Sample Case Study
Mr. John Smith is a 26-year-old, African American male who sustained a gun shot wound with retained bullet fragments. He was diagnosed with a C5 ASIA A spinal cord injury. This diagnosis implies no sensory or motor function preserved below the level of injury (Physiopedia, 2025). Associated with Mr. Smith’s diagnosis was a neurogenic bladder, neurogenic bowel, neuropathic pain, and spasticity. Mr. Smith spent 11 days in acute care followed by 20 days in inpatient rehabilitation in a spinal cord injury model system. Treatment providers included a physiatrist, urologist, orthopaedist, primary care physician, occupational therapist, and physiotherapist, as well as an activity-based therapy provider. Mr. Smith is married with three children all under the age of five years. The life care plan was finalized 15 months after the date of injury.
The Life Care Plan
Barros-Bailey, Rutherford-Owen & Preston (2024) identified a six-phase life care plan method. A more fulsome description of each phase can be found in the primary reference. In the following sections, each phase of the six-phase methodology in life care plan preparation will be presented, accompanied by a brief summative description. While there are many similarities in the steps and processes involved in life care planning in the United States and Canada, there are some critical differences. In each phase, the similarities between the two nations will be presented followed by a review of any salient differences considering the American versus Canadian context.
Phase 1– Determining the Purpose
Setting the stage for the life care plan, this step involves identifying the purpose of the plan (e.g., a comprehensive life care plan in comparison to another form of report). This foundational step informs the decisions and actions to be taken throughout the life care planning process. In this phase, the life care planner confirms the nature of the loss, as well as intended purpose and use for the plan. In both countries, the most common causes of injury are motor vehicle collisions, professional malpractice (e.g., birth injuries, diagnosis delay/error, surgical outcomes, drug dosage or dispensing error), slip and falls, and assaults. Although the comprehensive process is similar, it is well-established that the process is to be individualized to the specific characteristics and needs of the case. Retainer agreements vary among life care planners.
Phase 2 – Review Evidence and Conceptualize Case
Before meeting with the evaluee (the person who is the subject of the life care plan), a detailed and comprehensive review of the secondary data is undertaken. Secondary data is data collected by someone else but reviewed by the life care planner to inform the foundation to the life care plan (Barros-Bailey, 2018). This is most often provided by the retaining referral source, and includes documentation authored by primary and specialist physicians, allied health professionals, emergency services, as well as legal, educational, and vocational sources. Documentation can be extensive, including data on pre-existing and concurrent issues. The life care planner identifies any data gaps and discusses with the referral source how to remedy the identified gaps.
A detailed review and analysis lead to a case conceptualization, which is innately informed by the scope of professional practice of the life care planner. Each life care planner has a professional scope of practice to which they must adhere throughout the life care planning process (International Academy of Life Care Planners (IALCP), The Life Care Planning Section of The International Association of Rehabilitation Professionals, 2022). The life care planner’s scope of practice, experience, and skills inform a worldview or lens through which they conceptualize the case. The case conceptualization will include delineation of the index injury within the context of the evaluee’s comorbidities, documented professional diagnoses and prognoses, impairments and strengths, environmental considerations (e.g., physical home structure, social supports), and current recommendations for care. Based upon the developed case conceptualization and the life care planner’s scope of practice, the life care planner develops their scope-specific individual assessment protocol to inform the future steps of the process.
For Mr. Smith, documentation review was undertaken of the secondary data provided by the referral source, which included emergency response documentation, hospital and medical records, allied health and counseling records as well as deposition transcripts. The developed case conceptualization included a defined understanding of the nature of the injury, documented diagnoses and prognoses, impairments and strengths, environmental considerations, and the current required level of care. An assessment protocol was developed based upon the life care planner’s scope of practice, with specific consideration of the case conceptualization. The intended assessment instruments were organized for the assessment with the evaluee. Consent and release forms were developed to permit both the required assessment as well as the subsequent collaborations and investigations critical to the life care plan development. This process would similarly occur in both the United States and Canada.
Phase 3– Collect Primary Data
Phase three is informed by the active and strategized primary data collection by the life care planner. Primary data is data that is collected by the life care planner (Barros-Bailey, 2018). This includes the data collected from the evaluee (e.g., subjective and objective data) via interview and implementation of the assessment protocol. Primary data is also collected via surveys, interviews, and collaboration with others, family members, members of the treatment team, assessors, and any other relevant collaborative sources.
Akin to what occurred with Mr. Smith, there are considerable similarities across the two countries in this phase. A formal interview is conducted with the evaluee. During this interview, the life care planner explores the evaluee’s first-person, lived experience of their injury, recovery, function, and needs. While there are specific circumstances that may restrict the evaluation to occurring virtually, an in-person evaluation is most common. Such an evaluation allows for observations of the evaluee performing functional activities within their specific environment and administration of assessment protocols. An evaluee’s environment is informed by characteristics (e.g., physical, social, financial, institution or societal policies) that may facilitate or restrict functional participation. These characteristics of the environment can become more evident during in situ observation of functional performance. The observations and outcomes from the assessment protocol may inform the content of collaborative inquiries and recommendations to be included in the life care plan.
As relevant to the impairment and context, individual instruments (e.g., Bathel index, Disability Index, PHQ-9) can be completed by the evaluee. Whether during the same interview with the evaluee, or occurring at a separate time, a family member or close friend may be interviewed as to their observations of the evaluee’s status, needs, pre- to post-injury changes, etc. This third-party observation of changes in the evaluee over time can be helpful. Such individuals may also be asked to complete selected instruments (e.g., Modified Caregiver Strain Index, WHO Disability Assessment Schedule). The descriptions from the evaluee and their family member(s), the results from their completed instruments, and the life care planner’s objective observations, both naturally as well as from the assessment protocol, are then triangulated. Any inconsistencies with the secondary data are explored and reconciled to develop a cohesive understanding.
With the evaluee’s consent, the life care planner will then determine the method they will use to collaborate with others related to the evaluee’s current and future causally related needs. These collaborations most often include medical and professional treatment providers. With catastrophically injured individuals, there are commonly large teams of professionals, necessitating numerous physician and allied health collaborations. In the case of Mr. Smith, this included his physiatrist, occupational therapist, and physiotherapist. Reiteration letters are commonly created following each collaboration and returned to the professional for review and authentication.
Phase 4– Research and Data Analysis
Phase four, typically the most time-consuming phase, involves applying the identified needs to appropriate life care plan categories. Categories represent a clustering of similar needs (e.g., treatment, personal care, equipment). Careful needs appraisal with associated researched costs is critical to developing a valid and reliable life care plan that meets standards of practice (IALCP, 2022). The planner substantiates the needs within the case-specific primary and secondary source data, clinical practice guidelines, and evidence-based practice literature. Clear grounding of the needs within the evidence enhances the internal and external consistency, as well as the validity of the life care plan.
Across both countries, and akin to the process used with Mr. Smith, this step involves researching the costs for the evaluee’s needs using a consistent, valid, and reliable approach (IALCP, 2022). Costs are to be verifiable, geographically relevant, and representative of the services available to address this specific evaluee’s needs (IALCP, 2022). Non-discounted/market rates are to be reflected. More than one cost estimate shall be considered, when appropriate (Johnson et al., 2018).
Overview of Contextual Differences in Phase 4
While costing data contained in a Canadian life care plan is derived through valid and reliable methods, the approach taken to obtain the data is quite different from the United States. This difference is approach is due to the structure of the Canadian health care system, access to stable and long-term public programs that the Canadian judiciary considers in their decisions, different regulations regarding collateral funding sources, and the lack of Canadian geographically based databases of reasonably available sources.
There are strengths and limitations inherent to Canada’s public health care system. While there is equitable access to required medical care, there can be long wait lists (Moir & Barua, 2024). Additionally, there is a shortage of physicians in Canada. For example, the Canadian Institute of Health Information (2024) indicated that 5.4 million adult Canadians, representative of approximately 17% of the population, do not have access to a regular primary health care provider. There are some private diagnostic services (e.g., MRIs) available in some jurisdictions of Canada but private medicine remains rare.
In contrast, the American health care system operates through a complex blend of private and public financing, with most individuals covered through employer-sponsored insurance, while others rely on government programs such as Medicare and Medicaid. The United States spends more per capita on health care than any other country (Gunja et al., 2023) and leads in medical innovation, offering patients access to advanced technology, specialized providers, and cutting-edge treatments. The American health care system is plagued by high costs, administrative inefficiencies, and significant disparities in access and outcomes. Preventive care is underutilized, and major public health indicators such as life expectancy and maternal mortality rank below those of peer nations. The fragmented nature of care delivery often undermines coordination and drives up costs, without corresponding improvements in health outcomes (Gunja et al., 2023).
In the United States, the collateral source rule is a common law doctrine that prevents a defendant from reducing liability by the amount of compensation a plaintiff receives from independent sources, such as health insurance. This has obvious implications for life care planning. The rule aims to ensure full accountability for tortfeasors and to avoid penalizing injured parties for having secured benefits through foresight or employment. However, many states have modified or abolished the rule in certain tort contexts, leading to variation in its application (Atchity, 2021; Stern & Rutherford-Owen, 2022).
In 2002, Dr. Paul Deutsch, who is considered to be the founder of life care planning (Bonfiglio & Marcinko, 2024), wrote the following related to the Individuals with Disabilities Education Act (IDEA), a law that makes available a free appropriate public education to eligible children with disabilities throughout the United States:
…IDEA is viewed as one of the most stable collateral sources available for children with disabilities. Services provided to school children with disabilities under the IDEA or Section 504 of the Rehabilitation Act of 1973 are stable, time tested and reliable and funding for continued services under these programs has been a government priority that is expected to continue (Deutsch & Sawyer, 2002, as cited in Neulicht & Berens, 2011, p. 294).
Although IDEA was established in 1975, several authors in the most recent life care planning handbook continue to reference IDEA as a resource for educationally necessary needs in pediatric life care plans in the United States (Bagnell & Moberg-Wolff, 2024; Berens & Neulicht, 2024; Sutton, 2024).
Similarly, in Canada, there are longstanding, publicly funded programs, such as the Ontario Drug Benefit and the Assistive Devices Program of Ontario. The Ontario Drug Benefit Act was introduced in 1990 and an act of parliament would be required to change it. The Assistive Devices Program of Ontario came into existence in 1982. Both programs are long-established government programs that have endured for at least 35 years. They have clearly established standards for entitlement and quantum of benefit. To avoid duplication within the life care plan (i.e., applying a cost for a need that will be funded by a public program), non-discretionary, longstanding public programs that have clearly established entitlement criteria and established quantum of benefit bear consideration in a Canadian life care plan.
Phase 5 – Report Findings
As was developed for Mr. Smith, a life care plan includes a narrative report that describes and grounds the outlined needs within the presented primary and secondary data as well as evidence-based literature. The narrative should clearly present the information from the referral, the secondary data documentation analysis and case conceptualization, the assessment findings, collected primary data, and finally, the identified needs. The narrative should be clearly written, organized, demonstrate consistency, and present the evaluee’s needs in a well-reasoned manner. Narrative formats vary between life care planners and some referral sources may have a preferred format. Life care planners will quantify the needs and related costs in tables either embedded within the narrative or appended to the narrative. This is well described in the Standards of Practice #15 & #16 (IALCP, 2022) and is consistently present in life care plans authored both in the United States and Canada. Given that Canadian life care plans can be initiated later than those in the United States and thus involve more extensive documentation review, some Canadian life care planners will include a lengthy documentation summary and analysis as an appendix to enhance the readability of the remainder of the life care plan.
Phase 6 – Re-Evaluation
In practice, the process of life care planning is iterative. That is, through data collection and analysis, there may be a need to return to previous phases to ensure that the needs outlined in the life care plan are grounded in substantive and defensible data. A life care plan is most commonly defined as follows:
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. (International Conference on Life Care Planning, 1998, emphasis added).
This reflects the understanding that needs change over time. Even the most rigorously developed, valid, and reliable life care plan may be periodically re-evaluated, due to individual or contextual changes. This may prompt renewed collaboration and a revised treatment plan. At the request of the referral source, a life care planner may prepare an addendum to the original report, detailing any changes since the time of the original report with an explanation of how the changes impact the previous recommendations. Alternatively, a more fulsome updated report may be indicated. Further consultation or collaboration may be indicated with treatment providers followed by the previously outlined steps and details. This process would be common across both the United States and Canada.
Upon reading the physiatrist’s deposition testimony related to Mr. Smith, the life care planner learned of possible updated recommendations pertaining to antispasmodic agent frequency and neurogenic bladder management. Consequently, a follow-up phone conference with the physician resulted in new recommendations, and an updated plan was submitted to the referral source.
Conclusion
Based upon the above analysis, there are clearly high degrees of similarities in the steps and processes involved in life care planning in the United States and Canada. However, due to identified societal differences in healthcare delivery including the availability of healthcare providers and the legal systems of Canada and the United States, and their accompanying practices, there are noteworthy differences in the life care plans prepared in each country. This article has detailed salient differences in the operationalization of each phase of life care plan development. Specific differences were discussed including the requirement to consider the socialized medical system of Canada and stable, enduring publicly funded healthcare delivery programs, and the lack of available databases for Canadian life care planners.