paul m. deutsch & associates, p.a. life care plan …...eric henderson projected evaluations...

Eric Henderson Projected Evaluations

Life Care Plan

Item / Service Age Year Purpose Cost Recommended ByCommentFrequency/

Replacement

DOB: Dec 1, 1970Feb 1, 2004Jul 18, 2005T8 ASIA-AParaplegia/TBI

D/A:

Primary Disability:Date Prepared:

Paul M. Deutsch & Associates, P.A.10 Windsormere Way, Suite 400Oviedo, FL 32765(407) 977-3223 Fax (407) 977-0311

Rehabilitation /Long-Term NeedsAssessment

Assess HandicappingConditions.

$0 - $0Per Year

Paul M. Deutsch,Ph.D., C.R.C. CCM.CLCP, FIALCP Lic.Mental Hlth. Couns.(Chptr. 491 Psych.Pract. Act.)

Ending

Already accomplished as of 5/16/05initial evaluation and 5/27/05completion of evaluation.

Beginning Per Unit

A life care plan is a dynamic document based upon published standards of practice, comprehensive assessment, data analysis, and research, which provides anorganized, concise plan for current and future needs, with associated costs, for individuals who have experienced catastrophic injury or have chronic health careneeds. IALCP - International Academy of Life Care Planners, 2003. Definition established during the 2000 Life Care Planning Summit)

Through the development of a comprehensive Life Care Plan, a clear, concise, and sensible presentation of the complex requirements of the patient are identifiedas a means of documenting current and future medical needs for individuals who have experienced catastrophic injury or have chronic health care needs.

The goals of a comprehensive Life Care Plan are to: improve and maintain the clinical state of the patient; prevent secondary complications; provide the clinicaland physical environment for optimal recovery; provide support for the family; and to provide a disability management program aimed at preventing unnecessarycomplications and minimizing the long-term care needs of the patient.

The main avoidable complications requiring careful monitoring and appropriate preventative and treatment programs are: bladder and renal tract complications;constipation or diarrhea; under nutrition; respiratory infections; stress ulceration; deep vein thrombophlebitis; decubitus ulceration; complications of medicationsand disruption of family dynamics.

1 X Only

1

34 5/2005

34 5/2005

NeuropsychologicalEvaluation

Evaluate for cognitivedeficits for considerationof potential for supportedemployment.

$2500 - $3400

Per Year


Ending

Records do not reflect aNeuropsychological Evaluation havingbeen accomplished to date.

Beginning Per Unit

Eric was involved in a MVA on 2/1/04. His GCS was initially 3; intubation was successfully achieved 23 minutes following arrival of EMS to the scene (Lake SumterEMS 2/1/04). CT of the head revealed diffuse right frontal subarachnoid hemorrhage, petechial hemorrhage, occipital skull fracture, right frontal contusion,opacification of the right middle ear and right basilar skull fractures. By 2/2/04 he was intermittently following some commands. (ORMC 2/1/04-2/24/04).Discharge was to Shepherd Center, 2/24/04, with the following diagnoses: MVA with ejection, Right 1st rib fracture, Right basilar skull fracture and occipital skullfracture, Subarachnoid fracture, T6-T7 Spine fractures, Paraplegia and Acute respiratory failure.

1 X Only

2

34 7/2005

34 7/2005

Growth Trend To Be Determined By Economist. Table 2 Copyright ©1994. page 1


Life Care Plan


Replacement


D/A:



Psychological Formulate baseline andtreatment plan to assistwith adjustment todisability.

$600 - $900

Per Year


Ending

$120-$180/hour. An evaluation wouldtake 4-6 hours to complete, or a total of$600 to $900, based on an average of$150/hour.

Beginning Per Unit

The Veteran’s Administration (VA) annual exam for persons with SCI developed its list of 33 preventative procedures from research published by the U.S. Preventive ServicesTask Force (USPSTF), the Clinical Practice Guidelines published by the Consortium for Spinal Cord Medicine (CSCM), and MEDLINE, 33. These include, but are not limited to,Psychosocial Assessment.

1 X Only

3

34 7/2005

34 7/2005

Physical Therapy Monitor therapy programand equipment needs. $0 - $0

Per Year

Dr. Robinson,Treating PrimaryCare Physician,7/7/05 letter; A.Zotovas, MD,ConsultingPhysiatrist.

Ending

1 X / year to age 65, then 2 X / year. Aspart of SCI re-evaluation. (Evaluationnow for intensive rehab.)

Beginning Per Unit

According to research published by the U.S. Preventive Services Task Force (USPSTF), the Clinical Practice Guidelines published by the Consortium for Spinal Cord Medicine(CSCM), and MEDLINE, 33 preventive procedures are recommended in the Veteran’s Administration (VA) Annual Exam for persons with SCI. These include the following: Sensoryand Motor level reflex functions, Skeletal Changes, ADL function changes which can be accomplished through a Physical Therapy evaluation.

1 X / Year to age 65;then 2 X / year.

4

34 11/2005

Life Exp.

Occupational Therapy Monitor independencewith activities of dailyliving skills and makeequipmentrecommendations.

$0 - $0

Per Year

Dr. Robinson,Treating PrimaryCare Physician,7/7/05 letter; A.Zotovas, MD,ConsultingPhysiatrist.

Ending

1 X / year to age 65, then 2 X / year (Aspart of SCI re-evaluation.)

Beginning Per Unit

According to research published by the U.S. Preventive Services Task Force (USPSTF), the Clinical Practice Guidelines published by the Consortium for Spinal Cord Medicine(CSCM), and MEDLINE, 33 preventive procedures are recommended in the Veteran’s Administration (VA) Annual Exam for persons with SCI. These include the following: Sensoryand Motor level reflex functions, and ADL function changes which can be accomplished through an Occupational Therapy evaluation.

Focus will be to assess his ability to perform ADLs, self-care and assess equipment to make adjustments or changes as he ages, as his condition changes or as his needs or hisenvironment changes.

1 X / Year to age65; then 2 X /year. To beginupon completionof intensive rehabpost woundhealing. 5

35 3/2006

Life Exp.



Life Care Plan


Replacement


D/A:



Recreational Therapy Assess leisure interestsand recommend adaptiveequipment.

$450 - $600

Per Year

Paul M. Deutsch,Ph.D., CRC, CCM,CLCP, FIALCP &Andrea Zotovas,MD

Ending

Cost includes start-up equipment andsupplies. Periodic evaluationsnecessary to accommodate for phasechanges. (To begin post wound care.)

Beginning Per Unit

In the areas of physical medicine and rehabilitation, studies have documented these Recreational Therapy (RT) outcomes: Improved physical health; Reduced complicationsrelated to secondary disability; Improved long-term health status and reduced health risk factors; Improved cognitive functioning; Improved psychosocial health and well-being;Reduced reliance on the health care system; Increased life satisfaction; High-quality social relationships; Decreased depression; Increased self-efficacy, self-confidence, andadjustment to disability; Improved self-esteem; Increased ability to use activity to cope with stress from hospitalization/illness; Decreased social isolation; Increased perceivedquality of life; Improved community functioning and ability to overcome barriers. Source: Sorensen, Beth, MS, TRS/CTRS, CCM; Luken, Karen, MS, TRS/CTRS. ImprovingFunctional Outcomes with Recreational Therapy. The Case Manager, September/October 1999, pages 48 – 52.

1 X / 4-6 Years

6

35 1/2006

70 2040

Handicapped DriverEvaluation

Evaluate driving abilityand recommend adaptiveequipment.

$625 - $725

Per Year

Paul M.Deutsch,Ph.D.,C.R.C. CCM. CLCP,FIALCP & AndreaZotovas, M.D.Ending

Re-evaluations set with eachequipment change due to newtechnology. (To begin post woundcare.)

Beginning Per Unit

A Driver Rehabilitation Therapist (DRT) will perform a specific evaluation in each area that is necessary to determine if the person has the potential to drive. The DRT should beeducated, experienced and qualified in assessing all necessary areas through clinical tests, hands-on evaluation and observation in-vehicle. The following areas would beconsidered during the evaluation, depending on the client’s diagnoses: (1) Physical Functioning, including range of motion, muscle strength, coordination, trunk balance/mobilityand sensation; (2) Visual Functioning, including visual acuity, eye range of motion (ROM), peripheral fields, depth perception, visual efficiency and abnormal eye motions; (3)Perceptual Functioning, including figure ground, visual discrimination, spatial relations, form constancy, visual memory and visual closure; (4) Cognitive Functioning, includingresponse time, judgment, decision-making, concentration, attention span, memory, problem solving, selective and divided attention; (5) Communication Skills, including writtenand verbal as related to driving performance; and (6) Social Skills, including emotional and behavioral as related to driving performance. Source: Susan L. Pierce, OTR, CDRS,Chapter 6C, A Comprehensive Approach to Transportation Assessment, Guide to Rehabilitation, AHAB Press, 8/1999, White Plains, NY.

1 X / 5-7 Years

7

35 1/2006

75 2045



Life Care Plan


Replacement


D/A:



Nutritional Evaluation Assess dietary needsand makerecommendations.

$134 - $400Per Year

Andrea Zotovas,MD, Guidelines asnoted & Dr.Robinson, TreatingPrimary CarePhysician, 7/7/05

Ending

Initial evaluation will cost: $134 to $400for a two hour consultation.

Beginning Per Unit

The Veteran’s Administration (VA) annual exam for persons with SCI developed its list of 33 preventative procedures from research published by the U.S. Preventive ServicesTask Force (USPSTF), the Clinical Practice Guidelines published by the Consortium for Spinal Cord Medicine (CSCM), and MEDLINE, 33. These include PsychosocialAssessment, Vocational Rehabilitation, Sexuality, Rehabilitation evaluation to include changes due to aging, Dietary and Nutritional Assessment.

The importance of a nutritional diet in the prevention of cardiovascular disease, cancer and other chronic diseases has been well documented in the literature. A number of issuesrelated to SCI including neurogenic bowel management, the functional implications of being overweight, abnormalities of glucose metabolism and cardiovascular disease riskreinforce the importance of this topic. A survey of long-term SCI survivors found that their food intake differed nutritionally from that of the general population as well as fromoptimal dietary standards. Nutritional assessment and counseling should be routinely incorporated into the clinical follow-up approach to the aging SCI population. Source:Lammertse, Daniel P., MD, Maintaining Health Long-Term with SCI, Topics in SCI Injury Rehabilitation 2001;6(3):1-21, Thomas Land Publishers, Winter 2001.

Consult a dietician and correct nutritional deficiencies by increasing protein and calorie intake and A, C, or E vitamin supplements as needed. Source; Ayello EA. Preventingpressure ulcers and skin tears. In: Mezey M, Fulmer T, Abraham I, Zwicker DA, editor(s). Geriatric nursing protocols for best practice. 2nd ed. New York (NY): Springer PublishingCompany, Inc.; 2003. p. 165-84.

1 X / Year

8

34 7/2005

Life Exp.

Vocational Evaluation Assess vocational abilityand makerecommendations.Repeat to facilitate jobchanges.

$545 - $1250

Per Year

Paul M. Deutsch,Ph.D., CRC, CCM,CLCP, FIALCP

Ending

To follow neuropsychologicalevaluation.

Beginning Per Unit


1 X Now; repeat 1time at age 40-45.(Consideration isgiven to theimpact of the dualdiagnosis, TBIand SCI) 9

34 7/2005

42 2012


Eric Henderson Projected Therapeutic Modalities

Life Care Plan


Replacement


D/A:



Individual Counseling Aid in psychosocialadjustment and offersupportive interventions.

$120 - $150

Per Year

Paul M. Deutsch,Ph.D., CRC, CCM,CLCP, FIALCP Lic.Mental Hlth. Couns.(Chptr. 491 Psych.Pract. Act.)

Ending

$3,120 to $3,900 for 26 sessions; then$1,440 to $1,800 for 12 sessions;thereafter $540 to $810 / year forsupport.

Beginning Per Unit


No characteristic pattern of adjustment exists for those with a SCI. Many of those with SCI are able to respond constructively to the enormous stressor with which they are faced.Group and individual psychological treatment, including a cognitive behavioral approach, may be conducive to positive adjustment. Significant depression occasionally occursand may require pharmacologic intervention. Persons with SCI have an increased risk of death from suicide, particularly in the years immediately following injury. After 10 years,the rate of suicide approaches that of the general population. Source: Saulino, M., MD, Ph.D., Vaccaro, A., MD. Rehabilitation of Persons with Spinal Cord Injuries. E-Medicine:Common Medical Problems; Functional Rehabilitation; Life in the Community, 12/8/03.

1 X / week for 26weeks; reducedto 2 X / month for6 months;thereafter 4 - 6 X /year as neededfor support. 10

34 7/2005

Life Exp.

Family Counseling Assist in adjustment todisability and thechanges in familydynamics

$120 - $150

Per Year

Paul M. Deutsch,Ph.D., CRC, CCM,CLCP, FIALCP Lic.Mental Hlth. Couns.(Chptr. 491 Psych.Pract. Act.)

Ending

$720 - $900 for 6 sessions.Beginning Per Unit

Family Counseling and Education: Spouses or family members of long-term SCI survivors who fulfill a caregiving role report more symptoms of stress and depression thantheir partners or spouses who are not caregivers and that the most stressful situations for spouses involve health issues of their partners and family, marital interactions, and theburden of caregiving imposed on them. Source: Steins, S., Kirshblum, S., Groah, S., McKinley, W., & Gittler, M. (2002). Spinal cord injury medicine. 4. Optimal participation inlife after spinal cord injury: Physical, psychosocial, and economic reintegration into the environment. Archives of Physical Medicine and Rehabilitation, 83, S72-S81.

2 X / month for 3months

11

34 7/2005



Life Care Plan


Replacement


D/A:



PhysicalTherapy(IntensiveProgram)

Improve strength,endurance and provideSCI education; then tomaintain strength andmonitor home exerciseprogram.

$180 - $224

Per Year

Andrea Zotovas,MD & Dr. Robinson,Treating PrimaryCare Physician,7/7/05 letterindicated PT wasnecessary.

Ending

$7,272 - $9,696 for 12-16 weeks, then$808 - $1,212 / year thereafter.

Beginning Per Unit

Eric was unable to participate in a full rehabilitation program due to his skin issues early on, therefore, he must be provided with additional, intensive servicesonce his skin issues allow for proper PT programming. Goals of this program will be extensive, working on strength, endurance, bed mobility, transfers,appropriate equipment use, range of motion and stretching. Additionally, he will work on weight bearing activities such as using a standing frame. The goals ofproper equipment use are to facilitate, or allow Eric to perform as much ADLs and self-care and mobility tasks as possible and to increase safety of these activities. Persons with a Dual Diagnosis (DDS) evidenced a significantly more impaired Cognitive FIM score at admission and discharge from rehabilitation. Personswith a DDS also achieved a significantly lower Motor FIM change than persons with SCI. Conclusion was that persons with a DDS achieved smaller functionalgains during rehabilitation than peers with SCI. Brain injuries tended to achieve smaller functional gains during rehabilitation than peers with SCI. Braininjuries seem to limit functional gains, although the relationship between brain injury severity and functional change is not linear.Source: Effect of Co-Morbid Traumatic Brain Injury on Functional Outcome of Persons with Spinal Cord Injuries. Macciocchi, S.; Bowman, B., MD., Coker, J.,MPH, Apple, David, MF, D. Leslie, MD. American Journal of Physical Medicine and Rehabilitation, Vol. 83, No. 1, January 2004. The term Dual Diagnosis refers to the presence of traumatic brain injury (TBI) in individuals who have sustained a traumatic spinal cord injury (SCI). For allpersons with SCI, rehabilitation involves the learning of new strategies to maximize independence and facilitate care in the areas of mobility, bowel and bladderfunction. Individuals with the dual diagnosis of SCI/TBI however, are likely to require different rehabilitation strategies, including extra reinforcement andpractice of newly learned skills. They may find it difficult to pay attention, learn and remember new information, organize and prioritize new information andperform multiple tasks simultaneously.Source: Connections – A Publication for People with Spinal Cord Injuries, Karen Kepler, DO, Ph.D., Fall/Winter 2003, Volume XII Issue 2. Publishedsemi-annually by Kessler Medical Rehabilitation Research and Education Corporation (KMRREC) for people with SCI and their families. Project funded byNational Institute on Disability and Rehabilitation Research.

3 X / wk for 12-16wks, then 4-6 X /year thereafterfor maintenanceand caregivertraining due toturnover. 12

34 11/2005

Life Exp.

Career Guidance &Counseling

Job planning andplacement.(Consideration is given tothe impact of the dualdiagnosis, TBI and SCI).

$2945 - $3926

Per Year


Ending

To begin after completion of intensiverehabilitation program. Repeatedperiodically as a reflection of thedifficulties he will face in fluentlymaking job changes.

Beginning Per Unit

$72-$79/hour for vocational counselor rate, or an average of $75.5/hour X 3 X / week for 13 weeks = $2,945. $75.5 /hour X 4 X / week for 13 weeks = $3,926.

(Consideration is given to the impact of the dual diagnosis, TBI and SCI)

Career guidance to include: (A) career exploration; (B) career decision making; (C) matching of interests, job satisfiers, motivators, and abilities to available alternativesvocationally; (D) goal setting; (E) job seeking skills training.

3-4 X /wk for 13wks. initial prog.;post placementcounseling toinsure success.Total: 3 X overwork life. 13

35 3/2006

50 2020



Life Care Plan


Replacement


D/A:



Nutritional Follow-Up Follow up to ensureappropriate changes indiet and adherence toprogram specifics.

$67 - $100

$134 - $200Per Year

Dr. Robinson, PCP7/7/05 letter.

Ending

Dr. Robinson, PCP 7/7/05 letter. (“Istrongly recommend. nutritionevaluation of total needs, and proteinintake”).

Beginning Per Unit2 X / Year

14

34 7/2005

Life Exp.

Occupational Therapy Maintain activities of dailyliving skills and work withnew equipment.

$180 - $224

Per Year

Andrea Zotovas,MD & Dr. Robinson,Treating PrimaryCare Physician,7/7/05 letter.

Ending

$808 to $1,212 every other year.(Consideration is given to the impact ofthe dual diagnosis, TBI and SCI)

Beginning Per Unit

According to research published by the U.S. Preventive Services Task Force (USPSTF), the Clinical Practice Guidelines published by the Consortium for Spinal Cord Medicine(CSCM), and MEDLINE, 33 preventive procedures are recommended in the Veteran’s Administration (VA) Annual Exam for persons with SCI. These include the following: Sensoryand Motor level reflex functions, Skeletal Changes, ADL function changes which can be accomplished through Occupational Therapy.

4-6 sessionsevery other yearto train with newequipment.

15

35 3/2006

Life Exp.


Eric Henderson Wheelchair Needs

Life Care Plan


Replacement


D/A:



Manual Wheelchair Backup to power chair atan older age. $4000 - $4203

Per Year


Ending

Actual purchase date is 5/2004. (AHSSeating and Mobility.) Purchase price:$4,000 approximately.

Beginning Per Unit

The pressure on the skin must be reduced by turning the patient in bed every 2 hours and by the use of a pressure-reducing mattress. Pressure-reducing mattresses includelow–air loss beds, air-fluidized beds, and Roho cushion mattress seats for wheelchairs. Furthermore, sitting patients should shift their body weight every 15 minutes. With thehighest complication rate of all procedures performed, pressure sore reconstruction is perhaps the most complex challenge to plastic surgeons. Treatment of patients withpressure sores involves several considerations to minimize the risk of adverse outcomes of the reconstruction. Patients must be meticulously and compulsively preparedpreoperatively, with nutritional deficiency, anemia, spasms, and coexisting urinary infection corrected. Patients must have adequate social resources, includingpressure-release beds, wheelchair mattresses, and a compliant attitude to prevent recurrence. Intraoperatively, technical points of pressure sore reconstruction must befollowed stringently to minimize the risk of complications. The postoperative regimen for the transition from flat bed rest to sitting and from weight-shifting into and out of thewheelchair in the return to daily living must be strict and careful. Even with close adherence to the above stated guidelines, pressure sore recurrence rates are high. Whencaring for patients with chronic pressure sores, flap procedures must be planned carefully and social resources must be provided assiduously to reduce the high risk ofadverse outcomes in this complication-prone population. Source: Wilhelmi, Bradon J MD; Neumeister, Michael, MD, FRCSC, FACS Pressure Ulcers, Surgical Treatment andPrinciples. Last Updated: January 25, 2005. http://www.emedicine.com/plastic/topic462.htm.

1 X / 5-7 Years

16

33 5/2004

Life Exp.

Custom PowerWheelchair

Mobility$13132 - $15557

Per Year


Ending

Beginning Per Unit

Upper extremity entrapment neuropathies have been reported in up to 63% of paraplegics. The most common involvement is carpal tunnel syndrome; the ulnar entrapments at thewrist and elbow are also common. The neuropathies are caused by a combination of repetitive trauma and elevated nerve pressure due to long-term use of wheelchair push rims.Source: Whiteneck, GG, Charlifue, SW, Gerhart, KA, et al, eds. Aging with Spinal Cord Injury. New York, NY, Demos Publications, 1993.

1 X / 4-6 Yearsbeginning at age40-45

17

42 2012

Life Exp.

Shower/CommodeWheelchair

Aid in bathing$875

Per Year

Paul M. Deutsch,Ph.D., CRC, CCM,CLCP, FIALCPbased on medicalinformation andclient interview

Ending

FL Home Health. Actual purchase priceand date noted.

Beginning Per Unit1 X / 3-4 Years

18

33 8/2004

Life Exp.


Eric Henderson Wheelchair Accessories and Maintenance

Life Care Plan


Replacement


D/A:



MAINTENANCE:Manual Wheelchair

Maintain equipment

$400 - $425Per Year


Ending

Maintenance on equipment begins oneyear after each new chair is purchaseduntil such time as the manual chairbecomes a backup to the power chair.Then, maintenance is every two years.


19

34 7/2005

Life Exp.

Power Wheelchair Maintain equipment

$1300 - $1550Per Year


Ending

Maintenance on equipment begins oneyear after each new item is purchased.


20

43 2013

Life Exp.

Shower Wheelchair Maintain equipment

$83 - $120Per Year


Ending



21

34 7/2005

Life Exp.

ACCESSORIES:Wheelchair Cushion

Positioning and supportwhile in wheelchair andprevention of skinbreakdown

$500

Per Year


Ending

Actual date and purchase price noted.Beginning Per Unit1 X / 2 Years untilpower chairbegins, then hewill require 2cushions/2years.

22

33 5/2004

Life Exp.

Cushion Covers Protect cushions$35 - $40

$35 - $40Per Year


Ending

Beginning Per Unit1 X / Year to age42, then 2/year.

23

34 7/2005

Life Exp.



Life Care Plan


Replacement


D/A:



Jay Protector Small, lightweight cushionused to protect buttockswhen transferring on hardsurfaces.

$220 - $245

Per Year


Ending

Beginning Per Unit

Eric tends to brush his buttocks along the rims of the wheelchair wheels while transferring. This protector will provide cushioning when performing transfers.

1 X / 2-3 Years

24

34 7/2005

Life Exp.

Beasy Transfer Boards(2)

Assist in transfers andreduce friction onbuttocks.

$450

Per Year


Ending

Unit cost is for two boards. Costobtained from allegromedical.com.


25

34 7/2005

Life Exp.

Wheelchair CarryingPack

Convenience in carryingpersonal items $45 - $55

$45 - $55Per Year


Ending

Costing information obtained fromquickie-wheelchairs.com.


26

34 7/2005

Life Exp.

Wheelchair Gloves Protect hands from injurywhen pushing manualwheelchair.

$30 - $39

$69 - $104Per Year


Ending

Cost obtained from allegromedical.com.Beginning Per Unit2-3 X / year whilethe manual chaircontinues to beprimary means ofmobility, to age40-45, 2010 to2015. 27

34 7/2005

45 2015

Power WheelchairBatteries

Provide power

$400Per Year


Ending

Battery purchased one time per yearexcept the year in which new powerchair is purchased.

Beginning Per Unit1 X / Year (tobegin at age 43,one year afterinitial purchase ofpower chair andbattery).

28

43 2013

Life Exp.



Life Care Plan


Replacement


D/A:



Portable Ramps Accessibility$328 - $681

Per Year


Ending

Beginning Per Unit1 X / 10 Years

29

34 7/2005

Life Exp.


Eric Henderson Orthopedic Equipment

Life Care Plan


Replacement


D/A:



Easy Stand MobileStanding Frame

Provide physical benefitsof standing. $5220 - $5665

Per Year


Ending

Beginning Per Unit1 X / 5-7 Years toage 59 (4purchases total).To begin afterintensive rehabprogram iscompleted). 30

35 3/2006

59 2029

Maintenance of StandingFrame

Maintain equipment

$215 - $225Per Year


Ending

Maintenance on equipment begins oneyear after each new item is purchased.Maintenance to continue for 3-5 yearsafter the last purchase, at age 59.


31

36 3/2007

63 2033


Eric Henderson Home Furnishings and Accessories

Life Care Plan


Replacement


D/A:



Hand Held Shower Aid in bathing$23 - $29

Per Year


Ending


32

34 7/2005

Life Exp.

Raised Toilet Seat Bowel/bladder care$29 - $47

Per Year


Ending


33

34 7/2005

Life Exp.

Padded Bathtub TransferBench

Aid in bathing$139 - $185

Per Year


Ending


34

34 7/2005

Life Exp.

Tub & Toilet Safety Rails Safety aid$0 - $0

$0 - $0Per Year


Ending

Beginning Per Unit1 X Only -included in thecost ofarchitecturalrenovations.

35

34 7/2005

34 7/2005

Temperature ControlGuards (3)

Prevent scalding with hottap water $75 - $90

Per Year


Ending

Unit cost is for three.Beginning Per Unit1 X / 4-6 Years

36

34 7/2005

Life Exp.



Life Care Plan


Replacement


D/A:



Fully Powered HospitalBed

Proper positioning andease in care. $3100 - $3995

Per Year


Ending

His current bed ($3,100) is in poorcondition. Recommend replacement atthis time.


37

34 7/2005

Life Exp.

Maintenance of HospitalBed

Maintain equipment

$205 - $215Per Year


Ending



38

35 7/2006

Life Exp.

Alternating PressureMattress System

Promote healing ofcurrent wounds andprevent further wounddevelopment.

$2635 - $3449

Per Year


Ending

Beginning Per Unit

The pressure on the skin must be reduced by turning the patient in bed every 2 hours and by the use of a pressure-reducing mattress. Pressure-reducing mattresses includelow–air loss beds and air-fluidized beds. With the highest complication rate of all procedures performed, pressure sore reconstruction is perhaps the most complex challengeto plastic surgeons. Even with close adherence to clinical practice guidelines, pressure sore recurrence rates are high. When caring for patients with chronic pressuresores, flap procedures must be planned carefully and social resources must be provided to reduce the high risk of adverse outcomes in this complication-prone population.When the SCI is combined with a TBI (Traumatic Brain Injury), stringent supervision and follow-up becomes that much more important. Source: Wilhelmi, Bradon J MD;Neumeister, Michael, MD, FRCSC, FACS Pressure Ulcers, Surgical Treatment and Principles. Last Updated: January 25, 2005. http://www.emedicine.com/plastic/topic462.htm.

1 X / 4-6 Years

39

34 7/2005

Life Exp.

Maintenance of MattressSystem

Maintain equipment

$135 - $140Per Year


Ending



40

35 7/2006

Life Exp.



Life Care Plan


Replacement


D/A:



Trapeze Bar with Base Assist with turning in bedand transfers. $378

Per Year


Ending


41

34 7/2005

Life Exp.


Eric Henderson Aids for Independent Function

Life Care Plan


Replacement


D/A:



Aids for IndependentFunctioning

Enhance independence inpersonal care, householdchores, and cooking.

Per Year


Ending

$300 - $400 initial start-up cost onetime only; thereafter $200 - $250 / yearfor replacement of broken equipment ornew items.

Beginning Per Unit

Examples of such equipment are as follows: Dressing Aids (Sock/Stocking donners - $40, Long-handled shoehorn - $9, etc.); Long-handled reacher - $45; Long-handled bathsponge - $10; Long-handled toenail clippers - $62; Household and kitchen equipment (bowl holder with bowl - $54, ergonomic adaptive cookware set - $126, push/pull helper - $6,folding pan holder - $15, kitchen rollabout - $23, long reach duster - $16, long reach bathroom cleaner - $14, etc.); jointed para inspection mirror - $19; leg lifter - $20; Suppositoryinserter - $83; Anus stimulator - $69 (to be provided at an older age); etc.

Initial purchase ofitems now, thenannual allowancefor replacementor additions.

42

34 7/2005

Life Exp.

Adaptive Clothing Enhance independence

$616Per Year


Ending

Adapted from Veteran's Administrationguidelines; rate effective 8/2005.

Beginning Per UnitAnnual allowance

43

34 7/2005

Life Exp.

Environmental ControlUnit

Used to enhanceindependence to enableEric to reduce constanttransferring from bed tochair in order to controlhis environment.

$400 - $695

Per Year


Ending

A wide variety of options exist,depending on the amount of items to becontrolled.


44

34 7/2005

Life Exp.

Maintenance/UpgradeECU

Maintain equipment

$50 - $75Per Year


Ending



45

35 7/2006

Life Exp.


Eric Henderson Supplies

Life Care Plan


Replacement


D/A:



Miscellaneous Supplies Daily care

$1874 - $2027Per Year


Ending

Beginning Per Unit

Eric’s current supplies include the following: Supra Pubic Catheters (Provided by Urologist with monthly changes/visits); Gloves: $14/box of 100, or $98/year; Skin Creams(Sween: $79/year; Xenaderm: $165/year; Duoderm: $63/year; Panafic: $100/year; Bactroban: $120/year); Plastic Bags: $15/year; Leg Bags: $312/year; Bed Bags:$231-$374/year; Sodium Chloride Irrigation: $676/year; Tape: $15-$25/year .

Eric currently uses a significant amount of supplies to treat his pressure sores on his lower extremities. There is no way to predict if/when he will cease using these supplies,however, he remains at a very high risk for further skin breakdown given his diagnoses.

Annual cost

46

34 7/2005

Life Exp.

Sexual Function Items To allow for sexualfunctioning

Per Year


Ending

Beginning Per Unit

NOTE: Erect-Aid can be used in conjunction with injections and/or oral medication. The injections would not typically be used with the oral medication.

This is a list of options available, pending physician evaluation: Battery Powered Erect-Aid System - $525 - $675 every 3-4 years, Injection therapy (i.e.Caverject) - $140 - $208 / 6 injections (minimum of $1,680 - $2,496 / year), or Viagra $89 / 10 pills (Minimum of $1,068 / year).

Sexual functioning and sexual health is also an important secondary issue that must not be ignored. Source: Jackson, A.B., M.D. Secondary Conditions of a Spinal CordInjury. Summary in An In-Depth Analysis of Medical Disabilities by Specialists in Their Fields. August 29, 2000.

See individualitems

47

34 7/2005

Life Exp.


Eric Henderson Medications

Life Care Plan


Replacement


D/A:



Prescription Medications Medications asprescribed. $642

$7704Per Year

As prescribed bytreating physicians.

Ending

This represents his current regimen andis certainly subject to change withaging and changes in status. This doesnot take into consideration anymedications such as antibiotics to treatinfections.

Beginning Per Unit

Current medications include the following: Paxil: $102/Mo.; Trazadone: $13/Mo.; Lasix, 20 mg: $9/Mo.; and Lasix: 40 mg: $11/Mo.; Ditropan: $109/Mo.;Reminyl: $172/Mo.; Baclofen: $21/Mo.; Potassium, 20 mg: $14/Mo.; Potassium, 10 mg: $12/Mo.; and Adderall: $179/Mo.

Annual costs

48

34 7/2005

Life Exp.


Eric Henderson Home Care / Facility Care

Life Care Plan


Replacement


D/A:



Skilled Nursing Visit Supervisory visits;medication set ups andskin checks

$55 - $100

$2860 - $5200Per Year


Ending

Dr. Brink, treating wound physicianopined Eric would require another 2-3months of visits at the wound carecenter; after that, Skilled Nursing Visitsweekly are recommended formedication set ups and skin checks.

Beginning Per Unit1 X / week

49

34 10/2005

Life Exp.

Case Management Coordinate services$72 - $79

Per Year


Ending

$1,812-$3,624/year with an agencyhired aide, or $7,248 to $9,060 /yearwith a privately hired aide.

Beginning Per Unit

NOTE: A case manager will be used to implement plan, act as resource support person, and liaison with professional treatment team. Other support assistance as needed tomaintain independence for as long as possible will be provided through the case manager.

In order to assist Eric in finding appropriate candidates and maintaining a proper schedule for the attendants, a case manager would be required at least 8-10 hours per month inorder to maintain the private hire and the responsibilities attached thereto. The cost of case management for private hire option would be $7,248 to $9,060 for 96 to 120 hours peryear.

2 - 4 hrs / month(24 - 48 hours /year) with agencyhired aide, 8-10hours/month witha privately-hiredaide. 50

34 7/2005

Life Exp.

Interior / Exterior HomeMaintenanceto include housecleaning

Maintain home$65 - $85

$3380 - $4420Per Year


Ending

Beginning Per UnitRegular weeklyservice

51

34 7/2005

Life Exp.

Supported Work Program Provide structure andavocational activities. $100

$24000Per Year


Ending

Beginning Per Unit5 days / week; 48weeks / year

52

34 7/2005

65 2035



Life Care Plan


Replacement


D/A:



Home Health Aide/Personal Care Attendant

Assist with activities ofdaily living. $16 - $20

$26280 - $39420Per Year


Ending

Rate shown is through an agency. Seenotes below for costs of private hireaide.

Beginning Per Unit

According to the study on expected functional outcomes, in a monograph entitled: Spinal Cord Medicine. Outcomes Following Traumatic Spinal Cord Injury:Clinical Practice Guidelines for Health-Care Professionals, Consortium for Spinal Cord Medicine, PVA, 1999, those with paraplegia at the T1-T9 level have anExpected Assistance Data level of 2 hours per day, Median of 3 hours per day, or an Interquartile Rate of 0-15 hours per day. There is no specific "formula" todetermine the amount of hours of assistance a person may require, as the variables are so diverse in any given member of the population with a SCI. As noted inthe Interquartile Range cited above, a range of 0-15 hours per day of assistance might be required. The ideal outcome for each patient may not always beachieved. Patient outcomes may fall short of target levels of performance because of such coexistent conditions as cognitive impairment, obesity, age, upperextremity injury, or pre-existing medical conditions. Secondary conditions such as depression, spasticity, or contractures also may hinder achievement oflong-term outcomes. The goal of the Life Care Plan is to identify those needs that are dictated by the injury, which will reduce complications, and provideneeded supports. It is anticipated, that with the supports that are built into the plan [therapies, equipment, rehabilitation], the potential need for specifichours of care per day can be reduced to some extent. A range of hours per day has been identified for those instances in which illness, injury or other problemsmay require assistance in daily living activities.There are two options to consider: Private Hire (attendant that Eric hires), or an Agency Hire (attendant hired through a Home Health Agency). HHAs in Eric’s geographical area(Orlando/Lake County) earn a mean hourly wage of $8.82 (Source: U.S. Department of Labor, Bureau of Labor Statistics, Occupational Employment Statistics, May 2004 StateOccupational Employment and Wage Estimates, Orlando, Florida. MSA, www.bls.gov.) We must also add in an additional 25% factor to that hourly rate to cover matching socialsecurity, quarterly unemployment compensation, worker’s compensation and appropriate accounting/administrative costs. Therefore, the total hourly rate would be $11.03 perhour, or $16,104 to $24,156 year, based on 1,460 to 2,190 hours per year.Once Eric’s wounds are healed, additional intensive rehabilitation is recommended so that he can build strength and endurance, learn additional wheelchair skills, including safetransfers and learn additional adaptive functioning to enhance his ability to live as independently as possible. Nevertheless, Eric will require some level of care now forsupervision and safety, with the number of hours provided increasing gradually as he ages.

4-6 hours per dayfrom now throughage 40. (1460 -2190 hours peryear)

53

34 7/2005

40 2010



Life Care Plan


Replacement


D/A:



Home Health Aide /Personal Care Attendant

Assist with activities ofdaily living as age anddisability combine tocreate greaterdependence.

$16 - $20

$39420 - $52560Per Year


Ending

Rate shown is through an agency. Forprivate hire, rate costs would be$11.03/hour, or $24,156 to$32,208/year.

Beginning Per Unit

Aging with Disability: Declining years occur with each decade of life in relation to the duration of injury. If one was injured at the age of 10, for example, by around 20years post injury, decline in function begins and continues to fall with each decade. (Kempt, Bryan "Long Term Outcomes with Disability," Rancho Los Amigos Seminar, Sept.1998, as cited in Life Care Planning for SCI, Intelicus/University of Florida coursework, Module 2).

Analysis of functional changes over time showed 22% of the participants reported needing more assistance with activities over the several years prior to the initial assessment.This subgroup of individuals who needed more help was significantly older than those who did not. Average age when additional assistance was first needed was 49 years forthose with cervical levels of injury and 54 years for those with lower injuries. Help with transfers was most commonly documented, followed by assistance with dressing andmobility. Older age onset of disability, however, results in an earlier decline in physical functioning, and therefore, earlier assistance than noted above would be anticipated.Source: Ohry A., Shemesh Y., Rozin R. Are Chronic SCI’d patients Prone to Premature Aging? Med Hypotheses. 1983; 11:467-469; and Trieschmann, R.B. Aging withDisability. New York: Demos; 1987; as noted in: Lammertse, Daniel P., MD, Maintaining Health Long-Term with SCI, Topics in SCI Injury Rehabilitation 2001;6(3):1-21, ThomasLand Publishers, Winter 2001.

6-8 hours per day(2,190 to 2,920hours per year)

54

41 2011

50 2020


Personal care as age anddisability combine tocreate greaterdependence.

$16 - $20

$52560 - $65700Per Year


Ending


Beginning Per Unit


8-10 hours perday (2,920 to3,650 hours peryear)

55

51 2021

61 2031



Life Care Plan


Replacement


D/A:





$16 - $20

$78840 - $105120Per Year


Ending


Beginning Per Unit



56

62 2032

72 2042



$16 - $20

Per Year


Ending

$118,260 to $157,680 for agency hiredaide. For private hire, rate costs wouldbe $11.03/hour, or $72,467 to$96,623/year.

Beginning Per Unit



57

73 2043

Life Exp.


Eric Henderson Future Medical Care Routine

Life Care Plan


Replacement


D/A:



Outpatient Spinal CordInjury RehabilitationEvaluation (ShepherdCenter)

Assess disability,evaluate needs, monitorcondition

$4268 - $5268

Per Year

Dr. Robinson,7/7/05; A. Zotovas,MD & Guidelines asnoted.Ending

Beginning Per Unit

Medical Tests: The Veteran’s Administration (VA) annual exam for persons with SCI developed its list of 33 preventative procedures from research published by the U.S.Preventive Services Task Force (USPSTF), the Clinical Practice Guidelines published by the Consortium for Spinal Cord Medicine (CSCM), and MEDLINE, 33. These include thefollowing: Medical History and Physical Exam including Sensory and Motor level reflex functions, Skeletal Changes, ADL function changes, Skin Integrity, Cardiovascularassessment, Pulmonary Function; Urinary testing such as: Creatinine clearance, Renal Sonogram, Renal Scan (CT), IVP, Cystoscopy with biopsy, and Urodynamics;General Medical Tests including Chest X-ray, Electrocardiogram for asymptomatic coronary heart disease, CBC and Chemical Profile (including lipids), Urinalysis andCulture/Sensitivity to include acid phosphatas/prostatic specific antigen for patients over age 40, Rectosigmoidoscopy (over age 40), or colonoscopy when indicated, Abdominalsonogram; Functional and Other Evaluations to include: Psychosocial Assessment, Vocational Rehabilitation, Sexuality, Rehabilitation evaluation to include changes dueto aging, Dietary and Nutritional Assessment.

Costs include: $900-$1,500 assistive tech/rehab engineering evaluation per 3 years; Outpatient Exam Room: $340; Physiatry: $550; Urology: $400; Pressure Mapping $264; PT:$314; OT: $314; Recreational Therapy: $264; Nursing: $110; Seating Evaluation: $350/5 years; Urodynamic Studies: $1,364-$1,561; Renal Scan: $761; Renal Ultrasound: $198;Pulmonary Function: $400; and Labs: CMP: $138; Creatinine: $112; UA: $77; EKG: $100; Misc. X Rays: $80-$100 each; Spine X-ray per section: $110; MRI of the C spine $1,540and Cystoscopy: $310. Housing is $100/day. Not all labs or tests are done each year. Therefore a range of costs is provided to account for this variability.

1 X / Year

58

35 7/2006

Life Exp.

Inpatient Spinal CordInjury RehabilitationEvaluation

Assess disability,evaluate needs, monitorcondition as age anddisability combine tocreate greater need.

$6050 - $9050

Per Year

Andrea Zotovas,MD

Ending

Shepherd CenterBeginning Per Unit

Medical Tests: The Veteran’s Administration (VA) annual exam for persons with SCI developed its list of 33 preventative procedures from research published by the U.S.Preventive Services Task Force (USPSTF), the Clinical Practice Guidelines published by the Consortium for Spinal Cord Medicine (CSCM), and MEDLINE, 33. These include thefollowing: Medical History and Physical Exam including Sensory and Motor level reflex functions, Skeletal Changes, ADL function changes, Skin Integrity, Cardiovascularassessment, Pulmonary Function; Urinary testing such as: Creatinine clearance, Renal Sonogram, Renal Scan (CT), IVP, Cystoscopy with biopsy, and Urodynamics;General Medical Tests including Chest X-ray, Electrocardiogram for asymptomatic coronary heart disease, CBC and Chemical Profile (including lipids), Urinalysis andCulture/Sensitivity to include acid phosphatas/prostatic specific antigen for patients over age 40, Rectosigmoidoscopy (over age 40), or colonoscopy when indicated, Abdominalsonogram; Functional and Other Evaluations to include: Psychosocial Assessment, Vocational Rehabilitation, Sexuality, Rehabilitation evaluation to include changes dueto aging, Dietary and Nutritional Assessment.

1 X / Year tobegin at age 65.

59

65 2035

Life Exp.



Life Care Plan


Replacement


D/A:



General Medical Medical care needed inaddition to the annualphysical everyone shouldhave.

$55 - $115

$330 - $690Per Year

Dr. Robinson,Treating PrimaryCare Physician,7/7/05 letter.Ending

Beginning Per Unit

The Veteran’s Administration (VA) annual exam for persons with SCI developed its list of 33 preventative procedures from research published by the U.S. Preventive ServicesTask Force (USPSTF), the Clinical Practice Guidelines published by the Consortium for Spinal Cord Medicine (CSCM), and MEDLINE, 33. These include the following: MedicalHistory and Physical Exam including Sensory and Motor level reflex functions, Skeletal Changes, ADL function changes, Skin Integrity, Cardiovascular assessment,Pulmonary Function.Cardiovascular Problems with aging: Alterations in lipid and glucose metabolism indicated that persons with SCI have an elevated risk of coronary heart disease andother manifestations of cardiovascular disease. Interventions should include periodic assessment of risk factors such as blood lipids, glucose, weight, blood pressure, dietaryhabits, smoking, activity level, and alcohol consumption. Patients should be encouraged to maintain a heart-healthy diet with low saturated fat and cholesterol. Weight controlshould be promoted and incorporated into nutritional counseling. Exercise and a general increase in physical activity should be encouraged. Source: Lammertse, Daniel P., MD,Maintaining Health Long-Term with SCI, Topics in SCI Injury Rehabilitation 2001;6(3):1-21, Thomas Land Publishers, Winter 2001.

6 X / Year (Due toeffects of dualdiagnosis) Mayincrease infuture, but cannotbe determined atthis time. 60

34 7/2005

Life Exp.

Physiatrist Evaluate and monitor forproblems associated withSCI & TBI, andrehabilitation needs.

$67 - $70

$134 - $140Per Year

Andrea Zotovas,MD & Guidelines asnoted.

Ending

Beginning Per Unit

The Veteran’s Administration (VA) annual exam for persons with SCI developed its list of 33 preventative procedures from research published by the U.S. Preventive ServicesTask Force (USPSTF), the Clinical Practice Guidelines published by the Consortium for Spinal Cord Medicine (CSCM), and MEDLINE, 33. These include the following: MedicalHistory and Physical Exam including Sensory and Motor level reflex functions, Skeletal Changes, ADL function changes, Skin Integrity, Cardiovascular assessment,Pulmonary Function; Urinary testing such as: Creatinine clearance, Renal Sonogram, Renal Scan (CT), IVP, Cystoscopy with biopsy, and Urodynamics; General MedicalTests including Chest X-ray, Electrocardiogram for asymptomatic coronary heart disease, CBC and Chemical Profile (including lipids), Urinalysis and Culture/Sensitivity toinclude acid phosphatas/prostatic specific antigen for patients over age 40, Rectosigmoidoscopy (over age 40), or colonoscopy when indicated, Abdominal sonogram;Functional and Other Evaluations to include: Psychosocial Assessment, Vocational Rehabilitation, Sexuality, Rehabilitation evaluation to include changes due to aging,Dietary and Nutritional Assessment.

2 X / Year

61

34 7/2005

Life Exp.



Life Care Plan


Replacement


D/A:



Urologist Monitor urological system$124.41

$1493Per Year

Dr. Robinson,Treating PCP; A.Zotovas, MD,Consulting PM & R,and currentschedule.

Ending

Dr. Robinson, Treating Primary CarePhysician, 7/7/05 letter indicatedUrological follow-up

Beginning Per Unit

Lower urinary tract complications include: cystitis, epididymitis, orchitis, penoscrotal abscess, penoscrotal fistula and bladder stones. Lower urinary complications may lead toupper urinary tract complications, which can cause renal failure and renal death. Urodynamics, renal scan and renal ultrasound have improved methods of assessing the patientwith a neurogenic bladder and renal function. Earlier intervention and prevention of deterioration of renal function are the benefits resulting from these tests. Both bladder andrenal calculi are still a threat to all persons with neurogenic bladders. Complications can develop in patients who do not have any signs or symptoms. Therefore, regular follow-upof the patient is of utmost importance in reducing the threat of renal damage and renal failure. Source: Jackson, A.B., M.D. Secondary Conditions of a Spinal Cord Injury.Summary in An In-Depth Analysis of Medical Disabilities by Specialists in Their Fields. August 29, 2000.

1 X per month toinclude change ofsuprapubiccatheter

62

34 7/2005

Life Exp.

Orthopedics Monitor spinal injury anddeterioration of joints. $65 - $120

$65 - $120Per Year

Andrea Zotovas,MD

Ending


63

34 7/2005

Life Exp.

Wound Care Specialist Treat and monitor woundsthen annually to monitorfor complications.

$75 - $150

Per Year

Dr. Brink, CurrentTreatingPodiatrist/WoundCare Specialist.Ending

$975 to $1,950 for 13 weeks; then$75-$150/year thereafter.

Beginning Per Unit

This recommendation is made by Dr. Brink but additionally Dr. Robinson indicated Eric has, “surprising metabolic problems for his young age. Edema withelectrolyte disturbances, anemia. Leg wounds seem traumatic as he learns to use the wheelchair but edema and possible low protein intake are effectinghealing.” For these reasons the wound care monitoring is in the plan.

1 X / week for 13weeks; thenannuallythereafter tomonitor forcomplications.

64

34 7/2005

Life Exp.



Life Care Plan


Replacement


D/A:



Laboratory Testing Monitor condition

$359Per Year

Andrea Zotovas,MD & Guidelines asnoted.

Ending

Urinalysis - $38 (2 X / year), Culture &Sensitivity - $85 (2 X / year); CBC - $33(1 X / year); Comp Metabolic $50 (1X /year); Draw fee - $15 for each blood lab.

Beginning Per Unit

The Veteran’s Administration (VA) annual exam for persons with SCI developed its list of 33 preventative procedures from research published by the U.S. Preventive ServicesTask Force (USPSTF), the Clinical Practice Guidelines published by the Consortium for Spinal Cord Medicine (CSCM), and MEDLINE, 33. General Medical Tests includingChest X-ray, Electrocardiogram for asymptomatic coronary heart disease, CBC and Chemical Profile (including lipids), Urinalysis and Culture/Sensitivity to include acidphosphatas/prostatic specific antigen for patients over age 40, Rectosigmoidoscopy (over age 40), or colonoscopy when indicated, Abdominal sonogram.

See individualtests

65

34 7/2005

Life Exp.

Renal Diagnostic Testing Monitor functioning$0 - $0

$0 - $0Per Year

Andrea Zotovas,MD

Ending

Urodynamic Studies, Renal Ultrasound,Cystoscopy - all included in theoutpatient clinic fee.

Beginning Per Unit

The Veteran’s Administration (VA) annual exam for persons with SCI developed its list of 33 preventative procedures from research published by the U.S. Preventive ServicesTask Force (USPSTF), the Clinical Practice Guidelines published by the Consortium for Spinal Cord Medicine (CSCM), and MEDLINE, 33. Urinary testing such as: Creatinineclearance, Renal Sonogram, Renal Scan (CT), IVP, Cystoscopy with biopsy, and Urodynamics.

Perceived quality of life has been directly linked to the patient's ability to independently manage bladder function and is one of the most significant issues addressed in therehabilitation inpatient and outpatient setting. Routine laboratory testing including urinalysis, based on symptomatology, and serum creatinine are helpful in the evaluation of thelower urinary tract. A person with SCI should have urodynamic testing to establish the regimen of care. This testing should be used to evaluate, periodically, for ongoingappropriateness of the management methods. Additionally, most urologists recommend a surveillance program to ensure that occult damage to the urinary system has notoccurred over time. A yearly exam is appropriate especially in the initial 3-5 years after injury. This exam can identify any neurologic changes and guide the establishment of anappropriate management pattern. After the initial post injury period, testing at 3-to 5-year intervals is recommended. Source: Horton, J., Chancellor, M., & Labatia, I. (2003).Bladder management for the evolving spinal cord injury: Options and considerations. Topics in Spinal Cord Injury Rehabilitation, 9 (1) 36-52.

See individualtests

66

34 7/2005

Life Exp.



Life Care Plan


Replacement


D/A:



MRI of the Thoracic Spine Monitor for complications$0 - $0

$0 - $0Per Year


Included in the cost of the outpatientSCI follow-up evaluations.

Beginning Per Unit

MRI for Syrinx: Classic research on syrinx (syringomyelia) indicated this was a relatively rare sequela of SCI, occurring in < 3.2% of patients. This was based on symptomaticpatients, and identification was possible only by myelography. With the advent of MRI, studies by Backe, et al indicated that routine MRI scans done showed a prevalence of asyrinx at 51% at a mean age of 15.6 years. Spasticity did correlate with the presence of a cyst. Forty-three percent of patients with a cyst had severe spasticity, compared withonly 9% of patients with no cyst. This prevalence of syrinx was 15 times higher than that reported in previous studies using myelography of symptomatic patients. The results ofthis study were consistent with those of Hussey et al, who routinely performed MRIs on their patients and found a 64% prevalence. Source: Topics in SCI Rehabilitation,Pediatric Rehabilitation; "Orthopedic Problems in the Child with SCI", Randal R. Betz, Volume 3, Number 2, Fall 1997, An Aspen Publication.Cystic Degeneration: The development of cystic cavities (syringomyelia) in the area of the injured spinal cord is fairly common. The enlargement of these cystic cavities eitherproximally or distally to the injured area is less common but may lead to neurologic changes. The neurologic examination is very important in documenting neurologic loss andrecognizing cystic degeneration as a possible complication. The CT scan with delayed myelogram or the MRI can confirm this diagnosis. Surgical shunt procedures to drain thefluid from the cystic cavity have been successful in halting the loss of neurologic functions. Source: Jackson, A.B., M.D. Secondary Conditions of a Spinal Cord Injury.Summary in An In-Depth Analysis of Medical Disabilities by Specialists in Their Fields. August 29, 2000.

1 X / Year

67

34 7/2005

Life Exp.

Dexa Bone Scan Monitor for osteoporosis$350 - $550

Per Year



68

34 7/2005

Life Exp.


Eric Henderson Future Medical Care Aggressive Treatment

Life Care Plan


Replacement


D/A:



Sperm Harvesting toincludeElectroejaculation andSperm Aspiration (ForInformation Only)

To harvest sperm toimpregnate spouse

Per Year

Based on publisheddata as noted.

Ending

The type of harvesting procedure bestsuited for Eric will need to bedetermined by his doctor.

Beginning Per Unit

The estimated cost for Sperm Harvesting is as follows: Electroejaculation done as an outpatient is estimated to cost $1,500 - $2,000. Electroejaculation done under anesthesiais estimated to cost $2,600 - $3,400. (Electroejaculation procedures may need to be repeated 2-3 times for successful harvesting). Another method of harvesting is SpermAspiration, which consists of the following procedures: Testes biopsy, physician fee, hospital charge, pathology lab work, and sperm aspiration. Estimated cost $6,800 - $7,000.After the sperm is harvested, by either method, there are fees for cryo preservation of sperm if the specimen is to be saved. An average of five samples are usually recommendedfor saving at $125 per sample, per year ($625 / year). Sperm harvesting has to be done in conjunction with artificial insemination or InVitro fertilization for impregnation to occur.

NOTE: Sexual functioning and sexual health is also an important secondary issue that must not be ignored. Men are finding success in becoming fathers using various methodsincluding electroejaculation, vibrator use to stimulate reflex ejaculation, and surgical options. Pregnancy rates have been reported at close to 30%. In a man with a cauda-equinalower motor neuron injury, there are no reflex erections. About 30% may have erotic semi-rigid erections and a slightly greater percent are considered to be able to have childrenthan those with upper motor neuron injuries. Erect-Aid can be used in conjunction with injections and/or oral medication. The injections would not typically be used with the oralmedication. Source: Jackson, A.B., M.D. Secondary Conditions of a Spinal Cord Injury. Summary in An In-Depth Analysis of Medical Disabilities by Specialists in Their Fields.August 29, 2000.

To be determined

69

To be det.

To be det.

Artificial Insemination(Alternative to InVitro)(For Information Only)

Pregnancy$1775 - $3000

Per Year


Ending

This recommendation is provided forinformation purposes, pending the needfor an evaluation to determine whattype of fertility treatment would beappropriate.

Beginning Per Unit

Estimated costs associated with each attempted insemination include: Initial evaluation, Fertility Pills and/or Fertility injections; Insemination and Ultrasounds. Total perprocedure is estimated to be $1,775 - $3,000. Average of 5 attempts could be needed before impregnation occurs. ($8,875 - $15,000 total for 5 attempts)

Average 5procedures toimpregnate

70

To be det.

To be det.

InVitro Fertilization(Alternative toInsemination) (ForInformation Only)

Pregnancy$7000 - $9000

Per Year


Ending

$32,000 - $48,000 for 4-6 procedures.Beginning Per UnitAverage 4-6procedures toimpregnate

71

To be det.

To be det.


Eric Henderson Transportation

Life Care Plan


Replacement


D/A:



Adapted Van withWheelchair Lift and HandControls

Transportation

Per Year


Ending

Specific cost cannot be indicated untilan evaluation is done. Estimate:$45,000-$50,200 for drivingadaptations, tie down, raised roof, andlift (minivan).

Beginning Per Unit

NOTE: Trade-in value to be determined by economist. For information purposes, the average cost of a typical family car in the U.S. is $27,550 (2003 dollars). This should besubtracted from the price of the van.

The costs associated with modifying a vehicle vary greatly. A new vehicle modified with adaptive equipment can cost from $20,000 for a paraplegic, up to $80,000 for aquadriplegic. Modifications to a van for a simple wheelchair driver with no high tech equipment may cost $18,000 to $20,000. Sources: Pierce, Susan L., OTR, CDRS; AComprehensive Approach to Transportation Assessment. A Guide to Rehabilitation, AHAB Press, Inc., Pub. 559 R. 14 8/99. Chapter 6C, p. 6C.01-6C.10. NHTSA AdaptingMotor Vehicles For People With Disabilities. http://www.nhtsa.dot.gov/cars/rule/adaptive/brochure/brochure.html Drive Master. User Friendly Electronic Driving Aids For The"90’S" http://www.drivemaster.net/edriveaids.htm

1 X / 5-7 Years

72

34 7/2005

Life Exp.

Adapted EquipmentMaintenance

Maintain equipment

$300 - $400Per Year


Ending

Per year allowance incurred every yearexcept new van purchase years.


73

35 7/2006

Life Exp.

American AutoAssociation (AAA)

Emergency roadsideassistance

$56 - $78Per Year


Ending

Beginning Per UnitAnnualmembership

74

34 7/2005

Life Exp.


Eric Henderson Architectural Renovation(s)

Life Care Plan


Replacement


D/A:



ArchitecturalRenovations to makehome Accessible

Accessibility$50000

Per Year


Ending

Beginning Per Unit

Modifications/Architectural Renovations, according to Moreo Brothers, includes the following:Minimal modifications can average $6,000 - $10,000. This would include: Roll-in shower, personal shower head with 6' hose, anti-scald device, grab bars, handicaptoilet, slip-resistant floor tile and 36" doorway. More extensive modifications can average $8,000 - $14,000. This would include the above items plus: Enlargementof bathroom size to accommodate wheelchair turning radius (best accomplished if a walk-in closet adjoins the bathroom), roll-under vanity sink with lever or single-pull faucets,lowered mirror over the sink, insulated pipes to prevent leg burns, additional lighting, accessible towel bars, soap dish and toilet paper dispenser. Accessible design that isimplemented at the time architectural plans are drawn for a single-family home can be provided in a cost-effective manner that is also aesthetically appropriate. For example, newsingle-family home blueprints can include 36" doorways with lever handle hardware; support backing placed in the walls of bathrooms for present/future grab bars; low-inclineconcrete walkways to eliminate steps at the front & rear entries; accessible electrical switches & lighting; curbless, roll-in showers; and other significantly important accessibilityfeatures for the existing or potential needs of homeowners. On average, the cost to build a fully accessible single-family home in the U.S. is approximately8% - 12% of the total cost of "standard" construction.(1) Moreo, James, Moreo Construction, 1820 SW 100 Ave., Miramar, FL 33025 (954) 432-4999,(2) Moreo, Nick, Moreo Construction, 130 NW 72nd Terrace, Pembroke Pines, FL 33024 (954) 435-6749,(3) Moreo, Roy, Moreo Construction, 46 Meadow Lake Circle N., Lake Placid, FL 33852 (941) 699-5968An additional source to use, and one which should be used by the economist if no specific house evaluation has been accomplished, is the$50,000 grant the Department of Veteran’s Affairs allows for accessibility requirements for disabled veterans.

1 X Only

75

34 7/2005

34 7/2005


Eric Henderson Leisure Time/Recreational

Life Care Plan


Replacement


D/A:



Gym Membership Therapeutic exercise

Per Year


Ending

$75 - $99 one time only enrollment fee;then $40 - $54 / month thereafter.

Beginning Per Unit

The implementation of an exercise plan has many benefits including increased oxygen availability. In addition, an exercise plan can help improve transfers and mobility, whichmay contribute to better weight shifts and bed positioning. Source: McDonald, H. Preventing pressure ulcers: Consider causative factors and a preventative regimen whenaddressing the probability of pressure ulcers in patients with spinal cord injuries. Long- Term Rehab, 40-46.

Annualmembership fee

76

34 7/2005

70 2040


paul m. deutsch & associates, p.a. life care plan …...eric henderson projected evaluations...

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