PD400 class 1, 2, 3, 4 Flashcards
palliative care
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.
thanatology
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.
permits for setting up business
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
booking/schedule software?
..
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”)
professional support team
external expertise to employ
pcpi
Practice Competencies and Performance Indicators
vision/mission statement
..
business model
..
technicians and entrepreneurs have different skill sets
..
vision statement
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)
vision statemnt of the CMTBC
innovative regulation that shapes the future of exemplary health care
mission statement
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?
Mission Statement CMTBC
Ensuring the public’s right to safe, ethical and competent massage therapy through excellence in regulation.
three basic legal structures
sole proprietorships
partnerships
corporations
sole proprietorship
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.
partnerships
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.
corporations
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.
sole proprietorship or partnership – are good for…
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
corporation — good for…
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
accountant
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
disability insurance
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 (?)
note clause in insurance
have you had a claim in the last ___ months/years
—> premiums could go up
—> could get refused (?)
other expenses/insurance
professional liability insurance
general liability private
CMTBC dues (?)
continuing education (500/yr ?)
—> optional, but recommended
—> Tax write-off?
other sole proprietorship expenses
GST
taxes
rent (for studio space)
business license
CPR recertification
figure out the TAX WRITE OFFS
..
GST
investing GST and earning interest before paying it out to CRA
how to find good accountant?
someone who has experience with HCP
ask other RMTs –> ask them who they use as an accountant
ask for multiple opinions from multiple accountants (?)
note also CPP/ RRSP contributions
..
laundry expenses
laundry services
e.g.
3700/year (308/mo)
insurance
you have to read the contract carefully, because the contracts be very different, and price reflects differences
if employer supplies everything to “Contractor” CRA says that they are no longer “Contractors” but
Employees
to avoid this, employer can avoid supplying everything
E.g.
Oil
But supplies:
laundry, reception, billing, etc.
note independent contractor vs employee
(?)
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
Class 2
..
what type of people does Commercial Real estate sales/leasing (possibly) typically attract?
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.
how do agents in commercial corporate firms begin their career?
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.
how do residential real estate agents start their careers?
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.
commercial
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)
(commercial real estate members/agents) Expect prospects to be organized and already know the following:
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
residential re agent
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)
commercial…
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.
if issue with commercial realtor?
If you have an issue with conduct of a Commercial Realtor you can lodge a complaint with BCFSA
residential…
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.
what is interest in land?
..
register a lease
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.
property id
All properties are identified by a unique 9 digit number called the Property Identification Number (PID) at the Land Title Registry of BC.
title
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 !
ending lease early?
sold w/o knowledge?
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.
how are comercial rental rates often calculated?
Commercial Rental Rates are often calculated and expressed based on the Total Area of the property
such as $28/sqft.
sq ft of property is convention
but most legal documents will refer to ….?
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
components of rent (formula)
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
triple net lease define
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.”
escalating lease
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)
commercial real estate terminology
An excellent website for easy to understand Commercial Real Estate information is at https://www.bdc.ca
incidental expenses
Your costs on top of base rent. These can include property tax, insurance, utilities, maintenance,common area costsand repairs.
common area maintenance
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.
gross rent lease
A type of commercial real estate lease under which you pay a single amount to the landlord that covers base rent and allincidental expenses.
modified gross lease
A type of a commercial real estate lease under which you and the landlord share certainincidental expenses.
net lease
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.
double net lease
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
triple net lease
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.
percentage rent lease
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.
tenant improvement allowance
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.
tenant inducements
Incentives offered by a landlord to encourage you to rent a space. Examples include several months rent free or help with paying forleasehold improvements.
trade fixtures
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.
turnkey improvements (aka turnkey buildouts)
Renovations that a landlord carries out at your request when you sign a lease. A landlord may agree to these as a tenant inducement.
Leasehold improvements (also known as tenant improvements)
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.
leasehold improvement loan
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.
principal payment holiday
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.
collateral define
something pledged as security for repayment of a loan, to be forfeited in the event of a default.
money speak
..
amortizaiton
Amortization – A stream of Payments over time - ie: mortgage with an interest rate for the “Use of the Money” for a specified time period
fully amortized
after the stream of payments the debt is zero
term mortgage
after the stream of payments there is an outstanding balance owning (sp.??? owing?)
principle
the amount lent
interest rate
the user fee for the $$ – I.e. 3.4% per annum, compounded quarterly
principle and interest
annual, monthly, bi-monthly
collateral
what secures the loan — what creditors can take from you if you Default on your payments
personal guarantee
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
unsecured debt
no collateral for loan
depreciation
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
Capital Cost Allowance
(the amount of depreciation you can claim on your taxes for an asset is less and less over time until fully depreciated)
types of property
..
Live-Work Strata Titled Space to Purchase or Lease
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.
Strata Titled Office Spaces for Purchase
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.
Storefront – Retail
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.
Professional Buildings – Medical-Dental
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.
Packaged Offices
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.
A. Employee
Simplest/Easiest arrangements. You work for someone else. You are classified as an employee and are protected and supported by BC labor laws
pros employee
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.
Cons (employee)
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.
B. Business for Self
Also known as sole proprietor or independent contractor
You are basically running a business within a business.
e.g.
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.
Business for self (pros)
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
Business for self (cons)
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!
C. corporation
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.
Some self reflection
How do you want to practice?
What are some of the pros vs cons of practicing by yourself vs being part of a team?
Pros (corporation)
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
Cons (corporation)
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?
When is a good time to start my own business?
- Is it based on $$$ saved? Is it based on opportunity? Is it based on your support system?
- 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?
- What is the lease rate? How big of a space is it? What are the triple net costs?
- What is TRIPLE NET?
—> Utilities, insurance, and rent rolled into 1 rent. - 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? - Do you have partners, staff, or are you going to do it by yourself?
if you purchase/owned
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..
if you lease/rent
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
ongoing costs of running a business
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
B. Non-Measurable costs
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
So what are the benefits of owning your own clinic/corp?
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.
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.
Time with family? How important is that?
note working after 5pm
people with coverage generally work 9-5
note that if you start with Jane then decide to switch
you can access charts (records) and put them in your own personal storage to keep (for 16 years for patients)
Class 3
…
intro to loss grief and bereavement
..
“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)
I.e. showing empathy towards the things that makes people grieve
ACute frief is
definite syndrome with boht psychoogical and physical symptoms
grief has both ___ and ___ Sx
physical and psychological
grief may occur immediaitely after a….
crisis
it could also be…
delayed
may be…
exagerated
may APPEAR to be…
absent
typical pattern of grief is
distorted
Distorted patterns of grief can be transformed into a
Distorted patterns of grief can be transformed into a normal grief reaction with appropriate clinical interventions.
loss
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.
other emotions related to grief
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
bereavement
the state of deep grief or loss
mourning
the period of accepting loss
grief
generally thought to be an inward expression
sudden death vs expected death
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.
physical responses to grief
panic
difficulty swallowing
increaesd HR/BP
exhaustion
insomnia
mm pain
altered eating patterns
headaches
sinus headaches
Sinus headaches are headaches that may feel like an infection in the sinuses (sinusitis). You may feel pressure around the eyes, cheeks and forehead.
