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Semester 4 > PD400 class 1, 2, 3 > Flashcards

PD400 class 1, 2, 3 Flashcards

1
Q

palliative care

A

Palliative care is an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex, and often terminal illnesses.

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2
Q

thanatology

A

Thanatology is the scientific study of death and the losses brought about as a result. It investigates the mechanisms and forensic aspects of death, such as bodily changes that accompany death and the postmortem period, as well as wider psychological and social aspects related to death.

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3
Q

permits for setting up business

A

putting up walls for building permit

permit for setting up plumbing/sink

permit for setting up electricity

Before going for permits, you have set up municipal building plan

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4
Q

booking/schedule software?

A

..

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5
Q

janitor, receptionist, IT, other therapists, lawyer, banker/financial advisor, accountant, laundry/cleaner, realtor,

what about –> MPT, PT, nutritionist, etc.
(These should be included in “range of community resources for referral … for ongoing patient support”)

A

professional support team

external expertise to employ

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6
Q

pcpi

A

Practice Competencies and Performance Indicators

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7
Q

vision/mission statement

A

..

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8
Q

business model

A

..

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9
Q

technicians and entrepreneurs have different skill sets

A

..

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10
Q

vision statement

A

future focus

what you want to become

embrace envisoned “
–> meant to inspire

first step developing realistic vision

pen picture of business

could be 3-5 year
5-10 years
10-20 years (huge business)

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11
Q

vision statemnt of the CMTBC

A

innovative regulation that shapes the future of exemplary health care

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12
Q

mission statement

A

enduring statement of purpose that dinstinguishes one organization from other siimlar organizations

what is our business?

describes organization’s purpose, clientele, services, markets, philosophy, and basic technology

allows client to distinguish one business from another and decide which is more suitable for them?

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13
Q

Mission Statement CMTBC

A

Ensuring the public’s right to safe, ethical and competent massage therapy through excellence in regulation.

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14
Q

three basic legal structures

A

sole proprietorships

partnerships

corporations

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15
Q

sole proprietorship

A

You alone own it and are 100% responsible for its debts and liabilities. All earnings are taxed as your personal income. This is the most popular small business structure because it’s simple and straightforward.

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16
Q

partnerships

A

Two or more owners agree to share profits and losses according to their share in the firm. In a general partnership, all partners are liable for debts; in a limited partnership, one or more partners limit their liability by not actively managing the business.

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17
Q

corporations

A

The company earns revenue, incurs losses and pays taxes separately from its owners. Companies often pay tax at a lower rate than individuals. Owners’ liability is limited to what they invest in the company, and they have options as to when and how they take money out of the company.

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18
Q

sole proprietorship or partnership – are good for…

A

You will be the sole owner or own the business with just a few partners

You plan to start the business using only personal savings or investments from friends and family

You expect business revenues to support only you and your partners or family members

You plan to do most of the work yourself

You will borrow personally on behalf of the business

You are in a low personal income bracket

Your business is highly unlikely to face a lawsuit or get into debt

You have limited net worth (personal assets)

If you answered yes to most of these questions, you should operate your business as a sole proprietorship or partnership

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19
Q

corporation — good for…

A

Ownership will be divided among several shareholders

You expect significant start-up costs

You will be hiring employees and paying out wages and salaries

You will require additional financing beyond savings and investments from family and friends

You expect increasing revenues and a rising asset base

You will probably need to raise equity or issue debt, either now or later

You will put a full management and organizational structure in place

You expect to look into income-splitting and tax-deferral options

You want to protect your existing substantial net worth

If you answered yes to most of these questions, you should operate your business as a corporation

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20
Q

accountant

A

find a good accountant

the accountant that was responsible for Laurie’s debt to CRA was negligent, so find someone who is talented and who has experience with accounting for healthcare professionals

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21
Q

disability insurance

A

one case of someone who didn’t get disability insurance,

and they broke their scaphoid rock climbing

and afterwards they tried to get disability insurance

and they were refused disability insurance

but if they had gotten it previously it would have been fine (?)

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22
Q

note clause in insurance

A

have you had a claim in the last ___ months/years

—> premiums could go up

—> could get refused (?)

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23
Q

other expenses/insurance

A

professional liability insurance

general liability private

CMTBC dues (?)

continuing education (500/yr ?)
—> optional, but recommended
—> Tax write-off?

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24
Q

other sole proprietorship expenses

A

GST

taxes

rent (for studio space)

business license

CPR recertification

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25
Q

figure out the TAX WRITE OFFS

A

..

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26
Q

GST

A

investing GST and earning interest before paying it out to CRA

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27
Q

how to find good accountant?

A

someone who has experience with HCP

ask other RMTs –> ask them who they use as an accountant

ask for multiple opinions from multiple accountants (?)

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28
Q

note also CPP/ RRSP contributions

A

..

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29
Q

laundry expenses

A

laundry services

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

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30
Q

insurance

A

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

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31
Q

if employer supplies everything to “Contractor” CRA says that they are no longer “Contractors” but
Employees

A

to avoid this, employer can avoid supplying everything

E.g.
Oil

But supplies:
laundry, reception, billing, etc.

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32
Q

note independent contractor vs employee

A

(?)

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

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33
Q

Class 2

A

..

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34
Q

what type of people does Commercial Real estate sales/leasing (possibly) typically attract?

A

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.

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35
Q

how do agents in commercial corporate firms begin their career?

A

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.

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36
Q

how do residential real estate agents start their careers?

A

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. 

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37
Q

commercial

A

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)

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38
Q

(commercial real estate members/agents) Expect prospects to be organized and already know the following:

A

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

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39
Q

residential re agent

A

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)

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40
Q

commercial…

A

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.

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41
Q

if issue with commercial realtor?

A

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

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42
Q

residential…

A

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.

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43
Q

what is interest in land?

A

..

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44
Q

register a lease

A

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.

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45
Q

property id

A

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

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46
Q

title

A

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 !

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47
Q

ending lease early?

sold w/o knowledge?

A

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.

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48
Q

how are comercial rental rates often calculated?

A

Commercial Rental Rates are often calculated and expressed based on the Total Area of the property

such as $28/sqft.

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49
Q

sq ft of property is convention

but most legal documents will refer to ….?

A

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 

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50
Q

components of rent (formula)

A

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

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51
Q

triple net lease define

A

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.”

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52
Q

escalating lease

A

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)

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53
Q

commercial real estate terminology

A

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

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54
Q

incidental expenses

A

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

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55
Q

common area maintenance

A

Anincidental expensein 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.

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56
Q

gross rent lease

A

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

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57
Q

modified gross lease

A

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

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58
Q

net lease

A

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.

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59
Q

double net lease

A

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

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60
Q

triple net lease

A

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.

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61
Q

percentage rent lease

A

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.

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62
Q

tenant improvement allowance

A

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 atenant inducement.

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63
Q

tenant inducements

A

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

64
Q

trade fixtures

A

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.

65
Q

turnkey improvements (aka turnkey buildouts)

A

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

66
Q

Leasehold improvements (also known as tenant improvements)

A

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.

67
Q

leasehold improvement loan

A

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.

68
Q

principal payment holiday

A

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.

69
Q

collateral define

A

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

70
Q

money speak

A

..

71
Q

amortizaiton

A

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

72
Q

fully amortized

A

after the stream of payments the debt is zero

73
Q

term mortgage

A

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

74
Q

principle

A

the amount lent

75
Q

interest rate

A

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

76
Q

principle and interest

A

annual, monthly, bi-monthly

77
Q

collateral

A

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

78
Q

personal guarantee

A

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

79
Q

unsecured debt

A

no collateral for loan

80
Q

depreciation

A

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

81
Q

Capital Cost Allowance

A

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

82
Q

types of property

A

..

83
Q

Live-Work Strata Titled Space to Purchase or Lease

A

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.

84
Q

Strata Titled Office Spaces for Purchase

A

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.

85
Q

Storefront – Retail

A

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.

86
Q

Professional Buildings – Medical-Dental

A

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.

87
Q

Packaged Offices

A

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.

88
Q

A. Employee

A

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

89
Q

pros employee

A

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.

90
Q

Cons (employee)

A

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.

91
Q

B. Business for Self

A

Also known as sole proprietor or independent contractor

You are basically running a business within a business.

92
Q

e.g.

A

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.

93
Q

Business for self (pros)

A

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

94
Q

Business for self (cons)

A

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!

95
Q

C. corporation

A

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.

96
Q

Some self reflection

A

How do you want to practice?

What are some of the pros vs cons of practicing by yourself vs being part of a team?

97
Q

Pros (corporation)

A

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

98
Q

Cons (corporation)

A

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?

99
Q

When is a good time to start my own business?

A
  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?
100
Q

if you purchase/owned

A

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..

101
Q

if you lease/rent

A

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

102
Q

ongoing costs of running a business

A

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

103
Q

B. Non-Measurable costs

A

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

104
Q

So what are the benefits of owning your own clinic/corp?

A

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.

105
Q

Less stress in your life? More stress. A business is like a child. You have to nurture and treat it as if it’s your life. It lives and dies with you.

A

Time with family? How important is that?

106
Q

note working after 5pm

A

people with coverage generally work 9-5

107
Q

note that if you start with Jane then decide to switch

A

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

108
Q

Class 3

A

…

109
Q

intro to loss grief and bereavement

A

..

110
Q

“Nothing that grieves us can be called little; by the eternal laws of proportion a child’s loss of a doll and a king’s loss of a crown are events of the same size.”

(Mark Twain quote)

A

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

111
Q

ACute frief is

A

definite syndrome with boht psychoogical and physical symptoms

112
Q

grief has both ___ and ___ Sx

A

physical and psychological

113
Q

grief may occur immediaitely after a….

A

crisis

114
Q

it could also be…

A

delayed

115
Q

may be…

A

exagerated

116
Q

may APPEAR to be…

A

absent

117
Q

typical pattern of grief is

A

distorted

118
Q

Distorted patterns of grief can be transformed into a

A

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

119
Q

loss

A

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.

120
Q

other emotions related to grief

A

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

121
Q

bereavement

A

the state of deep grief or loss

122
Q

mourning

A

the period of accepting loss

123
Q

grief

A

generally thought to be an inward expression

124
Q

sudden death vs expected death

A

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.

125
Q

physical responses to grief

A

panic

difficulty swallowing

increaesd HR/BP

exhaustion

insomnia

mm pain

altered eating patterns

headaches

126
Q

sinus headaches

A

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

127
Q

sadness and depression vs immune system

A

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

128
Q

grief passing vs IS

A

When the pain of loss is accepted, healing begins.

129
Q

when massage therapist is asked to attend funeral

A

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

130
Q

how often are statements told to grievers perceived as helpful

A

“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.”

131
Q

platitude define

A

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

132
Q

platitudes…

A

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”.

133
Q

why do people struggle to say something helpful to someone grieving

A

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.”

134
Q

what not to say?

A

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.

135
Q

what can you say? …?

A

“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.”

136
Q

protecting yourself during other people’s grief process

A

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.

137
Q

loss of enthusiasm in profession?

A

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

138
Q

what can you do to maintain enuthusiasm in profesison?

A

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

139
Q

burnout vs grief

A

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.

140
Q

Burnout and ICD (international classificaiton of diseases)

A

“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.”

141
Q

caregiver fatigue

A

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

142
Q

caregiver fatigue vs apathy

A

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

143
Q

caregivers and MT

A

“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.”

144
Q

3 fundamental principles t remmeber when working with loss/grief

A

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.“

145
Q

guidelines for comuniating with terminally ill patients

A

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.

146
Q

special concerns for palliative care

A

..

147
Q

primary goal of massage therapy

A

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.

148
Q

what to do as condition progresses

A

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

149
Q

pain medicaiton and illness

A

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.

150
Q

what about rest of medical team of pt

A

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

151
Q

bedsores / decubitus ulcers (pressure ulcers)

A

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.

152
Q

preparedness for conversations about death

A

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

153
Q

investment in ongoing relationship (?)

A

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

154
Q

palliative care boundaries

A

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.

155
Q

boundaries with dying patients

A

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?

156
Q

in what scenarios must extra measures be taken to maintain therapeutic boundaries?

(If someone answers yes to any of these questions, it may mean that they need help with maintaining their therapeutic boundaries.)

A

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?

157
Q
A

Semester 4 (10 decks)

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