Life Care Plans in Nursing Home Cases
How do you prove the long-term impact of nursing home abuse in court? Life care plans show the cost of future medical needs and help establish the full value of a case. They’re essential in getting justice for victims. In this week’s episode, nursing home abuse lawyer Rob Schenk welcomes guest Bonnie McCormick to explain what life care plans are, who creates them, and how they’re used in nursing home litigation.
McCormick:
So I will go into these databases. I will put in the CPT code for physical therapy or a doctor’s office visit or whatever, less based on that geographic area, Valdosta, Georgia, rural Georgia. Then I go to Fair Health and do the same thing and get that cost. And then I go to PMIC and get that cost. So I have three data points and whichever one is the median. That’s the one we use.
Intro
Schenk:
Hey out there. Welcome back to the Nursing Home Abuse Podcast. My name is Rob. I will be your host for this episode. Today we are talking about life care plans in nursing home cases. In other words, how we essentially account for future damages, how those costs affect our clients, and how those are computed and how they’re argued. We’re definitely not having that conversation alone. We have the fantastic Bonnie McCormick. To walk us through this process.
Alright, let’s get into the meat and potatoes of the episode. We’re talking about life care plans. What are they? When do you use them? What is involved in making them? But we’re not doing that alone.
We have Bonnie McCormick with us. Bonnie McCormick is a seasoned nurse with nearly 32 years of experience bringing a strong clinical background in both hospital and long-term care settings. She also has extensive expertise in the managed care industry. Since 2018, Bonnie has worked as a legal nurse consultant and is a certified life care planner, a dedicated patient advocate. Learn more about Sunshine Nurse.
Throughout her career, she remains committed to improving healthcare outcomes. Bonnie resides in Jacksonville, Florida with her husband and sons, and actually you can. To Bonnie. She was on the podcast. Oh, I don’t know. We batch record these, so I’m not quite sure what number this would be. Maybe, let me see if I can figure that out.
Bonnie, I think episode 2 54. She talked about infection control and prevention in nursing homes. So this is Bonnie’s second appearance in the show and we are so happy to have her back on. Bonnie, welcome back to the show.
McCormick:
Thank you. Thank you for having me.
What is a life care plan?
Schenk:
I guess the first question we should talk about is what is a life care plan?
McCormick:
That’s a great question. A life care plan is a comprehensive evidence-based document that outlines the current and future medical therapeutics, supportive care needs of an individual who suffered a catastrophic injury or a chronic illness, and it projects the costs over the individual’s lifetime and serves as. Kind of a roadmap for future care needs and the, and along with the costs associated with those needs.
This study reviews collaborative decision-making in long-term care planning on the impact of preventive health measures in elderly populations.
Schenk:
In general. Why, like why would you want a life care plan? What is a life care plan used to do?
McCormick:
The life care plan is used to guide caregivers and attorneys on what the person who has been injured or who has a chronic illness of some sort.
Chronic pain, chronic injury, any of that. It helps them have a roadmap so you know what’s coming down the road. Based on my experience as a life care planner, as a nurse for over 30 years and all of the clinical experiences that I’ve had, it helps to have a roadmap to know what’s coming down the road. So you can quantify. That number and make a more educated decision on how much this is all gonna cost.
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Schenk:
So it’s a part of the damages process. If you’re bringing a case they bring on Bonnie to say, what are the future costs of That’s right. Treating this individual’s injuries.
McCormick:
That’s exactly right. And a life care plan doesn’t go into causation. The Life care plan is really only about the damages that are sustained and how much they’re gonna cost throughout the person’s lifetime.
What training or background is required to become a life care planner?
Schenk:
So I guess before we get into the more substance of the life care plans, like what’s the what does the life care planner’s background consist of? What experiences in education does the typical life care planner have to do what they do?
McCormick:
To become a life care planner, you typically need a clinical background, most commonly in nursing or rehab or case management, something like that.
Plus there you do need some formal training in life care planning through a recognized certification program. Most life care planners also have experience in legal nurse consulting or catastrophic case management or disability evaluation. So not everybody can be a life care planner. You really do have to have some specialized training and knowledge.
It really helps to have a background in case management and coding and costing and working in databases to really be effective. But you also have to be able to understand the client in a holistic way so that you can project costs, not just for their. Medical care, but also looking at, do they need home modifications?
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Do they need to be transferred to a higher level of care? Are they gonna need trans, have their transportation needs? Like all the supplies that might have come with a new injury. So you really have to have a really strong clinical background, but you also have to be able to look at it from a case management perspective and understand what all the needs are globally for that person as they relate to the injury at hand.
What are the typical costs to nursing home plaintiff attorneys?
Schenk:
For me I’ve been doing nursing home abuse cases for over 10 years at this point. I’ve never, I’ve unfortunately, my, a lot of my clients have passed.
Or the injuries are such that it’s like a broken bone or a pressure injury that’s healed and comes back or whatever. I’ve never really. Considered life care planning
McCormick:
Right.
Schenk:
In, in some of my cases. Can you provide an example, like obviously don’t, you don’t have to give away any privileged information, but who does nursing home abuse? What kind of case would warrant a life care plan?
McCormick:
Okay. So I’ll tell you about the last one I just did. A few weeks ago for a nursing home case. ‘Cause I don’t just do nursing home cases, I do all of them. Sure. But the last nursing home case I had, it wasn’t a nursing home necessarily, it was assisted living. So there was a woman who was in assisted living who was doing very well, very independent living a great life.
And, she did have some comorbidities and some needs, but assisted living. The facility did not recognize that she was deteriorating. She got a terrible. Obstruction bowel obstruction, and she ended up pering and getting peritonitis and ended up with a colostomy, which then meant that she could no longer live in assisted living.
She needed a higher level of care, and she has all these supplies. There were all kinds of things that she could no longer do because of her injury. She deteriorated after she had to have the colostomy surgery. She tried to go to rehab. Get it back, but she was never the same again. So now all these costs are associated with her immobility and for the rest of her lifespan, which because she’s very elderly, the rest of her lifespan was only about six and a half years, if I remember correctly.
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But those are costs that are associated with that, and she no longer could stay at the existing level of care. So we had to move her up to a different level of care, which is more expensive. We had to provide all kinds of supplies for her colostomy care. We had to get, wound care nurse in there because she was having issues with it.
So that’s the kind of thing that I’ve seen that’s just one example of a life care plan that I’ve done for an elderly woman, where even though she only has technically five or six years left in the CDC. We use the CDC guidelines for life expectancy, but at the end of the day, she could live another 10 years.
You’d never know. But it’s, the point is to get her back to as close to independence that she was prior to this injury. So that she can continue to live her life as best she can.
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Schenk:
In Georgia, we have the old 1949 mortality table. It hasn’t been updated. Yeah, it hasn’t been updated in 70 years, but it’s still, that’s the, that’s actually in our code. Like it’s in Georgia code that you use that for life. Really life expectancy. Yeah. See,
McCormick:
I would probably just go back to the CDC ’cause that’s federal. If, I don’t know. I’ve never actually done a life care plan for an elderly person in Georgia. That is very interesting. But yeah. There are all kinds of tables out there that use statistics, national statistics, and national data that the Center for Disease Control uses for life expectancy.
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Schenk:
Okay. I understand the basic blueprint. You’ve got how long the person likely will live, whatever center you use, whether it’s the federal CDC or the back woods, George, the mortality table,
McCormick:
the world. But like,
Schenk:
How are you quantifying this stuff? Do you have to go out and hey, ostomy care person, would, how much do you charge? Like how do you blueprint all the costs?
McCormick:
Like I said, we extrapolate the cost of the care over the remainder of the person’s expected lifestyle lifespan using the CDC life expectancy charts as a foundation, but then.
We reference national costing databases to determine a median cost for each service or item tailored to the individual’s geographic location. So the final report quantifies the injuries impact not just on physical health, but on every aspect of the person’s life. Factoring in the medical care, the living arrangement changes, transportation needs, any other life adjustments resulting from the injury.
But we do use national databases that gather data from all over the country, and then we use a geographic zip code locator because somebody needs. Physical therapy in rural Georgia, it’s not gonna cost the same as someone who needs physical therapy in San Francisco. It’s gonna be different. So you have to use geo, zip locators and geographic adjustment factors for that.
But we use national databases that are very expensive that we belong to costing and coding databases to help us pull that data.
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How do you determine future cost of care, especially with fluctuating healthcare prices?
Schenk:
By that same token then, like how do you know what a physical therapist is gonna cost in rural Georgia, like in five years? Like how are you just doing like inflation? Like how do you adjust for that?
McCormick:
That’s a good question. We do not adjust for inflation. So all life care plans are in the today moment. And then an economist will go through and take our final numbers and then project those out according to inflation. So I might come up with $1.8 million in costs, but then an economist will take that 1.8 and project it out to the person’s lifetime with inflation adjustments.
What elements go into building a comprehensive life care plan for an elderly individual who has been injured?
Schenk:
Okay, so this is the dumb question, but what does it look like? What is it? Is it a piece of paper? Is it a little graph? Walk us through what we would see if we got a life care plan for one of our clients.
McCormick:
I’m a nurse life care planner. There’s other kinds of life care planners, like psychologists and rehab people.
I can only speak to how a nurse life care planner would do it and how I do it, but it’s a document and it’s a very lengthy document and it has all kinds. It has an overview of the con of the condition in the background it takes into account. Like comorbidities prior, existing conditions so that we can take those costs out because if somebody already had.
Diabetes or something, we’re not gonna cut that factor into the broken hip, for example. We have, we have to be able to show which prior conditions we’ve taken out and we go through that whole thing. We explain their condition very clearly. We do a case overview just real quick ’cause we’re not into causation.
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Then we start, then we get to the. Lifetime cost tables, and then we break it down. This is the outpatient costs. These are the in, in, inpatient hospital costs. These are the therapy costs. Transportation if there’s any increase in lodging expenses, we do therapies, we do home modifications.
If someone is living at home, I would have to cost out a brand new bathroom for somebody because the wheelchair won’t fit through the door anymore. It’s not a DA compliant. This week I had to figure out how much a handicap accessible van costs, that you can get a scooter in the back of, so someone with, a leg injury can continue to have mobility and so forth.
So it really just takes, it’s just a bunch of tables after that. And then one big number at the bottom. And then I provide detailed cost tables showing the three data points. ’cause I always use three data points to cost out my life care plan. So I’ll use, the median of those three. And then I provide at the end as an appendix. All the big ugly cost tables that go along with it and showing all the costs.
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Schenk:
I think I might’ve missed that. What do you mean? Like the three? The three numbers and you show the median. What does that mean?
McCormick:
So let’s say you wanna know physical therapy, what it costs in rural Georgia. Okay. Like Valdosta, Georgia, we use for example.
So we’ll go in and put in a, I’ll go to, I use Find a Code. I use fair help.org and I use PMIC, which is a physician fee reference. So I will go into these databases and I have several other databases, but those are the three I use this week anyway. And I will put in the CPT code for physical therapy or a doctor’s office visit or whatever.
Let’s say it’s a follow-up doctor’s visit that would, with moderate, you know. Complexity. That would be a 9 9 2 1 4. So that’s the CPT code. So you put the CPT code in there and find a code will give me based on that geographic area, Valdosta, Georgia, rural Georgia. What it would cost in that zip code. Then I go to Fair Health and do the same thing and get that cost, and then I go to PMIC and get that cost.
So I have three data points and whichever one is the median. That’s the one we use to cost it. That’s, we don’t use the low one, we don’t use the high one. We use the one in the middle.
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What are the typical defenses?
Schenk:
Bonnie, this all seems well and good, but what are. What are some of the kinds of the attacks or the defenses against this? Like what are, when you’re cross-examined, what how are they coming at you?
McCormick:
They try to come at you, you are disputing causation. But then I just refuse to get into that conversation because. I don’t I’m not here to talk about causation. We can argue that the injuries were due to a underlying health condition rather than neglect or claiming the plaintiff received appropriate care based on their baseline status.
But at the end of the day, we just have to isolate it down to the injury and how the injury itself has affected their. Their future care. And that’s why I do include comorbidities and prior conditions so that, I cut that off at the knees. And defense teams may also challenge the necessity or the duration of future care projected in the life care plan.
So they’ll say, oh, she’s very elderly, she’s not gonna live six more years. And we say, how do you know that you know better than the CD, C? All I can only go by data that is nationally recognized in peer review.
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Schenk:
I see. So essentially they’re, they wanna try to attack you on causation, which is no good because you’re not there to testify to that.
I’m not. Then they want to argue, and then the argument is the mortality tables. And then what ab are you ever attacked in terms of these numbers don’t make any sense, like, why you don’t need a van? Like, why does this person need a van, get them a, a dune buggy or whatever. It’s like, how are you attacked in that way?
McCormick:
Not really, because. I approach life care planning from a practical perspective. My clients generally don’t want me to be unfair. I’m not costing out. A Tesla truck, something very expensive, right? The mobility van I just cost out this week was a Chrysler Pacifica used for $43,000.
That is a very reasonable cost and I can prove and that was the median cost from the three vehicles that I looked at. So they can try to come after me with the numbers, but those are indisputable where I have, because I have three data sources and I, and the industry standard is to use three data points and use the 75% percentile of the median.
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That’s how we do it. That’s just the industry standard. So they can try to, nobody really has tried to come after me as far as like the actual numbers themselves. ’cause they’re indisputable the way I put them in a, the only thing that they try to come after is like some type of therapy that’s not necessarily.
They think it’s not medically necessary like prolotherapy or PRP therapy or something, which is why I do a lot of peer reviewed research and put that in the life care plan with a PA formatted, peer reviewed literature. Because, and the other thing too is I’m not coming up with those treatment plans myself.
I’m collaborating with the. The physicians who are coming up with these treatment plans, I’m just costing it out’s
Schenk:
That was actually gonna be my next question. Do you like putting hands on the on, on this particular person that you’re doing the life care plan for? Or are you just, is it just you’re just looking at medical records? Are you walk, how are you coming up? If the person needs physical therapy, how do you know that?
McCormick:
It’s not in my scope of practice to prescribe. Therapies for somebody. But what I do is I do a full nursing assessment. So I meet with the person, depending on the injury. I either meet with them in person or I meet with them via Zoom.
It just depends on the person. I’ve done both. And then I go through everything psychosocial that they want to talk about with me. Then I get into their symptoms and I create nursing diagnoses list. So when I say they need. Certain therapies, it’s either based on a treatment plan provided to me by a physician, or it’s based on my nursing knowledge over the last 30 plus years of what a person will need, who is in the same position as them based on my experience and training.
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Schenk:
Okay. Because I guess there would be instances in which it’s okay, they’re prescribed X for a certain amount of time, but like. How are you gonna figure out whether or not that needs to be continued, right?
McCormick:
The short answer is it’s based on my experience over the last 30 years working in managed care, working in case management, working at the bedside based on my 30 years of knowledge and experience as a nurse, and also based on physician treatment plans that have been provided to me.
And it’s also based on the standard of care. Throughout the United States at, at this time, I know that if somebody has a spinal fusion, they are going to need physical therapy. I know that because of my 30 years of experience and knowing that I, my time in the hospital and I know what a spinal fusion is, and I know what that’s what’s gonna take after that.
But most of the time the physician will have written that as a follow-up care order. And then also we take into account aging with the illness because a lot of people, are gonna deteriorate no matter what you do. And so you have to take that into account and look to the future like, they’re probably in the future going to need X, Y, and Z because of the injury that they have right now.
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Schenk:
Okay, so I can see that being a fight amongst the lawyers, then you’re just providing, you’re providing the number and the cost and then they can argue about part of this cost has to do with the fact that the individual’s just getting older. Part of this cost is to do with something that they already had to begin with, et cetera. You’re just providing the numbers. I get it.
McCormick:
So I’m providing the numbers and a framework for care and the framework.
Schenk:
Okay. So what about, the idea that you are saying that you’re providing a nursing care plan, right? Does that mean that you can provide a life care plan for somebody that, like you said, like a ostomy, somebody that, I don’t know, like maybe they broke a leg and now one leg shorter than the other one? Is there a limit to the quote unquote nursing life care plan that you can do?
McCormick:
It has to be within reason. If somebody’s had some kind of leg in or a below the knee amputation. For example, I pretty much know they’re gonna have to, have a prosthesis and they’re gonna have to, along with that prosthesis, they’re gonna need gait training, they’re gonna need physical therapy, they’re gonna need massage therapy, they’re gonna need all these other, all these other therapies that may or may not be written in a doctor’s order.
I try to get a doctor to give me treatment plans, but sometimes they’re not very responsive. But I can. Provide a usual and customary treatment plan. That’s, this is usually what happens with someone with A-B-K-A-A below the knee amputation because I can do literature searches and I can provide that documentation with peer reviewed literature and from my experience of the last 30 years of being in this industry.
Schenk:
Well, Bonnie, thank you so much for coming on the show and sharing your knowledge with us once.
McCormick:
Thank you so much for having me,
Schenk:
Folks. I hope that you enjoyed this episode of the Nursing Home Abuse Podcast. If you have any ideas for topics that you would like for me to talk about, please let me know If you have any ideas for people that you want me to talk to.
Please let me know as well. New n New Nurses, new episodes of the Nursing Home Abuse Podcast come out every single Monday. And once again, please make sure to enter to win the Nursing Home Abuse Podcast coffee mug by going to our TikTok and answering the question of the week, along with your favorite guilty pleasure television show.
And with that folks. We’ll see you next time.
Bonnie McCormick’s Contact Information: