Preparing for a Life Care Planning Assessment with an Occupational Therapist

A life care planning assessment is a critical step in understanding your long-term needs following an injury or illness. If you’re scheduled for a two-hour session with an occupational therapist, it’s natural to feel a mix of curiosity and apprehension. This assessment is designed to help you, not only to outline your current abilities and limitations but also to pave the way for strategies and resources that can enhance your quality of life. Here’s how you can prepare to make the most out of this comprehensive evaluation.

Understand the Purpose of the Assessment
The primary goal of a life care planning assessment is to develop a clear and evidence-based plan that addresses your ongoing medical, therapeutic, and daily living needs. The occupational therapist will evaluate your functional abilities, identify challenges, and recommend tailored solutions. This plan may include recommendations for assistive devices, modifications to your home or work environment, therapy services, and other resources to support your recovery or management of a chronic condition. This assessment also involved consulting with any treating or other retained experts on your file.

Gather Relevant Documentation (if able)
Before your assessment, try to organize documents that may help the occupational therapist understand your situation. Your attorney will have likely provided medical records, but it is helpful to consider these addition documents:

 

Reflect on Your Daily Activities
Think about how your condition affects your daily life. Be ready to discuss:

 

Keeping a journal for a few days leading up to the assessment can help you recall these details. Note times of day when symptoms are better or worse, as well as any activities you avoid due to discomfort or difficulty.

Dress Comfortably
Wear clothing that allows for ease of movement. The assessment may involve physical tasks or exercises to evaluate your range of motion, strength, and endurance. Comfortable attire will help you participate fully without unnecessary discomfort.

Communicate Openly and Honestly
Your occupational therapist relies on accurate information to provide meaningful recommendations. Be transparent about your symptoms, even if you’re worried they might seem minor or subjective. This is especially important for issues like pain, fatigue, or mental health challenges, which are often invisible but have a significant impact on daily life.
If certain tasks feel embarrassing to discuss, remember that the therapist’s role is to support you without judgment. Sharing openly will ensure your assessment reflects your true needs.

Prepare Questions or Concerns
Use this opportunity to gain clarity about your condition and potential next steps. Some questions you might consider include:

 

Rest and Hydrate
A two-hour assessment requires focus and energy. Try to be well-rested and hydrated before the session. If you use any mobility aids, assistive devices, or braces, have them with you.

Post-Assessment: What to Expect
After the assessment, the occupational therapist will develop a comprehensive life care plan. This document will include recommendations tailored to your unique needs and circumstances. It may take a few weeks for the final report to be prepared, especially if the plan is part of a legal case. Use this time to reflect on the experience and start implementing any immediate strategies or suggestions provided during the session.

Conclusion
Preparing for a life care planning assessment with an occupational therapist can help you maximize the benefits of this invaluable process. By organizing your documents, reflecting on your daily challenges, and communicating openly, you’re taking an important step toward a plan that supports your recovery and long-term well-being. Remember, this assessment is a collaborative effort designed to empower you with tools and resources to enhance your quality of life.

Select a Qualified Life Care Planner

For a case that warrants a life care planner, a colleague provides the name of someone they have used before.  A curriculum vitae (CV) may or may not be on hand, but either way, will this person be helpful to your case? 

First of all, it is important to understand that life care planning is a profession with its own standards of practice, certified professionals, and peer-reviewed journals, textbooks, and annual conferences.  “Life Care Planner” is a trademarked term to be used by those who are certified by the International Commission on Health Care Certifications (ICHCC) or certified by the Certified Nurse Life Care Planner (CNLCP®) Certification Board.  Even Physician Certified Life Care Planners meet the requirements set out by the ICHCC.  When a life care plan is developed using a methodology consistent with the standards of practice for life care planners, the plan should be able to be replicated by another life care planner regardless of professional designation.  Without a certification in life care planning, the professional you retain to provide life care planning services may not know the life care planning methodology needed to provide a defensible expert report.

Besides certification, there are other items to consider when reviewing a professional’s CV to determine their qualifications for providing life care planning services that will meet your client’s needs.  

Does the life care planner have relevant education, work, and forensic experience?  If the evaluee has a traumatic brain injury, does the life care planner outline relevant continuing education courses and hands-on work experience with this population?  Certified life care planners are required to have at least three years of relevant rehabilitation experience.  This allows a variety of work experiences that they will reflect upon in their life care planning practice.  If the life care planner is new to forensic work, they will likely require some guidance regarding report writing, court rules, and resources on providing expert testimony.  

Does the life care planner engage in professional life care planning activities such as subscribing to the profession’s journal and attending life care planning conferences and courses?  Life care planning evolved out of the rehabilitation profession in the 1980s. Understanding the history of life care planning and the prominent professionals who have developed the profession assists the life care planner in their role of educating the court.

Individuals of any profession tend to participate in professional activities and subscribe to professional journals as part of their ongoing professional development.  Is the life care planner a member of the International Academy of Rehabilitation Professionals (IARP)?

IARP publishes the standards of practice for life care planners.  Being a member of IARP provides the life care planner with real-time updates from the field of life care planning through online community networks and the Journal of Life Care Planning.  

These organizations provide updated definitions, standards, and treatment guidelines that impact the development of a life care plan.   

The more time an individual commits to their profession, the more integrated they become in the profession’s language and standards.  Publishing an article within a peer-reviewed journal requires a deep dive into a topic, exemplary writing skills, and acceptance of the writing by other professionals within the field.  Within life care planning, this translates into more ease educating others about the standards of practice of life care planning and the development of a defensible plan.

When a professional is recognized by their peers for an achievement, it adds more credibility to them as a professional, especially in the court of public opinion.

Many times, life care planners have a history of working with a special population (e.g. worker’s compensation system, school system, concussion, facial burns, spinal cord injury, etc.) that may benefit your case.  If they do not, they may know another life care planner who would be suitable.

Life care planners are trained not to be a “secretary”, simply providing the costs of others’ recommendations, nor a “know-it-all” relying on themselves for each recommendation.  By asking the life care planner how they have established the medical foundation for the life care plan, you are ensuring they are aware of and following the standards of practice for life care planners.  Establishing a medical foundation should include: 

Turning Point Life Care Planning takes pride in having a group of highly qualified Certified Life Care Planners who meet these criteria.  Each therapist comes with years of hands-on rehabilitation experience to be able to develop a life care plan for many types of injury, e.g. TBI, PTSD, SCI, Chronic Pain, Somatic Symptom Disorder, Amputations, Burns, Pediatrics, Medical Complications, Disfigurement, Psychiatric Disorders, etc.  

Life Care Planning

Life care planning is a profession with its own standards of practice, certified professionals, with peer-reviewed journals, textbooks, and annual conferences. “Life Care Planner” is a trademarked term to be used by those who are certified by the International Commission on Health Care Certifications or ICHCC. When a life care plan is developed using a methodology consistent with the standards of practice for life care planners the plan should be able to be replicated by another life care planner.

Life Care Planning is a transdisciplinary practice. To be a Certified Life Care Planner is to be an experienced rehabilitation professional licensed to practice within a healthcare profession, e.g. Register Nurse (RN), Occupational Therapist (OT), Physical Therapist (PT), Vocational Counsellor or a Medical Doctor (MD). Certification requires 120 hours of education specific to the practice of life care planning, a certification exam and submission of a life care plan to be approved by the ICHCC board. Continuing education in life care planning is required to maintain certification. The education must include a component on ethics.

A Life Care Plan is defined 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 health care needs.” (International Conference on Life Care Planning and the International Academy of Life Care Planners. Adopted 1998, April.) It is a way to plan for the lifetime needs of an individual with a disability.

Life Care Plans are often used in a forensic setting to help resolve personal injury cases where an individual has sustained an injury at the fault of another person. The subject of the life care plan is referred to as an evaluee. The life care plan is intended to be educational and written so that the plan is understandable by the lay person, using non-technical language which can realistically be implemented.

The standard methodology used to develop a life care plan consists of step-by-step procedures which include: initial case intake, review of medical records and supporting documentation, interview with evaluee and a collateral interview (if appropriate, e.g. TBI), consultation with therapeutic team members, formulation of preliminary opinions, cost research, and confirmation of projections with the evaluee.

Best practice is to conduct the interview at the evaluee’s home; however, due to COVID-19 restrictions and individual preferences, a virtual assessment has become common practice. The home assessment enables the life care planner to consider the social and physical environment that may facilitate or restrict the evaluee’s function. For example, for an evaluee who uses a wheelchair, the need for home or vehicle modifications can be assessed; or for an evaluee with chronic pain, the need for ergonomic equipment or in-home rehabilitation may be considered.

Especially when the evaluee has experienced changes in cognition, collateral interview with a family member, caregiver and/or a close friend will assist with determining the change in function since the subject event and the current level of care being provided. It is standard practice to replace the gratuitous support provided to the evaluee as it is not deemed a reliable source of long-term support.

Given the transdisciplinary nature of life care planning, for areas of the plan that are outside the scope of practice of the life care planner, the life care planner relies on the medical records, consultation with the evaluee’s treating team members (e.g. specialist physicians, chiropractor, physical therapist, psychologist, etc.) or other experts involved with the case (e.g. orthotist, psychiatrist, physiatrist, etc.) to help develop the medical foundation for the life care plan. The life care planner is not intended to be a “secretary” simply providing the cost of the recommendations or others; nor, are they intended to be a “know-it-all,” relying on themselves to provide the foundation for the entire life care plan. In forensic practice, the life care planner applies their knowledge and experience in life care planning to vet care recommendations to ensure each item in the life care plan is likely to be beneficial and appropriate for the evaluee, e.g. a recommendation for pool therapy is not appropriate for someone allergic to chlorine or if an evaluee who would have likely incurred the expense for a gym pass or childcare absent the subject event, they would not be entitled to be compensated for these expenses related to the subject event.

The litigation process is usually the evaluee’s one shot at receiving the funding they require for future care; therefore, it is important that the pricing in a care plan be up-to-date, accurate and enable multiple options of providers within their geographical area. Collateral sources are not relied upon as a reliable source of lifetime funding. There are 18 standard categories of care considered in a life care plan which include: medical services, evaluations, medications, therapies, orthotics and prosthetics, wheelchair equipment, wheelchair maintenance, aides for independent living, home modifications, health maintenance and leisure, vocational/education. Given the potential longevity of the life care plan, e.g. decades, the life care planner provides accurate and geographically specific costing. It is of no help to the evaluee or their caregivers to provide resources that do not provide the intended services, e.g. a case manager who does not work with individuals under the age of 65 with a TBI but specializes in geriatric case management. Providing backup documentation for the resources is best practice and allowed by the majority of subscription fee reference databases given the forensic application.

The goal of each life care plan is to assist the evaluee is to restore function where possible; maintain function and prevent or reduce the risk of secondary complications, e.g. falls, pressure sores, etc. The plan details the services and charges for the services needed by the evaluee over the course of their lifetime. Alternatives for care take into account the developmental stages of the evaluee and the least restrictive environment. The life care planner must be willing and available to communicate the life care plan and objectives to the evaluee and the relevant parties, e.g. attorneys, judge and/or jury.

Traumatic Brain Injury

Have you been told you may have had a concussion or a mild traumatic brain injury (mTBI) that doesn’t feel mild?  You are not alone.  By definition, traumatic brain injury (TBI) arises from external forces or actions that cause the brain to move against the skull or be penetrated.  This can occur in sports, automobile accidents, unintentional falls, gunshot wounds, assaults but the majority of TBI that result in hospitalization are from falls and motor vehicle accidents.

A TBI is classified as mild (mTBI), moderate or severe.  A concussion falls under the mildTBI category but does not mean the symptoms are mild.  A mTBI can result in physical, visual, auditory, cognitive and emotional problems that interfere with someone’s ability to participate in their usual daily activities.

The people at the highest risk of sustaining a TBI requiring hospitalization are people over the age of 75 and males.  These injuries were mostly causes by unintentional falls and car accidents.  TBI is most common amongst people ages 15 to 24 years old.  For additional statistics on brain injury visit Brain Injury Canada (www.braininjurycanada.ca) or Center for Disease Control (CDC) (www.cdc.gov /traumaticbraininjury).

The Centre for Disease Control (CDC), also provides useful information on Brain Injury including monitoring, prevention and links to apps for training and concussion identification.

PROGNOSIS

Once a diagnosis of concussion or TBI is made it is important to follow the recommendations of your treating family doctor or specialist and maintain regular follow-up to monitor symptoms.  The majority of individuals diagnosed with a concussion or mTBI will have a full recovery within six weeks; however, a small percentage may continue to experience disruptive symptoms and require additional medical care and specialized rehabilitation services.  Spontaneous recovery or natural healing of the brain tends to occur within the 18  to 24 months after a moderate to severe TBI, but adaptations will continue to occur that may improve daily functioning.

Many personal factors can speed up or prolong recovery.   Recovery tends to be slower in adults over the age of 40.  Other factors that impact recovery including:  low blood pressure, loss of oxygen to the brain, severity of the injury, prior head injuries, mental illness and other health factors.  At Turning Point, we identify risk factors early in the recovery process and belief in early intervention to help the recovery process.

ASSESSMENT

Occupational therapists (OTs) are trained to identify the physical, cognitive and emotional impairments that are restricting participation in daily activities.  The assessment process typically begins with a referral from a family physician, insurance company, lawyer, other therapists or a self-referral.  Turning Point provides in-home assessments consisting of interview, testing, observations and consultation with other team members to provide a coordinated recovery progress.

TREATMENT

Occupational therapists develop physical activation and cognitive rehabilitation programs while recognizing the psychological impact of the injury.  Education is key and other functional activities are designed within a community-based rehabilitation program to optimize recovery.  OTs are responsible for the assessment and planning of rehabilitation programs, and OT Assistants (COTAs) help reinforce the strategies taught by the OT.  For example, if memory is an issues, the OT will determine a targeted intervention and set up repeated sessions with the client and COTA.  The COTA may review use of memory strategies such as establishing a routine; use of assistive technology such as a smart phone or smart watch to set reminders; remediation activities such as challenging the memory through memory exercises; and functional activities such as creates to-do or other lists to participate in weekly grocery shopping or work tasks.

For those with moderate to severe TBI, treatment is likely to be prolonged and may also include wheelchair and seating assessments, recommendations for home modifications, assistive technology and home support services.

RESOURCES

There are many online and local resources to help support those who have experienced a TBI.  Our OTs often provide clients with support group information, apps available for smart phone, virtual exercises options, etc.  Some clients require OT assistance to apply for disability services such as government benefit programs or school accommodations.  Our OT practitioners love what we do and are available to take your questions and try to help you get the services you need to improve recovery and daily functioning.  We take self-referrals and will attempt to secure funding for services if needed.

Preparing for a FCE

Functional Capacity Evaluations are requested when someone needs to know if you are safely able to do your past or present job.  

 

BEFORE ARRIVAL

Your evaluator will have received and read your medical records and be familiar with your injury, treatment and diagnosis.  They may send instructions beforehand to make the day go well.  For example, usually you will want to wear comfortable, athletic clothing unless instructed otherwise.  And, if scheduled for a full-day, then you need to be prepared with a packed lunch or go nearby for lunch.  Try to get a good night sleep the day before and arrive on-time to your scheduled appointment.  The length of FCEs can vary, but it i typically booked for a 1/2 day or full-day.  It is normal to feel some anxiety, but try to use breathing or other strategies beforehand.

 

FCE DAY

The standard parts of a FCE includes the following: 

  • signing informed consent which includes a description of the FCE, risks and the purpose
  • being informed on how to communicate your symptoms during the evaluation 
  • wearing a heart rate monitor to ensure your safety and monitor your exertion 
  • sharing your current symptoms including location and severity 
  • sharing your current medical and therapy schedule 
  • bring a list of your current medications
  • grip strength testing – your evaluator is looking for you to try your best all-day
  • explaining your social and work history – it is helpful to bring a resume or CV if you have one
  • undergoing a musculoskeletal examination to see how your body moves, observe any swelling, etc.
  • cardiovascular testing by walking, stepping, and/or climbing 
  • other physical tasks that are designed to test your essential job demands
  • work simulation tasks to mimic the actual job
  • some tests are repeated
  • some time cognitive tests are given depending on the injury and job

 

During the FCE, you will be providing feedback frequently while your evaluator is observing your body positions and making sure you are safe throughout the day.  At the end of the day, your evaluator may request you contact them with any change in symptoms over the next one to three days.

 

AFTER THE FCE

If you experience a change in symptoms in the days following the FCE, it is best to contact your evaluator and let them know.  Sometimes, they will reach out to follow-up with you.  Although your job is done, the evaluator will analyze your data, review your medical records again and start writing the report.  The FCE report is typically sent directly to the individual or entity who has requested and funded the FCE.  If you would like a copy of the FCE report, contact your evaluator.

 

FCES AT TURNING POINT

Our facility is located on the 17th floor of a building located in Los Angeles.  We offer free parking and our clinic is accessed via elevator.  Your evaluator will meet you at the reception area and show you around.  You will be shown the clinic where you will be spending your time, the kitchen where you can store your lunch, as well as the washroom for breaks as needed.  The lunch break is usually ~30 minutes.  There are many restaurants within walking distance or you have access to a shared lounge with cable television.  There is guest wifi.

 

You will be given a heart rate monitor that will monitor your heart rate for the day. Our office uses digital measuring devices to ensure your measurements are taken, recorded and stored accurately.  

 

You can see learn more about your evaluator by accessing the Our Team page on this website or give us a call if you have any additional questions.   Remember to communicate with your evaluator for a safe experience.

 

Can’t Sleep?

Practice Good Sleep Hygiene 

Learning how to practice good sleep hygiene may help you find a restorative sleep once again.  What is sleep hygiene?

Sleep hygiene is defined by Oxford as, “habits and practices that are conducive to sleeping well on a regular basis.”  Sleep is the foundation that allows us to function in our daily lives.  If we don’t sleep well, we can’t think as well and any pain or mood symptoms can worsen.

A first step in rehabilitation is often to help restore sleep.  Your family doctor may have medical suggestions (medications, sleep study, sleep specialist or other therapies) and occupational therapists often provide tips to help you develop healthy sleep habits.

Here is a handout on sleep hygiene to get you on your way to finding that refreshed morning feeling.

Sleep Hygiene PDF

Tips for Pacing.PDF

Mindfulness

What is Mindfulness?

Mindfulness is the awareness that arises when we pay attention, in a particular way, on purpose, in the present moment, without judgement (Kabat-Zinn, 2011). We learn to step out of automatic pilot, which in turn affects how we make decisions and react to situations in our lives.

Key Learnings:

We spend most of our time ruminating about the past or worrying about the future. Through mindfulness, we can learn to bring moment to moment awareness to everyday experiences that we ordinarily do not notice. By learning to pay attention in this way, we learn to recognize thoughts as thoughts, feelings as feelings, and body sensations as body sensations. A mindfulness practice involves learning formal practices (e.g., seated mindfulness meditation) and informal practices, where we can bring mindful awareness to our everyday experiences (e.g., brushing our teeth, eating a meal).

A New Way of Relating to Pain:

There are ways that we can learn to skillfully deal with pain. With mindful awareness, we can learn to notice the changing physical sensations of what we call “pain”, and our reactions or aversion to pain including contracting, pushing away, discomfort and repulsion. We can learn to let go of the resistance which leads to mental suffering around pain, and instead, to notice thoughts as thoughts, emotions as emotions, and to directly experience the physical sensations in a clear, open way.

How to get started?

Daily Opportunities for Mindfulness:

 

Adapting:

 

Mindfulness Tool: STOP

 

Recorded Meditations

 

Free Meditation Apps

 

Mindfulness courses (in Los Angeles area)

Cognitive Strategies after Concussion or Mild TBI:

Some people who have sustained a concussion may experience a change in their thinking (cognitive skills) and may have trouble with:

Sometimes these changes can make everyday tasks more difficult. So, what can you do?

Keep organized 

• Use a daytime calendar, or phone to help you remember appointments and things you need to do.
• Keep important things (like keys, phones, medications) in the same place so you don’t forget where you put them.

Use strategies to help you focus and remember

• Set alarms to help you remember to do things at a certain time.
• Write notes to yourself and place them in areas where they remind you to do important tasks.
• Avoid noisy and distracting environments that make it hard to concentrate instead.
• Try to work in a quiet area when you need to work, read, or study.

Try to reduce stress 

• Take a rest break before you feel tired or overloaded.
• Break up large or complicated activities into smaller more manageable tasks.
• Pace yourself and don’t try to do everything at once.
• Practice deep breathing and relaxation strategies. (See our resource page on diaphragmatic breathing).

If you feel that your thinking doesn’t go back to normal after a few weeks see your doctor or health care provider and discuss the possibility of getting support during your recovery. Our occupational therapists at Turning Point are trained in cognitive rehabilitation and can assist you learn additional strategies to manage your thinking difficulties. Talk to your OT and they can work with you to make a personalized plan.

More information about concussions and mTBI can be found at: www.brainstreams.ca

Chronic Pain

For the first time since 1979, International Association for the Study of Pain (IASP) introduced a revised definition of pain, the result of a two-year process that the association hopes will lead to improved ways of assessing and managing pain.

The definition is: “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage,” and is expanded upon by the addition of six key Notes and the etymology of the word pain for further valuable context.

 

A multi-national, multidisciplinary Task Force developed the revised definition with input from all potential stakeholders, including persons in pain and their caregivers.

The revised definition was introduced in this article in the journal PAIN and a via a press release. An infographic also illustrates the changes.

IASP Announces Revised Definition of Pain

Standards of care to manage chronic pain includes the development of self management skills, but for many people, professional guidance is helpful to know what questions to ask, where to go for support and little things you can do to reduce your pain intensity and improve daily functioning.

Much of the educational information we provide and reinforce to our clients can be found on the Fraser Health website,  Manage Pain .  I highly recommend reviewing the relevant subheadings which include: medication usage, support groups, exercise, depression, sleep and even financial resources.  There are links to helpful videos and local resources.  I hope you find this website useful in your journey to develop your own self-management toolkit to manage your pain.