Pediatric therapists tally lifetime cost of care
Pediatric therapists tally lifetime cost of care
Life care consultation is a tedious job
When Els VanDenynde, OTR/L, consults about a lifecare plan for a young patient, she has to be able to specify what kind of therapy, equipment, and supplies the child will need 20, 30, or even 50 years down the road.
Several times a year, the pediatric rehabilitation staff at Scottish Rite Children’s Medical Center in Atlanta are called on to determine how much medical care will cost during the lifetime of a newly disabled child. The children are usually referred to Scottish Rite if there are legal issues involved in their case, says VanDenynde, who is lead therapist on the inpatient rehabilitation unit. Typical patients are suffering from birth defects, spinal cord damage, or brain injuries.
Using a lifecare plan assessment as a guide, the therapists use their clinical experience to list all testing, care, equipment, and supplies the child can be expected to need during a lifetime. Each discipline fills in the projected cost for its area, and all recommendations are compiled into one document, which is discussed by the interdisciplinary rehab team, lawyers, parents of the child, and the lifecare planner.
"It’s very time-consuming. We have to do a lot of nitpicking, such as figuring out what prices are for diapers and how many the child will need for the rest of his life," VanDenynde says.
Children who come to Scottish Rite Children’s Medical Center for a lifecare plan are admitted for three or four days for testing and evaluation. The first day is devoted to medical testing. During the next two or three days, therapy staff do a thorough assessment of the child’s level of functioning and make projections about the kind of equipment and intervention the child may need long term.
"One thing that makes it hard for us is projecting the child’s future functional level. They are usually still in the process of healing when we are called upon," VanDenynde says.
The lifecare planning document has spaces for the therapists to record the type of therapy, frequency, duration, and cost. (See sample and explanation, p. 149.) There is a space for the rationale for therapy, diagnostic testing, and equipment.
Documenting the lifecare plan requires attention to every detail involved in the patient’s future care. Therapists itemize durable medical equipment, including accessories, maintenance, and costs to upgrade the equipment as the child grows. Equipment may include aides for independent living such as kitchen equipment, positioning devices, orthotics, prosthetics, home renovations, and medical supplies. Staff also include the cost of special summer camps when children get older. The form includes a section for listing any potential complications, such as skin breakdown in spinal cord injured patients; a vocational educational plan; and a section on family educational needs. The staff also list community support groups the family can use.
[Editor’s note: For more information on Scottish Rite’s lifecare planning, contact Els VanDenynde at (404) 256-5252, ext. 5113.]
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