Attendant care is usually the largest category in a catastrophic life care plan. The planner specifies the level of care, the hours across the day and week, the basis for those hours, the agency or private-hire rate in the person's market, how family-provided care is treated, and respite for the caregivers. Each of those choices is tested in a rebuttal, so each is documented.
A wheelchair is replaced every few years. Attendant care recurs every day. For a person with a high-level spinal cord injury, a severe brain injury, or cerebral palsy with significant motor involvement, the cost of the people who provide daily assistance and supervision typically exceeds every other category combined. Small differences in hours or rate compound over decades, which is why attendant care receives the closest scrutiny from opposing experts and why the planner's documentation must be complete.
The plan states the level of care required, because the level determines who can provide it and what it costs. The common levels are companion or supervisory care for a person who is physically able but cannot be left alone safely because of cognitive or behavioral impairment; personal care or home health aide assistance for hands-on help with bathing, dressing, transfers, toileting, and feeding; licensed practical or vocational nursing for delegated skilled tasks such as medication administration, tube feeding, and routine catheter or wound care; and registered nursing for ventilator management, complex assessment, and unstable medical conditions. Many plans specify more than one level across the day, for example aide-level care for morning and evening routines and supervisory care in between. The level is a medical determination: the planner documents the treating provider's statement of what the person needs and matches the level to it.
Hours are built from the person's day, not assumed. The planner documents the person's function from the record and, where possible, from direct observation in the home: what assistance is needed to get up, bathe, dress, eat, toilet, transfer, and get to bed; whether the person can be left alone and for how long; what happens overnight; and what changes on days with appointments or therapy. From that the planner constructs a schedule across the 24-hour day and the 7-day week, distinguishing active hands-on hours from supervisory presence and identifying whether overnight care is awake or asleep. The treating physician or therapist confirms the level and the general scope of hours. For a person who cannot be left alone, the plan will often show continuous coverage, and the planner should say so directly rather than presenting a partial schedule and leaving the gap unexplained.
The same hour of aide care costs more through a licensed agency than through a directly employed caregiver, because the agency rate carries recruitment, supervision, training, insurance, payroll taxes, and coverage for absences. The plan states which basis it uses and why. Agency rates are appropriate when the family cannot realistically act as an employer, when skilled care is needed, or when reliable coverage for absences matters. Private-hire rates are appropriate when the family can manage employment and the plan accounts for the employer's costs, including payroll taxes, workers' compensation coverage, and backup coverage, rather than quoting a bare hourly wage. Rates are researched in the person's own market from agencies and, where applicable, state rate schedules, and the source and date of each are recorded as described in the cost research methodology.
Most catastrophically injured people receive substantial care from family members, and the plan must address it honestly. The planner documents what the family currently provides and at what cost to the family members' own health, employment, and sleep. The plan then projects care at the level and hours the treating team supports, priced as paid care, because family members age, become ill, and cannot be assumed to provide skilled or continuous care indefinitely. Whether family-provided care is compensable, and at what rate, is a legal question that varies by jurisdiction; the plan gives counsel the hours and the market rate so the legal question can be answered, and it identifies separately any period during which the plan assumes family care will continue.
Where the plan relies on family care for any period, it includes respite: paid coverage that gives the family caregivers scheduled relief. Respite is specified as hours or days per period at the appropriate level of care and priced at the applicable rate. Its purpose is to keep the family-care assumption realistic. A plan that projects a parent providing care for years without relief is projecting a schedule no one can sustain, and an opposing reviewer will say so.
The work file for attendant care contains the functional basis for the hours, the provider statements supporting the level, the observed daily schedule where an evaluation was performed, the rate quotes with agency names and dates, and the reasoning for the agency or private-hire choice. Because needs change with age and condition and rates change with the local care market, attendant care is re-examined at every plan update. In pediatric plans it is restated at each developmental stage, as described in the pediatric guide. The rebuttal guide lists the questions an opposing reviewer will ask of each of these elements.
The level of care is a medical determination documented by the treating provider. The hours are built by the planner from the person's documented function and daily routine, confirmed against the provider's statement of need.
It depends on the level of care, the family's ability to act as an employer, and the need for reliable coverage. The plan states the basis chosen and why, and prices private-hire care with employer costs included rather than as a bare wage.
The plan documents family-provided care and projects the same care at market rates for the period the treating team supports it, because family care cannot be assumed to continue indefinitely. Whether it is compensable is a legal question for counsel.
No. The plan distinguishes awake overnight care, needed when the person requires turning, suctioning, or supervision during the night, from asleep or on-call presence. The two are priced differently.