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How Life Care Planners Determine the Need for Home Healthcare in Personal Injury Cases
A practical, real‑world look at what goes into these decisions
As a personal injury attorney you have probably seen many life care plans. So you know one thing jumps out immediately: home healthcare is often one of the biggest expenses. With costs for skilled nursing, home health aides, homemaker services, and in home therapies, the costs per week or month can be substantial. Because these services can continue for years, or even a lifetime, the limit recommendations for home healthcare to care that is medically necessary and needed due to the injury that is the subject of the personal injury case.
As with all services in a life care plan, the expert should document a reasonable basis for recommended home healthcare services. This blog will discuss how life care planners should determine and document what type of home healthcare services are needed due to the injury and the reasonable frequency and duration of each service. Let’s walk through the process in an easy-to-understand way.
Why the First Step Is Always Understanding the Person
Before any recommendations are made, a life care planner examines the person’s medical history, current medical status, and functional abilities. This isn’t just about reading charts, it’s about understanding:
- What could the person do or not do before the injury or illness?
- What can they do now?
- What changed, and why?
- How does aging, treatment, and their specific condition change these needs over time?
Physical and cognitive function covers everything from brushing teeth to climbing stairs or managing a full workday. Medical records help, but they often include subjective information. That’s why best‑practice guidelines strongly encourage in‑person interviews and direct observation.
Nothing replaces seeing someone in their home environment and interviewing them and those they live with. A life care planner can learn a lot by watching how a person moves through their space, what slows them down, and what could make their life easier.
Why Doctors Don’t Determine Nursing Hours
This surprises many people: even though a physician may recommend that someone needs home healthcare, they are not the one who determines the number of hours or type of personnel needed.
Doctors diagnose and treat.
Nurses provide direct patient care and assess care needs to establish nursing practice guidelines.[1]
Life care planners translate those needs into recommendations and estimated costs.
That said, if a treating provider, physician, or nurse has completed a home assessment or used a structured tool, that input can be extremely helpful in creating the life care plan.
The Tools That Bring Objectivity to the Process
Life care planners should not rely on guesswork. They should use standardized tools to measure physical and cognitive function. A few examples are:
- Katz Index of Independence in Activities of Daily Living (ADLs)[2],[3]
- Lawton–Brody Instrumental ADL Scale[4]
- Observed and Objective Measures of Physical Function Algorithm (OOMPF)[5]
These tools help answer questions like:
- Can the person bathe and dress independently?
- How safely do they move around indoors?
- Can they manage stairs?
- Do they need help with cooking, shopping, transportation, or managing medications?
- How is their functional cognition?
Objective data used in life care planning makes recommendations stronger, clearer, and easier to defend.
Home Healthcare Models Are Changing Fast
Life care planners often include a home‑based option as an alternative to residential or nursing facilities because many individuals prefer to remain in their home if possible. But recommendations must reflect what is reasonably available in the person’s geographic area.
Because life care plans in personal injury cases are not limited by Medicare or private insurance criteria, it is important to understand the services that may be available. The range of home‑based care is expanding rapidly, and life care plans may include:
- Hospital‑level care at home
- Skilled nursing care at home
- Home- and community‑based services
- Hospice and palliative care
- Personal assistance services
The Needs Assessment: Where Everything Comes Together
Once the life care planner understands the person’s abilities, limitations, and environment, the next step is determining what types of personnel are needed. These may include:
- Registered nurse (RN)
- Licensed vocational nurse/licensed practical nurse (LVN/LPN)
- Personal care assistant (PCA)
- Homemaker or housekeeping services
- Transportation services
- Adult/pediatric day programs
State nursing board guidelines and rehabilitation experts help ensure that recommendations are reasonable and within scope of practice.
Staying Within Scope: What Life Care Planners Can Recommend
Life care planners of any professional discipline can assess physical function, including strength, range of motion, balance, and sometimes endurance, through tools like the OOMPF which help make assessments more objective and reliable.
They can also recommend non‑medical services, such as:
- Housekeeping or lawn care
- Non‑skilled attendant care
- Transportation
- Home modifications
- Basic safety equipment (grab bars, non‑slip mats, elevated toilet seats, handheld showers)
These home healthcare recommendations often make a huge difference in a person’s day‑to‑day safety and independence.
Life care planners may only recommend services within their professional licensure and scope of practice. However, it may be reasonable for a life care planner to consider a home assessment by a physical or occupational therapist to help determine a person’s level of physical and cognitive function and independence, or to identify additional services that may benefit them.
Final Thoughts
Determining home healthcare needs, including the type, amount, and duration, is not just about checking boxes or following a formula. It is a thoughtful, structured process that combines medical information, functional assessment, home observation, and objective tools. When done well, it ensures a person receives the right services —neither too little nor too much—so they can live as safely and independently as possible. It also allows the life care planner to confidently defend their opinion on home healthcare needs in a forensic setting, if necessary.
[1] American Nurses Association, What is Nursing, https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/, accessed on January 19, 2026.
[2] National Library of Medicine, Activities of Daily Living, https://www.ncbi.nlm.nih.gov/books/NBK470404/, accessed on January 19, 2025.
[3] Best Practices in Nursing Care to Older Adults, Katz Index of Independence in Activities of Daily Living (ADL), https://hign.org/sites/default/files/2020-06/Try_This_General_Assessment_2.pdf, accessed on January 19, 2026.
[4] Best Practices in Nursing Care to Older Adults, The Lawton Instrumental Activities of Daily Living (IADL) Scale, https://geriatrictoolkit.missouri.edu/funct/Lawton_IADL.pdf, accessed on January 19, 2026.
[5] Journal of Life Care Planning, Establishing a Basis for Supportive Care Recommendations in a Life Care Plan Utilizing the Observed and Objective Measures of Physical Function Algorithm (OOMPFA),https://jlcp.scholasticahq.com/article/151659-establishing-a-basis-for-supportive-care-recommendations-in-a-life-care-plan-utilizing-the-observed-and-objective-measures-of-physical-function-algori, accessed on January 19, 2026.
Read the full The Reasonable Charge for Home Health Care In Life Care Plans White Paper
Calculate the private-hire cost of home health care by state or metropolitan statistical area and provider type by using RPC’s Home Health Cost Calculator