Tackling Life Expectancy in Life Care Planning
According to The International Association of Rehabilitation Professionals (IARP), life care planners evaluate individuals with disabilities or chronic health conditions to quantify the needs created by the disability or medical condition. The life care planner then develops an integrated plan that includes items and services required and the specific costs associated with these items and services.
According to the Life Care Planning and Case Management Handbook[1], “to accurately project lifetime daily, medical and rehabilitative care in a life care plan, an accurate prediction of life expectancy is needed.” However, there are no requirements in our standards of practice suggesting life care planners must calculate the actual costs through life expectancy. To calculate lifetime costs, a life expectancy and years of residual life must be selected to sum annual costs. Some life care planners independently provide a modified life expectancy based on the opinions of physicians or make assumptions using other resources. According to the IARP Code of Ethics, assuming invalid representations of fact, or altering the methodology or process without foundation or compelling reason, is unethical and could lead to inadequate funding for future resources.
When asked to comment on life expectancy, one option for life care planners is to use data from published reports such as the National Vital Statistics System. The Centers for Disease Control and Prevention (CDC) typically publishes this data annually. However, it is important to note that the most recent version (2022) is based on data collected from 2019 (each chart generally is two to three years behind due to data collection and research). These charts report life expectancy for the total United States population and life tables for males, females, and different races and ethnicities. Should a physician be unable to comment on the remaining years of life, life care planners can offer the option of using the least restrictive demographic category of male versus female from these charts as a courtesy to referral sources. Then the life care planner can provide the referral source with an estimate of lifetime costs before an economist adjusts the figures to present value.
Choosing a more specific life expectancy based on race, ethnicity, geography, co-morbidities, etc., requires the life care planner to make independent assumptions that could drastically impact the final lifetime costs. Therefore, we believe it is best to offer the least restrictive, binary male versus female life expectancies when this is requested. For example, what if an evaluee is of mixed race, has a history of heart disease, or is a smoker? These additional demographics and specific variables require assumptions that may not reach the more probable than not including criteria for life care planning. Furthermore, these assumptions may require medical opinions outside the scope of many life care planners.
[1] Weed, R. O., & Berens, D. E. (2019). Life Care Planning and Case Management Handbook (4th ed.). Abingdon, UK: Routledge Press.