Life Care Planning

Overview and Description

Physiatrists provide a comprehensive assessment of patients with functional impairments impacting their ability to participate in personal, occupational and societal roles and plan for their future needs.¹ Life care planning is a natural fit within the field of physical medicine and rehabilitation. This article defines life care planning, life care plans and the implications if not performed properly.

Life care planning is “a process of applying methodological analysis to formulate diagnostic conclusions, and opinions regarding physical and/or mental impairment and disability for the purpose of determining care requirements for individuals with permanent or chronic medical conditions and quantifying these requirements in monetary terms”.² The process seeks to answer some basic questions.²

• What is the subject’s condition?
• What medically related goods and services do a subject’s condition require?
• How much will the medically related goods and services cost over time?

The process of life care planning leads to the creation of a life care plan by life care planners. The agreed upon definition of a life care plan is “a dynamic document based upon published standards of practice, comprehensive assessment, data analysis, and research, which provides an organized concise plan for current and future needs with associated costs, for individuals who have experienced catastrophic injury or have chronic health care needs”.³ A life care plan is essentially a budget for people who lack the ability to independently perform basic activities of daily living (ADLs) such as feeding, bathing, grooming, mobility, bowel and bladder management, communication abilities, etc.^2,4 Common mechanisms of injury that require life care plans include motor vehicle, trucking maritime and shipping, and work-related/workplace accidents; birth injuries; medical malpractice; premises or product liability; drug-related injury; plant explosions; slip and fall accidents; assaults; animal attack/dog bites; wound by projectile injuries.² Common injuries include: acquired brain, spinal cord or orthopedic injuries; amputations; burns; psychological; visual or hearing impairment; gastrointestinal; etc.² Life care plans “provide litigators, insurance companies, trusts and courts with a qualified, quantitative, and referenceable basis upon which to assess and substantiate the monetary value of an individual’s future medical needs.”²

A life care plan contains facts or objective findings gathered from records, interviews, and patient examination. It also contains opinions regarding a patient’s impairment level and duration as well as future care needs. Lastly, it draws conclusions on future needs and the cost.² We will explore the history of life care planning, who qualifies as a life care planner and the processes. A list of comprehensive legal, medical, financial, and end-of-life planning resources are provided in Table 1.^3,4

Relevance to Clinical Practice

History

The term life care plan was first introduced to the healthcare field in 1985 in the Guide to Rehabilitation coauthored by Paul Deutsch PhD, who is considered the founder of life care planning.³ It first stemmed from his work in a legal publication in 1981 titled “Damages in Tort Actions” which established guidelines for determining damages in civil litigation. The first definition of a life care plan was published in the 1990s in the first edition of the Life Care Planning and Case Management Handbook.⁵ In 1998 the first proposed life care planning standards of practice were created and published in 2000, with the latest update in 2022 by the International Academy of Life Care Planners (IALCP).⁶

Who are life care planners?

Life care planners can be physicians or non-physicians (e.g. nurses, vocational specialists, or other non-physician rehabilitation professionals).¹ A physician can independently formulate and defend medical opinions regarding a subject’s medical condition, and recommendations for future medical care and that is an advantage of using a physician life care planner.³ The Commission on Disability Examiner Certification saw more standardization was needed, which led to the formation of professional groups including the International Commission of Health Care Certification (ICHCC) and the American Association of Nurse Life Care Planners (AANLCP), which later became the IALCP to establish their own practice standards and credentialing.^2,3 Essentially, professionals should only practice within their scope and that certain exams may not be reliable for establishing credentials for life care planning.^1,3

The ICHCC is the key organization for Certified Life Care Planners (CLCPs). The criteria for qualified health care professional candidates to become certified are⁹

• Have a bachelor’s degree except nurses who must have at least a diploma in nursing (Certified Nursing Assistants and Licensed Practical Nurses are excluded from qualifying)
• Complete a 120-hour training program in LCP or an area that can be applied to developing an LCP. Sixteen hours of the 120 are “specific to a basic orientation, methodology, and standards of practice in life care planning”.⁹ A link to approved training programs for ICHCC credentials can be found in Table 1.
• Should have minimum 3 years field experience in area of formal training 5 years prior to applying but if they do not, they can: graduate from an accredited training program which includes practicum or internship under the direction of a CLCP; or have one year supervision with a CLCP approved by the ICHCC and submission of quarterly supervision summaries.
• Must be certified, licensed or meet legal mandates of state to practice service delivery within defined scope of practice.
• Must submit one life care plan as author or co-author.

The American Academy of Physician Life Care Planners (AAPLCP) promotes additional certification of physicians through the Certified Physician Life Care Planner (CPLCP) with specific criteria.⁸ There may be more qualified CLCPs due to experience that do not possess this added certification. The criteria per the AAPLCP is for actively practicing physicians with: “at least 10 years of clinical practice experience from the date upon which they completed residency in their relevant medical specialty and…have maintained Board Certification in at least one of the twenty-four medical specialties recognized by the American Board of Medical Specialties for at least 10 years”.⁸ This is a change from prior to 2024, which limited medical specialty to Physical Medicine and Rehabilitation. The AAPLCP criteria for additional certification can be found on their website. The ICHCC is also the governing body for CPLCP.

Standards of practice

The IALCP Standards of practice are as follows^3,6

• Case initiation: Responding to referrals and requests for service, establishes expectation
• Assessment and evaluation: Data collection from multiple sources with a consistent approach of a patient (also referred to as the evaluee) such as review of medical records, conducting interviews/exams
• Analysis and synthesis to identify functioning, disability and health: Potentially including videos of day in the life of evaluee with living arrangements, adoptive and assistive devices used, medications administered factoring in age, region
• Delineation of future care recommendations and considering pre-existing conditions to determine needs, duration and frequency of services
• Collaboration with other parties involved
• Outlining costs that are geographically relevant and reliable citing cost data as costs can vary by location
• Creating work product communicating medical opinions
• Consistency within the life care plan and adherence to the standards of practice to ensure the opinions are congruent
• Education of consumers/users of life care plans
• Forensic application for litigation purposes as a consultant, giving expert testimony, maintaining records

The role of the physiatrist, rehabilitation nurse, psychologist, neuropsychologist, occupational therapist, physical therapist, speech language pathologist and assistive technology, audiologist, and economist are further explored in depth in the Handbook and input from these providers should be integrated within plans if appropriate.³ Specific needs are also outlined for the following perspectives: amputee, acquired brain injury, burn patient, depressive and/or obsessive-compulsive disorders, and schizophrenia, chronic pain, spinal cord injury, organ transplantation, visual impairments, elder care management, forensic issues, perspectives of plaintiff’s attorney, defense attorney, and elder law attorney.³

The process

The methodology followed while creating a life care plan can be described in six phases¹⁰

1. Determining the purpose
2. Reviewing evidence and conceptualizing case
3. Collecting primary data
4. Research and data analysis
5. Reporting findings
6. Re-evaluation

Phase 1 (purpose): In the United States, attorneys, liability insurance carriers or other entities may request life care plans and retain a life care planner and requests a life care plan rather than another type of report.¹⁰

Phase 2 (review): The referral source usually collects data that is then reviewed by the life care planner, including documentation from “physicians, allied health professionals, emergency services, as well as legal, educational, and vocational sources”.¹⁰ This review leads to understanding the nature of the injury, comorbidities, impairments, prognoses, and required level of care.

Phase 3 (data collection): The evaluee is interviewed to gather subjective and objective data. Questionnaires such as the Disability Index and PHQ-9 may be administered, and family members and/or members of the treatment team may also be interviewed.¹⁰ Inconsistencies are addressed and resolved.

Phase 4 (data analysis): This is the most time-consuming phase, categorizing the needs as treatment, equipment, etc. and delineating the costs researched to have a reliable life care plan.¹⁰ Case-specific data sources, clinical practice guidelines, and evidence-based literature should be used with costs discussed further in a later section.

Phase 5 (report findings): The needs and related costs are placed in tables as described in the Standards of Practice.¹⁰ Certain procedures may be required in the court system.

Phase 6 (re-evaluate): The referring group may request an addendum for any changes impacting the original recommendations as this is a dynamic document.

Cost analysis

Cost analysis represents the quantification of future care needs across an individual’s expected lifespan. The objective is to produce accurate and transparent cost projections that are directly grounded in medical necessity and consistent with accepted life care planning standards.¹¹

Costs included in a life care plan encompass direct medical expenses, such as physician services, diagnostic testing and laboratory studies, medications, rehabilitation therapies, durable medical equipment and supplies, acute care services, assistive technology, and nursing or attendant care, as well as medically related non-medical expenses, including home modifications, transportation needs, and vocational or educational supports.^2,3,7,11 Each cost item must be supported by medical records, treating provider recommendations, clinical practice guidelines, or peer-reviewed literature, rather than generalized assumptions.¹¹

Accurate cost development requires the use of current and geographically relevant pricing data, often derived from multiple sources such as local providers, vendor quotes, published fee schedules, or institutional pricing databases.^6,11 Costs should be usual, customary and reasonable (UCR) and not discounted as discounts may not be available in the future.¹⁰ More than one cost estimate should be considered. Because health care costs vary substantially by region, reliance on local or regional data improves credibility.

Across most life care plans, attendant and nursing care represent the largest projected lifetime expense, particularly for individuals with severe physical, cognitive, or medical impairments. Determination of the appropriate level of care (e.g. CNA, LPN, RN), hours per day, and duration must reflect functional status, medical complexity, and safety requirements.⁴ For example, skilled needs, such as catheter care, require at least an LPN level of care whereas medication delivery may vary by state.

Cost analysis also incorporates life expectancy estimates to define the duration of projected services, which is further explored in a different section. When available, condition-specific survival data should be used in place of general population life tables, as standard actuarial data may underestimate or overestimate longevity in individuals with catastrophic injury or chronic disease.⁴

Accounting techniques

Accounting techniques in life care planning are used to organize, project, and interpret cost data in a manner that is internally consistent, transparent, and reproducible. These techniques ensure that financial projections align directly with the clinical narrative and remain defensible across clinical, administrative, and legal settings.^6,11

Life care planners typically employ a micro-costing approach, in which each service, supply, or intervention is itemized individually. For each item, unit cost, frequency, and duration are specified, allowing annual and lifetime costs to be calculated. This approach improves traceability and enables reviewers to link every projected cost to a clinically supported recommendation.^6,11

Because life care plans project costs over extended periods, economic adjustment methods are commonly applied, often in collaboration with an economist or financial analyst. These include adjustments for medical cost inflation and to express future costs in present-value terms.^4,6 Additional accounting considerations include replacement and depreciation modeling for durable medical equipment, as well as scenario-based projections when future interventions or complications are likely but not certain.^3,4 The collateral source rule is a law doctrine that prevents liability reduction that a plaintiff receives from independent sources, such as health insurance, but some states have voided this rule leading to variations.¹⁰

It is recommended to use a life care plan checklist such as one in the Case Management Handbook. It includes³

• Evaluations with nonphysicians accounted for such as speech and physical therapist, rehab psychologist, case manager
• Functional assessments such as educational, vocational or neuropsychological
• Wheelchair and durable medical equipment needs, maintenance and accessories over time
• Orthotics/prosthetics such as braces, prosthesis
• Home furnishings and renovations such as ramps, home modifications, wheelchair accessibility and different controls
• Medications, nonprescription medications and supplies such as for bowel and bladder care
• Home or facility care or recreational activities
• Routine medical care with diagnostic labs, imaging, medical, vision, dental visits
• Transportation and modifications
• Complications and future medical care needs such as hospitalizations, probable future surgeries
• Vocation and education plans

Life expectancy

Katz shares a practical example of a life care plan for an evaluee with a spinal cord injury.

After determining the physical and cognitive impairments, one must estimate prognosis through a combination of life expectancy curves and survival from the illness.⁴ Life expectancy is reported for people belonging to a specific group and refers to the average number of years the members of the group survive.⁴ Life expectancy can be calculated using life tables from the National Vital Statistics Reports. It is important to note that these life tables may not accurately reflect life expectancy for individuals with serious medical illnesses or disabilities, as they are derived from U.S. Census data representing the general population, most of whom have only routine health conditions.⁴ Life expectancy should also be based on the assumption of an individual receiving quality care, as outlined by a life care plan.³ With regards to an evaluee with a spinal cord injury, resources from the National Spinal Cord Injury Statistical Center (NSCISC), Paralyzed Veterans of America, and Model Spinal Cord Injury Center database can be paramount in predicting life expectancy.⁴

Duration of care calculations

Duration of care calculations are used to estimate how long specific medical, rehabilitative, and support services will be needed over an individual’s lifetime. These calculations are done by utilizing life expectancy data. As mentioned previously, because life expectancy data are derived from the general population, they may not accurately reflect individuals with significant medical conditions or disabilities. Therefore life care planners must use data in the setting of an individual’s medical prognosis, comorbidities, functional status, and anticipated disease progression.³ When performing duration of care calculations, it is important to consider the timing of each cost element as well as the length of time the element will be needed.³ The life care planner should be as specific as possible to when an item or procedure will be required and for how long in order for an economist to make accurate calculations of cost.³ For example, if a medical item costs $12,000 and will need to be replaced every 4 years, the life care planner may average the expenditures to $3000 per year.³ If, however, an item’s initial costs and the replacement values are known, an economist can more accurately calculate the specific cost per year as opposed to an average.³ Calculations are done using the total present value, which considers the rates of price inflation and interest, and that is the value that a jury will be asked to consider in legal cases to provide for lifetime medical needs of an individual.³

Cost of a life care plan

There are two costs to consider with life care planning: the fees for the life care planning process and the expected total cost listed in the plan. Creating and preparing a life care plan can cost between $5,000-$30,000, with the higher cost usually including court of law.⁵

Cutting Edge/Unique Concepts/Emerging Issues

Prior to 2024, CPLCP Certification was limited only to Physical Medicine and Rehabilitation physicians. Now it is available to any medical specialty recognized by the American Board of Medical Specialties (ABMS).⁸ This could potentially lead to life care planners who are not as familiar with the impairments physiatrists routinely see because of catastrophic injuries, placing life care plans at risk of not capturing all needs for the future. However, physiatrists make up most of the CPLCP certifying board. Regardless, many life care planners are nonphysicians.

An interesting comparison is life care planning compared to managed care. For example, with workman’s compensation, the life care plan can become very restrictive and block access to care if it does not account for proper future planning.¹²

Gaps in Knowledge/Evidence Base

Life care plans and planners need to provide credibility to the formed medical opinions and conclusions. The lack of input from treating physicians and inexperience of the life care planner for caring for people with catastrophic injuries can play a role. Patients can benefit from the expertise of a physiatrist. However, this is an area of care where trainees lack exposure as it is not a part of residency milestones, and introduction could be beneficial given future patients may present with a life care plan. Life care planning and physiatry seem like a perfect pair, and this could be a very rewarding aspect of care for the physiatrist who wants to branch out into this line of work.

References

1. Gonzales JG, Zotovas A. Life care planning: a natural domain of physiatry. PM R. 2014;6(2):184-187. doi:10.1016/j.pmrj.2014.01.011
2. Frequently Asked Questions About Life Care Plans And Life Care Planning. Physician Life Care Planning. Accessed October 24, 2025. https://www.physicianlcp.com/faqs/life-care-planning/
3. Weed RO, Berens DE, Taylor & Francis. Life Care Planning and Case Management Handbook. Fourth edition. Routledge; 2019.
4. Katz RT. Life Care Planning – a Practical Illustration. Phys Med Rehabil Clin N Am. 2019;30(3):683-696. doi:10.1016/j.pmr.2019.04.004
5. What is Life Care Planning? Accessed October 24, 2025. https://rehabcarecoord.com/life-care-planning/
6. International Academy of Life Care Planners. Standards of practice for life care planners. 4th ed. International Academy of Life Care Planners, The Life Care Planning Section of The Association of Rehabilitation Professionals; 2022. Accessed October 24, 2025. https://member.aanlcp.org/wp-content/uploads/2023/03/IALCP-Standards-of-Practice-2022-4th-ed.pdf
7. About the American Academy of Physician Life Care Planners. Accessed October 24, 2025. https://aaplcp.org/About/About.aspx
8. Certification The Pinnacle of Life Care Planning. Accessed October 24, 2025. https://cplcp.org/Certification.aspx
9. Certified Life Care Planner (CLCP) Candidate Handbook and Application Form. International Commission on Health Care Certification. Accessed January 9, 2026. https://www.ichcc.org/certifications/manuals.html
10. Morrison, T., Ramos, P., & Cowitz, E. (2025). A Comparison of the Steps, Processes and Considerations Involved in Developing a Life Care Plan in the United States and Canada. Journal of Life Care Planning, 23(2), 3–14. https:/ / doi.org/ 10.70385/ 001c.138605
11. Johnson CB, Weed RO. The life care planning process. Phys Med Rehabil Clin N Am. 2013;24(3):403-417. doi:10.1016/j.pmr.2013.03.008
12. Giardino AP, De Jesus O. Managed Care. [Updated 2022 Oct 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK564410/

Author Disclosure

Erin Kelly, DO
Nothing to Disclose

Aslihan Sahin, DO, MBS
Nothing to Disclose

Arman Jahangiri, DO
Nothing to Disclose