life care plan - fig education nlcp report... · the nurse life care plan is a projection of mr....

FIG Services, Inc.

P.O. Box 1161 • Hendersonville, NC 28793

(828) 698.9486 Ph • (828) 698.9327 Fx

FIGservices.com

NURSE LIFE CARE PLAN REPORT

REFERRAL: James Walker CLIENT: Christopher Mason

REFERRAL: Walker & Walker, LLC

ADDRESS: 321 West Main Street ADDRESS: 123 Wilson Court

Lexington, KY 29072 Somewhere, KY 42129

PHONE: 123/456-7890 PHONE: 123/456-7890

FAX: 123/456-7891 DOB: 01/07/73, Age 37

EMAIL: [email protected] SSN: 000-00-0000

DOI: 05/23/08

REFERRAL DATE: 04/17/10

INTERVIEW DATES: 08/08/10

12/11/10

REPORT DATE: 12/23/10

DIAGNOSES: (acute and chronic medical diagnosis)

Introduction Mr. Christopher Mason was referred by Referral Source for the development of a Nurse Life Care Plan in an

effort to address current and future medical and non-medical needs related to catastrophic injuries sustained

on 05/23/08.

(paragraph briefly explaining acute and chronic treatment/complications/outcome) Physicians have

recommended further surgeries and long term medical care.

This Nurse Life Care Plan report will comment on Mr. Mason’s past surgeries/procedures, current medical

status, and future medical treatment recommendations with associated costs as related to the accident on

05/23/08. Recommendations included in this Nurse Life Care Plan report are based on a reasonable degree of

certainty in an effort to manage symptoms, reduce complications/secondary diagnosis, maintain functioning,

and optimize independence throughout Mr. Mason's lifespan. The recommendations are gathered from

information provided by medical providers, Mr. Mason, as well as knowledge/experience from this Nurse

Life Care Planner. The Nurse Life Care Plan report and tables were completed following a review of the

provided medical records, meeting with Mr. Mason and his family, and communication with medical

providers. This Nurse Life Care Plan report is being submitted with the understanding additional medical

information may be received from the medical providers. The Nurse Life Care Plan recommendations are

subject to change if additional medical information is received from the medical providers. Prior to court

appearance, consideration will be given to any changes in Mr. Mason’s medical condition and this Nurse Life

Care Plan will be revised as needed.

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(client name) – Nurse Life Care Plan

Prepared by Shelene Giles

The Introduction serves as a brief summary of Mr. Mason’s medical care. Please refer to the Medical

Timeline for details of Mr. Mason’s medical condition/treatment/outcome.

Records Reviewed (Provider) 00/00/0000 – 00/00/0000

Records Requested (Provider) 00/00/0000 – 00/00/0000

Medical Timeline (include objective or subjective symptoms/limitations listed in the medicals)

Date Provider Comments

Review of medicals should focus on SOAP approach - subjective, objective,

assessment, and plan. Do not interpret medicals - only record. Exclude details

not currently relevant - lab work, negative diagnostic studies, names of

providers, etc. Consider underlining info that will impact long term care and

complications reflected in NLCP recommendations.

Current Medical Providers & Treatment (brief paragraph of current medical providers & treatment - begin where Medical Timeline ends)

Mr. Mason’s medical providers are as follows:

Medical Provider

Address

Phone

(paragraph of medical care, last office visit, next office visit, recommendations from specific medical

provider)

Medications Medication dose/frequency (reason for taking)

Relevant Past Medical History

(paragraph of past medical history or unrelated medical diagnosis that is relevant to case, list allergies, list

medications)

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Symptoms/Limitations (list symptoms/limitations reported by client or observed by NLCP) Mr. Mason and his wife reported the following ongoing symptoms and limitations in activities of daily living

since the burn accident:

(list symptoms/limitations by body part/system, give detail in paragraph of symptoms/limitations with

examples provided by client/family/care giver)

Psychosocial Information (explain family dynamics before/after accident)

Educational/Vocational Information (explain educational/vocational history, explain return to work status and future plans, is client receiving

Social Security Disability benefits)

Summary and Treatment Recommendations

(explain collaboration with health care providers)

Recommendations from this evaluation and medical questionnaires are reflected in the Nurse Life Care Plan

tables. It is anticipated Mr. Mason will have chronic symptoms and residual disabilities resulting from the

catastrophic accident. Given the severity of Mr. Mason’s medical condition, it is also anticipated long term

medical care is expected through his life. As Mr. Mason ages, there is a likelihood of complications, both

medical and psychological. Physicians have recommended additional surgical interventions to improve Mr.

Mason’s symptoms, functioning, and quality of life. Physicians have also indicated the need for ongoing

medical treatment related to Mr. Mason’s severe injuries and residual disabilities. The attached tables include

recommendations to assist in Mr. Mason’s medical, psychological, and rehabilitation needs.

Complications Physicians and research have indicated the following complications (medical and psychological) resulting

from Mr. Mason’s extensive injuries/surgeries: (list complications that were documented in medicals, noted

by health care providers, and generated from NLCP's research - document cite reference/copy research

article)

Though the cost of these complications cannot be predicted, recommendations have been provided in the

following tables to help prevent/lessen these complications. The cost of treating these complications are not

included in the Nurse Life Care Plan tables.

Conclusion The attached Nurse Life Care Plan tables outline the recommendations for Mr. Mason’s current and future

needs provided by his medical physicians and this Nurse Life Care Planner. National Vital Statistics Report,

Vol. 58, No. 21, June 28, 2010, Table 1 yields an average life expectancy of a 37 year old to be 42.5

additional years. A life expectancy of 43 additional years was used in determining frequency and cost of Mr.

Mason’s medical/psychological/rehabilitation needs. The life expectancy given in the Nurse Life Care Plan

does not represent the opinion of this Nurse Life Care Planner. Rather, the life expectancy is taken from the

latest federal data and is used for calculating costs. Opinions on the life expectancy tables are deferred to an

appropriate expert.

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While it is not possible to predict with absolute certainty all future medical and technological advances or

associated complications pertaining to Mr. Mason’s case, the Nurse Life Care Plan tables reflect what can be

reasonably anticipated for Mr. Mason’s future medical and non-medical needs based on the information

provided. The Nurse Life Care Plan is a projection of Mr. Mason’s current and future medical and non-

medical needs, and should be updated with significant changes to Mr. Mason’s condition.

Thank you for the opportunity to assist with Mr. Mason’s case.

Shelene Giles, MS, BSN, BA, RN, CRC, CNLCP, CLCP, MSCC

Nurse Life Care Planner

Enclosures: Authorization to Release Medical Information, Curriculum Vitae

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Resources

Client: (client name) Diagnosis: (medical diagnosis from page 1)

Life Expectancy: 42.5 additional years, 2011 – 2054, Age 80 Date Prepared: 12/23/10

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Medical Care

Recommendation

& CPT codes

Indication/Nursing Diagnosis Duration –

Begin/End

Frequency/Replacement Cost Cost

Resource Visits, Burn Specialist

CPT 99213

Assess/treatment of hypertrophic

scarring & burn related conditions

2011 – 2054 Yearly $116.61 x 43 = $5,014 PFR

Comments: (explain rationale for recommendation in above table)



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Surgeries/Procedures

Recommendation

& CPT codes

Indication Duration –

Begin/End

Frequency/

Replacement

Approximate

Cost*

Cost

Resource 1. Right shoulder hemiarthroplasty (replacement & revisions)

CPT 23331, 23470

Surgery 2011 – 2054 Allow for 3 $84,049 x 3

= $252,147

PFR




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Therapeutic Evaluations & Modalities

Recommendation

& CPT codes


Begin/End

Frequency/ Replacement Cost Cost

Resource Physical Therapy evaluation

CPT 97001

Assess functioning

& provide treatment

recommendations

2011 – 2054 Allow for 10 $192.86 x 10 = $1,929 PFR




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Diagnostic Studies & Lab Work

Recommendation

& CPT codes


Begin/End

Frequency/

Replacement

Cost Cost

Resource X-rays, right upper extremity

CPT 73020, 73070, 73120

Assess orthopedic status

& secondary diagnosis

2011 – 2054 Yearly $303.19 x 43 = $13,037 PFR




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Medications

Recommendation Indication/Nursing

Diagnosis

Duration –

Begin/End

Frequency/

Replacement

Cost Cost Resource

Seroquel XR 150mg Depression/anxiety 2011 – 2054 Monthly

(#30)

$249.97 x 510 = $127,485 Drugstore.com




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Scar Management


Diagnosis

Duration –

Begin/End

Frequency/

Replacement

Cost Cost Resource

Scar massage

CPT 97124

Impaired skin integrity 2011 – 2054 Allow for 100

sessions over LE

$121.99 x 100 = $12,199 PFR




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Medical Supplies


Diagnosis

Duration –

Begin/End

Frequency/

Replacement

Cost Cost Resource

Medical supplies (dressings,

gauze, tape, creams/ointments)

Impaired skin integrity 2011 – 2054 Yearly allowance $250 x 43 = $10,750 Quality Medical Supplies




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Durable Medical Equipment/Aids for Independent Function


Diagnosis

Duration –

Begin/End

Frequency/

Replacement

Cost Cost Resource

Shower chair Self-care deficit 2011 – 2031 Allow for 4 $63.36 x 4 = $253 Rehabmart




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Orthosis/Prosthesis


Diagnosis

Duration –

Begin/End

Frequency/

Replacement

Cost Cost Resource

Ankle-foot orthosis (AFO)

Impaired mobility 2011 – 2031 Yearly $363.36 x 54 = $19,621 Rehabmart




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Mobility


Diagnosis

Duration –

Begin/End

Frequency/

Replacement

Cost Cost Resource

Manual wheelchair

Impaired physical

mobility

2011 – 2031 Allow for 2 $225 x 2 = $450 Allegro Medical




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Home Care/Living Arrangements


Diagnosis

Duration –

Begin/End

Frequency/

Replacement

Cost Cost Resource

Home health aide Impaired home maintenance,

Self-care deficit

2011 – 2054 4 – 8 hours/day $16/hour x 4-8 hours/day

x 365 days x 42.5 years

= $992,800 - $1,985,600

Genworth Survey 2010

Metlife Market Survey 2010




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Home Modifications


Diagnosis

Duration –

Begin/End

Frequency/

Replacement

Cost Cost Resource

Home Modifications Impaired home maintenance,

Impaired mobility

2011 – 2054 Allow for 2 $50,000 x 2 = $10,000

ABC Contractors




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Transportation


Diagnosis

Duration –

Begin/End

Frequency/

Replacement

Cost Cost Resource

Handicap permit Handicap parking permit 2011 – 2054 Every 2 years $8 x 22 = $176 Kentucky DMV




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Educational/Vocational


Diagnosis

Duration –

Begin/End

Frequency/

Replacement

Cost Cost Resource

Vocational Evaluation Assess capabilities 2011 - 2013 One time $1,000 FIG Services, Inc.




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Other


Diagnosis

Duration –

Begin/End

Frequency/

Replacement

Cost Cost Resource

Nurse Case Manager Complete nursing process with

implementation & evaluation

of NLCP recommendations

2011 – 2054 Allow for 250

hours over LE

$75/hour x 250 hours

= $18,750

FIG Services, Inc.




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Lifetime Cost Projection

Recommendation

Lifetime Cost

Medical Care

$

Surgeries/Procedures

$

Therapeutic Evaluations/Modalities

$

Diagnostic Studies & Lab Work

$

Medications

$

Scar Management

$

Medical Supplies

$

Durable Medical Equipment/Aids for Independent Function

$

Mobility

$

Home Care/Living Arrangements

$

Home Modifications

$

Transportation

$

Educational/Vocational

$

Other

$

Total

$

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