We’ve previously blogged about establishing future care costs in situations where children or others have been injured due to the negligence of a physician or other healthcare professional (medical malpractice). This week, we explore the related topic of Life Care Plans or Future Cost of Care Reports.
Future Care Costs
In medical malpractice litigation, our primarily goal is to recover compensation for our clients to pay for the needs and expenses they require to move forward over their lifetime. These are called “Future Care Costs”.
Future care costs must generally be calculated in the event of a brain injury or other catastrophic injury causing serious disability, following which the injured person will require a lifetime of care. Future care costs are the amount needed for services and assistance that will, as much as possible, restore the injured child or person to the position they were in before the injury occurred. This can add up to be millions of dollars to cover all of their needs, including private funding for therapies, equipment, private nursing, rehabilitation support workers or disability support workers (RSW/DSW), accessible vans/vehicles, and home accessibility modifications (such as lifts).
Future care costs are evaluated and calculated based on the current needs of the injured individual, as well as that individual’s anticipated lifetime future needs.
Decisions about injured individuals requiring significant, ongoing, long-term care in their home are often made with the assistance of a Certified Life Care Planner who can prepare a Life Care Plan or a Future Care Cost Report.
What is a Life Care Plan/Future Care Cost Report?
Life Care Plan and Future Care Cost Report are essentially interchangeable terms for the same document.
A Life Care Plan/Future Care Cost Report is a detailed, comprehensive, and dynamic analysis of the impairments of an individual, their realistic needs post-injury, and the associated costs of meeting those needs for the duration of their lifetime. It is a valuable tool in helping the injured individual, his or her treatment team, as well as his or her medical malpractice lawyer to identify and manage care requirements for the injured individual. It is enormously useful in medical malpractice cases.
What Information is Included in a Life Care Plan/Future Care Cost Report?
Life Care Plans outline medical, therapy, transportation, equipment, supply, pharmaceutical and other costs for a person and should address, among other things:
- The level of medical, attendant, or other professional care required, including physiotherapy, occupational therapy, psychology, and others;
- Other medical needs required, including orthotics, dentistry, vision care, and others;
- Any assistive device or devices required;
- Any medications required;
- Any modifications required to the home, vehicle, or other relevant aspect of the injured person’s daily environment;
- Housekeeping or home maintenance required;
- Transportation to and from appointments and treatment;
- Any vocational retraining required; and
- Life expectancy of the injured individual.
Who Writes the Life Care Plan/Future Care Cost Report?
Generally, Life Care Plans/Future Care Cost Reports are written by regulated healthcare professionals, including occupational therapists, physiotherapists, nurses, or physicians who are also Certified Life Care Planners.
In most cases, the request for a Cost of Future Care Report will be made by the medical malpractice lawyer.
The person preparing the report may then:
- Review all relevant medical and other documentation;
- Interview the injured person and their family;
- Ensure that any additional information that may be needed is provided (such as any updated assessments, medical records, and similar); and
- Research current market rates of services and treatments.
A Sample Future Costs of Care Report for a Child with Cerebral Palsy
Below are examples of 3 sections of a Life Care Plan setting out only the costs of Attendant Care, Medication and Equipment.
Every Plan is tailored to meet each of our clients’ specific needs and circumstances. These sample sections (for illustrative purposes only) might be for a child with cerebral palsy (GMFCS V, hypotonia) due to hypoxic-ischemic encephalopathy (HIE)/neonatal encephalopathy or asphyxia at birth (perinatal asphyxia) and delivered by emergency c-section. After a Code Pink was called he was incubated and brought to the Neonatal Intensive Care Unit (NICU). He developed seizures and an Infant Cooling Evaluation (therapeutic hypothermia/brain cooling) trial was initiated and he was transferred by air ambulance to the Hospital for Sick Children (Sick Kids Hospital) in Toronto.
He is now 12 years old with significant brain damage and permanent impairments requiring 24/7 care. He is non-verbal has been diagnosed with global developmental delay, is wheelchair dependant, has seizures, is fed by gastronomy tube (g-tube), has Gastroesophageal Reflux Disease (GERD), and wheelchair dependent with thorocolumbar scoliosis and hip subluxation, and recurrent aspiration pneumonia.
| ATTENDANT CARE (1:1, 24/7) | |||
| Age 12 to Age 70 (58 years) | |||
| Service | Hours per Day | Days per Year | Annual Cost |
| Registered Nursing Care Attendant (RN) | 24 | 356 | $531,009.60 |
| Personal Support Worker (PSW) | 24 | 356 | $270,332.16 |
| STATUTORY HOLIDAYS | |||
| Registered Nursing Care Attendant (RN) (18 hours per day for 9 statutory days) | 24 | 9 | $20,137.68 |
| Personal Support Worker (PSW) (1 hour per day for 9 statutory days) | 24 | 9 | $10,251.36 |
| TOTAL PER YEAR | $831,730.80 | ||
| MEDICAL TECHNOLOGY/EQUIPMENT | ||
| Age 12 to Age 70 (58 years) | ||
| ITEM | Initial Cost ($) | Annual Cost ($) |
| Luer lock tip feeding and irrigation syringes disposable: 60cc –for administering meals 60cc (30 pack) for administering feeds @ $24.02/month x 12 | – | $288.24 |
| Catheter tip Luer Lock Enteric Adapter @ $34.94/mth x 12 | – | $419.28 |
| Enteral Feeding Universal Adapter x 3 @$18.00 each x 4 – for administration of G-feed feeding protocol – secures the feeding tube to the administration set to prevent accidental disconnection – allows enteral irrigation and administration of non-intravenous medication without disconnecting the entire feeding set. Box of 10 | – | $216 |
| PH test indicator strips – 100/pk @ $13.30 x 4 | – | $53.20 |
| G-Tubes x 12 @ $200 each | – | $2,400 |
| Feeding bags – $10 each x 8/month x 12 | – | $960 |
| Micropore tape for securing feeding tube @ $20/month | – | $240 |
| Medicine syringes – for administering medications via G-tube – Pack of 10 | – | $144 |
| Medique Alcohol wipes (for cleaning stoma/Gtube site before and after each meal – to keep infection free) 200/pk; minimum 10 swabs/day (2 per meal) @ $7.85/pk x 4 | – | $31.40 |
| Cotton swabs (for cleaning hard-to-reach areas around the button/bumper) @ $9.85/1170 | – | $9.85 |
| Gauze pads (for cleaning the area around the tube insertion after each meal or dressing if instructed to do so) – 4” x 4” @ $9.32/box of 100 x 4 | – | $37.28 |
| Latex Gloves – small, medium, large to accommodate various caregivers – feeding hygiene @ $62.15/box of 1000 x 4 | – | $248.60 |
| Glove dispenser – for storing3 boxes – hygienic, one location in kitchen/food prep area | $66.65 | – |
| Disposable Oral Care Sponge Swabs – pk of 50 @ $46.30 x 8 (Amazon.ca) for teeth/mouth cleaning twice daily | – | $370.40 |
| Lip balm – to lubricate lips (dry mouth due to lack of stimulation) Burt’s Bees @$4.98/month | – | $59.76 |
| Splash (2 bottles) andNeonate (1 bottle) per day@ $38/day | – | $13,870 |
| Medical Records Log Books – to keep daily record of seizure, medication administration, response, sleep, feeding issues, suctioning, contacts etc – @ $8/book x 12 | – | $96 |
| Reserve for cost of adult nutritional meals (increased volume) and any changes should a GJ tube[1] be inserted to replace G-tube | – | $500 |
| Respiratory Equipment | ||
| Suction Machine (Portable) | $1300 | $433.33 |
| Portable Battery Pack (for suction machine) to ensure back up battery and mobility for use outside the home (e.g. at camp, travelling) | $160 | $53.33 |
| Suction Machine Tray – for holding items during procedure | $35 | $11.33 |
| Suction tubing x 2 @$34/month | – | $816 |
| Catheters (suctioning) x 120 @ $0.65 each | – | $78 |
| Filters (suctioning) x 1 @ $20 each/month x 12 | – | $240 |
| Masks – hygiene, prevent cross-infection – $17.59/100 x 12 | – | $211.08 |
| Bathing | ||
| Dura Tilt Wheeled Shower/Commode – with safety belt | $1,629 | $162.90 |
| Toileting[2] | ||
| Diapers (small/medium adult) – Tena Super Briefs 12 per pack @ $10.15/pack – uses 5 diapers per day = 180 -182.5 packs per year or 15 packs per month + 2.5 extra packs($2.12/month) = $154.37/month | – | $1,852.44 |
| Diapers (small/medium adult) –1xTranquility super absorbent overnight briefs – 10 packs of 10 @ $89.95[3] x 4 | – | $359.80 |
| Wet Ones – 1 pack /month @ $12/pk x 12 | – | $144 |
| Disposable incontinence pads 17”x24” [for wheelchair use] @ $51/300 x 2 pks/annum | – | $102 |
| 2 washable incontinence pads 17” x 22” @ $8.30 each [wheelchair use] | – | $16.60 |
| Latex Gloves – small, medium, large to accommodate various caregivers – toileting hygiene @ $62.15/box of 1000 x 4 | – | $248.60 |
| Glove dispenser – for storing3 boxes – hygienic, one location by changing area | $66.65 | – |
| Automatic trash can – hygienic disposal of soiled waste | $223 | $22.30 |
| Hand sanitizer – anti-bacterial soap @ $7.85/236ml x 12 | – | $94.20 |
| Sensor Soap Pump Dispenser – touch free for optimum nursing care/hygiene | $50.85 | $16.95 |
| Performa X-Frame Hi-Lo Changing Table[4] – for diaper changes, hygienic | $2,200 | $220 |
| Miscellaneous | ||
| Modified Clothing – such as side opening trousers, custom opening for G-tube ($20), coats and jackets ($395-555), rain/winter cape ($255-$280) for use in wheelchairs, no thumb mitts ($50), swim brief (for adults and teens with incontinence) ($49-59), boots ($165-$190)[5] | – | $500 |
| Soft Fall Mat – for floor exercise (strength, ROM) | $221 | $44.20 |
| Residential Stand-by Generator and charger: to ensure back-up power source in event of main power failure as several medical devices rely on electricity to recharge batteries and to maintain temperature regulation – a/c or heating – inc. shipping and installation[6] | $7,000 | $1,400 |
| Allowance for additional medical devices and annual service fee and replacement parts for motorized equipment and generator – conservative estimate. | – | $2,000 |
| TOTAL INITIAL COST | $22,811.96 | |
| TOTAL ANNUAL COST | $5,333.28 | |
| MEDICATIONS | |||
| Age 12 to Age 70 (58 years) | |||
| Recommended | Annual Reserve | ||
| Apo-Lorazepam 1mg – sublingual [as needed for seizures >3 minutes]x10 annually @ $0.45/tab | $4.50 | ||
| Levetiracetam – 300mg and 350mg daily [seizure] | $1,110.72 | ||
| Apo-Clobazam/Clobazam – 10 mg x 2 daily [seizure] $8.75 for 2 blister packs of 30 each | $105 | ||
| Domperidone – 10mg x 4 daily [GERD] | $280.08 | ||
| Omeprazole – 20mg x 2 daily [GERD] | $390.79 | ||
| Fluticasone -125 mcg 1 puff- 2 x daily in winter or if ill in summer [nasal spray/allergies or allergy like symptoms] | $372.60 | ||
| Polyetheylene Glycol 3350 (Peglyte or Restoralax) 10ml daily as needed [constipation] | $301.20 | ||
| Betamehasone 0.1% ointment (15g)– to affected areas twice daily [skin irritation] | $124.80 | ||
| Hydrocortisone 1% cream (454g) – to affected area twice daily [skin irritation] | $233.40 | ||
| Benadryl – 8.75 mg every 6 hours as needed [allergies, recommended to deter hand biting] | $69.24 | ||
| Polysporin topical – 30g to skin three times daily for bite marks to hands and arms – as needed | $40.80 | ||
| Clotrimazole Cream – 1% (30g) – topical every diaper change [diaper rash/skin care] | $80.40 | ||
| Vitamin D – 2000IU – daily | $240 | ||
| Calcium with Vitamin D3 – 5ml – supplemental to enteral feeds | $180 | ||
| Multi-Vitamin 5 ml – twice daily – supplemental to enteral feeds | $480 | ||
| Contingent Allowance – for medications not listed, added complications and particularly as she ages. | $ 2,500 | ||
| TOTAL ANNUAL COST | $6,513.53 | ||
At Sommers Roth & Elmalah, our team of skilled and knowledgeable medical malpractice lawyers have been representing clients in some of Canada’s largest medical malpractice trials. We provide trusted and compassionate guidance to families affected by medical error and negligence and our experience with these cases is extensive. With offices in downtown Toronto, we represent clients in all areas of Ontario and across Canada. Call us at 1-844-777-7372 or contact us online for a free consultation.
[1] Gastrostomy-jejunostomy tube