Many spinal cord injury survivors require personal care assistance for activities they can no longer perform independently. Attendant care costs often represent the largest component of lifetime damages, potentially exceeding medical expenses.

What Attendant Care Covers

Activities of Daily Living (ADLs)

  • Bathing and personal hygiene
  • Dressing
  • Eating—feeding assistance if needed
  • Toileting—catheterization, bowel programs
  • Transfers—bed to wheelchair, wheelchair to car
  • Mobility—positioning, wheelchair assistance

Instrumental Activities

  • Meal preparation
  • Housekeeping
  • Laundry
  • Transportation
  • Medication management
  • Communication assistance

Medical Care

Higher-level injuries may require skilled care:

  • Respiratory management—suctioning, ventilator care
  • Wound care
  • Medication administration
  • Monitoring for complications

Hours of Care Needed

High Quadriplegia (C1-C4)

Typically requires 24-hour care:

  • Cannot perform any ADLs independently
  • Ventilator-dependent individuals need constant monitoring
  • Requires skilled nursing for respiratory care
  • May need awake overnight care for positioning and emergencies

Low Quadriplegia (C5-C8)

Typically requires 8-16 hours of care daily:

  • Needs help with most ADLs
  • May have some independence during day
  • Typically needs help with morning and evening routines
  • May need overnight availability

Paraplegia

Typically requires 0-8 hours of care daily:

  • Many paraplegics achieve significant independence
  • May need help with bathing, transfers, housekeeping
  • Higher paraplegia requires more assistance

Types of Caregivers

Family Caregivers

Family members often provide care, but their services have compensable value:

  • Value calculated at replacement cost—what hiring help would cost
  • Family caregivers deserve compensation even without out-of-pocket cost
  • May burn out without paid relief help

Personal Care Assistants (PCAs)

Unskilled caregivers who assist with daily living:

  • Hourly rates: $15-25/hour depending on location
  • Most common type of attendant care
  • Can be hired through agencies or privately

Home Health Aides

Trained aides with some medical skills:

  • Hourly rates: $20-30/hour
  • Can assist with some medical tasks
  • Supervised by nurses

Licensed Practical/Vocational Nurses (LPN/LVN)

Nurses who can provide skilled care:

  • Hourly rates: $25-40/hour
  • Can perform most nursing tasks
  • Often used for ventilator patients

Registered Nurses (RN)

Required for complex medical needs:

  • Hourly rates: $35-60+/hour
  • Full nursing scope of practice
  • Supervisory role over other caregivers

Calculating Lifetime Attendant Care Costs

Hourly Need × Hours Per Day × Days Per Year × Years of Life Expectancy

Example calculation for C4 quadriplegic:

  • 24 hours/day × 365 days/year = 8,760 hours annually
  • Mix of care: 8 hrs skilled ($35/hr) + 16 hrs PCA ($20/hr)
  • Daily cost: $280 + $320 = $600/day
  • Annual cost: $219,000
  • 30-year life expectancy: $6.5+ million (before present value reduction)

Present Value Calculation

Future attendant care costs are reduced to present value, accounting for:

  • Expected wage inflation for caregivers
  • Discount rate for invested funds
  • Life expectancy projections

Life Care Plan Documentation

A life care planner documents attendant care needs:

  • Specific hours needed based on functional assessment
  • Type of caregiver required for each task
  • Local wage rates for each caregiver type
  • Projected cost through life expectancy

Challenges in Attendant Care Cases

Defense Arguments

Defendants often try to minimize care needs:

  • Arguing family can provide care (ignoring burn-out)
  • Claiming less skilled care is sufficient
  • Disputing hours needed
  • Using lower wage rates than realistic

Counterarguments

  • Family caregiver burnout is well-documented—paid help is necessary
  • Safety requires appropriate skill levels
  • Functional assessments document actual needs
  • Local wage surveys prove actual rates

Conclusion

Attendant care costs for spinal cord injuries can exceed all other damages combined. Proper documentation through life care planning is essential to ensure compensation covers the personal assistance you'll need for the rest of your life.