Life Care Planning for Acquired Brain Injury

Life Care Plans

A life care plan provides a comprehensive plan for the needs of an individual who experiences a catastrophic injury or illness, such as a brain injury. This could include a diverse range of considerations, such as physician care, therapy, durable medical equipment, aides for communication, and support care in the form of assisted living or a home health aides. This dynamic document maps out the care required throughout the rest of their life.

 

Acquired Brain Injuries and Strokes

An acquired brain injury is damage to the brain after birth, unrelated to congenital or degenerative diseases. These impairments may be temporary or permanent and can cause partial or complete functional disability and/or psychosocial maladjustment. In many cases, an acquired brain injury can be the result of a stroke, which is the sudden death of brain cells due to a lack of oxygen. Strokes, also known as cerebrovascular accidents or CVAs, are caused by the blockage of blood flow or the rupture of blood vessels of the brain and can result in a sudden loss of speech, weakness, or paralysis, often of one side of the body. Other causes of acquired brain injury include trauma such as a motor vehicle accident, near-drowning, or falls. Aneurysm, tumors, infectious diseases, and the lack of oxygen to the brain, such as from a heart attack also may result in brain injury.

 

Additional Considerations for Brain Injury and Stroke

Unlike in cases of amputation or complex orthopedic injury, psychological and/or behavioral symptoms are common in brain injury and some stroke patients. This could include a change in personality, increased impulsivity, and other behavioral issues. Speech and language impairments are common and can be very frustrating for the individual and their loved ones. There may also be medical issues such as seizures, gastrointestinal and genitourinary complications, endocrinological dysfunction and swallowing disorders. These individuals are also at increased risk of Alzheimer’s disease, non-Alzheimer’s dementia, brain atrophy, age-onset depression, suicide, and reduced life expectancy. Of these potential complications are considered when creating the life care plan.

 

Individuals who have difficulty regulating their emotions and behavior may require an inpatient neurobehavioral treatment program. A supported living facility or in-home attendant care may be necessary if they previously lived alone or their family is unable to fully care for them. Life skills coaching to relearn or remember skills for day-to-day life, recreational therapy, speech language pathology, and/or occupational therapy may also be needed. A guardianship and/or trust may be recommended if the individual suffers from cognitive deficits, to ensure that their assets and benefits are protected. A brain injury and stroke can affect the entire family, so counseling for not just the individual, but also for the family, may be needed.  Respite care is also an important consideration in that it provides relief for the family and prevents caregiver burn out.

 

Young children who have suffered brain injuries may not have yet hit their developmental milestones. This could mean that habilitation (learning skills for the first time) is needed. Psychosocial support such as family counseling, parent-to-parent support groups and individual counseling as the child ages with their disability are important considerations. Initial care provided by pediatric medical specialists and/or developmental pediatricians will require transition to adult physicians when appropriate. An Individual Education Plan (IEP) provided by the public-school system identifies and provides supports for children with disabilities; however, those services must frequently be supplemented by tutoring and therapy outside the school setting. Another consideration for this population is that physical growth and maturity will mean more frequent equipment replacements. Guardianship and long-term living options also need to be assessed, keeping in mind that parents and other family may not always be available over the course of the child’s life.

 

The ultimate goal of a life care plan is to provide the guideline to restore and maintain an optimal level of health and functioning in the most appropriate and least restrictive environment. The hope is for individuals to be as independent as possible and have the supports in place to live as long and as fulfilling a life as possible within their limitations.

 

Sample Case

Let’s take a closer look at a hypothetical case. A 16-year-old individual was involved in a motor vehicle accident, resulting in a serious brain injury and multiple orthopedic injuries. Assuming this individual underwent extensive and effective rehabilitation allowing them to make a nearly complete physical recovery; however, with cognitive deficits in multiple domains. It has been determined that they can re-enter high school but with various services and supports in place. Here is an overview of the various services this individual’s life care plan will need to consider:

 

  • Medical evaluations and care will most likely be required from a variety of medical professionals, which could include (but not be limited to) pediatric and eventually adult neurological, endocrinological, orthopedic, and psychiatric specialties. Diagnostically, MRIs, CAT Scans, and X-Rays may be required at various periods throughout the life of someone in this circumstance, as well as various lab tests. The plan could also include medications to address medical and psychological ailments resulting from the accident, as recommended by physicians.
  • Support Care will also be a large part of this individual’s care plan, because although they are physically independent, they will be unable to live completely independently due to cognitive limitations. This means that items such as case management, a limited guardianship and a voluntary trust, including subsequent attorney and accountant fees will also need to be considered. Membership for local Brain Injury Associations and costs for educational conferences for both the patient and guardians should also be considered.
  • Additional Services to meet future educational and employment goals may need to be incorporated, such as tutoring, vocational counseling, vocational training and job placement assistance. These services will supplement those available in the public sector. Education assistive software and technology to help with his memory and other cognitive functions could also be recommended.
  • A vocational evaluation could also be performed to analyze lost earnings. Suppose prior to the injury, it was anticipated that this individual would have completed a four-year college degree and possibly pursued a master’s degree. By consulting with a neuropsychologist, the probability of the individual completing advanced education can be more properly determined. If this assessment declares that the individual will be unable to reach their original academic goal, a vocational expert can calculate lost earnings throughout his work life expectancy. Furthermore, the expert can recommend additional education, training and supports that would be needed to maximize the individual’s vocational potential.

 

These recommendations are some of the many considerations life care planners encounter as they review each unique case. This hypothetical individual has varied needs that would have to be addressed in order to maximize their independence and quality of life. Securing changes in education and vocational supports to accommodate his new reality are vital in making sure they reach their potential. Each client also has additional considerations that take a careful and holistic look at their life and support systems to provide a plan that provides optimal quality of life.

 

If you have any questions about your life care planning needs, don’t hesitate to reach out to speak with an expert on our team to learn more.