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Life Care Planning Practice: External Influences
LIFE CARE PLANNING
Life Care Planning Practice: External Influences by Patricia McCollom, RN, MS, CRRN, CCM, CLCP
O
n April 12, 2000, the Life Care Planning (LCP) Summit took place in
Dallas, Texas, resulting in significant impact on the practice of life care planning. Six organiza-
Paul Deutsch, PhD, told the audience that practitioners have the responsibility to carry the process of LCP forward with accurate research and a retrospective review of life care plans. Reliability and validity will continue to be the most complicated of issues related to the practice.
came together to present their views and visions
Tyron Elliott, an attorney, began by emphasizing that “the role of judge, attorney, and expert witness have all changed in light of Daubert and Kumho Tire” (Supreme Court decisions). He discussed proving reliability and qualifying experts. (For a more detailed discussion by Elliott, go to www.atty.org and see “Daubert: The Emerging Profile.”)
for the future.
Dr. Richard Bonfiglio presented the group with five issues regarding LCP
tions and professionals who have been pioneers in the development of this specialty practice
TCM 62
July/August 2000
practice. He noted that life care planners should not develop plans “in a vacuum,” should communicate with the treatment team, and indicate prevention and longterm consequences are key factors in planning. Second, he identified the problem of life care planners without a medical background predicting needs that are inconsistent with the individual’s clinical status. He further commented on the need for medical consistency and identified the concern that life care plans must be consistent, whether referred by plaintiffs or defense counsel. Tim Field, PhD, focused on defining expert testimony as reliable and valid. He compared science versus specialized knowledge as provided under Rule 702. He prepared his remarks by abstracting from a book published this year, A Resource for the Rehabilitation Consultant on the Daubert and Kumho Rulings, which he cowrote with several colleagues. Fred Raffa, PhD, a forensic economist, discussed the relationship between the economist and the life care planner. He listed four recommendations for life care planners in preparation for testimony: be thorough and specific in identifying the nature and extent of your background, clarify methodology and use of resources, be thoroughly prepared, and communicate with the attorney in an effort to be prepared to educate the court regarding what has been done and how the work was completed. Overall, the faculty unanimously spoke of the need for collaboration and mutual support as the LCP practice grows and expands beyond the litigation arena. The Process Roger Weed, PhD, who served as conference moderator, brought the group together. His mission was to create a summit meeting that was interactive in nature and allowed attendees to join with faculty to discuss issues within five topic areas: professional preparation, methodology for life care plan preparation, reliability and validity, information dissemination, and ethics. Weed considers these issues the critical factors in the growth and development of the practice. The attendees rotated through the five topic areas, communicating their con-
cerns, conflicts, and beliefs. The issues were prioritized using a modified nominal technique. The conference concluded with a report to the entire group regarding findings and priority issues. The cosponsors of the summit intend to publish the proceedings and make them available to interested parties. The Issues A session on professional preparation, led by Horace Sawyer, discussed the transdisciplinary nature of LCP and the inherent differing perspectives among nurses, vocational counselors, and other professionals involved in the practice. Certification as a life care planner was identified as a major issue, with some attendees defining professional preparation as specialized knowledge and others saying certification. Ongoing dialogues anticipated as a result of attendee input include clarifying the meaning and value of certification and educating various publics on certification. The methodology issues section headed by Ann Neulicht and Patti Constantini generated audience responses regarding life care planners’ need to be clear about the process they go through, understanding it and being able to articulate procedures involved therein. Consistency in practice, whether working for the prosecution or defense, was a repeated concern of the participants. The reliability and validity session led by Tyron Elliott demonstrated the practitioners’ understanding of the importance of external influences affecting LCP. As the courts have mandated methods, procedures, and tools for expert witness testimony (Daubert v. Kumho Tire), practitioners struggle with the “newness” of practice and lack of peerreviewed practice. Research data, data collection, and database availability were primary concerns. Information dissemination, led by Tim Field and Ann Llewellyn, focused on existing standards, methods, and procedures readily available to the public through existing publications and websites. Public awareness about LCP and sharing of research were noted concerns. The ethics forum was facilitated by Patricia McCollom and Linda Shaw. Discus-
sion points included relevancy of professional standards vis a vis practice guidelines and certification, documentation requirements, objectivity, confidentiality, and professional respect among colleagues. The Outcome The Life Care Planning Summit 2000 did not answer all the questions generated by practitioners—that was not its intent. Ongoing questions will continue about methodology, credentials, “what is and what is not,” and how we do what we do, to whom, and based on what! Perhaps the ongoing questions will stimulate an even greater need for answers and alignment of organizations to forge a way to consistent, reliable, valid, ethical practice. However, what the summit did accomplish was extraordinary. For 10 hours, LCP professionals were brought together to focus on issues impacting all life care planners and discussion took place about priorities and resolutions. Eye to eye, conflicting viewpoints were stated, and everyone listened. As a result of the meeting: • The proceedings will be published. • Further discussion will occur regarding practice guidelines, standards, and certification. • An ongoing dialogue regarding ethics will take place. • Multiple topics have been identified as potentially excellent advanced practice education programs. Ultimately, LCP practitioners will elevate the field to the next level. The work must be accomplished by collaboration. ❑ Patricia McCollom, RN, MS, CRRN, CDMS, CCM, CLCP, is the president of Mc/RS in Ankeny, Iowa, a nurse consultant, and an editorial board member for The Case Manager. Reprint orders: Mosby, Inc., 11830 Westline Industrial Dr., St. Louis, MO 63146-3318; phone (314) 453-4350; reprint no. 68/1/109131 doi:10.1067/mcm.2000.109131
July/August 2000
TCM 63
Life Care Planning Practice: External Influences by Patricia McCollom, RN, MS, CRRN, CCM, CLCP
O
n April 12, 2000, the Life Care Planning (LCP) Summit took place in
Dallas, Texas, resulting in significant impact on the practice of life care planning. Six organiza-
Paul Deutsch, PhD, told the audience that practitioners have the responsibility to carry the process of LCP forward with accurate research and a retrospective review of life care plans. Reliability and validity will continue to be the most complicated of issues related to the practice.
came together to present their views and visions
Tyron Elliott, an attorney, began by emphasizing that “the role of judge, attorney, and expert witness have all changed in light of Daubert and Kumho Tire” (Supreme Court decisions). He discussed proving reliability and qualifying experts. (For a more detailed discussion by Elliott, go to www.atty.org and see “Daubert: The Emerging Profile.”)
for the future.
Dr. Richard Bonfiglio presented the group with five issues regarding LCP
tions and professionals who have been pioneers in the development of this specialty practice
TCM 62
July/August 2000
practice. He noted that life care planners should not develop plans “in a vacuum,” should communicate with the treatment team, and indicate prevention and longterm consequences are key factors in planning. Second, he identified the problem of life care planners without a medical background predicting needs that are inconsistent with the individual’s clinical status. He further commented on the need for medical consistency and identified the concern that life care plans must be consistent, whether referred by plaintiffs or defense counsel. Tim Field, PhD, focused on defining expert testimony as reliable and valid. He compared science versus specialized knowledge as provided under Rule 702. He prepared his remarks by abstracting from a book published this year, A Resource for the Rehabilitation Consultant on the Daubert and Kumho Rulings, which he cowrote with several colleagues. Fred Raffa, PhD, a forensic economist, discussed the relationship between the economist and the life care planner. He listed four recommendations for life care planners in preparation for testimony: be thorough and specific in identifying the nature and extent of your background, clarify methodology and use of resources, be thoroughly prepared, and communicate with the attorney in an effort to be prepared to educate the court regarding what has been done and how the work was completed. Overall, the faculty unanimously spoke of the need for collaboration and mutual support as the LCP practice grows and expands beyond the litigation arena. The Process Roger Weed, PhD, who served as conference moderator, brought the group together. His mission was to create a summit meeting that was interactive in nature and allowed attendees to join with faculty to discuss issues within five topic areas: professional preparation, methodology for life care plan preparation, reliability and validity, information dissemination, and ethics. Weed considers these issues the critical factors in the growth and development of the practice. The attendees rotated through the five topic areas, communicating their con-
cerns, conflicts, and beliefs. The issues were prioritized using a modified nominal technique. The conference concluded with a report to the entire group regarding findings and priority issues. The cosponsors of the summit intend to publish the proceedings and make them available to interested parties. The Issues A session on professional preparation, led by Horace Sawyer, discussed the transdisciplinary nature of LCP and the inherent differing perspectives among nurses, vocational counselors, and other professionals involved in the practice. Certification as a life care planner was identified as a major issue, with some attendees defining professional preparation as specialized knowledge and others saying certification. Ongoing dialogues anticipated as a result of attendee input include clarifying the meaning and value of certification and educating various publics on certification. The methodology issues section headed by Ann Neulicht and Patti Constantini generated audience responses regarding life care planners’ need to be clear about the process they go through, understanding it and being able to articulate procedures involved therein. Consistency in practice, whether working for the prosecution or defense, was a repeated concern of the participants. The reliability and validity session led by Tyron Elliott demonstrated the practitioners’ understanding of the importance of external influences affecting LCP. As the courts have mandated methods, procedures, and tools for expert witness testimony (Daubert v. Kumho Tire), practitioners struggle with the “newness” of practice and lack of peerreviewed practice. Research data, data collection, and database availability were primary concerns. Information dissemination, led by Tim Field and Ann Llewellyn, focused on existing standards, methods, and procedures readily available to the public through existing publications and websites. Public awareness about LCP and sharing of research were noted concerns. The ethics forum was facilitated by Patricia McCollom and Linda Shaw. Discus-
sion points included relevancy of professional standards vis a vis practice guidelines and certification, documentation requirements, objectivity, confidentiality, and professional respect among colleagues. The Outcome The Life Care Planning Summit 2000 did not answer all the questions generated by practitioners—that was not its intent. Ongoing questions will continue about methodology, credentials, “what is and what is not,” and how we do what we do, to whom, and based on what! Perhaps the ongoing questions will stimulate an even greater need for answers and alignment of organizations to forge a way to consistent, reliable, valid, ethical practice. However, what the summit did accomplish was extraordinary. For 10 hours, LCP professionals were brought together to focus on issues impacting all life care planners and discussion took place about priorities and resolutions. Eye to eye, conflicting viewpoints were stated, and everyone listened. As a result of the meeting: • The proceedings will be published. • Further discussion will occur regarding practice guidelines, standards, and certification. • An ongoing dialogue regarding ethics will take place. • Multiple topics have been identified as potentially excellent advanced practice education programs. Ultimately, LCP practitioners will elevate the field to the next level. The work must be accomplished by collaboration. ❑ Patricia McCollom, RN, MS, CRRN, CDMS, CCM, CLCP, is the president of Mc/RS in Ankeny, Iowa, a nurse consultant, and an editorial board member for The Case Manager. Reprint orders: Mosby, Inc., 11830 Westline Industrial Dr., St. Louis, MO 63146-3318; phone (314) 453-4350; reprint no. 68/1/109131 doi:10.1067/mcm.2000.109131
July/August 2000
TCM 63