Coping with severe disability through life care planning.

• Author: Woodrich, Frank

OVER the past half century, remarkable progress has been made in the development of medical and rehabilitation resources for the management of severe disability. Every year thousands of people survive head, spinal cord and other severely disabling injuries thanks to the emergency medicine, pharmaceutical and rehabilitation advances.

The process of adjusting to and coping with severe disability can be lengthy and complicated for the injured person. It is important to recognize that each individual will have different demographic and psychosocial resources to bring to the rehabilitation process. Severe disability requires that multidisciplinary services be provided by a myriad of medical and rehabilitation specialists in order to achieve the best possible outcome--independence with dignity for the disabled person.

Life care plans

Services must be individualized to meet the unique needs of each disabled person. The often lengthy rehabilitation process and the need for multiple services over an extended period of time have made comprehensive rehabilitation planning, or "life care plans," as they are called, an emerging methodology for the management of severe disability.

Rehabilitation plans for the management of disability are not new. Individualized, written rehabilitation plans have been used for decades by state agency vocational rehabilitation counselors to assist their clients in achieving a successful rehabilitation outcome. And for years, habilitation plans, known as "hab plans," have been used by rehabilitation professionals to outline the medical services and therapies, training, job and residential placement services needed by their developmentally disabled clients. Special education programs use the individualized education program, known as an IEP, to outline the services needed by disabled students in order to benefit from their public education programs.

Used in litigation

In litigation, life care plans have emerged as the primary method utilized by plaintiffs' attorneys to document the future needs of severely disabled clients. Insurance companies also utilize life care plans in an attempt to evaluate damages objectively for the purpose of case settlement. Because of the eclectic nature of the rehabilitation process, the rehabilitation professional is uniquely qualified to assess the impact of catastrophic injury on the future needs and life pursuits of disabled persons, both adults and children.

Life care plans may address future medical services, therapies, rehabilitation, activities of daily living, equipment needs, home and job site modifications, appropriate education and residential programs, support care, and analysis of the disabled individual's return to work options.

Analyzing the plan

But how does one determine if the contents of a life care plan are client centered or attorney driven? Life care plans often are unrealistic and exorbitant. Many are based on a medical model of care that treats the disabled person as a patient rather than as an individual with a disability. Many can result in fostering dependence rather than creating independence, autonomy and a healthy adjustment to the limitations created by the individual's disease or injury.

Advocates for disabled persons have long recognized that without the ability to achieve control over their lives, disabled people can become dependent on a medical model of care that is...