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Life care planners document the present and future medical, psychosocial and economic needs of individuals with catastrophic disability or long-term health care needs.

Richard Hess Jr., RN, CNLCP, said he's poised on the "cutting edge" of a health care practice that is exciting, creative and challenges his clinical and case management skills: that of a certified life care planner for people who have suffered catastrophic injuries or illnesses. "It's a great career track, it's a new frontier," said Hess, a former critical care nurse and case manager. Hess, who launched a business offering LCP 2½ years ago in Middlebury, Ind., said the emerging field is full of rewarding opportunities for advanced practice nurses who have strong entrepreneurial and reasoning skills.

Hess is one of an estimated 1,000 board-certified life care planners in the country-about 60 percent of them nurses. The life care planners are especially qualified to document the present and future medical, psychosocial and economic needs of individuals with catastrophic disability or long-term health care needs. Like Hess, many planners are in independent practice, creating the complex life care "road maps" for disabled individuals' medical care and claims payments.

For Carol Jacobs, RN, CNLCP, going into life care planning was a natural evolution after 25 years of case management work with a workers compensation insurance firm. Two years ago, she became an independent contractor, accepting case management from her home office in San Diego and becoming certified in LCP. "Being independent is so nice, I should have done it sooner," said Jacobs, who received her nursing diploma in 1965 from Allegheny General Hospital School of Nursing in Pennsylvania. She later moved to Southern California for further education and experience, working in various hospital ICUs for about 12 years before going into insurance. Since becoming certified in LCP, that area of her business has steadily grown.

A typical life care plan takes Jacobs about 40 hours to prepare and involves meeting with the patient and visiting the home environment. She confers with all the physicians involved with the patient's care, as well as therapists and others. "I have to look into the future to anticipate complications and to discuss those with the primary doctor," she said. She also has to estimate life expectancy and outline all the costs involved for home modification, specially equipped vans or vehicles, wheelchairs, special beds, braces, medication, therapy, lab work, X-rays, hospitalization and other needs.

Both the patient and his or her insurance company must accept the life care plan. If the insurance company rejects it, the company's lawyer can subpoena the life care planner, who then must defend his or her cost projections for patient care, services and equipment in court. "It takes a lot of years of experience," Jacobs said. "You have to feel comfortable in your shoes and with what you're recommending."

"An LCP has to be specific to a particular patient, but you need to support every nickel allocated for that person," said Sherry Ficklin, RN, CNLCP, an Oklahoma City nurse who consults nationally in catastrophic case management. Ficklin's work is about 30 percent LCP. "Once you're impeached, the LCP becomes public record, so your entire career can depend on how well you write your plans."

Hess, Jacobs and Ficklin opted to become board-certified LCPs by taking an intense seven-day course offered by the Draper, Utah-based American Association of Nurse Life Care Planners. The course averages $2,500 and is offered at various locations. It prepares nurses for the three-hour certification test that costs $250. The test can be taken only by RNs with a valid license, a minimum of two years' case management experience and either 60.6 continuing education units from an approved LCP course, such as the AANLCP course, or evidence of 500 hours of life care planning experience within two years of application.

In addition to nurses, LCP is practiced by rehabilitation counselors, physicians, chiropractors, social workers, psychologists, occupational therapists, physical therapists and special education professionals. About 600 life care planners, 50 percent of them nurses, have been officially certified by the Commission on Health Care Certification in Midlothian, Va., which screens applicants for the $350 exam. "There's a range of specialty backgrounds with one thing in common-they meet the standards set by us to be certified," said Virgil May, CEO of the organization and a former rehab counselor. "Believe me, we turn a lot of people away."

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