Our highly credentialed vocational rehabilitation and life care plan experts write about topics that are important and relevant to our areas of practice. If you have a vocational or life care planning topic you would like to learn more about, please contact us to request a blog post on that topic.
Obtaining Life Care Plan Recommendations from Health Care Providers
Obtaining appropriate Life Care Plan recommendations from treating or consulting providers for present and future care requires specific collaboration. The sources must know the patient's history and be qualified to render opinions about the recommended care. This patient-specific knowledge flows from physical examination, treatment, review of records, research, and experience. Documenting treatment into the future, beyond the acute phase, does not seem to be the norm for many providers. For example, surgeons focus on symptoms and indications for surgery, including pre-operative and follow-up services, too, in essence, "fix" the broken anatomical structure. It may not be clinically significant to document projected future treatments or even inform their patients of likely medical outcomes. Medical documentation's general purpose is to memorialize what has happened or is happening in the immediate future, not to forecast possible long-term consequences.
Litigation or the possibility of testifying in deposition or trial can inhibit the provider's willingness to consult with a Life Care Planner. One concern is the potential exposure to the risk of liability for the treater's opinions. The presence of litigation should not affect a provider's medical care recommendations, but unfortunately, it may. Another hesitation to collaborate with the Life Care Planner is the potential time loss from clinical practice to attend trials and depositions. The provider may feel too busy with their patients to lose revenue while attending legal proceedings. Some of the more elusive consultations are with pediatric medical care projections and medical malpractice cases. There is a natural hesitancy to give recommendations or directly critique other professional colleagues.
Much of the success achieved in consultation depends on the preparation and skills of the Life Care Planner. Disclosure of litigation and a thorough explanation of the provider and planner's roles are essential at the beginning of the process to limit ambiguity and reassure the provider. A consultation with the provider needs to be scheduled in advance, with an estimated time required for the consult. It is best to provide signed consent to release medical information forms and potential questions before the consultation to expedite the process. Consultations and the opportunity to discuss the recommendations are preferred to written questionnaires in certain jurisdictions. The exchange of ideas allows the participants to discuss additional issues or information previously not known. If a provider will not agree to a consultation, the use of a completed, signed questionnaire similarly communicates the importance or the validity of the recommendations.
After the consultation, it is recommended that the Life Care Planner summarize in writing the recommendations provided to ensure accuracy and invite the consultant to review the summary and communicate edits. More complex cases may require more than one consult with the provider to account for the dynamic nature of medical needs. The ultimate goal is to produce a thorough, well-researched Life Care Plan built on strong medical recommendations communicated from the treating providers on a more probable than not basis
To strategize with one of our vocational or life care plan experts at Stokes & Associates, please call David Barrett at 504-454-5009, visit our website, www.stokes-associates.com, or e-mail dbarrett@stokes-associates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Ashley Lastrapes, MHS, CRC, CCM, CLCP, LPC, LRC
Brandy Bradley, MHS, CRC, LRC, CLCP
Pediatric Life Care Planning - In Amputation Injuries
When conducting a life care plan for a child with an amputation injury, the specific treatment needs can vary considerably among amputation types and changing needs of the individual because of growth and development through aging. An adult who becomes an amputee as a child will have different needs than those who became an amputee as an adult (Reddick-Grisham, 2004).
One difference when conducting a pediatric life care plan for amputation injuries is bone overgrowth, which can appear until the child reaches skeletal maturity. Therefore, the life care planner will need to consider surgeries to correct bone overgrowth. There could also be complications associated with early onset of degenerative conditions, for example, overuse injuries of the other limb/joints as a result of an amputation. This overuse could result in the need for orthopedic treatment, therapy, or surgeries as the individual ages.
Another main difference between adult and pediatric life care planning is the replacement frequency of prosthetic devices and associated supplies due to the child's growth and development rate. A child will need their prosthesis replaced more frequently than an adult, and this replacement frequency should be considered and included until the child reaches adulthood.
As in all amputation cases, aids for independent function will need to be addressed and included in the life care plan accordingly. For individuals with upper extremity amputations, items such as a toothpaste dispenser, a rocker knife, and a button hook can assist significantly with activities of daily living. Adaptive clothing may also be necessary. Adaptive devices to help the child engage in extracurricular activities may need to be included in the plan.
As the child ages, there will be additional needs to consider, such as vehicle modifications and adaptations, architectural renovations, as well as vocational and educational implications. When aging with an amputation injury, other considerations may include wheelchair needs for long-distance ambulation and the increased need for assistance, including home care or facility care.
We offer complimentary consultations concerning "hypothetical matters." To strategize with one of our life care plan or vocational experts at Stokes & Associates, please call David Barrett at 504-454-5009 or email dbarrett@stokesassociates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Ashley Lastrapes, MHS, CRC, CCM, CLCP, LPC, LRC
Brandy Bradley, MHS, CRC, LRC, CLCP
Vocational Analysis: Elements in the Process
Vocational Rehabilitation Counselors (VRCs) use the Dictionary of Occupational Titles as a reference text when conducting a vocational analysis. The text categorizes and outlines jobs by several variables that are analyzed by the VRC, including specific vocational preparation (SVP), general educational development (GED), and aptitudes.
The SVP is the typical training or educational time a worker requires to be able to function in an average capacity in that specific occupation. The SVP can range from unskilled to highly skilled. The SVP numbers, from lowest skill to highest skill, include the following:
Short demonstration only
Anything beyond a short demonstration up to one month
One to three months
Three to six months
Six months to one year
One to two years
Two to four years
Four years to ten years
Over ten years
The Dictionary of Occupational Titles also assigns every occupation a GED level for reasoning, math, and language. GED refers to aspects of education required for satisfactory job performance. The reasoning skill levels range from the lowest skill to the highest skill and include the following:
Applying common sense when understanding one to two-step instructions
Applying common sense when following detailed written or verbal instructions
Applying common sense when completing instructions in written, oral, or diagrammatic formats
Using rational systems to solve practical problems with a variety of concrete variables
Using logic and scientific thinking to understand problems, collect information, establish facts, and reach conclusions while dealing with abstract or concrete variables
Using logic and scientific thinking to understand a variety of intellectual and practical problems while dealing with non-verbal symbolism such as scientific equations
The math skill levels also range from the lowest skill to the highest skill and include the following:
Adding and subtracting two-digit numbers, performing simple multiplication and division
Adding, subtracting, multiplying, and dividing all units of measure and having the ability to work with decimals, fractions, ratios, rates, and percentages
Performing basic geometry, algebra, and having the ability to calculate interest, discounts, volumes, weights, and measures
Performing intermediate algebra, geometry, and shop math
Having the ability to perform advanced algebra, basic calculus, and basic statistics
Having the ability to perform advanced calculus, modern algebra, and advanced statistics
The language skill levels also range from the lowest skill to the highest skill and include reading, writing, and speaking. The language skills are based on grade equivalent as follows:
1st to 3rd grade
4th to 6th grade
7th to 8th grade
High school
College/graduate level
The Dictionary of Occupational Titles also assigns an occupation-specific aptitude level. Aptitudes refer to the ability to perform or learn a given work activity, and there are 11 aptitudes measurable in an occupation. The aptitudes are general learning ability, verbal ability, numerical ability, spatial ability, form perception, clerical perception, motor coordination, finger dexterity, manual dexterity, eye/hand/foot coordination, and color discrimination.
These are just a few of the variables analyzed by the VRC when developing a transferrable skills analysis. By understanding the individual’s skill level, general educational development, and aptitude levels of their work history, the Vocational Rehabilitation Counselor is better able to assess future employment options and vocational prognosis.
We offer complimentary consultations concerning "hypothetical matters." To strategize with one of our life care plan or vocational experts at Stokes & Associates, please call David Barrett at 504-454-5009 or email dbarrett@stokesassociates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Ashley Lastrapes, MHS, CRC, CCM, CLCP, LPC, LRC
Establishing Earning Capacity of a Business Owner
Vocational experts typically rely on several sources to help develop opinions regarding one’s earning capacity, including self-reported earnings, statistics, payroll documentation, and tax records. There are situations in which one resource may be a better representation of an individual’s earning capacity. A complicated example is assessing the earning capacity of a business owner. There is no specific reference to statistical wages for business owners when trying to support earning capacity. Therefore, using tax records as a foundation for one’s opinion is often necessary.
The business’ tax documents are studied to determine the gross earnings of the company, along with documented expenses required to operate the business. The documentation should outline business expenses, including materials and supplies, employee compensation and benefits, company vehicles, repairs and maintenance, advertising, rents, depreciation, taxes, and licenses, etc. Assuming the business owner has accurate records, the expenses can be deducted from the gross earnings to develop a reasonable estimate of the profit the business made for that calendar year, and thus earning capacity.
Consider a scenario involving the owner of a small pile driving company whose gross annual earnings are $550,000.00. Business expenses would include employee compensation, pilings, and related materials, rental fees, and maintenance of equipment used to drive the pilings, mortgage or rent for the warehouse and small office, company trucks and fuel, insurance, etc., for a total of $375,000.00. After deductions for expenses, the net income is $175,000.00. The net income may or may not be an accurate representation of the owner’s earnings for that year, depending on several factors, one of which would be whether the owner drew a salary. In that case, his salary plus net income would represent his earnings for the year.
Vocational experts must also consider that people do not always submit proper, accurate, or complete information to the IRS, rendering tax documentation unreliable. As a result, the approximated earnings would be invalid if the vocational expert were to rely solely on tax documents. It is the expert’s responsibility to request the full and accurate tax documentation as support for their opinion on an individual’s earning capacity as a business owner.
To strategize with one of our vocational or life care plan experts at Stokes & Associates, please call David Barrett at 504-454-5009, visit our website, www.stokes-associates.com, or e-mail dbarrett@stokes-associates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Ashley Lastrapes, MHS, CRC, CCM, CLCP, LPC, LRC
Brandy Bradley, MHS, CRC, LRC, CLCP
Medication and Work
After an injury and a medical release for work, individuals may continue to take prescription medicines such as muscle relaxers, anti-inflammatories, and pain medications. As vocational experts, we get asked “how” these medications may affect a person’s ability to obtain or maintain employment.
A vocational expert is not a medical expert and must rely on treating or consulting physicians to determine what limitations/side effects, if any, can be expected as a result of medication use. It is the vocational expert’s purview to assess job functions and employment requirements. If a physician limits a person from certain activities because of the side effects of medication, then the vocational expert can determine what jobs can or cannot be performed with or without accommodation.
There are instances when the physician does not specify limitations regarding the medicines and work. The vocational expert could assume that if prescribed narcotics produce sedating effects, it may be unsafe for the individual to operate a vehicle, heavy equipment, or dangerous machinery, and should avoid work at unprotected heights. As responses to medications vary, it cannot be assumed that all individuals are unemployable in any capacity.
Questions to clarify work suitability while taking medication include what effect, if any, do these medications have on this specific individual (e.g., drowsiness, etc.)? What type of job is the person performing or seeking (e.g., assembler, carpenter, etc.)? How often is medication being taken, and can it be taken after work hours? Do certain occupations or professions have legal or statutory restrictions regarding narcotics or related medication use (e.g., registered nurse, crane operator, commercial truck driver, etc.)?
For example, we performed a labor market survey for an individual taking pain medication who was released to work by his physician in a light capacity. Potential employers were contacted based on jobs that were within his physical restrictions and educational experience, including sales clerk, parts clerk, and office assistant. We asked employers whether the use of prescription pain medication would affect his potential hire/employment. Of the four employers contacted with suitable job openings, all reported that this individual would not be precluded from employment consideration because of prescription medication usage if the medication was disclosed upon pre-employment drug screening.
Medication effects vary regarding the impacted functions in jobs available in the labor market. Some medications come with warnings; however, these warnings do not neatly translate to job limitations but are merely cautions. The bottom line is, if a person is taking medication that hinders their ability to perform a job, then the position is not suitable for the worker. If, however, the person taking medication is not negatively affected by the drug, regardless of the cautions and the physician does not restrict the worker, then medication status is not a disabling condition. If there is no danger or risk, then medication is not the objection.
We offer complimentary consultations concerning "hypothetical matters." To strategize with one of our life care plan experts or vocational experts at Stokes & Associates, please call David Barrett at 504-454-5009 or email dbarrett@stokesassociates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Ashley Lastrapes, MHS, CRC, CCM, CLCP, LPC, LRC
Engaging Vocational Rehab and Life Care Planners in a post-COVID World
The recent Covid-19 pandemic has disrupted all our lives to some degree. For many of us, we have been on mandatory lockdown since mid-March forcing some drastic changes in how we work and live. At Stokes & Associates, we have been able to make a smooth transition to a mostly remote workplace, as our testifying experts have been conducting remote video interview evaluations for many years before the current health crisis. As many of you have gotten to know online videoconferencing platforms like Zoom quite well during the recent past, we are hoping to share some of our experiences leveraging technology to provide vocational assessments and life care plan evaluations.
Videoconferencing has been used for many years in the legal system for criminal arraignment hearings, Social Security hearings and other forms of testimony. This method has also been used to deliver medical services more efficiently in the Veterans Administration for many years and has demonstrated a high satisfaction rate among clinicians and patients. Since the Covid-19 pandemic, videoconferencing has become even more ubiquitous. For example, the U.S. Patent and Trademark Office is accommodating video hearings, and municipal offices are conducting marriage license applications via videoconference. The Tennessee Supreme Court heard its first oral arguments via videoconference.
One of the primary components of establishing a trustworthy video link is security. At Stokes & Associates, we exclusively use the Zoom Professional version with HIPAA compliance. Zoom has developed a comprehensive protocol to guarantee maximum privacy and security of the highest caliber to satisfy stringent HIPAA regulations. When we schedule an evaluation appointment, our staff forwards all the necessary documents to be returned electronically via DocuSign, allowing the evaluee to electronically sign paperwork on their mobile device with one click.
The typical methodology for conducting a vocational evaluation is to review medical records, interview the claimant, perform vocational testing, conduct vocational research, and complete the written report. Every step of this usual and customary process is possible using a remote protocol. The interview is conducted online at the claimant's convenience. Because the meeting usually occurs with the claimant in their home, we are also more likely to have the ability to interview a spouse or family member. Vocational testing is conducted online using digital stimulus materials and online response capabilities. We can collect the same achievement and interest data as an in-person interview.
Life care planning evaluations are just as efficient when conducted remotely. Again, seeing the evaluee in their home environment gives additional important information regarding mobility and safety needs. The claimant can provide us with a "virtual tour" of their home by navigating through the atmosphere, allowing us to ask questions about access. Additionally, it is often difficult for clients to remember the exact medications, equipment, and supplies that they use daily when they present for evaluations in our office. By being "in the home" with the client, we can review medication bottles, take screenshots of equipment model numbers, and get a "day in the life" view of what it is like to live at home with a physical impairment.
As testifying experts, we take our methodology very seriously. It is our rigorous reliance on generally-accepted, peer-reviewed evaluation protocols that give us the confidence to educate judges and juries of our findings. Our use of remote assessment has been supported in several state and federal court systems, allowing us to minimize travel expenses and minimize the time required to move from evaluation to final report.
We offer complimentary consultations concerning "hypothetical matters." To strategize with one of our life care plan or vocational experts at Stokes & Associates, please call David Barrett at 504-454-5009 or email dbarrett@stokesassociates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Ashley Lastrapes, MHS, CRC, CCM, CLCP, LPC, LRC
Who develops the best Life Care Plans?
As certified life care planners at Stokes & Associates, we are often asked about our credentials, training, and experience that inform our ability to comment on future medical care expenses. There is an ongoing discussion in the field regarding what specialties produce the highest quality life care plans (rehab counselors vs. rehab physicians vs. nurses, etc). The attached position paper by the International Association of Rehabilitation Professionals – Life Care Planning Section (IALCP) argues that life care planning is open to all who demonstrate the appropriate qualifications, experience, and skill to author a life care plan. A single profession cannot claim superiority over any other. The quality of a life care plan should be judged on the life care plan product and not the profession of the author.
The International Academy of Life Care Planners continues to be the leading organization promoting the transdisciplinary practice of life care planning. That means that it is, and has been, the position of this community that life care planning is a practice open to all those who demonstrate the appropriate qualifications, experience, and skill to author life care plans. There has been some recent concern among some life care planners about who is most qualified to author life care plans.
This paper is a reminder to the community, from the community, that the best life care plans depend on input from a variety of professionals. The life care planner analyzes information from multiple sources to create a consistent, comprehensive document using in-depth knowledge, experience, and clinical skills. It reflects the collaborative coordination of several professionals. There is no single profession that can claim to be the most qualified to do this. Our standards of practice remind us of this through this description of the origins of life care planning. (IALCP, 2015):
IALCP Transdisciplinary Practice Position Paper:
Historical Perspective
The development of an individualized plan of care has always been considered an integral part of the medical and rehabilitation process. This type of plan has historically been used by multiple disciplines. Rehabilitation professionals have created a rehabilitation plan. Nurses developed a nursing care plan. Physicians defined a medical treatment plan, and other professions developed plans specific to their practice. An integrated plan that includes all disciplines and specific costs of care has become an increasingly important aspect of the health care process due to rapid growth in medical technology and an increased emphasis on the cost of care. This process of developing an integrated plan and delineating costs has evolved over an extensive period of time and is now utilized by case managers, counselors, and other professionals in many sectors. These plans are also a valuable tool for rehabilitation planning, service implementation, management of health care resources, discharge planning, educational and vocational planning, and long-term managed care, among other areas.
Transdisciplinary Perspective
Life care planning is a transdisciplinary specialty practice. Each profession brings to the process of life care planning practice standards which must be adhered to by the individual professional, and these standards remain applicable while the practitioner engages in life care planning activities. Each professional works within specific standards of practice and regulatory requirements for his or her discipline to ensure accountability, provide direction, and mandate responsibility for the standards for which he or she is accountable. (I.C)
Further, the standards of practice clearly identify the educational background and professional preparation required (IALCP, 2015):
a. Possesses the appropriate educational requirements in a rehabilitation or health care field as defined by his or her professional discipline.
b. Maintains current professional licensure, provincial registration, or national board certification that is required to practice a professional rehabilitation or health care discipline.
c. Demonstrates that the professional discipline provides sufficient education and training to assure that the life care planner has an understanding of human anatomy and physiology, pathophysiology, psychosocial and family dynamics, the health care delivery system, the role and function of various health care professionals, and clinical practice guidelines and standards of care. The education and training allow practitioners in the discipline to independently perform assessments, analyze and interpret data, make judgments and decisions on goals and interventions, and evaluate responses and outcomes.
Healthy debates continue to flourish around how the best life care plans are developed based on the best methodologies and these conversations only make our practice better. However, these do not and should not result in any single profession claiming superiority over others. The quality of the life care plans should be judged on the life care plan product, not the profession of the author.
Further information on the scope of practice of the most common professions that create life care plans, and the scope of recommendations that they can contribute to future care planning can be found in the Journal of Life Care Planning, Volume 17, Number 1, 2019. The content of this journal clearly exemplifies the necessity of collaborative practice in life care planning.
We offer complimentary consultations concerning "hypothetical matters." To strategize with one of our life care plan or vocational experts at Stokes & Associates, please call David Barrett at 504-454-5009 or email dbarrett@stokesassociates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Ashley Lastrapes, MHS, CRC, CCM, CLCP, LPC, LRC
Pediatric Vocational Assessments
A review of a recent study, “The validity of exploring educational attainment levels and occupational skill and physical strength demand levels of caregivers when evaluating loss of earning capacity in pediatric cases.”
Vocational rehabilitation counselors have specialized training and knowledge needed to assist injured individuals with workforce reentry. The expert opinion of vocational rehabilitation counselors can be valuable to the trier of fact in deciding the damages related to loss of future earning capacity of an injured individual, in both adult and pediatric cases.
In the field of vocational rehabilitation counseling, one generally accepted model for assessing pediatric earning capacity is the PEEDS-RAPEL© Model (Neulicht & Berens, 2005). The PEEDS portion of this model addresses pediatric vocational assessments by evaluating parental and familial occupations and educational attainment, as these factors are thought to be part of a preinjury predictor of educational attainment and career choice of the adult child.
A recent study from Sapp, Remley, and Range (2020) examined evaluee files to compare the relationship between the parent’s educational attainment level, and primary occupation to the adult child’s level of educational attainment, and primary occupation. This study found that there was a positive association between the primary caregiver’s level of educational attainment and the adult child’s level of educational attainment. There was also a positive association between the primary caregiver’s occupational skill level and the adult child’s occupational skill level and between the primary caregiver’s occupational, physical strength demand level, and the adult child’s occupational, physical strength demand level. The findings of this study support the pediatric vocational assessment model, the PEEDS-RAPEL© Model.
When vocational experts are in the position of making recommendations in the vocational assessment of a child, factors such as the caregivers’ educational level, occupational skill level, and occupational, physical strength demand level should be considered. These factors can assist the vocational expert in developing the basis for their vocational opinions in these types of cases (Sapp, Remley, & Range, 2020).
Sapp, L.H., Remley, T.P., Range, L.M. (2020). The validity of exploring educational attainment levels and occupational strength demand levels of caregivers when evaluating loss of earning capacity in pediatric cases. The Rehabilitation Professional, 28(1), 5-14.
We offer complimentary consultations concerning "hypothetical matters." To strategize with one of our life care plan or vocational experts at Stokes & Associates, please call David Barrett at 504-454-5009 or email dbarrett@stokesassociates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Ashley Lastrapes, MHS, CRC, CCM, CLCP, LPC, LRC
Wage Earning Capacity of the Unemployed or Underemployed
Determining wage-earning capacity is a complex task for the rehabilitation consultant. Wage earning capacity references an individual’s ability to work and earn wages, pre-injury versus post-injury. Typically, when determining wage-earning capacity, the individual’s demonstrated earnings are used as a reference if the actual earnings fairly and appropriately represent the individual’s capacity to earn. This is not the case; however if the individual is unemployed or underemployed at the time of injury. The demonstrated wages, or lack thereof, may not appropriately represent the individual’s capacity to earn wages. Examples of this include the individual being previously incarcerated, a downturn in job availability (seen frequently in oilfield industries), or family obligations.
In these instances, it is the vocational rehabilitation consultant’s role to examine the individual’s vocational profile to accurately determine the individual’s capacity to earn wages. The vocational profile of the evaluee consists of age, education, training, work history, vocational test results, the severity of injury or disability, functional capacity, and work-life expectancy. Vocational consultants must also consider employment opportunities available, employment trends, labor market research, employability, and placeability of the individual.
For example, an offshore welder with a 15-year history of earning $130,000.00 per year is laid off due to a lack of available work. He has since found work as a small parts assembler earning approximately $35,000.00 per year. He was then involved in a motor vehicle collision and subsequently required a three-level lumbar fusion. His treating physicians have permanently limited him to a light physical demand level, which falls within his job at the time of injury as a small parts assembler. One may assume that there is no wage loss claim, as he can recapture his earnings at the time of injury. However, his true earning capacity is his demonstrated earnings as an offshore welder, which he can no longer do. At Stokes & Associates, we take great care to ensure a comprehensive and thorough vocational analysis when assessing an individual’s vocational outlook and wage-earning capacity.
We offer complimentary consultations concerning "hypothetical matters." To strategize with one of our experts at Stokes & Associates, please call David Barrett at 504-454-5009 or email dbarrett@stokesassociates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Ashley Lastrapes, MHS, CRC, CCM, CLCP, LPC, LRC
Quantifying Work Capacities in Neurocognitive Cases
Consulting with the treating/consultative specialist, such as a neuropsychologist, neurologist, or PM&R physician, helps determine what limitations exist as a result of the specific injury or illness. Psychological and neuropsychological evaluations, if performed, can play a part in delineating an individual’s abilities/limitations. It may not be enough, however, to ask the physician, “what are the limitations of this individual?” but rather, what are the levels of impairment, if any, on various cognitive/mental ability areas of functioning?
The specific responses to the following abilities will assist the vocational expert in assessing an individual’s work capacity/vocational outlook.
remember locations and work-like procedures
understand and remember very short and simple instructions
understand and remember detailed instructions
maintain attention and concentration for 2-hour blocks of time
sustain an ordinary routine without special supervision
perform activities within a schedule, maintain regular attendance, and be punctual within customary tolerances
make simple work-related decisions
get along with coworkers or peers without distracting them or exhibiting behavioral extremes
interact appropriately with the general public
accept instruction and respond appropriately to criticism from supervisors
meet deadlines and complete tasks
respond appropriately to changes in the work setting
function independently
We ask physicians to rate their abilities accordingly, such as:
Unlimited or Very Good - ability to function in this area is more than satisfactory, no limitations
Good (mild impairment) - the ability to function is limited but satisfactory, slight limitations
Fair (moderate impairment) - ability to function is seriously limited, moderate limitations
Poor (marked impairment) - unable to function in this area, marked limitations
None (severe impairment) - a significant loss of psychological, physiological, personal/social adjustment, severe limitations
Once specific limitations are outlined, we adjust a person's vocational profile accordingly to reflect the level of functioning including General Educational Development levels (Reasoning, Mathematics, and Language); Specific Vocational Preparation (time required to learn the techniques, acquire the information and develop the facility needed for average performance in a specific job situation); and Temperaments (ability to work in a variety of situations ). Addressing and clarifying the larger scope of a person’s residual cognitive/mental abilities post-injury assists the expert in addressing more comprehensively their vocational outlook and earning potential.
We offer complimentary consultations concerning "hypothetical matters." To strategize with one of our experts at Stokes & Associates, please call David Barrett at 504-454-5009 or email dbarrett@stokesassociates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Ashley Lastrapes, MHS, CRC, CCM, CLCP, LPC, LRC
What's in a Life Care Plan?
The International Academy of Life Care Planners (IALCP) defines a Life Care Plan as “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 healthcare needs.” So, what goes into a Life Care Plan?
The following are examples of topics, including medical and vocational needs that are typically found in specific sections of a Life Care Plan.
Projected Evaluations: Projected evaluations include evaluations by physicians or other allied health professionals such as physical therapists, speech therapists, psychologists, neuropsychologists, etc.
Projected Therapeutic Modalities: This section outlines the therapies and treatments that would be rendered to a patient for the medical needs associated with the indexed accident or injury.
Future Medical Care – Routine: This section outlines the regularly occurring visits and treatment with physicians or other allied health professionals on an ongoing basis.
Future Medical Care – Surgeries: Includes planned future surgeries or therapeutic procedures (injections, RFAs), as well as associated costs.
Medications: This section includes current and expected medications over the evaluee’s life expectancy. We typically include costs for brand and generic.
Equipment and Supplies: This section includes current and expected equipment and supplies as prescribed for the patient.
Diagnostic Testing: This section should include any diagnostic testing necessary for a patient as a result of the accident or injury.
Home Care/Facility Care: Supervision via a personal care attendant, RN, LPN, or other health care worker is valued based on number of expected hours of treatment.
Aids for Independent Function and Transportation: These are items that allow a patient to operate as independently as possible and may include transportation needs.
Architectural Renovations and Modifications: Depending on the severity of the injury, there may need to be an assessment for architectural renovations or home modification.
Orthotics and Prosthetics: This section is specific to patients with amputations, as well as bracing needed for increased functional ability.
Potential Complications: In life care planning potential complications should be assessed.
Vocational Assessment: Some Life Care Plans include a Vocational Rehabilitation Assessment.
Although Life Care Plans can vary in structure, these are some of the sections that you would find in a Life Care Plan.
We offer complimentary consultations concerning "hypothetical matters".
To strategize with one of our vocational experts or life care plan experts at Stokes & Associates please call David Barrett at 504-454-5009, visit our website, www.stokes-associates.com or email dbarrett@stokes-associates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Factors Relevant in the Assessment of Wage-Earning Capacity
The estimation of earning capacity in cases involving personal injury is important and often a complex task for the rehabilitation consultant. The vocational expert’s role is to examine the relevant vocational factors to determine the individual’s pre-injury vs. post-injury capacity to perform jobs and earn wages.
Some of the factors that are relevant in estimating earning capacity include:
Age: The age of the worker is important in determining how long the person will remain in the workforce as well as their wage-earning potential.
Education and Training: The level of education or training of an individual in terms of their knowledge, skills, and abilities.
Work Experience: Past work can be an indicator of potential or transferability of job skills.
Disability and Functional Capacity: Disability is defined as the inability to perform substantial gainful activity due to an impairment. Functional capacity to work is relevant, both pre and post-injury.
Worklife Expectancy: Helps to determine how many remaining years the worker has within the workforce.
Employment Opportunities/Future Trends: This is relevant for making reliable estimates of future employment opportunities and earnings. An understanding of the labor market is critical with respect to estimating future earnings.
Labor Market Surveys: Information regarding jobs in the relevant labor market area, generated by the U. S. Census Bureau as well as from contact with employers.
Employability: Addresses the question of whether a worker is able to be employed within any given labor market, or whether jobs exist in the labor market.
If the individual is unable to return to work at their usual occupation, it is the vocational expert’s role to compare pre-injury earning capacity with the expected post-injury earning capacity. In some cases, the loss of earning capacity is straightforward. For example, consider a 55-year-old truck driver (working as a driver since the age of 19) who was injured in a motor vehicle accident resulting in the inability to work in any capacity. His loss of future earning capacity would likely be based on actual earnings at the time of the injury projected over his remaining work-life expectancy.
Other cases may be less clear. For example, suppose the truck driver also had his 18-year-old nephew in the truck with him. Assume the boy suffered extensive head injuries which rendered him incapable of gainful employment for the rest of his life. Since he had very little work history, estimating a loss of earning capacity is more complicated and may be based on pre-injury vocational goals, age, and educational attainment. Although this example may be an extreme case scenario, many cases do not fit neatly into categories. A vocational expert can help tease out these complicated issues.
To find out more about our methods or to discuss a potential case assignment, we offer complimentary consultations concerning "hypothetical matters."
To strategize with one of our vocational experts or life care plan experts at Stokes & Associates please call David Barrett at 504-454-5009, visit our website, www.stokes-associates.com or email dbarrett@stokes-associates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Determining Damages in Wrongful Death Claims
In cases involving wrongful death claims, a suit is generally filed on behalf of the decedent’s family members, such as a spouse and/or minor children. As vocational rehabilitation experts, we are generally asked to determine the wage-earning capacity and vocational outlook of the decedent “but for” their untimely death. Completing a vocational analysis in a wrongful death claim differs slightly from other types of cases primarily because of the inability to personally interview the individual. Having a consistent methodology of conducting a vocational assessment and obtaining pertinent information from other sources allows the vocational expert to formulate vocational opinions within reasonable vocational probability. So how do we derive our opinions and conclusions?
The answer lies in relying on a consistent methodology. This includes:
Review of salient records including earnings statements (If the individual had an established work history)
Resume, job applications, and/or employment records (if available)
Education/school records
Although the decedent cannot be interviewed, collateral interviews of other sources can be extremely beneficial which can include family members, close friends, coworkers, and teachers. Multiple sources will assist in “telling the story” and provide an understanding of patterns and milestones in the individual’s career/vocational development.
Important information includes work history and related experience, skills and abilities, specialized training, educational background and/or educational pursuits (may have been in school at the time of death), hobbies/interests, ambitions, vocational goals, plans, and aspirations. If employed at the time of death, it is helpful to have employment/earnings data such as Social Security earnings records or tax returns.
Wage data can be obtained from reliable sources such as the Department of Labor, Bureau of Labor Statistics, the Occupational Employment Survey, as well as labor market research. Ultimately, the goal is to provide reliable vocational opinions based on the generally accepted methodology that provides accurate estimates for future monetary or losses of the decedent’s vocational outlook and wage-earning capacity.
To find out more about our methods or to discuss a potential case assignment, we offer complimentary consultations concerning "hypothetical matters."
To strategize with one of our vocational experts or life care plan experts at Stokes & Associates please call David Barrett at 504-454-5009, visit our website, www.stokes-associates.com or email dbarrett@stokes-associates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Vocational Rehab Testing and Third Party Presence
When conducting Vocational Rehabilitation Evaluations, we are sometimes asked to have a third-party present for the interview and testing portions of the process. With regards to the testing portion, we must object to a third-party’s presence and the audio/video taping of the testing evaluation (or administration).To do so would violate copyright laws, affect contractual agreements with the publishing companies, violate professional standards and ethics, and potentially invalidate the test results.
The publishers’ standards state that all rights are reserved, including translation, and that no part of the publication may be reproduced or transmitted in any form or by any means without written permission from the publisher including: electronic or mechanical, photocopying and recording, or by any information storage or retrievable system, unless such copying is expressly permitted by federal copyright law. These restrictions apply to recordings made by third-party observers as well.
Additionally, professionals who use the publisher’s tests are responsible for maintaining test security. The Standards for Educational and Psychological Testing indicate that test users have the responsibility to ensure the confidentiality of the test results and testing materials consistent with legal and professional ethics requirements. Furthermore, test content should not be shared with curious non-professionals or made available for public inspection.
Similarly, the Code of Professional Ethics for Rehabilitation Counselors insist that rehabilitation counselors administer tests/instruments according to the parameters described in the publisher’s manuals. When tests/instruments are not administered under standard conditions, as may be necessary to accommodate clients with disabilities or when unusual behavior or irregularities occur during the administration, those conditions are noted in the interpretation, and the results may be designated as invalid or of questionable validity.
Finally, the Code of Professional Ethics for Licensed Rehabilitation Counselors, states that Licensed Rehabilitation Counselors will make reasonable efforts to maintain the integrity and security of tests and other assessment techniques consistent with law, contractual obligations, and in a manner that permits compliance with the requirement of the Code.
Aside from copyright and ethical concerns, studies have reported that the presence of a third-party observer during assessment, particularly, video/audio recording, negatively affects the test performance of the examinee.
Historically in our experience, test publishers have consistently refused to release test items. For the reasons stated above, we are bound by standards and ethics, as well as legal and contractual obligations to object to having a third-party present during testing, allowing audio/video recording of test administration, or releasing the test instruments, or test content.
To strategize with one of our licensed vocational experts or certified life care planners please call David Barrett at 504-454-5009, visit our website, www.stokes-associates.com or email dbarrett@stokes-associates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, MHS, CRC, LPC, LRC, CLCP
Todd Capielano, M.Ed., LRC, CRC, LPC, CLCP
Life Care Planning in Pediatric Cases
Although life care planning methodology remains consistent across adult and pediatric cases, there are some unique circumstances the life care planner will likely need to consider when conducting the plan of a child. In pediatric cases, meeting with relevant family members or caregivers could be a significant piece of the process. A home assessment may also be useful and in some cases necessary, in gathering relevant information about the child.
In pediatric life care planning, the family members are often significantly impacted as a result of caring for a child with special needs and adopt roles and responsibilities that would otherwise not be required. For instance, a special needs child may need constant supervision, diapering, or nighttime feedings long after the reasonable demands of childhood requires a caregiver. As the child ages, developmental delays can become more apparent, resulting in an increasing need for care. Although the rehabilitation goal is typically to maintain the individual in their least restrictive environment, long-term living options such as facility care may need to be explored for when the child ages.
During the interview process, the life care planner can obtain critical information from the family regarding the child’s medical history and can begin to assess if there are differences in care needs that have occurred since disability onset. The family interview can also assist in obtaining information regarding the child’s growth and development as well as the child’s ability to perform the age-appropriate activities of daily living. An interview of the family can aid in the gathering of relevant information about the child’s specific treatment, medication, equipment, supplies, transportation, school status, and education needs, as well as the family’s ability to adjust to the child’s disability needs.
When pricing out future costs, depending on the service or item, there may be differences in costs for pediatric services and items which could impact the long-term plan if not adequately priced. The replacement of items may also differ in childhood than in adulthood. For instance, a child’s wheelchair may need to be replaced more frequently than an adult's wheelchair due to the rapid growth spurts of the child. The child’s medication needs can also differ significantly than as an adult. Consultation with relevant caregivers, which often includes physicians, allied health providers or other specialists, could clarify and verify specific differences in the level of care as the child ages.
For more information on methodology, pricing or other cost research related to life care plans, we offer complimentary consultations.
To strategize with one of our licensed vocational experts or certified life care planners please call David Barrett at 504-454-5009, visit our website, www.stokes-associates.com or email dbarrett@stokes-associates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, MHS, CRC, LPC, LRC, CLCP
Todd Capielano, M.Ed., LRC, CRC, LPC, CLCP
Vocational Analysis Testing - Interest Inventories
When performing a vocational analysis, the vocational expert relies on multiple pieces of data to formulate vocational opinions. In addition to obtaining a detailed medical and work history, it is important to consider the evaluee’s preferences for work, especially when alternative employment is necessary due to permanent physical restrictions. To measure preferences, vocational experts may rely on vocational testing, which typically includes interest inventories. Most interest inventories are based on John L. Holland’s theory that vocational and career choices are linked to the persons’ personality type, which influences interests.
Holland identifies six interest/personality areas:
Realistic - Realistic personality types prefer to work with things and are considered doers versus talkers or thinkers. Realistic persons tend to be competitive, assertive, independent, and practical.
Investigative - Investigative personality types prefer working with data, are considered thinkers, and tend to be intellectual, analytical, and observational.
Artistic - Artistic personality types like to work with things and ideas and are considered creators. Artistic persons are typically sensitive, inventive, creative, and emotional.
Social - Social personality types prefer to work with people and are considered helpers. They usually seek out relationships, are humanistic, responsible, and supportive.
Enterprising - Enterprising personality types are considered persuaders and like to work with people and data. For these individuals, the value is usually placed on money, reputation, and power.
Conventional - Conventional personality types prefer to work with data and are considered organizers. Conventional persons tend to be quiet, responsible, and well-organized.
The results of the interest inventories allow the vocational experts, not only to have insight into what type of career the evaluee would be interested in pursuing but also allows the expert to make inferences about the person’s personality features. These personality features can provide the vocational expert with information about how the person might approach the job search or present in an interview. Ultimately, interest inventories can assist in providing useful information related to a person’s vocational outlook.
To find out more about our methods or to discuss a potential case assignment, we offer complimentary consultations concerning "hypothetical matters."
To strategize with one of our vocational experts or life care plan experts at Stokes & Associates please call David Barrett at 504-454-5009, visit our website, www.stokes-associates.com or email dbarrett@stokes-associates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, MHS, CRC, LPC, LRC, CLCP
Todd Capielano, M.Ed., LRC, CRC, LPC, CLCP
David Barrett – Client Development – Vocational Rehab Experts and Life Care Plan Experts
When are jobs deemed available during vocational rehabilitation?
When providing vocational counseling services on worker’s compensation cases, our role is to assist the injured worker with a focus on job placement. Any jobs developed on behalf of the injured worker in their geographic area must be open and available. So, what is the definition of “available?”
Most Louisiana worker’s compensation courts agree that to demonstrate that a job is available within an employee’s physical capabilities, the treating physician must approve the job.
A conflict exists among appellate courts however, as to whether a job may be considered available to the employee before the physician approves the job.
In Banks, Jr. v. Industrial Roofing & Sheet Metal Works, Inc. (No. 96-C-2840, 07/01/97), one of the issues involved the timeliness of when jobs were identified by the vocational counselor as open and available and when they were presented to Banks. In determining job availability, will the court consider jobs that are available when the employee is notified of their existence or when the physician approves them?
The 3rd Circuit, requires that the vocational counselor identify available jobs, obtain physician approval of those jobs, confirm that the jobs are still available when approved by the physician, and then notify the injured employee of the jobs (East-Garrett v. Greyhound Bus Lines, 99-421 (La. App. 3 Cir. 11/3/99), 746 So.2d 715. The court explained its reasoning as follows: We find it implicit in the holding of Banks that the employer must establish that the jobs are still in existence when it is determined that they are within the employee’s capabilities.
In Davis v. Cippriani’s Italian Restaurant, , the 1st Circuit Court of Appeal upheld the trial court’s finding that vocational services provided to the employee were inadequate to show that the employee had wage earning capacity because “[t]he counselor was unable to show that the opportunities were still open at the time claimant’s treating physician signed-off on them.”
In Payne v. Lawn Lourd Lawn Service, the 2nd Circuit rejected the argument that an employer must obtain physician approval before notifying an employee of a job. The court found no requirement in the Banks decision for prior physician approval of jobs.
Although there is some disagreement by the courts as to whether a job may be considered available to the employee before the physician approves the job, it would seem that all the courts would agree that the treating physician’s opinion should be sought. Our practice is to provide the injured worker with job openings when they are identified while simultaneously sending the job descriptions to the treating physician for review and approval. When approved, the employers are re-contacted to determine the status, and the injured worker is notified immediately with the results. Ultimately, it is up to the courts to rule when a job is considered available.
We offer complimentary consultations concerning "hypothetical matters."
To strategize with one of our vocational experts or life care plan experts at Stokes & Associates please call David Barrett at 504-454-5009, visit our website, www.stokes-associates.com or email dbarrett@stokes-associates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, MHS, CRC, LPC, LRC, CLCP
Todd Capielano, M.Ed., LRC, CRC, LPC, CLCP
How does the new Hospital Chargemaster Rule Influence Life Care Planning?
As part of the Affordable Care Act, hospitals have been required to make public the prices they charge for their services. This provision of the ACA has not been enforced until a new rule by the Centers for Medicare and Medicaid Services took effect on January 1, 2019. The rule cited that hospitals would comply “as long as the information represents the hospital’s current standard charges as reflected on its chargemaster.” A hospital’s chargemaster is a summary of charges and services, which traditionally has been proprietary in nature. The “price” hospitals charge for treatment is many times a moving target. For example, the hospital’s published price is intended to appear competitively set but is neither the price eventually charged to consumers or to insurance companies. A recent Health Affairs study found that the average hospital with greater than 50 beds had a charge-to-cost ratio of 4.32, meaning that the hospital charged $432 when services actually cost $100. Furthermore, on average, hospitals charged 20 times more than their own costs for CT scans and anesthesiology, because it has been traditionally more difficult for patients to compare prices in these departments.
So, how does this new rule affect cost research for life care plans? Well, it's complicated. To comply with the letter of the law, hospitals must make their chargemasters public. The problem is, that most chargemasters are excel spreadsheets of largely unintelligible internal codes and cryptic abbreviations. To see how local hospitals were handling the transition, we did a survey of facilities in the New Orleans area.
We researched 10 major hospitals in the New Orleans area and searched their websites for the mention of public pricing information. Nine of the 10 hospitals had price lists available for review. Of those nine, all had downloadable Excel or CSV files. Finding the appropriate links was similarly challenging with all nine websites, with text-based hyperlinks found buried on “Patient and Visitors” sub-pages. None of the links on the nine sites were made available in sitemaps or searches for “pricing,” “chargemaster,” or another similar language, and none were highlighted on the hospital’s homepage.
There was some variability within the nine websites regarding the way information was displayed. Four of the nine sites listed a Current Procedure Terminology (CPT) code. The CPT code is the key piece of information necessary in doing cost research for life care plans as it is a universal identifier for the exact type of service. Most of the websites included text descriptions of the services being priced with a corresponding dollar amount. One site included an easy to follow chart of typical prices displayed in a range, and searchable by inpatient and outpatient services. However, these searchable charts did not seem to represent an exhaustive list of treatments/supplies.
Overall, publishing hospital pricing online is a good step in the right direction toward true pricing transparency. Our basic survey of hospital websites was in no way a definitive or controlled experiment, but initial results suggest variability in the way hospitals are “complying” with CMS’s new rule. In their defense, the new policy has only been in effect for less than one month, and hopefully, large health care systems will recognize the benefit of transparent pricing and continue improving their cost reporting. For more information on hospital pricing or other cost research related to life care plans, contact Stokes & Associates today.
We offer complimentary consultations concerning "hypothetical matters."
To strategize with one of our vocational experts or certified life care planners at Stokes & Associates please call David Barrett at 504-454-5009, visit our website, www.stokes-associates.com or email dbarrett@stokes-associates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, MHS, CRC, LPC, LRC, CLCP
Todd Capielano, M.Ed., LRC, CRC, LPC, CLCP
Determining the Loss of Earning Capacity in Pediatric or Young Adult Cases
This is a review of an article published in the Journal of Forensic Vocational Analysis, Vol. 18, No. 1, Summer 2018, by the American Board of Vocational Experts.
In this article, Terry Leslie, M.Ed., CRC, LPC, ABVE/D, a vocational and life care planning consultant, proposes a framework to guide vocational experts in determining loss of earning capacity in pediatric and young adult cases. Leslie suggests that the focus be on the “Sphere of Influence” instead of family or parents only, as these traditional relationships appear not to be as prevalent as they may have been in the past. The “Sphere of Influence” covers three general areas, including genetics, socio‑economic status, and the characteristics of the child themselves.
There are several medical conditions that may have genetic causes and need to be considered in determining the pre‑morbid level of functioning of a child compared to their post-morbid level of functioning. Such conditions include autism spectrum disorder; attention-deficit/hyperactivity disorder (ADHD); oppositional defiant disorder (ODD), specific learning disorders such as reading disability; and traits such as Tourette’s disorder, bipolar disorder, and cystic fibrosis as examples.
Regarding socio-economic status, individuals who have an influence on the child may include parents, grandparents, siblings, etc. Characteristics such as educational attainment, academic achievement, school absences, grade level functioning, as well as earnings records or criminal records can be helpful to the analysis. The author quotes the American Psychological Association Education and Socio-economic Status Factsheet which states that socio-economic status is often measured as a combination of education, income, and occupation. Leslie adds that a strong positive association between one’s school attainment and that of one’s parents has been consistently documented in numerous studies.
Regarding characteristics of the child/young adult that can affect the analysis may include work-life expectancy, education/academic skills development and attainment and test/evaluation scores; medical/psychological opinions and limitations; interests; residency; criminal or drug record; and skills developed by the child. Additionally, any medical or other conditions which are not related to the litigation and their effect on wage-earning capacity must be considered.
Assessing the loss of earning capacity requires special care. At Stokes & Associates, we refer to published, generally accepted methods similar to those outlined by Leslie to guide our assessments of individuals who for whatever reason have poorly defined work history or vocational trajectories.
We offer complimentary consultations concerning "hypothetical matters."
To strategize with one of our vocational experts or certified life care planners at Stokes & Associates please call David Barrett at 504-454-5009, visit our website, www.stokes-associates.com or email dbarrett@stokes-associates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, MHS, CRC, LPC, LRC, CLCP
Todd Capielano, M.Ed., LRC, CRC, LPC, CLCP
What are the Standards of Practice for Life Care Planners?
As certified life care planners, we must adhere to generally accepted ethical and practice standards that guide our professional forensic work. The Standards of Practice for Life Care Planners (IARP, 2005) is the most recently published resource intended to define the core knowledge, skills, and behaviors that life care planners should use in the course of work. In generating these Standards, a group of experienced life care planners took more than two years to review existing consensus statements (from 2006, 2008, 2010, and 2012), completed a role and function study, surveyed professionals in the field, and reviewed other existing professional standards of practice from related fields to arrive at a comprehensive set of guidelines for competent practice. The Standards are generally broken down into core areas including credentials, measurement, and dissemination of core, measurement, and validation of work product, professional self-determination, and early and ongoing development sources. The document is separated into Standards of Performance and Standards of Practice.
Standards of Performance relate to the readiness of an individual to work ethically and competently as a life care planner. Issues such as having the proper educational background, maintaining the appropriate licensures, participating in continuing education, and adherence to professional ethics are stressed. These Standards of Performance spell out the minimum professional requirements for life care planners, yet do not provide specific information regarding the technical practice of producing a plan.
In contrast, The Standards of Practice give clear guidance regarding the generally accepted methods for evaluating an individual and disseminating professional life care planning opinions in written format. They include:
Remaining within the professional scope of practice
LCP must have skill and knowledge in understanding health care needs in the plan
Performs a comprehensive assessment (multiple sources, systematic manner)
LCP uses a consistent, valid, and reliable approach to research, data collection, etc.
LCP Analyzes the data (assess the need for further evaluation or opinions)
LCP uses a planning process (organizing data, a method of inclusion/exclusion of services)
Seeks collaboration when possible (physician conferences, other treatment team members)
Facilitates understanding of the LCP process (maintains objectivity)
LCP Evaluates (review and revise the LCP, follow-up consultation)
May engage in forensic applications (adheres to legal rules and recommendations)
There are many important components of life care planning that flow directly from these Standards. For example:
Using non-discounted, market rate prices that are geographically specific when appropriate (Standards 4, 6)
Relying on all medical information and opinions to form life care plan recommendations (Standards 1, 2, 3)
Providing updated life care plans as the needs of the individual change (Standard 9)
Requesting and participating in physician conferences to obtain clear and concise medical recommendations (Standard 7).
We offer complimentary consultations concerning "hypothetical matters."
To strategize with one of our vocational experts or certified life care planners at Stokes & Associates please call David Barrett at 504-454-5009, visit our website, www.stokes-associates.com or email dbarrett@stokes-associates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, MHS, CRC, LPC, LRC, CLCP
Todd Capielano, M.Ed., LRC, CRC, LPC, CLCP