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Ongoing care 
The provision of care and support is essential in the plan for life. This element of the claim is almost always the most substantial one in financial terms and it is essential to get it right.
Care options
Care and support can take many different forms and families should not be put off by the fear that it carries sinister implications. In cases of tetraplegia, there will be an obvious need for extensive care, but the same does not necessarily follow for patients who are paraplegic. First of all, there can be enormous variation in the level of disability and handicap, so that people of similar age with the same level of lesion may cope differently. Secondly, people have very different attitudes to care; some insist on struggling against adversity despite the hardships, whereas others are more readily able to accept the need for support.
There are many different support solutions dependent on the injured person and their family's needs. If a person needs 24 hour care, it is obvious the family will not be able to supply that care and professional care will be bought in from the outside. Care can range from a few hours a week of domestic help to do the jobs around the house which the injured person can no longer do, to a 24 hour, 7 day care regime involving a team of carers and case management costing up to £3,000,000 a year.
Case management
A specialised aspect of care is case management which provides assistance to the injured person and his or her family in managing all the problems and eventualities which are likely to arise following severe injury. It is more common in severe brain injury, but can also be appropriate in relation to other types of severe injury including spinal cord injury.
What is required is a health professional (e.g. nurse, occupational therapist, psychologist) with significant experience of the care and management of people who have sustained the type of injury under consideration. It is now well recognised as being desirable in appropriate cases and a good case manager, instructed at an early stage, is likely to make a real difference to the injured person and his or her family.
Family care vs professional care
The starting point for many families is that they will look after the injured person for as long as necessary as they have already been closely involved in the case proceedings in the days and weeks following the accident. It is important however that families keep an open mind. Knowledgeable experts and lawyers will all agree that there is an increased burden on family carers and the time may come when they can no longer manage, either because of stress caused by the burden of care or simply due to the effect of increasing age.
This emphasises that it may be important to relive the burden on the family, possibly by the use of professional support workers.
A suitable care and support package for a person suffering severe brain or spinal cord damage would include the parents, spouse, partner or other relevant members of the family, acting in a family role not as full-time carers. They would be what I would see as the overall supervisors, in the sense that, seeing the patient in the ordinary course of family contact, they would be able to see how things are going, whether the support workers seem to be managing appropriately and that everything is working well. If and when there were any problems, which there are almost bound to be, the family would be able, having discussed things with the injured person in appropriate cases, to ask the case manager to investigate and solve the problems. In addition to being on call in that way, the case manager would be in regular contact with the injured person (weekly, monthly or longer, depending on circumstances), and would be constantly monitoring the carers.
Issues involved in professional care
The provision of care and support for an injured person is often difficult and it may be important to relieve the burden on the family if one can, possibly by the use of professional support workers.
The nature and extent of the injury will dictate the nature of the package, coupled with the considered wishes of the injured person and the family. Taking severe brain injury as an example, there may be various behavioural problems which make caring especially difficult, such as inability to control temper, lack of inhibition, inappropriate sexual behaviour, loss of motivation, and the all-pervading memory loss. These features make it very awkward for support workers to manage the injured person in a way which is satisfactory to both sides. It frequently happens that the injured person has numerous complaints about the carers; sometimes they are justified, because it is hard to find carers with sufficient experience and compassion to tolerate challenging behaviour. Sometimes, the insight of the injured person will be deficient, and he or she will fail to realise how impossible their behaviour is.
There is frequently a high turnover of carers. As a result, recruitment and training have to be built into the care package, because they are expensive and time consuming. The client may need professional help (i.e. the case manager) to make sure that suitable support workers are employed.
Care and accommodation
The arrangement of care can have an important effect on accommodation. To take the most extreme case, namely the person who needs one or two support workers 24 hours a day, plus extra help, that is bound to dictate a larger house, possibly with a suite of rooms for the carers. If the house is still the family's house, it is important that the family should not be overwhelmed by the carers, because it is intrusive to have strangers in your kitchen, bathroom and living rooms all day, every day. If 24 hour, 7 day care is necessary, it is likely that there will be at least two carers working each week (no-one can be expected to work 24 hours, 7 days), and therefore it is possible that there will need to be two carers‟ bedrooms, plus a kitchen, sitting room and bathroom for them.
