FUTURE CARE COSTING FOR CATASTROPHIC BRAIN INJURY

1. FUTURE CARE COSTING FORCATASTROPHIC BRAIN INJURY PUTTING IT ALL TOGETHER

2. OUTLINE • What is it? • Why do it? • When to do it? • Who should do it? • Overview of the process • Foundation for future care costing • Case study

3. WHAT IS IT? Future Cost of Care Analysis (aka life care plans) is used to predict the impact of disability on the individual. The impact is detailed in relation to the future goods and services and related costs, needed to restore the disabled party to pre-injury status insofar as is reasonably possible.

4. WHY DO A FCC? • To assist insurance companies to set reserves for fiscal management of the file. • To determine settlements which set aside sufficient reserves to meet the lifetime needs of the injured or chronically disabled person. • To provide a template of care for family/ caregivers to assist them in making informed decisions regarding care and expenditures.

5. WHEN TO DO IT? Early completion: Acknowledging that full functional prognosis may not yet be know. • Assists in setting appropriate reserves Later completion: Based on clearer understanding of functional status and potential. • Assists in settlement of file.

6. WHO SHOULD DO IT? Expertise and experience in the field of Rehabilitation. Credentials (Certified Life Care Planner): • Should have an understanding of the medical, physical, emotional, cognitive and behavioural sequelae of the impairment and disability. • Should have an understanding of the functional impact of the particular impairment. • Should have an understanding of the interdisciplinary approach to rehabilitation. • Should have an understanding of case law.

7. FOUNDATION FOR FUTURECARE COSTING Entitlement for Future Care based on: • Is the particular need attributable to the accident? • Is there a reasonable probability that the costs will be incurred in the future? • Are the costs extraordinary?

8. CASE LAW • If the plaintiff established a real and substantial risk of future loss, (s)he is entitled to compensation. Graham v. Rourke (1990). • Entitlement to compensation will depend in part on the degree of risk established. Graham v. Rourke (1990).

9. CASE LAW Con’t. • The paramount concern for the courts when awarding damages for personal injuries hould be to assure that there will be adequate future care. Andrew v Grand and Toy Alberta Limited (1978). • To the extent, within reason, that money can be used to sustain or improve the mental or physical health of the injured person it may properly form part of a claim. Andrew v. Grand and Toy “Alberta Limited (1978)

10. WHAT MAKES A GOOD PLAN? Clarity and Consistency: • A clear description of pre-accident and post status, consistent with documentation. • Clearly laid out theory regarding the most probable life course for the client. • Consistent with medical prognosis. • Consistent with rehabilitation team’s view and experience of the client. • Clarity in the presentation of costs.

11. OVERVIEW OF THE PROCESS • Referral • Data gathering • Review of documentation • Interview and functional assessment • Consultation with providers – multidisciplinary approach • Collateral information from friends and family. • Analysis of lifelong needs • Client specific research for resources and costs • Formulation of Table of Costs

12. DEVELOPING THE PLAN Understand the functional impact of the injury on the ability to manage: • Personal care and activities of daily living. • Homemaking and property maintenance. • Community mobility. • Financial Management. • Parenting. • Education or employment. • Leisure and recreation.

13. HOLISTIC APPROACH Person Life roles Environment

14. CASE STUDY Person • 28-years-old • Cantonese male • DOL: winter 1999 – (age 17) • Presentation: Behavioural and cognitive deficits, including communication impairment, aggressive and self-injurious behaviours. • Seizure disorder, addressed with medications • Assessed at or below the 1st percentile using the Adaptive Behaviour Assessment System

15. CASE STUDY Environment • Lives at home with his parents and maternal grandparents. • Two bedroom apartment in Toronto. • No external services in place for care giving. • Has worked with a case manager, an O.T. and a physio.

16. CASE STUDY Life Roles • Completed grade 9 and had been considered an excellent student. • Efforts to enroll him in Bloorview MacMillan Centre and school setting unsuccessful. • No noted program and/or productive role currently established.

17. THEORY OF CASE Pre-accident assumptions: • Client would have completed education and proceeded to independent living, a family, and remunerative employment. Post-accident assumptions: • No improvement expected in neurological condition. • Will require full-time caregiver support over lifetime.

18. THEORY OF CASE Con’t. Post-accident assumptions: • Improvement in daily function may be realized through the introduction and training of compensatory and behavioural strategies for the client and caregivers. • Will require assistance for home and property tasks. • Will require legal guardian for fiscal matters.

19. THE NEEDS

20. THE NEEDS Safe Environment: • Physical dwelling-home modifications. • Ensure home safety through provision of assistive devices. • Suitable caregiver support throughout the day to ensure safety. • Medications to manage behaviour and seizures.

21. THE NEEDS • Medical and Rehabilitation Services: • Case management. • Medical management for seizures and general health. • Intensive behavioural management. • Occupational therapy. • Speech language pathology. • Individual and family counselling/support. • Rehabilitation Support Worker. • Transportation.

22. THE NEEDS Productive Role: • Education. • Rehabilitation Support Worker for community outings to promote quality of life. • For long term introduction of community based day programming.

23. PROFESSIONAL SERVICES Name: _______________ Date of Birth: _______________ Date of Loss: _______________ TOTAL Fixed Cost Per Instance: $ 91,708.24 TOTAL: Fixed Cost: $3,441,004.16 TOTAL Annual Recurring Cost: $ 224,930.40

24. PROFESSIONAL SERVICES Con’t. Please Note: The timing and frequency of treatment set out in this report approximates requirements over a lifetime. Although the overall estimates are reasonable. I expect XXXX to resort to treatment to the degree and with the frequency that circumstances require from time to time Case Note:

25. PROFESSIONAL SERVICES

26. PROFESSIONAL SERVICES Con’t.

27. PROFESSIONAL SERVICES Con’t

28. COST OF CARE TOTAL Fixed Term: $ 92,824.00 TOTAL Annual Recurring Cost $286,725.50

29. COMPLEX VS. MILD • Attendant care/support • Attendant care/support • Attendant care/support

30. MAKING THE DOLLARS LAST Attendant Care – Considerations: • If family and friends were taken out of consideration, could client live alone? • If the client requires “intermittent” care is this predictable? • If a recommendation is made for privately hired services – who will manage implementing resources? • Practically what is available to purchase at market rates – per hour, live in model, minimum blocks of hours

31. MAKING THE DOLLARS LAST Rehabilitation Services Considerations: • Use of RSW services (under direction of professional) to implement treatment. • Reducing attendant care for hours when RSW is in place. • Looking at community resources for suitable programs • Examining cost effective transportation.

32. SUMMARY Ensuring that an individual and his or her family have access to necessary services will increase the individual’s opportunity to return as closely as possible to his or her pre-accident roles and responsibilities and to achieve reasonable dignity and quality of life

33. Thank you