The Supported Living Business Opportunity

For the small business entrepreneur, the supported living needs of adults with developmental disabilities spells opportunity.

The state of California spends over $200 million per year providing supported living services to developmentally disabled adults. According to California Department of Developmental Services, this number is expected to grow significantly as the population of people diagnosed with mental retardation, epilepsy, and other forms of developmental disabilities rises. Of particular concern is a spike in the number of children diagnosed with autism. As these children become adults, they will require supported living services.

Currently about 6 million adults in California require some level of assisted living. Claritas, Inc., a direct marketing and demographic analysis company, believes this number will double by 2020. While this article discusses the assisted living business opportunity in California, similar programs are available in every state.

Serving The Supported Living Market

California provides supported living services to adults with disabilities that live in their own homes or apartments. They need help with things like shopping, doctor appointments, medication administration, and job coaching, among others. While each SLS provider must negotiate a billing rate with the state, agencies are typically paid about twice the rate of prevailing wages for their area. This translates to approximately 45% gross margin rates.

The licensing requirements for SLS providers are very minimal, but you do have to work with a Regional Center to get vendored and receive client referrals. There is no advertising allowed in this business--and frankly you won't need it. All your business comes from Regional Center referrals.

Growing Pains

Assisting adults with developmental disabilities can be a rewarding line of work. But as a small business owner, it also comes with a few headaches.

The number one problem you will encounter is hiring, training, and retaining reliable employees to work with your clients. Typical state requirements demand your employees have clean criminal backgrounds, are drug-free, and are able to safely transport clients to appointments in their own vehicle. Business owners are expected to reimburse employees for gas and vehicle expenses incurred on the job.

As an employer, you will of course be required to carry worker's compensation insurance and significant levels of liability coverage. This is all doable however, and is just a cost of doing business.

Your role of supported living provider will also require assisting some of your clients with housing issues. This can be a difficult and frustrating experience, as the majority of your clients all live on SSI and have minimal support or contact with family members.

Getting Started

California provides help to its clients through its 21 Regional Centers scattered throughout the state. To start your own supported living agency, you must first get a vendor number from your local Regional Center.

Visit: http://www.dds.cahwnet.gov to find the Regional Center for your area. All you have to do is ask for assistance in getting vendored to provide supported living services.

At that point, you will be advised of upcoming training sessions you may attend.

Confidentiality - Disclosure to a Patient's Family

CONFIDENTIALITY AND FAMILY MEMBERS

It is well documented that health professionals owe a common-law duty of confidentiality with respect to health information. In McInerney vs McDonald, the Supreme Court of Canada confirmed this view by stating that:

[C]ertain duties do arise from the special relationship of trust and confidence between doctor and patient. Among these are the duty of the doctor to act with utmost good faith and loyalty, and to hold information received from or about a patient in confidence.

Physicians' obligations regarding patient confidentiality are also set out in the legislation that governs physicians in each province, in the rules of each provincial regulatory body, and in the codes of ethics or conduct that govern physicians' associations.

These authorities agree that the content of a patient's medical record may not be divulged except in specific circumstances.

[Some] circumstances... include communication to another health care-provider, who has a "need to know" information in the [patient's] record in order to carry out functions; legal authority for disclosure such as subpoena, reportable disease, child abuse; and on the consent of the patient to a third party, either implicitly, as to a paying agency, or explicitly to a lawyer or insurance company.

DISCLOSING INFORMATION WITHOUT CONSENT

When a relative becomes ill, it can be a very stressful time for the family. Family members and caregivers often assume a parental role in respect to their relative's care. Caregivers often think this role entitles them to complete disclosure of, and access to, the patient's health record.

When speaking with a patient's family, physicians should be understanding and empathetic and make every effort to alleviate their concerns. Medical information, however, may be shared with family members only with your patient's consent. Disclosure of information to a patient's immediate family without consent could result in a finding of professional misconduct by the appropriate regulatory body.

Provincial regulatory bodies, such as the College of Physicians and Surgeons of Ontario, have developed a set of rules, known as "regulations," that define professional misconduct. These regulations are developed under the authority of the Medicine Act and have the force of law. A physician's obligations regarding patient confidentiality under these regulations are very clear. In Ontario, according to the Regulated Health Professions Act, the Medicine Act therein, and related regulations, a breach of this duty legally qualifies as an act of "professional misconduct" and includes:

Giving information concerning the condition of a patient or any services rendered to a patient to a person other than the patient or his or her authorized representative except with the consent of the patient or his or her authorized representative or as required by law.

Physicians should take steps to ensure that patient confidentiality is maintained regardless of the technology used to communicate health information. Leaving a voice message could be a problem because more than one person might access messages. Physicians leaving messages on answering machines or voice messaging systems are advised to leave only their names and phone numbers. Physicians must exercise the same caution when sending confidential material by mail, fax, or e-mail.

CONSENT TO AN "AUTHORIZED REPRESENTATIVE"

The authorized representative who can release records, in addition to the patient, can be anyone the patient has given permission to access the records, usually by signing an authorization form. Typically, such authorization is given to lawyers or insurance companies to permit them to obtain medical information from the authorizing patient's physician. A patient's authorization for disclosure of his or her medical information to family members should always be explicit. Where such consent is given verbally, physicians should make a note in the patient's chart of exactly what the patient said in giving the consent. Written requests and consent to release information should be kept in the patient's chart.

Physicians should be cognizant of the fact that patients are not always aware of the contents of their medical records. For this reason, physicians will better serve their patients and protect themselves by informing patients of and discussing with patients what information is to be disclosed.

CONCLUSION

The special relationship between physicians and their patients is established firmly on trust and confidence. Any information patients provide in confidence must be kept private, unless a patient gives you permission or such disclosure is required by law. Patients' ability to decide with whom they will share information is crucial for protecting the right of privacy and for preserving trust in a therapeutic context. Inherent in keeping a medical record is the promise, implied or specific, that it will be kept confidential.

Non-consensual access to, and collection, use, or disclosure of, health information is a violation of patients' right of privacy, compromises a physician's duty of confidentiality, and could disrupt the trust and integrity of the therapeutic relationship. Attending physicians should never lose sight of the fact that accountability is owed first and foremost to their patients. The fundamental principle regarding health care information is that it belongs to the patient, not to the physician or the patient's family, nor to any other health care or government agency, unless required by law.

This article was originally published March 2003. Canadian Family Physician VOL. 49

Family Violence and Abuse - Helping Victims and Survivors

Introduction
Abuse and violence in the family refer to physically and emotionally harmful behaviors that occur between family and household members. It includes child abuse, child neglect, intimate partners abuse and violence, marital rape, and elder abuse. It could be a learned behavior that can be unlearned through therapy. Perpetrators try to isolate the family to keep it secret and avoid sanctions. They usually have some power and control over the other members of the family. They may rationalize the violence with their drug use. The use of cocaine, PCP, amphetamine etc may increase violent behavior.

Forms of Abuse
Physical abuse includes hitting, punching, shoving, stabbing, shooting, kicking, and withholding medication, wheelchair, food, and fluids. Sexual abuse includes coercion, marital rape, and withholding sex. Psychological abuse includes threat, harassment, and blackmail. Emotional abuse includes name-calling, insults, and ridicule. Economic abuse includes total control over finance, running up bills, forbidding school or work.

Reality About Violence
Family violence occurs at all levels of society. Separation or divorce may not end violence. Abuser does not need to be provoked. Some survivors wrongly tend to blame self. Treat the violence but also the alcohol, drug, stress, and mental health problems if any. Violence occurs between gays and lesbians too. Abused women are discouraged from disclosure by threats, fear, denial and disbelief expressed by 'confidants'.

Models of Intervention
The Paternalistic model assumes that the clinician has more knowledge than the patient; that the survivor is responsible for ending the violence; that the clinician should give advice and sympathy; and see the patient as a victim. Whereas, the Empowerment model, which is better, assumes that the clinician should mutually share knowledge with the patient, plan strategies with the patient, respect patient's competence, experience and strengths, and see the patient as survivor.

Response of Survivors to Violence
Physical signs of abuse include injuries at multiple sites in various stages of healing (head, neck, face, throat, sexual organs), headache, insomnia, and stress. Behavioral sign is that the individual does not leave the abuser or leaves and returns before making a final break. Psychological signs include delayed reaction, depression, lowered self esteem, attributions e.g. self-blame, impaired school or work performance and conduct, poor concentration and poor problem solving.

Why Doesn't The Individual Leave the Abuser?
Abused individuals do not leave the abuser for variety of reasons, which include fear of being stalked and killed (which is a realistic fear), strong emotional attachment to the abuser, determination to end the abuse, sanctions present in the couple's culture, fear of stigma, lack of resources to live away from the abuser, and consideration of what will happen to her children if she leaves. She may leave and return, thinking, "Maybe he will change".

Child Abuse & Neglect
In every state, child abuse and neglect are must be reported. Types of abuse include child sexual abuse, child physical abuse, child emotional abuse, and child neglect. Child that witnesses family violence may also suffer abuse.

Child Sexual Abuse
This is the involvement of children in sexual activities that they do not fully comprehend and to which they do not or cannot freely give consent. This violates child's trust in the adult that is supposed to protect him/her. Threat to the child, pet, and others keeps the child quiet. It results in confusion, shame, and helplessness. Its effect may last a lifetime and affect mental health. It may be guarded as a family secret.

Observable Signs of Sexual Abuse
The observable signs of child sexual abuse include physical aggression, excessive masturbation, social withdrawal, low self esteem, impaired school performance, sleep disturbance, STD's, bleeding, soreness, itching, UTI, pregnancy, bruises, swelling, redness, fracture, burns, and unkempt appearance.

School Violence
School violence is usually due to child drug use, child's access to guns, antisocial and impulsive behaviors, family dysfunction, community unresponsiveness, interpersonal disputes, and bullying and harassment by peers.

Child Abduction
Most abduction is done by a parent. 70% are by fathers, 25% by their mothers. Parents that are likely to abduct include those that have threatened or attempted it in the past, suspect abuse by the other parent, may be paranoid, may intend to use it as revenge, punishment, trophy, or one that strongly believes that child be raised in his or her home country.

Child Abuse Assessment and Intervention
Explore and be aware of your own attitude to abuse survivors so as not to be judgmental. Do a thorough history & physical assessment. Use private, quiet uninterrupted environment. Honestly state the purpose of the interview. Inform victim of the pending physical assessment. Use a calm and supportive approach. If possible, interview child separately first before joint interview with parent or guardian. Pay attention to child's affect (look) and behavior, mother's understanding of the problem, discrepancies in their stories, and parent's emotional responses. Document your assessment fully. Report suspected abuse to CPS. Coordinate services such as further assessment, psychological testing, individual psychotherapy, family psychotherapy, and group psychotherapy.

Intimate Partner Violence (IPV)
IPV is a pattern of coercive and assaultive behavior between intimate and dating partners. Abuse of female partners is the more prevalent IPV. Female violence is more often in self-defense. Many IPV end in homicide or homicide-suicide. Leaving or an attempt to leave by the victim increases homicide risk. There is a higher homicide risk with handgun, history of suicidal ideation or attempt, battering during pregnancy, sexual abuse, substance use, extreme jealousy, and controlling behavior ("if I can't have you, no one can"). Few women kill their abusers if there is no intervention. Assessment of IPV should be part of mental health assessment. Ask partners about history of conflicts, "pushing and shoving", and quality of relationship. Observe for hesitation, looking away, and unease. Be supportive, let victim know she is not alone. Describe and map the extent of injuries. Assess for attribution e.g. self-blame. Assess for depression, PTSD, and anxiety. If patient is the abuser, assess potential for further violence. Consult legal advisor for "Duty to Warn". Courts have made it mandatory abusers (happens to be mostly men) to be treated. Treatment includes confronting the violence, affirming that responsibility lies with the abuser, behavior therapy, anger control, attitude change to women, couple counseling, and cognitive behavior therapy (CBT). Empower the woman, using laws, community resources, support groups, and safe shelters. Mutually set goals with the victim. Mutually consider and choose from options. Help mobilize natural, social and professional supports.

Rape and Sexual Assault
This affects men, women and children, especially women and children. Sexual assault is a forced act of sexual contact without consent. It is usually done to humiliate, defile or dominate the victim. Rape is a felony, yet majority is unreported. Survivors of marital rape do not seek care because of embarrassment and humiliation. Careful assessment and questioning is needed. In caring for the victim, listen, be nonjudgmental, and provide emotional support. Document your observation and assessment fully. Help collect evidence if patient chooses to litigate. In the acute stage, assess for fear, disorganization, shock, and restlessness. In the second stage, assess for flashbacks, phobias to places and people, and sexual difficulties. Encourage the victim to discuss feelings. Explore options e.g. changing phone number. Explore available community services and support groups. Refer for physical treatment and psychotherapy. Plan for a follow-up phone contact in a few days.

Elder Abuse
There are about 5 million abused elderly persons in the US annually. Spouse abuse overlaps with elder abuse. The abused does not report for fear of being abandoned to a nursing home or being isolated. Signs include bruises on arms, wrists, ankles, face lacerations, vaginal lacerations, fractures, malnutrition, poor hygiene, dehydration, flinching and shrinking away in the presence of abuser. Help and care include reporting a suspected abuse to the Adult Protective Services (APS), counseling, psychotherapy, substance abuse and treatment of the abuser, if necessary.

Reference: Stuart, G. W. & Laraia, M. T. (2005). Principles and practice of psychiatric nursing (8th ed.). St. Louis, MO: Elsevier Mosby.

Are You Ready to Become A Nurse?

You may feel a bit overwhelmed with the number of choices that you have available when it comes to your upcoming career. If you enjoy being around people and helping individuals in a number of different ways, you may want to consider becoming a registered nurse. Of course, there are going to be many choices that must be made in advance of becoming a registered nurse and it certainly is important for you to understand the registered nurse job description of the type of nursing you plan on doing. Here are some tips which can help you in getting the education that you need and making choices that are going to be right for you.

Before you ever enter into any type of college, it's important for you to decide what type of nursing you plan on doing. For some individuals, it is going to be shaped according to the area where they plan on living. For example, if your area is largely a retirement community, you may want to consider working with elderly individuals, perhaps even in an assisted living environment. This can be a job that can do well for you throughout your entire life. If, on the other hand, the area where you live and study is rather transient, there are going to be other choices that are available to you. Make sure that you consider all of the choices that are available and perhaps even speak with some registered nurses in your area before making your final decision.

Once you have made your choice on what type of nursing you plan on doing, it's time for you to consider your college options. If you're already in the nursing field, many of your options are going to be limited if you plan on continuing to work while you're taking classes. There are plenty of online nursing degree program choices that are available which can assist those who are already in the workforce in getting registered. Those online courses can also benefit those who are new to the field, especially when you consider the following.

One of the most important things for you to do if you are planning on becoming a nurse is to volunteer at your local hospital. This can give you some serious job experience and can even help you in making choices that will benefit you while you're in school. In some cases, it can even give you an opportunity to advance your career once your education is over. After all, you will be in close contact with other nurses and doctors at the hospital when you volunteer in such a way. As they see you continue your education, they will be more inclined to bring you on board or to give a recommendation so that you can further your career in that way.

It is going to take some time for you to get the education that is necessary, and in all cases, good organization is going to be of great benefit. If you work on it regularly and are consistent with your efforts, you will find that you are able to enter the nursing field easily.

How to Start a Non-Emergency Medical Transportation Business

By now you must be aware of the many compelling reasons why a non-emergency medical transportation business offers entrepreneurs such a great business model. With the growth in the health care industry and the explosion of baby boomer retirees, this market is big and set to get even bigger still.

In this article we look at how to start a non-emergency medical transportation (NEMT) business. Learn about some of the steps that are involved and some of the aspects of this business that you will have to consider.

Franchise or Independent Operator?

There are now several players offering non-emergency medical transportation franchises. Entrepreneurs benefit with the franchise model as they can operate under an established brand and get advice and training to get started and run a business. However, with the franchise fees that must be paid initially and on an ongoing basis, the upside potential for profit is reduced. If you do your homework, you will find that this business is not that difficult and it is possible to start up and thrive independently.

Choosing the Right Area

Give some thought to the demographics of the area where you are setting up your business. Look for statistics that prove that there are a good number of elderly, disabled or Medicaid citizens living nearby. Compile a list of hospitals, dialysis centers, retirement homes, assisted living centers and other relevant operations. You could even make initial contact with some of these organizations and find out about the transportation solutions that they currently have in place.

Research the Competition

Identify all of the major competitors that you will have in your area and evaluate them in terms of their strengths and weaknesses. You may decide to incorporate parts of their business model into your own business and reject other parts. Learn as much as you can about them by reading their websites and calling their offices to ask questions. You can even spend some time following around some of their vans in order to understand how they work and to find out exactly who their customers are.

Getting Started - Licenses and Permits

Regulations and requirements for medical transportation businesses vary from state to state so you should make enquiries at the local level to find out what your obligations are.

As you are in the business of transporting paying customers from one place to another you will need some kind of permit, just as a taxi driver does. Your application for this kind of license will be handled by transportation authorities at the state or local level. Due to the nature of this work, some states will also require businesses in this industry to be registered with local health authorities.

There may also be other paperwork that needs to be done such as registering your business name, getting a business license (possibly more if you serve multiple counties) and zoning considerations if you run a home business.

Vehicles and Equipment

It is common for medical transportation services to purchase regular vans, either new or used, and then have them fitted out to suit special needs clients. Business owners typically start out with one vehicle and gradually add to their fleet as their business grows.

The best vans for an ambulette have a high raised roof and doorways. Access is usually on the side of the vehicle but can also be at the rear.

Some operators still use manual lifts to help them get wheelchair passengers into and out of their vans. However, you should be able to provide a faster, more professional service if you have a modern hydraulic lift installed.

Once inside the van, wheelchairs can be fastened to various securing devices so that they don't move around during transit. Vehicles also require customized seatbelts for wheelchair bound passengers. You can also improve the quality of your service if you have some comforts like TV and air conditioning.

A decent sized van that is properly kitted out should be able to transport four wheelchair bound passengers at a time as well as have extra seats available for caregivers. Depending on your clients, you may also need a space in your van that will allow you to fit in a passenger that is confined to a stretcher.

Insurance Policies

To protect yourself from unforeseen events you will need to purchase a variety of insurance policies. A general liability insurance policy will ensure that you are covered in situations where your customers are injured or suffer losses while they are in your care. You will also need regular automotive insurance to protect yourself in cases where your vehicles are damaged, stolen or involved in traffic accidents.

Payment Options

Decide on how you want to collect payment for your services. You may have to invoice medical institutions on a monthly basis or you may need to process credit card payments for individual clients. If you service large clients like Medicaid then it may be as simple as receiving a check in the mail each month. Talk to some prospective clients and look at what their needs are. Find out what payment options your competitors are offering.

Service Hours

Give some thought to your operating hours. The best ambulette services in the market usually offer weekday service from early morning to late at night with decent hours on Saturdays too. As a sole operator you will be limited in the hours that you can take on. As you expand into a multi-driver operation you will be able to offer more flexible scheduling to clients.

Staffing Requirements

If you start out doing all the driving while also managing your business you will quickly get burnt out. In order to grow you need to step back and hire some drivers so that you can move into a purely management and marketing orientated role.

Staff should have a drivers license that allows them to take passengers and they may also be subject to certain standards or requirements at the local level. No matter what you should make sure that your staff are trained on how to do the practical side of the job. They need to know how to assist passengers and their caregivers as they get in and out of vehicles. They should also be instructed to smile and make pleasant conversation if the opportunity arises so that they help your brand to gain a positive reputation.

Marketing

There are many different ways to market a non-emergency medical transportation business. For some ideas on markets that you can target read our article on Medical Transportation Business Opportunities.

Initially you will have to go out and meet prospective clients and possibly even bid to try and win contracts. However, if your team are doing a good job then you will find that eventually business will come directly to you through word of mouth and referrals.

You can of course improve your chances of getting calls from private paying clients if you do a little advertising. A website that comes up in the search results when people search for ambulette services in your area can really help. A small Yellow Pages listing will also almost certainly be worth the cost. You can pretty much try any method that other local service businesses are using to promote themselves. Vehicle advertising is great for exposure and flyers, postcards or door hangers may work as well.

Identifying And Defending Against Nursing Home Abuse

There is a wide array of injuries and ailments that can stem from nursing home abuse, many of which have nothing at all to do with a violent altercation. If your family member has sustained an injury from a fall due to improper supervision, if they've become ill as a result of dehydration or if an injury has resulted from improper or unnecessary restraints used by a staff member, you may be entitled to compensation.

In many cases a victim of nursing home abuse is either incapable or simply too afraid to express the pain or discomfort caused to them by the abuse or neglect of a staff member. This can make nursing home abuse or neglect very difficult to prove if there are not telltale physical signs or a reliable witness who's willing to come forward with the truth.

Physical signs like cuts, bruises and fractures can be a good indicator that the level of care isn't exactly where it should be in an assisted living facility, but there are far more subtle signs that could indicate a potential problem. Things like skin rashes, disorientation, weight loss and unexplained mood changes can all be potential signs that the appropriate level of care isn't being administered by the staff and that something needs to be done.

This is precisely why you need to reach out to a qualified team of attorneys if you feel as though something may be amiss at the home or assisted care facility in which one of your loved ones resides. A consultation with attorneys that specialize in cases of nursing home abuse and neglect can help you figure out the best course of action to follow regarding the care of your loved one.

If there are signs of nursing home abuse or neglect in your case, a personal injury attorney can begin to take the steps necessary to prepare your lawsuit against the facility. Your attorney can help you draft a formal complaint against the facility and fight for the medical care and financial compensation needed to help your loved one to recover from the abuse or neglect. By contacting a personal injury attorney who has tried elder abuse or neglect cases, you not only can get justice for your loved one but prevent other families from suffering as yours has.

It Doesn't Have to Be Yoga

Yoga is a wonderful practice. I want to begin this article with nothing but praise for the people fortunate enough to be daily practicing Yogis. I aspire to be like you! However, for the sake of researchers, seekers, and stiff people out there, I'd like to offer them a personal training session merely focused on their stiffness, and pre-exercise-begin-exercising-at-all, assisted flexibility program.

The purpose of yoga practice is to prepare the body and mind for meditation. This requires complete silence and stillness. There are various traditions, beliefs, postures, hand postures, breathing techniques, and words from Sanskrit that pass before you in your journey, and if you happen to drop in to a beginner yoga class, it appears that all of the other "beginners" already know the Vinyasa flow that goes with the Sun Salutation sequence, AND can already touch their toes.

After 30 years in the fitness business, I've read the Bhagavad-Gita, and all of the traditional required reading yoga books. I've attended the various styles of yoga presentations, and I have just recently come to a new awareness about me and flexibility. I have discovered that for me and many of my clients, becoming proficient in gentle stretching, while maintaining good posture, breath, and taking time to completely relax is a task of its own.

The trend in clubs and studios the world over is Yoga and Pilates. Everybody is doing it! That still doesn't mean that it is the right program for all of us. My solution to those that have been embarrassed in a beginning yoga class, but still have the desire to be relaxed and meditative like Yoga People is to follow a basic plan as your starter.

It's true that yoga postures or Asanas are designed to cleanse the body while bringing energy to certain centers. These concepts can begin with the following guidelines;

Breathe in slowly, expand the abdomen, then the ribcage, and finally the upper portion of the lungs. Then, breathe out in the same manner, letting the abdomen cave in as you exhale. I prefer to breathe in and out through my nose, although there are no specific rules about it, nasal breathing is considered better for several reasons. The health benefits include filtering the air from the external environment through the sinuses to the lungs. The sinuses do their natural job of filtering the air as it enters the lungs while the smaller diameter of the sinuses create pressure in the lungs during exhalation. This allows the lungs to have more time to extract oxygen from them. When there is proper oxygen-carbon dioxide exchange, the blood will maintain a balanced pH. If carbon dioxide is lost too quickly, as in exhaling through the mouth, oxygen absorption is decreased. Also, by breathing through the nose as opposed to the mouth, thirst and dehydration are decreased.

There's no need to breathe so deeply (in the beginning) that you feel like passing out, but if you are just beginning to incorporate a breathing routine into your day, pay attention to how often you are holding your breath. Your normal breathing should include an even inhalation of 1 count, hold for 3-4 counts, exhale for 2 counts. This should be a constant, even cadence all during your day.

When exercising, whether it be stretching, or picking up a package, always exhale on exertion. Inhale, then lift, and exhale. Or, if you are stretching, breathe evenly, and perform your stretch on the exhale, then keep breathing evenly. You will build your breath and movements into a rhythmic sequence. There will be no Sanskrit words to memorize, no postures that hurt your knees, just breathing and stretching being sure to include the four basic movements. They are, forward bending, back bending, side bending, and twisting.

Once you have developed a comfortable breath, it doesn't matter if you are standing, kneeling, or sitting in a chair, you will begin by lengthening your spine. This is done by expanding the rib cage through breathing, reaching up over your head to become taller, or on your hands and knees, pulling back or raising like a cat. However you go, the spine should be safely warm and long before you begin side bending or twisting.

Once the spine is lengthened and warmed, forward bending is an easy move. Again, this can be done while standing, sitting, or kneeling. You will advance this move as you become more flexible, but don't push it if you're not.

The next natural move would be backward bending. As a beginner, simply leaning backward while standing will be good enough. Place your hands at the back of your rib cage, inhale, then exhale as you lean back.

Now, you are ready for some bending at the waist. This shouldn't be anything too aggressive, just enough of a stretch that you can comfortable breathe with and hold for at least 30 seconds. Save the twisting for last, and again, begin with enough of a twist to feel a stretch, but not to torque your back.

Now that you have begun to breathe properly into the exertion, you are ready to design a full routine including all of the basic moves holding each for 30 seconds, while breathing properly throughout.
For the first several sessions, you should go through this routine which includes each of the directional stretches that are included in the Yoga Asanas. Become comfortable with the stretches, as well as your breathing. End with breathing only and sitting quietly for 5 minutes.

Once you have perfected this basic stretch sequence and become comfortable with your breath, sitting quietly, and moving slowly, you will be ready to move forward to learn more about Yoga. If Yoga is not what you're looking for, you might find a Personal Trainer to lead you into a more aggressive flexibility program. Once you have perfected this preliminary program, you will be ready for more!