PD400 class 1, 2, 3, 4 Flashcards

Question

figure out the TAX WRITE OFFS

Answer 1

investing GST and earning interest before paying it out to CRA

Answer 2

someone who has experience with HCP ask other RMTs --> ask them who they use as an accountant ask for multiple opinions from multiple accountants (?)

Answer 3

laundry services e.g. 3700/year (308/mo)

Answer 4

you have to read the contract carefully, because the contracts be very different, and price reflects differences

Answer 5

to avoid this, employer can avoid supplying everything E.g. Oil But supplies: laundry, reception, billing, etc.

Answer 6

(?) employee gets to keep the entire charged fee ---> But they pay rent to clinic owner ---> owner may supply things like laundry, billing, reception, etc. -- RMT brings oil ---> However, not all owners will provide all of this ----> some owners will require RMT to do more ---> But in this case, clinic/reception will take care of providing clients/patients for RMT VS. Employee ---> Employee receives a percentage of the charged fee --> But they don't pay rent to owner (E.g. 70/30, or 60/40 split) ---> Generally speaking everything is provided to the RMT

Answer 7

Commercial Real Estate Sales and Leasing usually attracts the Type A personality, often with Bachelor of Commerce Degree and in the higher levels of Corporate Realty an MBA is a requirement.

Answer 8

Agents in Commercial Corporate Firms are mentored for a long time and start as assistants to more experienced agents, often given the grunt work and will do the bulk of the showings, enquiries and weeding out of leads.

Answer 9

Residential Realtors often start careers with minimum educational requirements, usually 6 month course with 6 month post-licensing training as required by the BCFSA. The personality types most often attracted to residential are much more the “Touchy Feely” people, most are focused only on residential sales helping buyers and sellers. 

Answer 10

Work in teams, at a larger Corporate Brokerage with Jr. Agent qualifying all prospects May or may not be a Member of a Real Estate Board Are Licensed and Bound by the Standards of Practice of the British Columbia Financial Services Authority (BCFSA)

Answer 11

Location – why that location Budget - with financing in place Business Plan Partnership or Incorporation Docs Avail Understanding of physical requirements Understanding of leasing jargon Other professionals engaged such as Lawyers & Accountants

Answer 12

Usually works independently, under the umbrella of a brokerage ( ie Oakwyn) Usually focuses on a specific geographic area or neighbourhood Can be a specialist for types of properties, such as Condos, Detached homes Could work for a Developer on a Sales team at a pre-sale showroom, instead of in Re-Sale property Majority of Re-Sale agents are members of the Real Estate Board in their area. Are Licensed and Bound by the Standards of Practice of British Columbia Financial Services Authority (BCFSA)

Answer 13

Commercial Tenancy is only governed by Contract Law – there is no consumer advocate ! It is highly suggested you engage a commercial real estate lawyer to review any leases prior to signing There is a somewhat standard offer to lease, they can run 20-50 pages.

Answer 14

If you have an issue with conduct of a Commercial Realtor you can lodge a complaint with BCFSA

Answer 15

Residential Tenancies are governed under the Residential Tenancy Act of BC under the Ministry of Municipal Affairs & Housing If a property is managed by a Licensee you have recourse with both the BCFSA and Residential Tenancy Branch If you have issue with Landlord, can deal with RTB directly Must use the standard forms to be enforceable – RT lease is 6 pages plus any addendums for included items or terms outside of the standard terms.

Answer 16

One of the fundamental aspects of a commercial lease is the ability to register a lease of 5 years or more against the Title of the property.

Answer 17

All properties are identified by a unique 9 digit number called the Property Identification Number (PID) at the Land Title Registry of BC.

Answer 18

Title – shows who is the Registered Owner of the Property and any Charges which may affect dealings in the property such as Mortgages, Liens, Judgments, Easements or Statutory Rights of Way and Leases of more than 5 years !

Answer 19

This is important as it means the building you establish your business in can not be sold without your knowledge and your lease should have provisions for compensation for breaking the lease early or assumption of lease and notice to existing tenants of a change of ownership of the building.

Answer 20

Commercial Rental Rates are often calculated and expressed based on the Total Area of the property such as $28/sqft.

Answer 21

The Sq Ft of the property is the convention but most legal documents such as site surveys and architectural drawings will refer to Square meters 

Answer 22

base rent (E.g. $28/Sqft -- annual rate) leasable area (e.g. 1000 sqft) common area costs (e.g. $12/Sqft) property tax ($12,000) ---> $4,333.00

Answer 23

A triple net lease (NNN) assigns sole responsibility to the tenant for all costs relating to the asset being leased, in addition to rent. "Triple net refers to leases where a tenant rents an entire freestanding commercial building and pays for all property expenses."

Answer 24

lower lease rate in first years, get higher in later years (incentive to business owner to have less burden in initial years of business?) (alternatively, just to keep up with inflation)

Answer 25

An excellent website for easy to understand Commercial Real Estate information is at https://www.bdc.ca

Answer 26

Your costs on top of base rent. These can include property tax, insurance, utilities, maintenance, common area costs and repairs.

Answer 27

An incidental expense in some commercial real estate leases. All tenants generally share common area costs. Examples include fees for snow removal, janitorial services, landscaping, grass cutting and property management.

Answer 28

A type of commercial real estate lease under which you pay a single amount to the landlord that covers base rent and all incidental expenses.

Answer 29

A type of a commercial real estate lease under which you and the landlord share certain incidental expenses.

Answer 30

A type of commercial real estate lease under which you typically pay for one incidental expense directly. In a single net lease, you usually pay the base rent plus property taxes (though in some cases, you might pay for insurance or utilities instead). The landlord pays all other expenses.

Answer 31

A type of commercial real estate lease under which you usually pay the base rent plus two incidentals—for example, property taxes and insurance. The landlord covers all other expenses

Answer 32

A type of commercial real estate lease under which you typically pay the base rent, plus property taxes, building insurance and utilities, as well as other operating and maintenance costs. The landlord assumes no costs, other than those for structural repairs.

Answer 33

A type of commercial real estate lease under which you pay a base rent plus a percentage of gross sales over a certain minimum. These are usually used in malls and other multi-tenant retail locations.

Answer 34

A cash amount offered by a landlord to help you pay for renovations to a leased space. The allowance is usually a certain amount of money per square foot of rented space. It is sometimes offered as a tenant inducement.

Answer 35

Incentives offered by a landlord to encourage you to rent a space. Examples include several months rent free or help with paying for leasehold improvements.

Answer 36

Items in a leased space that you can take with you when you move out. A trade fixture can generally be easily removed without damaging the property. Examples include furniture, inventory and computers. Get advice from a commercial real estate lawyer before signing a lease to clearly define trade fixtures and to seek exclusions for assets you want to take with you when you leave.

Answer 37

Renovations that a landlord carries out at your request when you sign a lease. A landlord may agree to these as a tenant inducement.

Answer 38

Renovations to a leased commercial real estate space to make it suitable for your business. Unless otherwise specified in the lease, any improvement that is attached to the building usually becomes the property of the landlord—meaning you can’t take it with you when you move out. E.g. Examples can include machinery, flooring and built-in shelving. Get advice from a commercial real estate lawyer when negotiating a lease to seek exclusions for assets that you want to take with you when you leave.

Answer 39

If necessary, you can always apply for a leasehold improvement loan, a short-term loan (often amortized over five or six years) that you can use to pay for renovations to a leased space. You can sometimes negotiate a principal holiday for the first six to 12 months of the loan. Depending on the value of the improvement, a bank may accept the improvement as collateral for the loan, which could result in a lower interest rate than that for an unsecured loan.

Answer 40

The principal payment holiday concerns principal instalments only of amortising loans or leases granted to performing borrowers, and is granted for a period no longer than 12 months depending on the product type. Any principal instalments that fall due during the payment holiday are paid at a future date.

Answer 41

something pledged as security for repayment of a loan, to be forfeited in the event of a default.

Answer 42

Amortization – A stream of Payments over time - ie: mortgage with an interest rate for the “Use of the Money” for a specified time period

Answer 43

after the stream of payments the debt is zero

Answer 44

after the stream of payments there is an outstanding balance owning (sp.??? owing?)

Answer 45

the amount lent

Answer 46

the user fee for the $$ -- I.e. 3.4% per annum, compounded quarterly

Answer 47

annual, monthly, bi-monthly

Answer 48

what secures the loan --- what creditors can take from you if you Default on your payments

Answer 49

could put a lien on your house --- Best to "incorporate" your business -- may not absolve you from being personally liable for the debts of the Business

Answer 50

no collateral for loan

Answer 51

the decrease in Value of an Asset over Time. Buildings are considered fully depreciated at 40 years, even if they have a long economic life left in them

Answer 52

(the amount of depreciation you can claim on your taxes for an asset is less and less over time until fully depreciated)

Answer 53

These types of spaces are typically loft type condos that are specifically zoned to be able to have a business license associated with address. Each municipality has specific zoning requirements. Many sole practitioners find this a dual investment as they can live and operate the business out of the same location while building equity in real estate that they own. Many investors have bought into these types of developments and rent out these spaces as well.

Answer 54

This type of space has become more popular in the last 20 years. These are located in office buildings in many of the commercial districts of the lower mainland. The advantages are also that you can build equity in real estate, have more control over your improvements and the long term stability of growing a business knowing what your overhead is going to be based on a mortgage and not a lease. You can sometimes find these spaces for lease from the owner.

Answer 55

The costs for this type of location are quite high in established commercial districts. In the suburbs you may still find a reasonable rental rate in an older strip mall or shopping center. You may be governed by specific hours of operation and tenant improvement fees for changing signage, this is often negotiated.

Answer 56

The obvious choice – rents vary greatly and the vacancy rates in most of these buildings are currently low – with average rates being $50-$75 sq. ft.

Answer 57

This might be a good choice if you want to start small and have the ability to expand – or if you want to have a full service facility without the overhead. They usually have a reception area, a receptionist that will answer a phone with your specific business name. Often there is a lunch room, washrooms, conference room, and opportunity to have cross promotions with other businesses. May be more suitable for a consultative practice as these spaces are often small. Monthly rates range from $500-$1500 depending on the size of the office and services chosen.

Answer 58

Simplest/Easiest arrangements. You work for someone else. You are classified as an employee and are protected and supported by BC labor laws

Answer 59

Simple. You have set hours, set days, holidays. You show up to work, you are paid an hourly wage, and bonuses if any You get vacation pay, taxes deducted, CPP, EI You may/may not get health benefits, Life, Critical Illness (CI), Travel medical (Usually) You don’t worry about marketing, promotions, costs of business cards, uniforms, oils, supplies, etc. You are protected by the terms of a contract that govern your employment (ie. Employer can’t change things on you that are contrary to the terms of the contract) You work, you go home, you get your weekends/days off. Pretty sweet. When the toilet paper runs out, it’s not your problem. It’s someone else’s.

Answer 60

You don’t make very much. Not even close to RMT’s that work for self or run a practice. You are often paid a sub-standard rate with very little room to move up or improve. You are bound by a contract and must adhere to owner’s/business’s work policies (holidays, dress code, etc). Ie, if you don’t like something or don’t agree with something, you don’t really have a choice You have to get vacation and holidays approved ahead of time (ie. You can’t just go away for 3 weeks if you wanted to) You can’t just ad hoc change things regarding your employment. --> Days worked --> Pay --> Vacation No tax write offs. That dinner you had, that trip you took? That seminar…. nada If you miss too many days, you can be terminated If you underperform, you can be terminated If they don’t like you, feel threatened by you, or have a change in heart, you can be terminated.

Answer 61

Also known as sole proprietor or independent contractor You are basically running a business within a business.

Answer 62

For example. Mr. RMT is renting a space at Columbia Integrated Health Centre. (CIHC) Mr. RMT pays a flat rate rent for usage of the room or a percentage of billings which represents that rent. Patients perceive Mr. RMT as a therapist at CIHC. Mr. RMT generates income, collects GST, remits GST, pays himself, incurs expenses, has tax write offs etc.,. All of this is under the company name of ”Massages “R” Us”. (owned by Mr. RMT) Mr. RMT is an independent contractor/sole proprietor that is running a massage therapy business called Massages R us located at CIHC.

Answer 63

Therapists potentially make way more money than employees The harder you work, the more $ you make You make more per hour Therapists have more say and input into their practice Therapists have more freedom to dictate their holidays, days and hours Therapists now have multiple tax write off opportunities Less chance of being terminated You are an entrepreneur and officially a business person

Answer 64

Work more hours that don’t generate income. Ie, paperwork, marketing, meetings, errands, supply runs, etc.. If you don’t work, you don’t get paid. That holiday you take for 4 weeks… well, you’re not making any money You need to spend time and money on lawyers, accountants, book-keepers, Insurance, to support your business. Meetings, phone calls, etc… You need to spend money on supplies, seminars, insurance, Extra level of stress. Guaranteed!

Answer 65

Very similar in structure to a sole proprietor and independent contractor however YOU are the boss, and YOU wear all the hats. Comes with all the benefits of the Independent contractor There is no personal liability. Ie you are protected from being sued personally You have the benefit of a lower tax rate for corporations than sole proprietors You have access to professional support systems such as: ---> CFIB ---> Chambers of commerce ---> BBB You have recognition as a legitimate legal business entity. You are responsible for EVERYTHING!!!! Toilet paper, photo copier, maintenance, security issues, hiring, firing, etc… everything. You work way harder and way more hours that you don’t get paid for.

Answer 66

How do you want to practice? What are some of the pros vs cons of practicing by yourself vs being part of a team?

Answer 67

The business lives and dies by you and you alone You make all the decisions. You live with all the consequences No drama. You get have to hire/fire anyone Great for people who have leadership tendencies

Answer 68

The elevated and constant stress levels are immeasureable The business lives and dies by you and you alone. What if you get sick or injured? Go on holidays? Emergencies?

Answer 69

1. Is it based on $$$ saved? Is it based on opportunity? Is it based on your support system? 2. Location. Where do I don’t mind driving/commuting to everyday? Is it close to home? Where is there the most need with the least amount of saturation? 3. What is the lease rate? How big of a space is it? What are the triple net costs? 4. What is TRIPLE NET? ---> Utilities, insurance, and rent rolled into 1 rent. 5. Is it stratified? Can I purchase it vs leasing it? (in Vancouver, good luck with this one) ---> What are the pros and cons of renting vs buying? ---> You need to calculate how much a monthly lease is vs mortgage willl be? Amortize it over the next 20 years? Is it worth it? 6. Do you have partners, staff, or are you going to do it by yourself?

Answer 70

It’s yours, no one can raise rent, kick you out, tell you what type of business to run Most up front costs ---> Lawyers, taxes, bank costs, interest Amortirize it over 25- 30 years, you own it. You can build up equity that you can use for growth or expansion More worth it to put more money into renovations You are pretty set at that location forever..

Answer 71

Less up front costs Ie lawyers, banks, taxes You don’t own it so no equity After 25-30 years, you still don’t own it If you move, you lose the $ you put in for renovations. Pro: you can move easier

Answer 72

A. Measurable costs Lease/Rent/Mortgage Billing/scheduling software Cleaners and cleaning supplies Front desk/admin Marketing/promotions (business cards, brochures, pamphlets, etc..) Webpage/design/SEO/Google Ads/Social media Admin related: Tables, chairs, desks, computers, printers, paper, stationary etc… Clinic related: Massage tables, stools, pillows, sheets, bolsters, lotions, gels, laundry Business license, general liability insurance, professional liability, CI, DI, LI, AD & D, Utilities (internet, phone, hydro, cable, security monitoring etc…) Banking charges, fees, accounts, overdraft protection Interest on loans borrowed

Answer 73

Managing the team --> Conflict resolution, -->Mentoring /guiding/supporting --> Training Hiring/Firing staff, entry/exit interviews – all this takes lots of time/resources. Day to day maintenance and up keep of the offices space Trouble shooting – What happens when things break down? Accounting, Accounts receivables, outstanding invoices Payroll – takes time to do Marketing - someone needs to do it Team building – organization and carrying out Developing and maintaining systems within the office - Security/patient complaint resolution

Answer 74

You make more $ actively and cover your costs passively. You can see the “potential” income that the business can make and that you yourself can make --> Passively via income from the associate therapists. --> Actively via keeping 100% of what you bill from your treatment Better protection, tax bracket, and recognition. You get to make all the decisions No body can ever fire you or tell you what to do. There is gratification and reward in being an entrepreneur and creating a business to help others succeed.

Answer 75

Time with family? How important is that?

Answer 76

people with coverage generally work 9-5

Answer 77

you can access charts (records) and put them in your own personal storage to keep (for 16 years for patients)

Answer 78

I.e. showing empathy towards the things that makes people grieve

Answer 79

definite syndrome with boht psychoogical and physical symptoms

Answer 80

physical and psychological

Answer 81

exagerated

Answer 82

Distorted patterns of grief can be transformed into a normal grief reaction with appropriate clinical interventions.

Answer 83

The experience of loss is universal. Loss involves pain. Losses that are significant produce emotional upheaval. Loss requires change and adjustment to situations that are new, uncertain, and unchosen. Loss can impact many lives.

Answer 84

anger situational depresison irritability annoyance intolerance frustration ---> all may be exacerbated by sleep deprivaiton, ongoing changes in lifesryle, burdens of caregiving, and/or fear of separation & unknown

Answer 85

the state of deep grief or loss

Answer 86

the period of accepting loss

Answer 87

generally thought to be an inward expression

Answer 88

If grief begins with a sudden death, there is no time to prepare. Emotional forces and thought processes are scattered as the shock of loss overwhelms physical and mental defenses. There is no time to gather the coping mechanisms that protect us from emotional overload. This grief is frequently more acute than when a person has time to prepare for the loss and change in family dynamics. Grief is just as heartfelt, but it may be easier to withstand by having the process spread over a manageable time period.

Answer 89

panic difficulty swallowing increaesd HR/BP exhaustion insomnia mm pain altered eating patterns headaches

Answer 90

Sinus headaches are headaches that may feel like an infection in the sinuses (sinusitis). You may feel pressure around the eyes, cheeks and forehead.

Answer 91

Sadness and depression significantly lower resistance to opportunistic diseases, which may lead to physical illness in addition to emotional stress.

Answer 92

When the pain of loss is accepted, healing begins.

Answer 93

When life is done and there is nothing left but the process of dying, massage therapists are uniquely equipped to support the dying person and attending family or friends by addressing pain, nausea, anxiety, depression, anger, stress, and fatigue. Because massage therapy is a generalist form of healthcare, it is possible and even likely that massage therapists will be invited to share in the process of death as clients or their family members die.” ----> It is up to therapist to decide whether to attend

Answer 94

“According to one study, a person can expect to hear approximately 121 phrases in the three days following a death, of which only 19 are perceived as helpful by the grievers.”

Answer 95

a remark or statement, especially one with a moral content, that has been used too often to be interesting or thoughtful. plat = flat ---> dullness, banality

Answer 96

Platitudes are a form of communication that involve the use of trite, usually untrue statements in an attempt to alleviate emotional pain that we may feel helpless to “fix” in any other way. Examples of platitudes are: “Time heals all wounds” and “this grief will pass”.

Answer 97

Perhaps it ‘s because of our cultural death phobia, and the way it pathologies everything related to sadness. If we’re not better at dealing with grief, then it’s because we have never been taught better. Unfortunately, that leaves the majority of us with only one stock phrase in our repertoire, “I’m sorry for your loss.”

Answer 98

Grief is intensely personal so avoid saying “ I know just how you feel” You don’t. A simple “I’m sorry for your loss” can let survivors know that you care, or a good place to start if you are not sure what to say. But, it can be a little like the cashier saying “Have a nice day "at the grocery store. Never point out “It was for the best “ or “you can always get another job/pet/house (this belittles the relationship that was lost by implying that it is easily replaceable.

Answer 99

“I don’t know how to help you , but I want to try.” “I don’t know what to say” “This must be hard for you” “I don’t have an answer for that” “ I am sorry you are suffering right now.” “I am sorry for whatever challenges might lie ahead for you.” “Please accept my deepest condolences, I can’t imagine what you are going through right now.” “I am sorry to hear about______ . I am sure you are going to miss them terribly.”

Answer 100

In health care we tend to protect ourselves from grief by detaching when the pain of caring is overwhelming. You must resolve your feelings about death and loss, or you cannot give effective care. The term “burnout ‘ implies that your fire to help has gone out.

Answer 101

The loss of enthusiasm for your profession is a high price to pay for caring.

Answer 102

Develop outside interests that direct your mind away from health care. Protect yourself by taking time for yourself. Do things you enjoy. Rest, relax and eat right. Read literature regarding grief and “letting go” (?) Talk to your spiritual adviser about your doubts and fears. Take comfort from your faith and your support groups of family and friends

Answer 103

Burnout looks a lot like grief. When we fail to take care of ourselves, we risk losing ourselves, so BURNOUT ,may actually be an expression of the grief we feel about that loss.

Answer 104

“Is recognised in the International Classification of Disease (ICD), sponsored by the World Health organization (WHO). The ICD codes diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury and diseases. The ICD recognises burnout as “problems related to life-management difficulties.”

Answer 105

“Is a particular form of burnout resulting from increased caregiving in combination with ever decreasing energy reserves.”

Answer 106

“They may become disconnected to the point of not caring about the ill person because they have no energy left to give.”

Answer 107

“Massage therapy represents an excellent diversion from caregiving because it encourages caregivers to focus on themselves, which is opposite of what is usually demanded of caregivers.”

Answer 108

1) There is no right or wrong way to grieve. 2) Grief has no set timetable. It is like a river and sets its own course. 3) Normal grieving often involves extreme thoughts and roller coaster emotions. ---- "As you strive to be a compassionate listener these principles can be a touchstone in helping grieving individuals feel understood at a time when they often feel terribly alone.“

Answer 109

Avoid rote responses. Each person and family are unique and deserve to be treated as such. Relate person to person. Show humour as well as sorrow. Use your mind, eyes and ears to hear what is said as well as what is not said. Respect the individual’s pattern of communication and ways of dealing with stress. This is not the time to promote change! Humility and honesty are essential. Be willing to admit that you do not know the answer. Maintain a sense of calm. This will help the client’s sense of control. Never force the client to talk. Respect the client’s need for privacy and be sensitive to the client’s readiness to talk. Let the client lead the discussion to the future. Be comfortable with focusing on the here and now. Be willing to allow the client to see some fears and vulnerabilities. It is much easier to open up to someone who is “human and vulnerable” than to someone who appears to have all the answers.

Answer 110

The primary goal of massage treatment in advanced cancers is comfort and enhancement of quality of life. The gentlest and simplest techniques are often the most effective.

Answer 111

Body systems are weakening and close observation is necessary to ensure treatment adaptions are made as needed.

Answer 112

At this stage touch can sometimes increase the sensation of pain. Flexibility is required. Strong pain medication may significantly impair the patient’s ability to give reliable feedback.

Answer 113

Regular contact with the medical team will help keep you current about medication and health status changes.

Answer 114

There is a susceptibility of decubitus ulcers. Maintaining good skin lubrication and circulation, especially over bony areas, can help prevent their formation. Massage is not advised once redness of bedsore begins as it can speed up the breakdown.

Answer 115

You may need support if you are uncomfortable or unprepared for conversations about death.

Answer 116

Investment in ongoing relationships is slowly withdrawn and should not be taken personally.

Answer 117

Therapeutic boundaries keep caregivers emotionally whole and healthy. They help us to be available to clients when providing care and also to walk away when our work is done.

Answer 118

For individuals working with the dying, therapeutic boundaries may be more difficult to establish and maintain. It takes considerable energy and training for caregivers to repeatedly care for patients in long term care and then let go of patients as they die. This repetitive process can erode boundaries and affect the caregiver's ability to provide objective care. But how do you know if boundaries are intact?

Answer 119

Do you feel like family to this patient? Have you checked in with the patient's status when I am not scheduled to work? Do you feel that you are the only person who knows best what this patient needs?

Answer 120

medicaitons support (friends, family, emotional, practical, spiritual) comfort estate management (organizing belongings) respect choices autonomy patient-centered care therapy

Answer 121

any form of medical care or tx that concentrates on reducing the Sx of disease rather than curing disease relieving painor easing problem without solving the cause treatment approach is indiivdualizd and usually involves a health care team from sevreal/many disciplines

Answer 122

litearl definition: means to cloak or disguise

Answer 123

an approach to care that provides relief from pain/SSx for people close to dying

Answer 124

Both palliative care and hospice care provide comfort. But palliative care can begin at diagnosis, and at the same time as treatment. Hospice care begins after treatment of the disease is stopped and when it is clear that the person is not going to survive the illness

Answer 125

Elizabeth Kubler Ross

Answer 126

"On Death and Dying"

Answer 127

the book “On Death and Dying” which introduced the world to the five stages of grief…the basis of the Kubler Ross model , a theory based on her experience and interviews with terminally ill patients.

Answer 128

Originally this model was applied to those facing the reality of their own death but before long practitioners found the constructs of this neat and tidy model fit nicely with the analysis and treatment of grieving individuals.

Answer 129

Denial Anger Bargaining Depression Acceptance

Answer 130

Denial is a conscious or unconscious refusal to accept facts, information, reality, etc., relating to the situation concerned. It's a defense mechanism and perfectly natural. Some people can become locked in this stage when dealing with a traumatic change that can be ignored. Death is not particularly easy to avoid or evade indefinitely.

Answer 131

Anger can manifest in different ways. People dealing with emotional upset can be angry with themselves, and/or with others, especially those close to them. Knowing this helps us stay detached and non-judgmental when experiencing the anger of someone who is very upset.

Answer 132

Traditionally the bargaining stage for people facing death can involve attempting to bargain with whatever God the person believes in. People facing less serious trauma can bargain or seek to negotiate a compromise. For example "Can we still be friends?..." when facing a break-up. Bargaining rarely provides a sustainable solution, especially if it's a matter of life or death.

Answer 133

Also referred to as preparatory grieving. In a way it's the dress rehearsal or the practice run for the 'aftermath,' although this stage means different things depending on whom it involves. It's a sort of acceptance with emotional attachment. It's natural to feel sadness and regret, fear, uncertainty, etc. It shows that the person has at least begun to accept the reality.

Answer 134

Again this stage definitely varies, according to the person's situation. Broadly speaking, it’s an indication that there is some emotional detachment and objectivity. Dying people can enter this stage early, often a long time before the people they leave behind will enter this stage. note: others necessarily pass through their own individual stages of dealing with loss.

Answer 135

not adequate theory --> narrow in focus --> we experience more than that (5 stages) however, EKR opened the converstation (or reopened?) --> got us paying attention to the matter

Answer 136

It is just a theory There are many theories The 5 stages of grief are not an absolute truth. Like all theory it is based on a hypothesis (an educated guess) There is research that which supports this theory and research to contradict the theory. Do not expect grief to fall into a neat and easy pattern, formula, or timeline

Answer 137

“Grief is not a one way tunnel, it’s more like a labyrinth” They do not happen in a particular order, if at all. The stages are just tools , based on the experiences of many grievers.

Answer 138

“It is common to feel that you are making progress one day only to get knocked on your derriere the next.”

Answer 139

Grief is really complex.

Answer 140

The 5 stages leave you with a feeling that there is some finite end point to grieving. The theory will reach its end point , but your experience with grief won’t.

Answer 141

Elizabeth Kubler-Ross, pioneer of the conscious dying movement, lived to regret having described the common features of the grief journey in stages. She came to see that everyone grieves differently and that science collapses in the face of the mysteries of the heart. There is no map for the landscape of loss, no established itinerary, no cosmic checklist, where each item ticked off gets you closer to success. You cannot succeed in mourning your loved ones. You cannot fail. Nor is grief a malady, like the flu. You will not get over it. You will only come to integrate your loss, like the girl who learned to surf after her arm was bitten off by a shark. The death of a loved one is an amputation. You find a new center of gravity, but the limb does not grow back. When someone you love very much dies, the sky falls. And so you walk around under a fallen sky.

Answer 142

Death is a part of the cycle of life. Therapists may be invited to share in client transitions.

Answer 143

What are your family's attitudes about death and dying? How might these personal beliefs contribute to your reaction if you are presented with a client who is dying? How might you respond professionally, independent of personal beliefs?

Answer 144

Speak plainly and avoid lies or games about death. Actively listen. Provide information and perspective within the capacity of professional role. Offer supportive treatments with no promises of cure.

Answer 145

Provides relief from symptoms for people who are dying. Death is a normal part of life. No efforts are made to hasten or postpone death. Emphasis on ensuring quality of life.

Answer 146

Care integrates psychological and spiritual aspects. Employs a team approach including counseling. Offers support for both patients and families.

Answer 147

Be present. Offer choice. Negotiate a stop signal. Create an atmosphere of calm.

Answer 148

Ask about client status and prognosis. Employ careful infection control and adapt to site restrictions. Seek client goals. Establish informed consent. Adapt treatment to fit client capacity and comfort.

Answer 149

Check in with client if conscious or able to respond. Verify client status with caregivers. Seek permission to massage. Anticipate need for crisis management. ---> incontinence ---> vomiting ---> bleeding

Answer 150

Strategize treatments to facilitate: lymphatic drainage limb movement joint mobilization optimal respiration

Answer 151

Check in with client if conscious and able to respond. Verify status with caregivers. Provide pain relieving techniques, gentle joint mobilization. Observe client carefully for signs of distress. Cease treatment if treatment unwanted or client in pain.

Answer 152

Form of burnout occurring when caring for ill family or friends Fatigue occurs as levels of care increase. Reduced sleep and insomnia Results in caregivers feeling: ---> Inadequate ---> Exhausted ---> Disconnected

Answer 153

Caregivers can never get away from responsibilities. They must separate disease from impulse to help. They have a low sense of personal accomplishment and sense of failure: ---> Emotionally exhausted ---> Hopeless and despairing

Answer 154

Watch for signals of burnout or caregiver fatigue. ---> Clients may not know how to explain their situation. Listen for the unspoken story. ---> If information appears to be missing, clarify. Match client goals with therapist skills, not the other way around. Employ empathic investigation ---> "What would I want a therapist to ask me right now if I were this client?"

Answer 155

Don't overlook massage therapy's powerful medicine. ---> In the face of complex circumstances, massage therapists can offer respite, rest, recuperation. ---> Pay attention to client stories of secrets or scars. Employ concise communication skills when working with clients who are cognitively challenged. Be prepared to support clients through life transitions and even death.

Answer 156

“Suicide is a difficult topic to discuss- and the biggest barrier to preventing suicide is the stigma around it.

Answer 157

and the biggest barrier to preventing suicide is the stigma around it.

Answer 158

In 2020, about 3800 Canadians died by suicide.

Answer 159

When we reach out to people who are thinking about suicide, we can help them see that there is hope, they’re not alone, and help is available.”

Answer 160

People with mental illness- 90% Men- 75% Trans people- 1 in 3 trans youth LGBQ people- LGBQ youth are 7 times more like than straight youth Indigenous People- risk varies

Answer 161

Talking honestly, responsibly and safely about suicide can help you determine if someone needs help.

Answer 162

listening and showing concern. talking with them and reassuring them that they're not alone letting them know you care connecting them with help

Answer 163

showing concern can be an immediate way to help someone listening won’t increase the risk of suicide and it may save a life

Answer 164

crisis line counsellor trusted person ( neighbour, friend, family member or Elder

Answer 165

“Ask direct questions such as “Are you considering suicide?” THE MORE SPECIFIC AND DEADLY THE PLAN, THE GREATER THE RISK. Take answers seriously and don’t ignore the signals.

Answer 166

We are not responsible for the decisions that someone else makes. However, we are often in the best position to recognize and initiate the first response to someone’s signals of suicide.

Answer 167

Some suicides (20%) occur without any warning and others take place despite the very caring responses of friends, family and counsellors. Suicide is ultimately a personal choice- it is not our job to ‘save’ someone else’s life, only to offer them other options.”

Answer 168

intent means plan suicidality suicidal suicide attempt

Answer 169

motive behind action

Answer 170

the way the person intends to ...

Answer 171

fully formed and clear idea of how to accomplish suicide

Answer 172

the qualities of suicidal thinking or behaviour that a client may experience acutely or chronically

Answer 173

self-initiated, potentially fatal action of taking one's life

Answer 174

cutting, burning, or harming oneself. intent is to harm, not take one's life

Answer 175

act of taking one's life and is used to describe death by suicide this term is explicitly to avoid using the phrase "successful/succeeded" suicide --> b/c no suicide can be considered a "success"

Answer 176

learn risk factors, warning signs, and where to get help talk openly about what you have observed, about suicide, and concerns regarding clients' well-being actively listen if client is expressing feelings offer hope that alternatives are available (I.e. through professional help) seek patient's permission to contact doctor or mental health professional to inform him or her of your concerns seek peer supervision to manage feelings associated with client's crisis

Answer 177

offer reassurance that things will get better judge the client for feeling suicidal debate the morality of suicide avoid asking the person why they feel suicidal agree to keep a client's thoughts or actions secret

Answer 178

Assess the risk of suicide and/or harm. Listen non judgementally. Give reassurance and information. Encourage the person to get appropriate professional help. Encourage other supports.

Answer 179

“If it is clear that clients feel acutely suicidal, then therapists have an urgent responsibility to act on their behalf.

Answer 180

Acutely suicidal clients should not be left alone or allowed to leave. Call emergency services and do not leave them alone until help has arrived It may be necessary to call a client’s physician, even if the client does not want the call to be made or to call the client’s emergency contact.”

Answer 181

I notice that you have some scars, ... textbook says that you should ask "are you currently cutting?" ---> however, that seems like it is not the best question to ask, as only a professional would be able to potentially know just based on seeing the injury

Answer 182

The Adult Guardianship Act (the “Act”), defines “abuse” as “the deliberate mistreatment of an adult that causes the adult a. physical, mental or emotional harm, or b. damage or loss in respect of the adult’s financial affairs, ---> and includes intimidation, humiliation, physical assault, sexual assault, overmedication, withholding needed medication, censoring mail, invasion or denial of privacy or denial of access to visitors.”

Answer 183

Under Part 3 of the Act, anyone who has information indicating that an adult is abused or neglected (including self-neglect), and is unable to seek support and assistance because of: 1. physical restraint, 2. a physical handicap that limits their ability to seek help, or 3. an illness, disease, injury or other condition that affects their ability to make decisions about the abuse or neglect may report this information to a designated agency.

Answer 184

While there is no legal duty to report under the Act, it is worth noting that anyone who makes such a report will be protected from subsequent legal action, so long as the report was not made falsely or maliciously.

Answer 185

Designated agencies include: the five regional health authorities, the Providence Health Care Society; and Community Living BC (for adults with developmental disabilities).

Answer 186

Public Guardian and Trustee of British Columbia website

Answer 187

As medical professionals, registered massage therapists have an important role to play in keeping children safe. That role is to be aware of, and alert to, the signs of child abuse and neglect. A “child” is a person under 19 years of age.

Answer 188

a person under 19 years of age

Answer 189

Anyone who has reason to believe that a child has been or is likely to be abused or neglected has a legal duty under Part 3 of the Child, Family and Community Service Act to report the matter. Reports may be made to a child protection social worker at either a Ministry of Children and Family Development office, or at a First Nations child welfare agency that provides child protection services.

Answer 190

See the a) Ministry of Children and Family Development website b) and the Reporting Child Abuse c) and Keeping Kids Safe pages

Answer 191

The BC Handbook for Action on Child Abuse and Neglect for Service Providers also provides helpful information about recognizing and responding to child abuse and neglect.

Answer 192

adults, you may report children, you MUST report legally if you suspect abuse

Answer 193

use their terminology /lingo --> E.g. if they say "client" -- return message/email with "client" even if you prefer to use "patient"

Answer 194

if you use specific terminoogy, explain what it means E.g. U trapezius --> "a muscle that shrugs your shoulders" ---> you could evne show them a picture E.g. Strain --> "an injury involving tearing of some/many muscle fibres"

Answer 195

1. Potentially helpful in care of client 2. Affects your image and gives you credibility 3. Affects image of your profession

Answer 196

Remember, their reputation is on the line if they refer a patient to you, so they want to be absolutely confident you will provide not only great results, but also stellar service

Answer 197

Confidentiality Exclusionary zones File disposition Inter and intraprofessional dialogue Legal consequences of documentation

Answer 198

Legal standards of healthcare imply each of the following: Accountability Confidentiality and privacy Safety and security

Answer 199

Mutual values and commitment Self-regulation Shared body of knowledge and skills Application of sound judgment and evidence

Answer 200

Mutually agreed upon standards and ethics Social and therapeutic contract Respectful communication

Answer 201

Document client condition Measure outcomes Reflect clinical decisions

Answer 202

Third party or insurance payer actions Court proceedings

Answer 203

Record all information accurately and legibly, including: --> Date of treatment, time, and billing date. --> Employ accepted terminology and abbreviations. Include all correspondence and referrals. Keep client records secure and private.

Answer 204

Evidence demonstrates that something is true. Good evidence depends on data. All client records are considered evidence.

Answer 205

In order to support practice decisions, consider: Available research. Profession's best practices. Objective clinical findings.

Answer 206

Evidence-informed practice is easiest to defend when called as a court witness. Problems with records arise when therapists include the following: Judgments about client attitudes. Therapist intuition. Unproven claims. Potential sales pitches. Imprecise professional jargon.

Answer 207

Include client words to describe emotional state in subjective findings: ---> For example, sad, mad, glad Include client behaviors that confirm therapist impression in objective findings: ---> Include client behaviors that confirm therapist impression in objective findings:

Answer 208

Avoid diagnostic words like "depressed". --> Unless client indicates diagnosis confirmed by MD

Answer 209

Electronic health records (EHR) ---> Core data from multiple sources ---> Submitted by different providers ---> Data available to all who have secure access ---> Commonly used in hospitals or institutions

Answer 210

Electronic management records (EMR) ---> Office-based or cloud network systems ---> Electronic versions of paper records ---> Kept by healthcare professionals

Answer 211

In order to protect data from loss or theft, client records must be: Password protected. Securely and frequently backed up.

Answer 212

Keep other healthcare professionals informed about a client condition. Most common format is "SBAR".

Answer 213

SBAR, which stands for Situation, Background, Assessment, and Recommendation (or Request), is a structured communication framework that can help teams share information about the condition of a patient or team member or about another issue your team needs to address.

Answer 214

S = situation B = background A = assessment R = recommendation

Answer 215

Sent at end of treatment series to: - Summarize achievements. - Comment about outcomes. - Bring closure to client chart. Useful in third-party files to indicate beginning and end of treatment

Answer 216

Want to know: 1. Did you get their referral 2. How long and what results are expected? Don’t really care about: 1. What techniques you are doing. 2. Your assessment if it is the same as theirs. 3. Your technical jargon.

Answer 217

Client should receive an award as a result of a lawsuit. Client insurance benefits should stop or continue.

Answer 218

Usually arranged between clinic owners and associates Both parties responsible to ensure that contract reflects their best interests.

Answer 219

No documented evidence of agreement Difficult to enforce No protection

Answer 220

Agreement is only as good as the terms of the contract Essential to review carefully before signing

Answer 221

File disposition Exclusionary zones

Answer 222

File disposition determines who owns the client file.

Answer 223

The information about a client is the property of the client.

Answer 224

The recorded file of this information is considered a business asset.

Answer 225

Noncompetition clause

Answer 226

When a therapist leaves a clinic, this clause describes: ---> How closely a therapist may work to the previous location. ---> Period of time before a therapist may advertise new clinic location.

Answer 227

All contracts are binding. Don't sign unless you've understood the fine print. Refuse contracts that don't allow professional obligations. Evaluate the opportunity based on the contract.

Answer 228

Interprofessional Between professions Intraprofessional Within a profession

Answer 229

Would you communicate differently with your peers than with nonmassage therapy professionals?

Answer 230

Strong professional networks enrich client care: 1) Send thank-you notes for referrals. 2) Follow up with progress notes. 3) When care questions arise, consult with other professionals on the client's healthcare team. 4) Finish treatment plans with discharge notes.

Answer 231

There are 26 regulated health professions in British Columbia, of which 25 are self-regulating professions governed by 22 regulatory colleges under the Health Professions Act. One profession (emergency medical assisting) is regulated by a government-appointed licensing board under a separate statute.

Answer 232

The colleges have been delegated the authority under provincial legislation to govern the practice of their members in the public interest. Their mandate at all times is to serve and protect the public. The primary function of the colleges is to ensure their members are qualified, competent and following clearly defined standards of practice and ethics.

Answer 233

All colleges administer processes for responding to complaints from patients and the public and for taking action when it appears one of their members is practicing in a manner that is incompetent, unethical, illegal or impaired by alcohol, drugs or illness.

Answer 234

Health care professionals need to collaborate and cooperate with one another in order to help patients resolve health care problems. Three problem areas: 1. Role stress 2. A lack of inter-professional understanding 3. Autonomy struggles

Answer 235

The nature of health care work contributes to job stress. There are two types of role stress: 1. role conflict 2. role overload

Answer 236

Relates to professionals that are socialized to fit one role, yet are expected to fit another role. New graduates learn that their ideals and aspirations are seldom the same as the values that receive praise on the job. The discrepancy between these two very different value systems creates role conflict. (Nurses and social workers often experience stress and burnout carrying out their professional responsibilities).

Answer 237

Workload and scheduling stressors.

Answer 238

..Is often the underlying source of professional –professional tensions. Role stress leaves the professional in a vulnerable position, more easily stressed by minor conflicts with co-workers. The role overload of one professional may interfere with the role functioning of another. Professionals may withdraw from one another as a means of coping or may be unwilling to invest energy in maintaining professional relationships.

Answer 239

Why do health professionals know so little about one another’s roles?

Answer 240

Professional education that takes place in virtual isolation from other health disciplines is a major cause. The greater the gap in understanding of one another’s roles, the more negative we are toward collaborative decision-making. Limited amount of contact that exists between HCP on a daily basis. Busy schedules.

Answer 241

In recent years, HCP’s roles have expanded considerably, leading to confusion as to which professional has expertise in a particular area. This increases territorial disputes. When HCP roles overlap considerably, it is not unusual for one to think that the other is trying to take over power or responsibilities. This can result in unproductive competition.

Answer 242

Autonomy- the freedom to be self-governing or self-directing. The degree of autonomy depends on: 1) The permissible scope of practice for that group contained in the provincial licensing laws. 2) The ability of that group to secure access to necessary health facilities, such as hospitals. 3) The ability of that group to obtain reimbursement from private and third-party payers.

Answer 243

The dominant profession tends to underestimate the professionalism or competence of other professionals.

Answer 244

Stems from a lack of awareness - Focus on the issue. - Acknowledge what is true. - Avoid blaming.

Answer 245

Put aside professional rivalries or defensiveness. Focus on what is best for each client. Educate other professions in an evidence-informed way.

Answer 246

Professional practice and client-centered care is good for business. Professional accountability ensures client-centered care. Legal obligations require attention to documentation, confidentiality, and a predictable standard of evidence.

Answer 247

Contracts are legally binding and must be carefully considered before being accepted. Interprofessional communication creates opportunities for networking, education, and dialogue.

Answer 248

conflicts related to different roles of HCP (?)

Answer 249

Mechanics is the analysis of the action of forces on matter or material systems. (American Heritage dictionary-1995)

Answer 250

A more accurate term and tool for describing the endeavor to achieve efficiency in massage practices would be Body awareness. Body awareness incorporates a fuller understanding of the action of forces on the human body.

Answer 251

Massage therapists need to listen to their bodies The best way to maintain body mechanics and avoid injury is to pay close attention to how you feel as you work.

Answer 252

Is the use of tools in a way that helps the human body, as opposed to adapting the human body to fit the standard tools.

Answer 253

Our biggest investment and most important ergonomic tool (besides our bodies) is our table. Buy a hydraulic table if you can afford it. If not, invest in a small step stool and/or a pair of clogs that you can easily slip into and out of, in order to adjust your height. ---> Or, purchase an office chair with a hydraulic adjustment.

Answer 254

According to The American Heritage Dictionary, (1995), care means to be concerned or interested. Self-care is turning our concern and interest to maintaining one’s own good health in order to work easily and well.

Answer 255

to make preparations before a session (stretching and strengthening) and after (icing to relieve inflammation, and stretching to counteract curling of your upper back)

Answer 256

Psychological self-care (finding social support, setting good and safe boundaries for yourself and your guests) is as important as a regimen of exercise, good nutrition and adequate rest.

Answer 257

We need to learn to care for ourselves in body, mind, heart and spirit. Learning to attend to our physical and psychological needs is at he heart of the issue and is the essence of self-care.

Answer 258

Not a bodywork discipline per se, but has some strong influences. Means “supreme ultimate martial art exercise”.

Answer 259

Throughout Asia. Tai chi is not regarded as a martial art, but rather as a part of therapeutic remedies prescribed by traditional Chinese medicine.

Answer 260

The movements of Tai Chi percolate life force from the body’s center (hara) and send it circulating around the body.

Answer 261

Means to join together or yoke. Is intricately intertwined with ayurvedic medicine. Is an example of static unassisted stretching

Answer 262

Burnout. Vicarious traumatization. (a term used to describe what happens when helpers such as healthcare professionals feel traumatized by the experiences of their clients.)

Answer 263

Highly Motivated and Caring Therapists Most at Risk

Answer 264

A lack of work and home life balance. A feeling of disconnection from the world and others. Withdrawal from friends and social activities. Cynicism, despair, anger, fear, and a lack of motivation. Diminished capacity to manage day-to- day activities. Nightmares and intrusive imagery.

Answer 265

Observe personal responses to clients carefully. Establish work, play, and rest balance. Maintain connections with others.

Answer 266

A peer acts as professional sounding board. Discussions help therapists: ---> Understand responses to client situations. ---> Learn how their responses put them and clients at risk. ---> Clarifying boundaries.

Answer 267

psychotherapists counselors massage therapists experienced in psychological dynamics of patient relationsihp

Answer 268

formal, contractual informal mentoring occasion correspondence, phone group supervision peer support groups

Answer 269

confusion about a therapeutic relationship feeling ineffective and unable to establish boundaries encoutners with high-risk or vulnreable clients feeling bored/angry with clients surprising responses to clinical situations feeling burned out and exhausted

Answer 270

reflection and problem solving identifying blind-spots and weaknesses of care consideration of transference and counter-transference helping to establish healthy boundaries providing time with experienced mentor

Answer 271

Working with emotionally challenged clients means: ---> Adhering to a predictable framework. ---> Knowing how to ask questions. ---> Ensuring that clients are safe to receive treatment. ---> Responding empathically if clients become triggered. ---> Committing to therapist self-care, peer support or supervision.