology of life care planning.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

144. Research may include Housing Considerations/Architectural Renovations and may or may not be crucial to the life care planning methodology.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

145. Research may include Future Medical Care or Surgical Intervention and may or may not be crucial to the life care planning methodology.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

146. Research may include Orthopaedic Equipment Needs and may or may not be crucial to the life care planning methodology.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

147. Research may include a Vocational/Education Plan and may or may not be considered crucial to the life care planning methodology.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

148. Research may identify Loss of Valuable Services, such as Home Care/Attendant Care/Facility Care, Home Maintenance that includes house cleaning, lawn care, handyman services, and snow removal which may or may not be crucial to the life care planning methodology.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

149. Research may include Potential Complications and may or may not be crucial to the life care planning methodology.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

Cruciality: Report Review

150. Report Review may or may not be a methodological substation in the Life Care Planning Process.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

151. Conducting a follow-up virtual interview with the person with injury to review the report content may or may not be a crucial substation in the life care planning methodology.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

152. Completing a final review of the report paying particular attention to details may or may not be a substation in the methodology of the life care planning process.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

Cruciality: Invoice

153. Add to invoice travel and mileage, duration of communications with providers, family members, friend, research, etc. may or may not be a crucial substation of life care planning methodology.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

154. Invoice may or may not be a Methodological Substation in the Life Care planning Process

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

Cruciality: Report Delivery

155. Report Delivery may or may not be a Methodological Substation in the Life Care Planning Process

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

156. Saving a report in PDF format with a protected password may or may not be a substation in the life care planning methodology.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

157. Sending a report and invoice to the referral source via specified instructions (email, postal, hand-carried, or fax) may or may not be a substation of the life care planning methodology.

(Select only one)

o Strongly Crucial

o Crucial

o Neutral

o Not Crucial

o Strongly Not Crucial

Frequency Ratings of Methological Substations in the Life Care Planning Process

Rating Choices: 0%, 25%, 50%, 75%, 100%

Frequency: Substations of Life Care Planning Methodology

Please Review and Score the Items as they pertain to how frequently you would engage the item in the life care planning methodology. Regarding report writing section, items that address specific prosthetics or assistive devices the subject matter’s diagnosis fits that respective need. For example, the item that reads “Research may include wheelchair needs” requires the person to address the item as if there is a person who has mobility deficits and may require a wheelchair. This is true for all remaining research items.

Frequency of Receipt of Referral

158. Based on your life care planning 120-hour training plus your experience, the Receipt of Referral may or may not be a frequent methodological step in the life care planning process

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

159. The Receipt of Referral may be or may not be a frequent methodological step to confirm no conflict of interest, review information provided, and communicate with the referral source for clarification

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

160. The Receipt of Referral frequently includes a review with the referral source, the projected due date of the report, fees, expectations, review of the LCP process, and completeness of submitted records.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

Frequency of the File Review

161. The Review of the Files may or may not be frequently considered to be a primary methodological step in the life care planning methodology process

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

162. The Review of Files frequently allows me to put the provided documents in a preferred order, such as chronological, reverse chronology, or by record type.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

Frequency of the Scheduled Assessment

163. The Scheduled Assessment substation frequently refers to the life care planner’s initial communication with the person with injury who is the subject of the life care plan, and the scheduled assessment is therefore an important substation of the life care planning methodology.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

164. The Scheduled Assessment frequently may include an initiated introduction by the life care planner to the person with injury, an explanation of the purpose of the call, an explanation of the assessment and time allotted to complete the assessment, a confirmation of mutually agreeable assessment date and time, a confirmation of address and directions, a confirmation of other persons being present during the assessment, answering any questions the subject may have, and a reminder to the client of the upcoming appointment via email or telephone and to confirm the date is still appropriate to proceed

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

Frequency of Conducting the Assessment

165. Conducting the Assessment is frequently a significant methodological substation in the life care planning process. This substation may frequently include a repeated introduction of the life care planner to the person with injury, the life care planner’s review of the purpose of the assessment with the person with injury, an opportunity for the person with injury to ask any questions prior to proceeding, have the person with injury complete the required consent forms, review the medical history to date with the person with injury for accuracy, review pre-accident medical and other conditions developed since the event.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

166. When conducting the Assessment, it may or may not be important to frequently gather information regarding education/vocational history that may include highest level of education completed, job title, employer, number of hours/shifts, physical demands, workplace accommodations, relationship with employer, and barriers to returning to work.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

167. Conducting the Assessment may or may not require the life care planner to frequently gather information on current physical symptoms that may include the person with injury completing a body diagram, documenting symptom location and symptom descriptors, the pain intensity levels, frequency of pain (intermittent versus constant), duration, aggravating factors, alleviating factors, clinical course since the event, clinical course over the last 6-month period.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

168. The life care planner Conducting the Assessment may or may not frequently gather current cognitive symptoms that may include symptom descriptors, intensity of pain, frequency (intermittent versus constant), duration, aggravating factors, alleviating factors, clinical course since event, and clinical course over the last 6-month period.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

169. The life care planner Conducting the Assessment may or may not frequently gather information on current emotional symptoms that may include symptom descriptors, intensity of pain, frequency (intermittent versus constant), duration, aggravating factors, alleviating factors, clinical course since event, and clinical course over the last 6-month period.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

170. The life care planner Conducting the Assessment may or may not frequently gather information on current/ongoing treatment in terms of the diagnosis(es) of the person with injury, frequency of treatment, treatment goal, effect of treatment, last visit date, and the next visit date.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

171. The life care planner Conducting the Assessment may or may not frequently gather information on current medications that include the name of the medications, the dosage level, and the expected effects of medications, as well as any side-effects expressed by the person with injury.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

172. The life care planner Conducting the Assessment may or may not frequently gather information on the person with injury’s perceived functional abilities that may include sitting, standing, walking, lifting/carrying, pushing/pulling, bending, crouching/kneeling, stooping, stair climbing, reaching, handling, and finger dexterity.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

173. The life care planner Conducting the Assessment may or may not frequently gather information on social/leisure activities pre-accident and post-accident

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

174. When Conducting the Assessment the life care planner may or may not frequently gather information on the person with injury’s ability to perform the activities of daily living, which may include bathing, toileting, grooming, dressing, transferring, ambulating, and eating.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

175. When Conducting the Assessment the life care planner may or may not frequently gather information on ability to perform instrumental activities of daily living by comparing responsibility versus capability before and after the injury event.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

176. The life care planner when Conducting the Assessment may or may not frequently review and document Instrumental activities of daily living that include Daily Tasks, Weekly Tasks, Monthly Tasks, and Outdoor Household Maintenance.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

177. The life care planner may or may not review frequently Daily Tasks that are part of Conducting the Assessment and include meal preparation, meal clean-up, tidying, bed making, childcare, pet care, managing finances, and managing medications.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

178. The life care planner may or may not review frequently Weekly Tasks when Conducting the Assessment that include sweeping, vacuuming, washing floors, cleaning the bathroom, dusting, changing bed sheets, Laundry, taking out the garbage, and grocery shopping.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

179. The life care planner may or may not review and document frequently the Monthly Tasks when Conducting the Assessment and include cleaning appliances, cleaning windows, cleaning walls, cleaning blinds or curtains, cleaning light fixtures and fans, and arranging small indoor repairs.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

180. The life care planner may or may not review frequently Outdoor Household Maintenance as applied to Conducting the Assessment and include small outdoor repairs, gardening, lawn mowing, spring/fall clean-up, and snow removal.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

181. The life care planner Conducting the Assessment may or may not frequently present to the person with injury consent forms to be signed allowing the life care planner to contact pertinent collateral interviews with family members, friends or no medical personnel, and consultations with medical personnel currently involved with the person with injury.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

182. The life care planner Conducting the Assessment may or may not frequently complete the interview with an estimated time frame and the next steps outlined to include conducting collateral interviews, conducting consultations, begin writing the report, and arrange a follow-up with the person with injury to review gathered information and fill in any blanks, and invite the person with injury to ask any other questions before closing the interview.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

Frequency of Collateral Interviews (non-treatment personnel such as friends and family members).

183. The Collateral Interviews substation may or may not be a significant substation step in the life care planning process.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

184. With person with injury’s consent the life care planner may or may not frequently communicate via telephone or email with those persons close to the person with injury that can provide a perspective into future care needs.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

185. The life care planner may or may not frequently explain the purpose of the interview with all persons with injuries.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

186. The life care planner may or may not frequently conduct the interview with a primary focus of the person with injury’s ability to function independently before and after the injury event and ask about current functional changes.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

187. The life care planner may or may not confirm the date and time of the interview by phone, in-person, or virtual to all persons with injuries.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

Frequency of Completing Consultation (Treatment Providers)

188. The Complete Consultations is considered a frequent significant substation step in the life care planning process

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

189. With the person with injury’s consent, the life care planner may or may not frequently communicate via telephone, email, and/or fax with current treatment providers

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

190. The life care planner may or may not frequently explain the purpose of the interview to team providers

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

191. The life care planner may or may not frequently confirm date and time of interview by phone, in-person, or virtual to treatment providers.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

192. The life care planner may or may not frequently conduct an interview with the focus being on treatments and progress to date and future recommendations from treatment providers.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

193. The life care planner may or may not frequently summarize consultations and get agreement from providers.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

194. The life care planner may or may not frequently pay an invoice for time spent with a provider if required (reimbursed by referral source or included as expense in invoice submitted with report).

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

Frequency of Research

195. Research may or may not be considered frequently to be a significant substation step in the life care planning process

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

196. The life care planner may or may not frequently begin relevant research of best practices specific to client’s diagnoses and future needs

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

Frequency of Writing the Report

197. Report Writing may or may not be considered frequently to be the Primary Methodological Station in the Life Care Planning Process

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

198. The life care planner frequently prepares the template with the person with injury’s information and referral source information as well as pertinent dates of event, date of assessment, and date of the report.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

199. In the report, the life care planner frequently compiles information gathered from the initial interview.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

200. In the report, the life care planner frequently compiles information gathered from collateral interviews when writing the report.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

201. The life care planner frequently compiles information gathered at consultations to put in the report.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

202. The life care planner frequently compiles perceived functional deficits/capabilities in comparison to assessed function to put in the report.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

203. The life care planner frequently analyzes information gathered and uses the medical file to write a Medical Foundation that should include medical opinions from medical providers/physicians and specialists.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

204. The life care planner frequently analyzes information gathered and uses the medical file to write a Rehabilitation Foundation that includes rehabilitation services to date with ongoing efforts to achieve rehab goals.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

205. The life care planner frequently analyzes information gathered and uses the medical file to write a Psychological Foundation that includes psychological opinions from psychiatrists and psychologists

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

206. The life care planner frequently begins writing and researching person with injury needs based on gathered information, the medical file, and relevant research that will be part of the life care plan report.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

207. Research may or may not frequently include Projected Evaluations for a polytrauma person with injury.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

208. Research may or may not frequently include Projected Therapeutic Modalities for a polytrauma person with injury.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

209. Research may or may not frequently include Wheelchair Needs for a person with injury with mobility deficits.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

210. Research may or may not frequently include Wheelchair Accessories and Maintenance for persons with injuries with mobility deficits

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

211. Research may or may not frequently include Aides for Independent Living for a person with injury with manageable trauma.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

212. Research may or may not frequently include Orthotics/Prosthetics for persons with injuries with lower extremity amputations.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

213. Research may or may not frequently include Aids for Symptom Management

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

214. Research may or may not frequently include Medications and Supply Needs

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

215. Research may or may not frequently include Transportation for a person with injury with trauma that prevents independent mobility or the operation of a motor vehicle.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

216. Research may or may not frequently include Health and Strength Management for a polytrauma person with injury in extremities.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

217. Research may or may not frequently include Housing Considerations/Architectural Renovations

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

218. Research may or may not frequently include Future Medical Care or Surgical Intervention

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

219. Research may or may not frequently include Orthopaedic Equipment Needs for a person with injury with musculoskeletal trauma

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

220. Research may or may not frequently include a Vocational/Education Plan for persons with injuries who have work tolerance potential in spite of their trauma diagnoses.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

221. The life care planner may or may not frequently research and identify the person with injury’s Loss of Valuable Services, such as Home Care/Attendant Care/Facility Care, Home Maintenance that includes house cleaning, lawn care, handyman services, and snow removal.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

222. Research may or may not frequently include Potential Complications

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

Frequency of Reviewing the Report

223. Report Review may or may not be frequently considered a secondary Methodological Substation in the life care planning process

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

224. The life care planner may or may not conduct a follow-up virtual interview with the person with injury to review the report content

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

225. The life care planner may or may not frequently complete a final review of the report paying particular attention to details for all life care planning persons with injuries..

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

Frequency of Sending the Invoice

226. The life care planner may or may not frequently add to the invoice travel and mileage, duration of communications with providers, family members, friend, research, etc.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

227. The Invoice may or may not be considered a frequently Methodological Substation in the Life Care planning Process

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

Frequency of Delivering the Report

228. Report Delivery may or may not frequently be referred to as a secondary Methodological substation in the Life Care Planning Process

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

229. The life care planner may or may not frequently save report in PDF format with protected password.

(Select only one)

o 100%

o 75%

o 50%

o 25%

o 0%

230. The life care planner may or may not frequently send the report and invoice to the referral source via specified instructions (email, postal, fax, or hand-carried).

(Select only one)

o 100%

o 75%

o 50%

o 25%

Appendix D

Dr. Paul Deutsch’s Tenets of the Life Care Planning Service Delivery System and His Suggested Readings

PUBLICATIONS - LIFE CARE PLANNING

Tenets of Life Care Planning

The Principle of Consistency

Consistency in Litigation

The Basic Tenets of Life Care Planning

The Elements of the Life Care Plan

Review of Records

Medical and Case Management Foundations

Elements of the Life Care Plan

Elements of the Life Care Plan Defined and Discussed

Tenets of Life Care Planning

The Principle of Consistency

The Merriam-Webster Dictionary defines consistency as “(a) an agreement or harmony of parts or features to one another or a whole; (h) ability to be asserted together without contradiction; (c) harmony or conduct of practice with profession.”

Each of these subtle variations of the meaning of “consistency” are appropriate definitions relative to the methodology of life care planning. Without a consistent approach to gathering patient-specific data, analyzing it, and organizing it into a sensible format, it is not likely that the plan will be effectively implemented.

The most respected life care planners follow a consistent approach to plan development with each case; their plans are based upon the demonstrated needs of everyone for whom a plan is created. Life care plans are based upon the needs of an individual, not the forecasted financial resources available for implementation.

To these planners, it does not matter whether they are hired by plaintiff or defense in a litigated case, by an insurance company to assist with case management and reserve setting, or by any other party to develop a life care plan. The developed plan will be tailored to the actual needs of the individual as dictated by the onset of a disability. Variations between individuals with similar disabilities will occur because of different variables being considered, but the methodology for analysis should remain consistent.

Consistency in Litigation

When involved in forensic cases, care planners should not develop “luxury” plans that include the most expensive options possible when hired by a plaintiff yet search for ways to provide the barest minimum of services regardless of individual needs when hired by an insurance company. If this sort of a pattern is detected, one’s professional credibility and ethical conduct will eventually be called into question.

In some catastrophic injury cases, the needs of the individual may very well exceed the financial resources available to meet those needs. When this occurs, the discrepancy between the needs and the available funds must be quantified and the life care planner must educate those involved as to the consequences of not meeting the projected needs of the patient. Beyond that, the planner may convene members of the planning and implementation teams (including the patient and family, of course) and consider alternative resources, community programs, and creative resolutions to the issues of concern.

The Basic Tenets of Life Care Planning

The following principles constitute the guiding philosophies of life care planning:

First and foremost, life care planners are rehabilitation professionals and educators. The role of the life care planner is that of educator, not advocate. When developing a plan, one must maintain objectivity and base recommendations upon research literature, the opinions of consulting team members (physicians, therapists, etc.), and patient-specific data. The responsibility of the life care planner is to set forth attainable rehabilitation goals and to ensure that all parties involved in the process understand why specific items are included, how/when services should be provided, and how the plan is best implemented.
All plan recommendations should clearly relate to patient-specific evaluation data. It is essential that each recommendation is carefully tied back to the data collected in the clinical interview and history taken with the patient and family, as well as in the review of all medical/health related professional records. The basis for each item citation should be clear to others who review the life care plan; no one should be left to wonder why specific recommendations were made.
Assume the probability of success of recommendations. It is inappropriate to make recommendations in a plan, then to proceed as though those recommendations were not going to be successful. If the recommendations are worthy of inclusion, it is appropriate to assume the probability of their success. The plan should be built upon successful outcomes.
Life care plans are designed to answer questions, not raise them. The life care plan should be self-explanatory. If it is not, revisions should be made so that it is easily understood by all. Develop a format that is natural to your writing style, but also reader friendly. Use explanations in the comment box and footnote sections wherever necessary. Have a team member review the plan and objectively comment on the document’s readability. This will improve communications and reduce the time spent in deposition, if the plan is scrutinized within the forensic setting. It is even more critical when the plan is referred to within a general case management setting. Clarity of communication with the patient, family, and interested third parties is critical so that recommendations are not misinterpreted or misapplied.
Life care plans specify provisions throughout life expectancy and cannot depend on any one individual, service, or supplier for fulfilling plan recommendations. Always use at least three sources for the major cost items in the plan. Do not use negotiated rates because there is no guarantee that the cost will remain constant if the business/supplier should change hands; life care planners should not get into the habit of seeking discounted rates for repeat referrals. During the phase of plan development, costs should reflect real values of goods and services found within the patient’s local market. Also, eliminate the outliers from the market analysis so that unrealistically low/high rates do not misrepresent the actual cost of an item.
Recommendations must consider disability, individual, family, and regional factors. Make sure the services you are recommending are available in the patient’s geographical location; if not, provide transportation expenses or develop a program using area resources. For example, if the patient lives in a rural setting with few paved sidewalks, the wheelchair you recommend should be durable within that environment. Always consider the Individual variables that make the plan a custom fit to this patient and family. There are no generic life care plans!
Attend to details. A clearly written, well-documented life care plan and a professional image are significant steps toward credibility. Strive to maintain professionalism and to produce a professional product. Carefully proof all work for careless mathematical, grammatical, or terminology errors. Evaluate the narrative report, life care plan, and all correspondence for internal consistency and make certain that the recommendations progress in a logical sequence. When reviewing your work for submission to the referral source, patient, and family, remember that they are not likely to be familiar with the terminology, acronyms, medical codes, abbreviations, and nomenclature taken for granted by the planner. The plan is a tool of communication, not confusion!
Recommendations are proactive, not reactive. Life care plans should be developed and implemented in a preventative manner that minimizes the frequency of occurrence, severity, and duration of complications. The recommendations must be dearly related to evaluation data identifying specific individual needs and must be expected to benefit the Individual.

If an individual is not expected to benefit from a given service or piece of equipment, that recommendation should not be made. On the other hand, if a recommendation is expected to benefit the individual, the expected benefit should be considered in developing the rest of the plan.

For example, if an individual with paraplegia but no history of decubiti is provided appropriate wheelchair cushioning and training regarding pressure release, skin inspection, and other methods to prevent the development of decubiti, that individual’s life care plan should not include provisions for four surgeries per year to treat decubiti. The assumption being made is that the best care and recommendations will not work and such complications will occur unabated regardless of preventative intervention. It suggests that complications can be accurately predicted despite the lack of a statistical basis for that assumption. It also fails to consider the impact such an assumption concerning ongoing complications may have on life expectancy.

Recognize the benefits of maximizing patient potential. In addition to individual quality of life benefits, financial benefits may also result from maximizing rehabilitation outcomes through the provision of timely and appropriate services.

Consider the following example: Imagine the costs over a lifetime for two different 24-year-old individuals with C5-6 spinal cord injuries. One can turn himself at night or can tolerate six hours without being turned. The other cannot. The difference in expected lifetime costs reduced to present value for these two Individuals is over two million dollars. This difference is based upon the patients’ functional limitations and the degree to which their levels of independence impact staffing requirements for support care.

Life care planning is multidimensional. Life care planning is multidimensional, with each recommendation potentially affecting other recommendations and elements of the plan. Driven by a specific functional limitation or impairment, all items cited within a plan will impact other recommendations both directly and indirectly.

For example, multiple disabilities and multiple service providers might dictate similar recommendations, resulting in service overlaps or duplications. Consider the effects of a change from intermittent catheterization every four to six hours to a suprapubic catheterization program for a C5 tetraplegic who is not independent in self-catheterization.

With intermittent catheterization, the patient requires:

An LPN to perform the procedure
Visiting nurses are impractical, because the program would require four to six visits every twenty-four hours
The cost of visiting nurses would preclude this form of care from being a realistic, fiscally responsible option
Two twelve-hour shifts, or three eight-hour shifts of skilled nursing care are necessary

If a change to a suprapubic catheter occurs, the skilled nursing care can be accomplished with nursing visits for the bowel program every other day, at which time they can deal with the flushing of the suprapubic tube and the once per month tube change.

In addition to the modifications within the home care element of the plan, changes would also be required in supplies, routine and invasive medical care, and possibly within the medication element of the plan.

Consider the entire cost of each recommendation. Not only life care plan developers, but also case managers implementing these plans need to consider all of the cost factors associated with a given service option or piece of equipment.

For equipment, the overall cost must consider the cost of maintenance and the necessary frequency of replacement. This is particularly true when calculating the cumulative cost of assistive technology and equipment that makes use of consumable supplies.

Thomas and Kitchen (1996) compared the costs of hiring a personal care attendant through an agency versus through private hire. When the total cost (including employer social security and Medicare matches, state unemployment taxes, fringe benefits, payroll expenses, background checks, appropriate supervision, etc.) of a private hire are considered, the appeal of hiring through an agency increases.

The costs provided in a life care plan do not include two important categories: potential complications and future technology. The costs associated with these areas cannot be accurately predicted. The degree to which complications will be experienced or future technology developed to meet a given individual’s needs cannot be known. Therefore, these costs are not included in the final cost analysis of life care plans. However, it is important for life care planners and case managers to inform decision-makers that there is potential for development of complications, as well as invention of future technology, which could have an impact even though they have not been Included In the life care plan projections.

Within the narrative report or the life care plan, the planners should clearly state that the issues of complications and technological advancement were not ignored, but that no valid method of calculating the costs/needs associated with either area exists. Life care planners must be certain to educate others and indicate that recommendations are based upon what has been determined to occur within “reasonable rehabilitation probability.” Events that lie beyond the realm of reasonable rehabilitation probability simply cannot be accurately evaluated.

Consider the psychological effects of injury or disability. Psychological factors have a significant impact on the quality of life for Individuals with catastrophic injuries. Making the individual a part of the decision-making team early in the process, and at what level they can participate, is critical to the success of plan implementation. Having choices and exercising control over one’s environment are especially important for individuals with catastrophic injuries that interfere with mobility and physical function.

For example, installation of an environmental control unit is a psychological intervention, an aid for independent functioning, and a safety precaution. If a tetraplegic individual has a personal care attendant available to turn the channels on a television set or to dial a telephone, for example, a naive individual might question the need for a voice-activated system to operate those items. However, the psychological importance of restoring as much choice and independent control over one’s environment as possible should not be underestimated.

Psychological interventions should take into consideration the current demonstrated needs by the individual and his or her family, as well as future adjustments anticipated over the life span. For an adult who is injured, adjustments are expected during critical life phases, such as marriage, beginning a family, and retirement. For children with disabilities, appropriate short-term psychological goals should be established for different developmental stages.

Disability interacts with age to produce additional concerns. Not only psychological aspects, but also physical aspects of function, will normally vary with age. When disability interacts with the aging process, specific body parts are known to wear out faster than they would for an individual without a disability.

For example, an individual who uses a manual wheelchair during young adulthood may be expected to require a power wheelchair later in life. The patient’s shoulders, which were not designed to be weight bearing joints, will lose function over time faster than would be experienced by an individual who does not use a wheelchair. Aging with disability is a critical part of the life care planning process. The plan does not remain static throughout the lifespan of the patient but must anticipate the Items and services made necessary by the effects of age and disability. An excellent example of the research done in this area is discussed in Aging.

The Elements of the Life Care Plan

Upon completion, each life care plan should reflect the unique needs of the patient. The established methodology allows planners to consistently follow a specific sequence of tasks throughout the development process while, at the same time, customizing each plan according to the realities of a patient’s circumstance.

One of the most critical tasks to be completed during the plan development process is the clinical interview and history with the patient and at least one member of their family. This may not be possible in all situations (i.e., litigated cases) but should be attempted in every case. Patients and family members provide the planner with a wealth of information which cannot be conveyed from a review of written records, and this information helps the planner to more fully appreciate the functional, emotional, psychological, and vocational impact of the injury or illness.

Prior to conducting the clinical interview, however, it is suggested that life care planners complete a thorough review of all patient records. Not only will this prepare the planner for the interview, but it provides an opportunity to clarify errors or confusion within the record.

Review of Records

Reviewing patient records can be a daunting task if the life care planner has not developed a systematic data management system. To most effectively build a patient profile, the planner requests all medical, psychological, rehabilitation, educational (for children), and vocational (if applicable) records.

A comprehensive review of the records serves many purposes:

All medical and rehabilitation aspects of each case must be identified.
The planner may determine whether additional assessment is necessary in order to distinguish all patient needs.
The planner must be able to communicate the intricacies of each case with the treatment and consultation team.
If not clearly stated within the record, specific questions may need to be asked of specialists regarding future interventions, evaluations, and/or recommended therapies.
The planner is better able to understand the experiences of the patient and may approach delicate personal topics with greater sensitivity.

Medical and Case Management Foundations

Life care planning methodology dictates, and forensic practice requires that both medical and case management foundations are required in the development of each plan. This is one reason why professionals from both areas are well-suited to pursue board certification in life care planning; each contributes an essential component within the plan.

Medical foundations are required for any recommendations that are exclusively medical in nature. For example, invasive procedures, diagnostic testing, laboratory testing, prescription medications, surgical interventions, and similar items require physician support. The treating, consulting, or specialized physician must substantiate that the recommendations are medically sound. Case managers are not qualified to make medical recommendations.

Case management foundations are required for all items which fall outside of the medical arena. This is not to say, however, that life care planners do not need to be fluent in medical terminology and all related information. Planners are responsible for basing all rehabilitation, therapeutic, support care, vocational, equipment, supply, and other needs upon the patient’s medical diagnosis, substantiating medical data, and resulting limitations. Physicians are not qualified to make long-term rehabilitation recommendations.

Consider this example: Physicians provide comprehensive data regarding the medial aspects of the patient’s condition. Case managers then use this data to identify the appropriate level of support care as determined by the home health regulations and staffing guidelines.

Of course, this process may be accomplished in conjunction with the physician, but it is the responsibility of the life care planner to know the regulations within the patient’s state of residence. Physicians are generally not familiar with the issues surrounding patient care beyond the acute/sub-acute phases of rehabilitation. Their expertise is concentrated upon immediate treatment protocols necessary to stabilize and improve a patient’s physical condition.

Needs-Based Recommendations

Though the elements of life care plans are generally consistent when compared to one another, the content within each area is individualized to the needs of the patient and family. In addition to the items themselves, each associated cost, replacement schedule, dates of implementation and suspension, and the name of the professional making the recommendation are clearly identified.

Recall from the discussion of methodology that potential complications are not to be included within the text of the life care plan. Instead, complications are addressed within a separate element of the plan and provided only for the purposes of educating those involved in the case. Complications cannot be predicted nor budgeted for within the plan. While alerting the patient and others to the potential for complicating events, the planner has an opportunity to reiterate another of the basic principles of life care planning: A competently developed plan, if complied with, will minimize complications.

Elements of the Life Care Plan

Depending upon the specific needs of the patient, the following areas are to be addressed within the life care plan:

Projected evaluations

Projected therapeutic modalities

Diagnostic testing and educational assessments

Wheelchair needs

Wheelchair accessories and maintenance

Orthopedic equipment needs

Orthotic or prosthetic requirements

Home furnishings and accessories

Aids for independent function

Medication

Supply needs

Home care or facility-based care needs

Projected routine future medical care

Projected surgical treatment or other aggressive medical care

Transportation needs

Architectural renovations

Leisure or recreational equipment

Elements of the Life Care Plan Defined and Discussed

Projected evaluations: The first page of the life care plan refers to health-related professional evaluations. These may include, but are not limited to, evaluations by physical therapy, occupational therapy, recreational therapy, psychology, neuropsychology, developmental psychology, behavioral psychology, recreational therapy, speech therapy, vocational rehabilitation, or a range of other specializations. The important thing to remember is that physician evaluations are included on either the routine future medical care page or, in the case of aggressive medical intervention or surgical procedures, the aggressive medical care page. Evaluations are separated from the actual provision of therapies displayed on the next page because they are scheduled separately and often an individual will be evaluated numerous times without therapies being initiated until certain criteria are met. Even when therapies are ongoing, it is common to periodically step back and perform evaluations to determine the gains that have been made and establish goals for the next stage of therapy. This process also provides an opportunity for the planner to establish phase changes in the exercise program or regime.

Therapeutic modalities: The second page of the plan displays the type, schedule, frequency, and duration of therapies planned for the patient. Remember that therapies, like all recommendations, are needs that are driven and not dollar driven. For example, it is appropriate to note a home-based physical therapy program even when it is designed by the physical therapist during a once per year evaluation but administered by the paraplegic patient on an independent basis. Even when no dollars are displayed in the cost column, it is appropriate to display what is occurring in self-compliance with appropriate care.

Diagnostic testing/educational needs: This section represents educational testing requirements, special education needs for the pediatric patient, vocational training programs, or even college education programs that are recommended for the patient. These can include programs provided under the Individuals with Disabilities Education Act (IDEA) without charge in the plan or programs requiring extensive costs for tuition, lab fees, books, and supplies.

Wheelchair needs: Depending on the disability, this section can cover a broad range of wheelchair types supplied for a broad range of needs, desires, and Interest. The life care planner should become familiar with the basis for wheelchair prescriptions before including recommendations in the plan. The patient’s age, body type, height, and weight can significantly influence chair requirements as can the nature of the disability. The planner should pay particular attention to a cut-off date when ordering specialty chairs. For example, for the wheelchair athlete Interested in a sports wheelchair to play in a wheelchair basketball league, the planner should be careful not to continue replacing the sports wheelchair through the patient’s life expectancy.

Wheelchair accessories and maintenance: This page is largely self- explanatory, but a few points are important to keep in mind. Paying attention to small details can help bring credibility to a plan. For example, it is important to start maintenance costs one year after the purchase of the chair and not the same day the chair is purchased. The first year’s costs should be covered by the chair’s warranty. Consider carefully what the patient, based on the disability involved, is most likely to use in terms of accessories. Do not simply develop a standard list and apply it to every life care plan.

Orthopedic equipment: This page addresses equipment in the home that supports home-based therapies. For the adult patient, this equipment may include therapy mats, a therapy table, or specialty exercise equipment for use with the wheelchair. For pediatric patients, it may include therapy balls, grasshoppers, positioning bolsters, or a range of other appropriate equipment. Coordinate your recommendations with the physical and occupational therapists as well as with family members and, where appropriate, the patient.

Orthotics and prosthetics: This page addresses any upper or lower extremity splinting needs the patient may have. It is insufficient to only consider what the patient’s existing program already contains. Check with the therapist and treating physicians about future needs before budgeting for these items.

Prosthetics should be carefully planned for the amputee. Talk to the local treatment team and try and check with more than one prosthetist to see if there are unique aspects to the amputation. A variety of factors can influence the nature of the prosthetic device and the materials used in its construction: the nature of the amputation, the patient’s occupation, the patient’s leisure-time interest, and even the region of the country.

Home furnishings and accessories: A variety of items may be included in this page. The planner’s goal should be to consider furnishings from handheld showers to lift recliners that will improve the quality of life of the patient.

Aids for independent function: The focus of this section is on identifying the aids for independent function that will be most effective and most useful for the individual patient with whom you are working.

There are literally thousands of such aids available, but typically only a select number that a specific patient will choose to use on a regular basis. The life care planner must become familiar with the resources for identifying these aids and must educate patients on their availability and function.

Medications: The life care planner can only include the medications outlined by the physicians. Nevertheless, the list must be restricted to medications that will be used on a chronic basis. Acute medications cannot be included simply because there is no basis for determining the frequency or duration of use or even the phases in which they may be used. Thus, there is no way for an economist to cost out their inclusion in the plan.

Supply needs: These include all supplies associated with compliance with good care in relation to the disability. The planner should itemize these supplies in detail and include costs for each item.

Home care/attendant care/facility care: In plans where support care services are necessary, an average of 65% to 75% of the total cost are tied up in this one section of the plan. For this reason, it is extremely important that you document this section carefully. That is not to suggest documentation is not equally necessary in all areas, but it is important to re-emphasize the point here. If you are considering recommending home care, then review local home health regulations. Confer directly with the staff and administrative representatives of these agencies to assess the level of care which can be provided. Consider the options for providing home-based care programs. Look carefully at multiple alternatives for facility-based programs and do not be afraid to think creatively. Consider the patients and family’s ideas, goals and interests. Work together as a team.

Routine medical care: The routine medical care page should be completed, in part, with the aid of the treatment team. But if you are a case manager completing the plan, do not be afraid to exercise judgment. In your role as life care planner, you are expected to exercise good judgment. For example, certain medications require routine laboratory studies in follow-up. If the doctors have not specifically noted this, it is still in your purview to budget these laboratory studies in the plan as a standard of care. You are not ordering the test; you are simply providing for the line item in the budget. Failure to do so Is an oversight that you should not allow to happen. If you are not comfortable making recommendations involving routine procedures, go back and check with the appropriate physician. You must keep on top of these basic items and work closely with the physicians to complete this section and the aggressive medical portion of the plan.

Aggressive future medical care or surgical intervention: Only the treating physicians or a consulting doctor can complete this portion of the plan. The life care planner is responsible for carefully noting the procedure and, where possible, identifying procedure codes. It is necessary for the planner then to identify and document procedure/surgical costs, hospital costs, anesthesiology costs, or any other related charges.

Transportation needs: Any disability-related adaptations to vehicles should be noted in this section of the plan. This is the appropriate section to include anything from a simple spinner knob placed on a steering wheel for an upper extremity amputee or an adapted van for a wheelchair patient. The important thing to remember is that the life care plan should only include costs made necessary by the onset of a disability. If an individual would have had a vehicle in any case and now is getting an adapted van, then there would be an offset to that cost. Generally, the recommended offset is the average cost of purchasing an automobile in the U.S. One recommended source is the National Automobile Dealers Association (NADA), Industry Analysis Division. Currently, the estimated cost of the average new automobile is $26,150 (2002 data), which would be deducted from the price of a van as an offset.

Architectural needs: This section provides for all adaptations to the home made necessary by the disability. Like transportation, it is important not to “double dip” in this area. Remember that most people normally buy homes and automobiles from their earned wages. Therefore, if the case on which you are consulting involves wage loss reimbursement, then the cost of the basic home and automobile has already been covered. The life care plan only budgets for the costs of adaptations made necessary by the onset of the disability. If, in fact, there is no wage loss involved, or if it is insufficient to allow housing or transportation to meet appropriately adapted needs, then an exception is involved.

Leisure time/recreational needs: It is important to keep in mind that the life care planner is working with the whole patient. This means the planner is involved not only with physical disability but with the psychology, the vocational interests, and the leisure time/recreational life of the patient.