Hospital and Nursing Home Discharge: You Have a Right to Appeal

March 16th, 2010

When you or a loved is discharged from a hospital or nursing facility, it can be a very stressful process, and can be even more difficult if the patient, and their family or caregiver, are unaware of their options.  Medicare beneficiaries have important rights to receive proper medical care.

When a Medicare patient enters a hospital or nursing facility, there are strong financial incentives to discharge the patient as quickly as possible.  Medicare usually pays hospitals flat rates, based on the type of medical problem being treated.  If the hospital spends less money on medical care than Medicare pays, it makes money, but if the hospital spends more than Medicare pays, it loses money.  Therefore, the doctors and care providers in these facilities are urged to quickly discharge Medicare patients.

To protect patients from being discharged too quickly, Medicare gives the patient the right to appeal hospital discharge decisions. When a hospital, doctor, or Medicare health plan informs you of your planned date of discharge, it is important to tell them immediately if you think you are not ready to leave.  If your concerns about early discharge are not resolved through the staff, you should request an appeal.  Medicare will continue to cover your stay, as long as you file the appeal before you are discharged.

When filing an appeal:

  • It is best to file your appeal on or just before the planned discharge date.
  • To file your appeal, call Health Services Advisory Group (HSAG) at 1-800-841-1602.
  • Tell HSAG why you object the planned discharge and provide supporting information.
  • After you file your appeal, the hospital (or your Medical health plan) must give you a Detailed Notice of Discharge that explains the reasons it thinks you are ready to be discharged.
  • The hospital must send a copy of your medical records to HSAG for its review.

HSAG will usually inform you and the hospital of its decision within one day of receiving the necessary information, and is required to do it by telephone and in writing.  If HSAG decides that you are not ready to be discharged, Medicare will continue to cover your hospital stay.  However, if HSAG finds that you are ready to be discharged, Medicare will continue to cover your services until noon, of the day after HSAG notifies you of its decision.


19 Things Elders Have Learned – Humor

March 16th, 2010

19 Things Elders Have Learned

  1. Never, under any circumstances, take a sleeping pill and a laxative on the same night.
  2. Don’t worry about what people think; they don’t do it very often.
  3. Going to church doesn’t make you a Christian anymore than standing in a garage makes you a car.
  4. Artificial intelligence is no match for natural stupidity.
  5. If you must choose between two evils, pick the one you’ve never tried before.
  6. A person, who is nice to you but rude to the waiter, is not a nice person.
  7. For every action, there is an equal and opposite government program.
  8. If you look like your passport picture, you probably need the trip.
  9. Bills travel through the mail at twice the speed of checks.
  10. A conscience is what hurts when all of your other parts feel so good.
  11. Eat well, stay fit, die anyway.
  12. A balanced diet is a muffin in each hand.
  13. Junk is something you’ve kept for years and throw away three weeks before you need it.
  14. Experience is a wonderful thing. It enables you to recognize a mistake when you make it again.
  15. 7People who want to share their religious views with you almost never want you to share yours with them.
  16. You will never find anybody who can give you a clear and compelling reason why we observe daylight savings time.
  17. Never lick a steak knife.
  18. You should never say anything to a woman that even remotely suggests that you think she’s pregnant unless you can see an actual baby emerging from her at that moment.
  19. The one thing that unites all human beings, regardless of age, gender, religion, economic status or ethnic background, is that deep down inside we ALL believe we are above average drivers.

Help with Medicare Part D, prescriptions, questions

March 16th, 2010

“My Medicare Matters” is an educational and outreach initiative that helps people with Medicare and their families better understand Medicare.  This campaign is sponsored by the National Council on Aging (NCOA) and supported by AstraZeneca Pharmaceuticals, LP.

The “My Medicare Matters” national campaign has three goals:

  1. To maximize the number of people who are “informed consumers” of Medicare, including Part D and who are able to take appropriate next steps
  2. To maximize the number of eligible people who enroll in the Medicare Savings Program, Part D Extra Help/Low-Income Subsidy (LIS)
  3. Maximize access to related benefits for elders of modest financial means

For more information about My Medicare Matters, please visit for consumers and for professionals and volunteers who work with people with Medicare.

To contact Medicare directly, call 1-800-MEDICARE (1-800-633-4227)

About Me

January 25th, 2010

My name is Cheryl Mathieu, Ph.D., M.S.W.  I help people manage the challenges of aging and caregiving, especially with aging parents. I am a problem solver and an eldercare advocate. Whether you are a family caregiver or professional in aging, I can assist you in finding creative solutions, and peace of mind, in any eldercare situation.
I own my own Geriatric Care Management business in Southern California, and daily help caregivers and seniors get the assistance they need to remain independent in their homes and have the highest quality of life possible – assuring they are happy and safe.
Since 1984, l have been devoted to community service, elder advocacy, coaching caregivers, creating a meaningful life, and assisting others in creating what they want. I am dedicated to assisting individuals and their loved ones to achieve the highest quality of life, dignity, independence, integrity and joy.
My passion for serving the elderly began many years ago, while assisting both of my grandmothers with their goals to remain independent and have a good quality of life. I learned first-hand the physical challenges of aging, the drive to maintain independence, the difficulty of navigating the “systems,” the vulnerability of seniors, the healing of relationships that is possible, and all the difference a caring touch can make to a senior and their family. Although we hadn’t been close throughout our lives, I advocated for both of them during their last years – finding the best care and assuring they were happy and safe. I saw how loving and caring for them no matter what assisted them in healing their relationships with other family members, and created a peaceful completion for all.
In 1999, I formalized my specialized training in gerontology and aging, and began a career in geriatric care management.  I have a Master in Social Work from CSULB, a Doctorate in Social Work from UCLA, and a Master of Spiritual Science from Peace Theological Seminary. I love people and put my heart on the line to advocate for others.  Through academics and service experience, I have gained in-depth knowledge of issues related to aging and the life cycle.  I am devoted to my growth and development, and committed to maximizing the quality of life for those she serves.
The purpose of this blog is to share tips, strategies, inspiration and hope with all caregivers!!!

Feel free to browse, comment or ask questions.

All the best!
Dr. Cheryl

Alzheimer’s and Eating: Colorful Ideas

October 16th, 2009

Brightly colored tableware may be the key to getting Alzheimer’s patients to eat and drink more.

Significant weight loss can be seen in about 40% of people with severe Alzheimer’s disease.  This has most often been attributed to depression and eating difficulties, but a study that was conducted in 2004 and is published in the journal Clinical Nutrition, has indicated that vision problems might be the cause.

Serving meals on brightly colored tableware may encourage greater food consumption among patients suffering from Alzheimer’s.  This study showed that people with Alzheimer’s disease experienced a 24% increase in food intake and 84% increase in liquid intake when served on bright red or brightly colored blue tableware and cutlery as compared to white tableware and stainless-steel silverware.

If you are having trouble getting your Alzheimer’s patient to eat, consider using high-contrast tableware.  This is an easy and inexpensive solution, which helps maintain the patient’s diet and promotes independence.

Bright ideas brought to you by Emily

Reduced Social Activity Linked to More Rapid Loss of Motor Function in Older Adults

June 23rd, 2009

Loss of muscle strength, speed and dexterity is a common consequence of aging, and a well-established risk factor for death, disability and dementia. Yet little is known about how and why motor decline occurs when it is not a symptom of disease.  Motor functions enable us to act and move.

Researchers at Rush University Medical Center have found that, among the elderly, less frequent participation in social activities is associated with a more rapid decline in motor function.   “It’s not just running around the track that is good for you,” said Dr. Aron Buchman.  “Our findings suggest that engaging in social activities may also be protective against loss of motor abilities.”

These results raise the possibility that motor function decline can be slowed by encouraging people to engage in social activities, such as doing volunteer work, visiting friends or relatives, or attending church or sporting events. 

“There is gathering evidence that physical activity is only one component of an active and healthy lifestyle. Studies have shown, for example, that increased cognitive and social activities in the elderly are associated with increased survival and a decreased risk of dementia,” Buchman said. “Our study extends these findings, showing that social activity late in life is closely linked with healthy motor function.”

See full story

Firm Pushed Drug It Knew Didn’t Work

June 16th, 2009

Health insurers and states are suing Eli Lilly Co. over the way it marketed Zyprexa, an antipsychotic medication. Zyprexa was the firm’s best-selling drug in 2008.
(June 15) — Phamaceutical giant Eli Lilly & Co. urged doctors to prescribe its drug Zyprexa for elderly patients with dementia, even though the company had evidence the drug didn’t work in such cases, Bloomberg News reported.
The Bloomberg story is based on company documents that were unsealed in insurer lawsuits against the company over Zyprexa. Lilly began promoting the drug for use in elderly patients with Alzheimer’s and other forms of dementia in 1999, even though it had been approved only as a treatment for schizophrenia. The company also tried to get doctors to prescribe Zyprexa to elderly people struggling with moodiness and insomnia.

It’s unclear whether Lilly accepted the offer, Bloomberg said. It noted that a rival pharmacy company, Express Scripts Inc., also sent out letters touting Zyprexa. CVS and Express Scripts are not defendants in the lawsuit.
Zyprexa was Lilly’s best-selling drug in the U.S. in 2008, bringing in $14.6 billion. The documents were released as part of a $6.8 billion lawsuit over Lilly’s marketing of Zyprexa. Twelve states are also suing Lilly over the same matter.

21 Activities For People with Dementia

June 11th, 2009

Encouraging people with dementia to stay engaged and active can sometimes be a challenge if you haven’t done it before.  Below are 21 ideas to help you succeed. Be sensitive to the person’s abilities and desires.  Remember to keep the instructions simple and clear, pick the best time of day to engage the person, offer choices, be patient, flexible and creative and have fun!

1.  Physical activity – exercise (group or individual, walking, yoga)

2. Games, puzzles, crossword puzzles

3. Meal preparation (stirring, washing, mixing, tasting)

4. Housekeeping (folding, dusting, make the bed)

5. Music (listening to favorites, singing, live shows)

6. Work-type activities (safe items from the person’s professional work: a desk, papers to sort, tools)

7. Personal grooming (fix hair, do nails)

8. Gardening (watering, planting)

9. Massage (hand or foot, be sensitive to personal space issues)

10. Attending religious services

11. Magazines or books (pictures, familiar people or places)

12. Outings (art museums, coffee shop, beach)

13. TV (approprite and in small amounts, classic movies, Animal Planet, comedies like “I Love Lucy”)

14. Arts and crafts (meaningful and purposeful, not just to fill time)

15. Attend senior center or day care programs (when appropriate and the group’s ability levels match your needs)

16. Pet care (feeding, combing, petting)

17. Sorting (poker chips, coins, cards, silverware)

18. Engage with children (intergenerational activities)

19. Meditation and quiet time (soft music, low sensory input, holding soft animals and blankets)

20. Reminisce (structured discussions about old memories)

21. Eating (going for a favorite meal, ice cream shake)

Do you have other activities that have worked well?  Please let me know so I can post and share them with others! Participates in Aging Sensitivity Training

June 10th, 2009

LONG BEACH, Calif., June 8 /PRNewswire/ — In an effort to better serve Long Beach-area seniors, staff members from local legislators’ offices and community agencies recently participated in an interactive senior sensitivity training program sponsored by SCAN Health Plan. The award-winning Trading Ages(TM) program is a workshop that provides participants the opportunity to literally “walk in the shoes of a senior” through a series of hands-on exercises and sensory perception education.

“Through this program SCAN provides an invaluable opportunity to feel, see and hear the common physical and emotional challenges that are a part of the aging process,” said Long Beach Assembly Member Bonnie Lowenthal, who co-hosted the training with SCAN. “As society ages it is incumbent upon all of us to better understand what it’s like to grow older and raise our level of appreciation for seniors and what they confront.”

In addition to Assembly Member Lowenthal’s staff members, among those taking part in the day’s workshop were staff from the Long Beach City Council Offices, Long Beach Police Department, Long Beach Senior Advisory Commission, Los Angeles District Attorneys Office’s Victim Assistance Program, Santa Monica Police Department Elder Abuse Unit, and Long Beach-based Pathways Volunteer Hospice as well as, an online eldercare resource.

Read entire press release

How Can I Make My Aging Parents Do What I Want?

June 5th, 2009

I had two calls just today on a similar topic — How can I make my aging parents to “do what I want.” This question comes up a lot. The adult child sees mom or dad living in, what they consider, less than the best situation and the child thinks that things would be so much better if only they would do “X” (such as move closer to her, move to an assisted living or get caregiving in the home). The only problem is, Mom or Dad doesn’t want to do “X.”

The main thing to remember is this: People (everyone, including your parents) have the right to make their own decisions (even if they look like really bad decisions to you) for as long as they have “capacity.” Basically, “capacity” means that they understand the consequences of their decisions – the ability to receive, evaluate and communicate a decision to others. If they have advanced dementia or are in a coma, they probably don’t have capacity. Physical frailty is not sufficient in determining capacity.

If they have capacity, you can talk to your older loved one to see if they want to cooperate with what you have in mind, but if they don’t want to, nobody can make them. If you feel they aren’t safe and they refuse to get help, you could report them to Adult Protective Services (APS, available nation wide).They will do an assessment and determine if the person is safe or if they need a guardian. Powers of Attorney are documents a person signs, designating someone else to make decisions for them if they are no longer able to (such as for health care or financial decisions).

Ideally, everyone involved would talk and come up with a plan to support the older loved one in getting what they want while remaining safe and happy. If your mom or dad doesn’t want to change, the best you can do it make a “Plan B” – an alternative plan to implement when the “crisis” happens. Usually, an incident like mom falling and breaking a hip forces change. If you have a Plan B, you can sleep easier knowing you won’t be caught by surprise, because you know what your options are.

Answers to all your eldercare questions, and options for “Plan B” can be found in AgingPro’s Eldercare Basics E-Book.

You can have peace of mind when you know you’ve looked at all your options, and made the best decision you could in the moment.

Aging Humor June 3, 2009

June 3rd, 2009

AgingPro Funnies

Q:  How can you avoid that terrible curse of the elderly—–wrinkles?

A:  Take off your glasses and you won’t see them.

Q:  Is it common for 60+ year olds to have problems with short term memory storage?

A:  Storing memory is not a problem, retrieving it is a problem.

Q: What is the most common remark made by 60+ year olds when they enter antique stores?

A: “‘Gosh, I remember these.”

Dementia with Lewy Bodies Often Missed

June 2nd, 2009

(Source: Alzheimer Research Forum) – Perhaps the biggest, and quintessential, representative of a spectrum neurodegenerative disease is dementia with Lewy bodies (DLB). By some counts, this disease is the second most common form of dementia after Alzheimer’s disease (AD), with patient estimates ranging between one and two million in the U.S.

DLB is a double whammy of a disease. People with DLB have behavioral and memory problems as in AD and, to a varying extent, also suffer motor symptoms, as seen in Parkinson’s disease (PD). However, the cognitive symptoms of people with DLB tend to fluctuate frequently, their motor symptoms are milder, and they often have vivid visual hallucinations and particular visuospatial (visual perception of spatial relationships among objects) deficits. In short, DLB is neither AD nor PD, and yet defining its distinct identity has been a challenge.

This is Part 3 of a nine-part series.

Go to full story:

New U.S. Secretary of Health and Human Services Supports Long Term Care Workers

May 20th, 2009

The new U.S. Secretary of Health and Human Services, Kathleen Sebelius, wrote a letter to the editor of the Washington Post regarding the article: “Taking Care of Our Caregivers”. Sebelius explained that the Department of Health and Human Services is deeply concerned about the needs of long-term care workers and maintaining an adequate and high-quality workforce. To view:

Weight Loss and Alzheimer’s

May 19th, 2009

Researchers have discovered more evidence that rapid weight loss in old age may be an early warning sign of dementia.

Aging Humor: Never Stop Laughing

May 18th, 2009

You don’t stop laughing because you grow old, You grow old because you stop laughing!!

My memory’s not as sharp as it used to be. Also, my memory’s not as sharp as it used to be.

Just before the funeral services, the undertaker came up to the very elderly widow and asked, “How old was your husband?” “98” she replied, “Two years older than me.” “So you’re 96,” the undertaker commented. She responded, “Hardly worth going home, is it?”

Watch the “Alzheimer’s Project”

May 12th, 2009

Beginning Sunday, May 10, 2009, tune into HBO’s “THE ALZHEIMER’S PROJECT,” a groundbreaking documentary series that will change the way America thinks about Alzheimer’s disease. This four-part film, airing over three nights exclusively on HBO, gives the public a rare inside look at the faces behind the disease and the forces leading us to find a cure. With Maria Shriver.

Need Help Paying for Medicine? Check to See if You Could Receive Free Medicine!

May 11th, 2009

The Partnership for Prescription Assistance may be able to help you pay for your medications.   If you don’t have prescription coverage and can’t afford your medicines, call   888-477-2699  or go to  You could get them free or nearly free.

AgingPro Caregiving Tip: What is Mine to Do?

May 8th, 2009

AgingPro Caregiving Tip: What is Mine to Do?
When caring for an older loved one, it is important to ask yourself, “What is mine to do in this situation?” Some caregivers will find themselves called to give hands-on assistance, others will donate money, food or time, and still others will do nothing. Be aware that each person is doing the best they can at the moment.

Building resentment over what others are or are not doing in the caregiving role is neither productive nor healthy—for you, for them, or for your loved one. Determine what is yours to do, and do it to the best of your ability. You can’t possibly do everything that you think needs to be done. Tell yourself and your loved one, “I love you, and I’m going to do the best I can with what I have and with what I know.”

Swine Flu Prevention Tips

April 29th, 2009

6 Steps to Preventing the Flu: Good Health Habits Can Stop Germs

1.  Avoid close contact.

Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick too.

2.  Stay home when you are sick.
If possible, stay home from work, school, and errands when you are sick. You will help prevent others from catching your illness.

3. Cover your mouth and nose.
Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick.

4.  Clean your hands.

Washing your hands often will help protect you from germs.

5. Avoid touching your eyes, nose or mouth.
Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth.

6.Practice other good health habits.
Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food.

One-stop access to U.S. Government information on swine, avian and pandemic flu:

How to Survive a Hospital Stay

April 3rd, 2009



1.  POWER OF ATTORNEY  – Make sure the hospital has copies of the patient’s healthcare durable power of attorney that states who will make decisions if the patient can no longer do so for themselves.
2. CONTACT INFORMATION – of family or involved loved ones
3. MEDICATION LIST – Make sure the hospital has the patient’s current list of all the medications your loved one takes.
If possible, bring a list of surgeries, doctors, previous tests run (and results) and diagnoses.
5. REMOVE ALL VALUABLES – Do not leave valuables with your loved one at the hospital
6. PERSONAL ITEMS – Things that are good to have are glasses, hearing aids and dentures, but be careful with them!  If you leave items such as glasses, a cane, a walker, or dentures, make sure they are labeled and also listed in the patient’s chart on the “personal belongings” sheet.


1- PEOPLE TO MAKE FRIENDS WITH — Make friends with the discharge planner
– Get to know the nurses
2. TAKE CARE OF YOURSELF – Make sure the caregivers / advocates are taking good care of themselves during the hospital stay.
3. HIRE YOUR OWN ADVOCATE – An advocate such as a geriatric care manager knows how to navigate the medical system. They are invaluable. You can search for the closest Professional Geriatric Care Manager on’s Eldercare Directory.

Before your loved one leaves the hospital, make sure you have:

1. An understanding of your loved one’s condition and diagnosis, results of any tests, and any changes that have happened as a result of treatment during the hospital stay
2. A written medication list  (including dosage and potential side effects)
3. A written list of any needed follow-up physicians visits
4. An understanding of any problems or symptoms that may occur when the patient gets home – what to look for and when to call for help.
5. A written care plan with next steps
6. Any special equipment to prepare the home for your loved one’s return (hospital bed, home modification, rental equipment)
7. Arrangements for home health care or home care aid services- find out what services insurance will and will not cover
8. Education on any special needs your loved one may have when she arrives home
9. Transportation home, or wherever your loved one will be going.  Find out if insurance will pay for an ambulance, if necessary.