Issue 4

May 2018

A letter from the editor, Lesley Jane Seymour

Unfortunately, sexism is not new to Hollywood. Back in 2015, Patricia Arquette created a tsunami of outrage when she referenced the scandalous fact that most female actresses are paid significantly less than their male counterparts during her acceptance speech for the Oscars. “To every woman who gave birth, to every taxpayer and citizen of this nation, we have fought for everybody else’s equal rights,” she said. “It’s our time to have wage equality once and for all and equal rights for women in the United States of America.” The wonderful bare-faced Frances Mcdormand brought down the house during this year’s Oscar broadcast when she asked everyone to ask for an “inclusion rider” in their contracts so that there would be both gender and racial equality in future productions.   Sexism explains why the movie industry keeps churning out dumb movies about superheroes meant only for our teenaged sons—Hollywood’s most coveted audience. And why it ignores a vibrant, movie-loving audience like us! As Little Miss Sunshine writer, David T. Friendly, noted in the June 19, 2011 edition of the Hollywood Reporter, before the all-female cast of the hit Bridesmaids blew past the $100 million mark in just 23 days, “getting female-driven comedies to the big screen has been as hard as selling Disney an X-rated movie.”

Now throw in ageism–which is so rampant in Hollywood that you regularly see Gumby-like faces distorted by over-use of injectables or the sad, unrecognizable visage of Kim Novak at the 2014 Oscars. Ageism is so noxious that even a gifted star like Meryl Streep admitted she was shocked to be working at 60 by being “given great, weird, interesting parts well past my ‘sell-by date’.”

When I took over More magazine in 2008, it had established a habit of putting an actress’s age on the cover. This middle-finger to the taboo of aging was a draw for readers, who often wrote in saying it made them feel great that so-and-so “was 51–and still looked great.” But it also meant that the Hollywood agents who’d adored me when I was Editor-in-Chief of Marie Claire—where I could put their aspiring newbies on the cover—now treated me like I had head lice at a hat party. I was particularly confounded when superstars would declare they “loved turning 40” on the cover of a fashion magazine, but would decline to do a More cover because as one agent put it to me “she isn’t quite ready for that yet”—as if More was the last stop before the glue factory. Finally, one agent friend explained that aging actresses faced real financial danger because in the majority of contracts, leading men would demand that their scripted love interests “be at least 15 years–or more–younger”! I took age off the More cover.

For that reason, I hope you’ll applaud women like Caytha Jentis (see interview below), who are fighting the good fight to keep women of all ages visible on the screen. I laughed out loud while watching her video series called “The Other F Word” because she captured many hidden moments in our real lives. She even showed me a clip of an upcoming episode which includes a former magazine editor reinventing herself as an Uber driver who picks up her former assistant as a client. Let the laughter begin.


Boost Your Libido–and Cure Your Incontinence

What’s New That You Can Do--For Down There

By Didi Gluck

Illustration of heart in crotch
Libido by Kate Kalupson

What if we told you that there’s a simple, painless treatment that could help you stop peeing yourself every time Jimmy Fallon delivers his opening monologue—plus, rev up your sex life?

Yes, it involves a laser to the labia (um, and possibly even inside the vagina), but before you say “aw hell no!” hear us out. Laser vaginal rejuvenation—the name given to a family of non-invasive treatments that claim to improve urinary incontinence and tighten lax lips—is a heck of a lot less involved than going under the knife for, say, a labiaplasty (to get rid of “mud flaps”), or for a mid-urethral sling (to keep you from leaking when you laugh or cough).

Laser vaginal rejuvenation can significantly improve your quality of life, in as little as one session. “This new field of laser technologies offers a profoundly positive step forward for women with pelvic floor dysfunction, incontinence, or changes due to childbirth or genetic aging,” says Ellen Marmur, a dermatologist in New York City. “It is especially helpful after bearing children in one’s thirties or forties.” In the last two years, no less than four noninvasive treatments intended for use inside and outside the vagina have launched in the U.S.  Coincidence? Leah Millheiser, MD, a fellow of the American College of Obstetricians and Gynecologists, a clinical assistant professor in the department of obstetrics and gynecology at Stanford University School of Medicine doesn’t think so: “Women feel more empowered now than they used to. [They] say what is on their minds–and in no place is it more obvious than in the sexual healthcare arena.”

Jennifer Walden, MD, a board-certified plastic surgeon in Austin, TX, attributes the growing attention to vaginas to the rise of younger women seeking genital hair removal and being able to actually see their genitals.  With “the rise of social media and instant gratification, there has been a spike in women wanting their vaginas to look good,” she says.

Or maybe it’s just that the existing vaginal rejuvenation treatments were so abysmal. Who really has time (or patience) for Kegels or to apply a messy estrogen cream? As for surgery, some of us just aren’t willing to go under the knife for camel toe.

These new laser treatments, which include ThermiVa, a radio-frequency device, diVa (the combination of an erbium:YAG and 1470 diode laser), FemiLift and MonaLisa Touch (fractional CO2 lasers), all function similarly by creating microscopic wounds to the skin, which trigger the production of collagen that bulks up the vaginal wall,  improving blood flow. Each session takes from five to thirty minutes—depending on the device—and you can count on receiving two or three treatments, spaced two to six weeks apart. Depending on what part of your vagina’s anatomy requires tightening (inside or out), you may not be able to visually see the results. But you can expect to feel tighter, and like your vagina is more elastic and better lubricated (which all adds up to less incontinence and reduced pain during sex).

Vaginal rejuvenation probably won’t bother your partner either: “The increased collagen leads to more friction during intercourse, which heightens the intensity of orgasms,” says Carolyn Delucia, MD, a gynecologist at VSpot in New York City, a women’s sexual health and wellness medi-spa, where they use the FemiLift. “We’ve had husbands call to thank us.”

So what exactly can you count on if you schedule a vaginal rejuvenation treatment? This reporter had the opportunity to try  FemiLift (all sacrifice in the name of science, of course). It felt a bit like a sonogram. With my feet up in stirrups, Dr. Delucia inserted a probe that emitted energy into my vaginal canal. (Despite how this sounds, it was completely painless—though it should be noted that different lasers can yield different sensations.) The treatment took about five to ten minutes. Prices vary depending on where you are in the country, but at VSpot, FemiLift will run you $600–$1,500 per session. (As a reporter, I was told to come for three free visits spaced a few weeks apart for results that would last up to a year before a touchup was needed. I have yet to schedule my two follow-ups, but I plan to.)

Dr. Delucia told me that the best candidates include anyone who suffers from urinary incontinence, laxity—the aforementioned camel toe—due to aging or childbirth, and/or “vaginal atrophy,” otherwise known as the severe dryness and stiffness caused by a drop in estrogen, usually from menopause or breastfeeding. (Anyone with active herpes or problems healing are told to avoid any of these laser treatments.) And while research is ongoing to determine which device is best for treating each specific condition, Dr. Millheiser says MonaLisa Touch is often recommended for atrophic symptoms. Common short-term risks of the laser therapies include swelling and redness; since long-term data is not yet available,  it’s difficult to know what, if any, long-term risks exist.

If libido is your chief concern, less invasive options, like the Fiera Personal Care Device (Arousal Device–prices start at $200 at, a tiny plastic contraption that clips onto the labia to get your blood flowing to the area, are available.  But for women seeking to tighten up—in order to increase sexual pleasure or decrease leaks—relief may come in the form of a wand. Now if only there was a way to zap away menopause.

  1. Thersa Matteo

    You sure know what you’re talking about. Everyone is going to soon be visiting your site.

  2. Lynda hinch

    compared to other rejuvenating gels I tried in the past Myotaut tightening serum comes out on top. The first time I tried it I could feel the tightening effects immediately which is the result of better intimacy for me and my partner. I love the way it makes me feel rejuvenated and in control of my vagina health. I would recommend myotaut amazing serum to anyone who wants a better and satisfying sex life! Also, this serum had long-lasting effects in the vagina.

  3. Amanda T.

    Thank you! Also try the myutaut tightening serum I ordered it a week ago..first impression is good smell, dense and great on the delicate skin but will report

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The Find

New Farm-to-Vase Flowers

Sustainably farmed flowers can now be shipped directly to your door from around the world

By Lesley Jane Seymour

Farm Girl Flowers

Some women mainline chocolate. Others binge on salt. Me? I’m a flower junkie: I grow them, harvest them, photograph them, and steal their seed pods (from public lands only, I promise!) I dry and shake the dead heads for their seeds which I save and replant the next year. The inexplicable beauty of flowers—the artistic color contrasts, intricate petal arrangements, clever seed dispersal techniques, rhythmic openings and closings during the day—reveals to me a sense of the divine.

While I envy my neighbors’ organized Martha-Stewart-type gardens, what I really love are fields of wildflowers that grow without human management. Those fields, for me, represent the spirited resistance to the over-organized, over-planned hyper-efficient lives we lead—in which we now have to make an appointment to just talk to someone on the phone!

So I was more than thrilled recently to be on the receiving end of a few flower dis-arrangements from companies that are trying to make online flowers less boring and predictable by using more interesting blooms, being less wasteful, more transparent, and more sustainable. Bouqs is a wonderful service that picks flowers from the base of volcanos all over the world and sends them directly to your door starting at $36; you can even sign your mom up for a monthly subscription. They cut out the middleman and make more efficient use of every stem picked and show you how it’s done with amazing videos. Farm Girl Flowers says they source their flowers “ethically and honestly” and “support farms who pay living wages, avoid harmful chemicals, and have medical benefits for their teams.” Their gorgeous burlap-wrapped bouquets start at $48.

Farm Girl Flowers bouquet

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How To Declutter In the Digital Age

What the heck you do with Al Franken’s old cell phone number?

By Lauren Zalaznick

Photo by Christopher Flynn for unsplash

A huge shelf that stored all of our photo albums, negatives and loose photos fell down. So in the re-organizing process, my closets got a lot cleaner and neater. Marie Kondo would be proud. Well not really, because in real life you have to keep a lot of things that do not give one joy. My joyless examples: bubble wrap (in case we need it); batteries (pain-in-the-neck gadgets that they go in); cat carrier & rabbit carrier (need when they go to the vet); line tester, various extra cables, light bulbs; toolkit (blech to all); tax returns and other paperwork, assorted crap in a hideous filing cabinet (no joyfulness of any sort). But they are going to be very well arranged.

News Flash: physical photos are very efficient. They bring joy. They are easy to sort and label. Therefore they are easy to find. Very easy to create an album. Very easy to toss the bad ones. Downside: harder to preserve for all eternity.

Conversely, the idea of digital photos is great. The reality is not so much. It seems like it should be easier to sort them–then locate individual pictures, store them, meta-data the living crap out of them. Except it’s not. Upside: Keeping them forever is really easy. Except it turns out I’d like to dump 95% of the bajillions of iPhone photos I’ve taken over the past 10 or so years, but that process is so cumbersome off a hard drive that it will never happen. Or at least it is less likely to happen than sorting the final couple of hundred analog photos left in a shoebox that got short shrift in between the analog and digital eras. Lord knows I’d like to dump 99.9% of my photos off social media, but I think the word “eternity” has found new life in the form of Google and Facebook and is now called “fuhgettaboudit, your awful hair from 1999 is here to stay.”

Just for fun, on various plane rides and in the full throws of an OCD attack, I have also been cleaning out my Google address book. I’m up to the H’s. On the one hand, it is very satisfying to get rid of people’s ex-AOL email addresses, a fleet of Fax #’s, and remembrances of things past like your AIMs and MySpace pages. I see peers’ long trail of corporate email addresses as they’ve moved up from divisional to corporate addresses; also as one company after another has merged and been subsumed by the bigger corporate parent. It’s hard to fully “delete” people though, even when they’ve died! Or the many who I haven’t talked to in years and years or, actually, maybe never talked to in my life but have their info? Why I have Al Franken’s cell phone number, I just don’t know. Contestants from “Top Chef Masters“? Maybe I need a hot dinner reservation at some point, so I keep them? Camp friends’ home addresses from 1978? Hey, you never know.

I wonder what the cutoff age is for people to remember their home phone number. Twenty years? 30? I certainly remember mine, along with favorite phone numbers from throughout my life. Perhaps the best was the first one I had after college–995-0123. Then I liked my second one, which we had to get when we moved across 9th street–645-7067. (Sorry if anyone now has those numbers and are going to get crank calls from readers.) My first job/MTV Networks phone number was also really good: 258-2580. But now I think maybe I’m making up whether I actually had it or whether it was someone else’s. Either way, what could have been better?

Truth be told, I never liked our current home phone number. That may have contributed to the motivation for why, in the recent closet purge, I took out our last remaining physical phone in the house as well as the associated answering machine. Just saying “answering machine” makes me embarrassed that we still had one. Until yesterday. We didn’t dump it, however, before we recorded the messages on our iPhone from precious people from the past whose voices we had preserved on the machine for years and years. Some of whom are alive and very, very old. Some of whom are no longer with us. Now they’re loaded onto our iPhones, onto the hard drive digital files–or soon to be the freakin’ cloud–which no one can deal with as far as I can tell. But they will live with us for a digital eternity.

This piece was adapted from Lauren’s LZ Sunday Paper email newsletter. 



Zen and The Art of Decluttering: One woman’s quest to change how we think about stuff 

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Make Your Voice Heard

Fighting for the Other F Word

Caytha Jentis doesn’t accept Hollywood’s excuse that making movies for women 40+ is “tough”

By Lesley Jane Seymour

Pilot by Caytha Jentis

CoveyClub: Caytha, you are clearly a serial reinventor. Explain your various reinventions leading up to where you are now.

Caytha Jentis: I blame the fact that I’m a serial reinventor on my ADHD but I do believe women are the best at reinvention. When my kids were in preschool I went through what I call my “marathon stage”: I did long runs with a group during which lots of stories were shared. That led me back to writing. I had studied screenwriting and worked in the movie business BC (before children) and then transitioned into greeting card sales. But I started writing scripts again, the first of which was a romantic comedy. It was well received but it was the first hurdle I faced as I learned that in Hollywood, women’s stories, which had always been the staple of the now-extinct “movie of the week,” was a “tough sell” to the studios. That was when I decided to become a producer. I knew there was an audience for the [story I’d written], and with my background in the film industry and sales, I believed I had the makings of a producer. That lead to my first feature, And Then Came Love starring Vanessa Williams and Eartha Kitt, which got sold to Warner Brothers.

CC: Explain your current project and its challenges.

CJ: With three indie features under my belt [including the hilarious Bad Parents, adored by moms across the country], I was looking for a new story to tell and was reflecting on my own life and that of my friends. I thought the stories about turning 50 and about my kids growing up offered fertile ground for scripts that were more episodic. My web series, The Other F Word, is a comedic drama that I would jokingly refer to as “Girls for Grown-Ups.” I believe that while our kids are in their twenties figuring themselves out, we, as their mothers, are going through similar coming-of-age journeys into mid-life. The pilot script got great feedback but I was told that stories like these targeted a “tough demographic,” which was code for sexism and ageism. So I converted the script into a web series, which is currently streaming on Amazon’s self-publishing video platform. The show has been incredibly well received and we have been one of Amazon’s top series for the past five months. So, “tough demographic,” my ass! Our cast includes a lot of recognizable talent, like Steve Guttenberg, Judy Gold, and Gilbert Gottfried.

CC: Where do you hope to take the series?

CJ: I would like to see the show get picked up by a network. I am in production on season two and am determined to break through the Plexiglas ceiling with stories for this large, yet underserved, demographic. Season two’s episodes are longer so it will feel much more like a traditional television show.

CC: We believe every woman needs to have a reinvention idea in her back pocket. Do you agree?

CJ: Women, more than men, are defined by our bodies and have significant times in our lives that mark new chapters. As a result, we are constantly forced to take stock of who we are–opening the door to reinvention. We are also by nature reactive, needing to ask permission to be who we want to be. As we age, we get bolder and care less about that, which is one of the great benefits.

CC: What can a woman do to find an idea if she doesn’t have a reinvention idea or isn’t sure hers is good enough?

CJ: There have been many times when I felt stuck and found that the best thing to do is to constantly meet and talk with other people and literally throw ideas against the wall and see what sticks. Usually, the best success comes out of failure. We all have our “gimmicks” (à la Gypsy Rose Lee) and they all have value.

CC: How have the post-Harvey Weinstein and Time’s Up movements in Hollywood impacted the issue of ageism? Or is age still a bridge too far? 

CJ: I think things are starting to change in Hollywood in terms of ageism.  There are projects in development now about older women.  Features, by the way, has always been more open to telling all kinds of stories. Women like Madonna and Reese Witherspoon have been particularly vocal. 

CC: There’s been a lot of talk in Hollywood about how no one funds movies for women or made by women. Is this true and how do you deal with it?

CJ: It is sadly true. This past year has been the strangest one for me as I’ve been attempting to take that problem head on: I refer to myself often as a Don Quixote chasing windmills. There is a disconnect between Hollywood and the audience. I find that many of the stories that are told about the mom experience are far from authentic or real and that is because they are written by men. If I give up, then the guys win. And I do like to remind myself that if I enjoy the journey, there is no failure. I am a true extrovert and love the people that I meet through my projects, and while I produce on a very small budget, I know I am very rich in my world as a result. On The Other F Word in particular, I’ve done a massive grassroots campaign and believe I’ve become a connector; I have met many amazing women doing amazing things in midlife and confirmed what I always knew—that we are definitely stronger as a united force.


  1. Shari

    Great vignette and article – although it’s so disturbing that Hollywood is so sexist. Ageism is a fact there. Until very strong female leads stand up to it/fight it, it’s the reality. Can we strike Hollywood? Can we successfully boycott ? The only way to fight this is to hit’em where it hurts, in the wallet.

  2. Dianne Sippel

    At first I felt disheartened then Jentis lifted my spirits with “If I give up the guys win.”
    Made me chuckle and Jentis hit the Ball out of the park commenting “If I enjoy the journey ,there is no failure and more magazine always made that point clear.
    Keep theses interviews up they are so needed today.

  3. Tina Carusillo

    Thanks for introducing me to this series and Caytha’s work.
    ‘If I give up, then the guys win.’
    I’ll keep watching.

  4. Alessandro Machi

    Write your script with a majority of male names, get the funding, then convert the names to the female version of the name, and make your movie your way. I recall Sharon Stone on the Steven Colbert show stating that over the years she has on occasion fought to have a role named for a man converted to a women’s role without really changing the script very much.

  5. Alessandro Machi

    I’m curious about the 18-49 demographic that seems to determine if a TV show is picked up or not for a new season. Has an actuary ever actually studied if that is the most effective age group to be concerned about?
    Maybe there should be two demographics, 18-34 would be one, and then 35 to 59 could be another one. Isn’t it possible that the 18-49 demographic is too wide of a demo to be using to determine if a show is picked up?

  6. Ann Taylor

    “If I enjoy the journey, there is no failure.” This is the statement that stuck out for me. Keep working it!! and Thank you!

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Say what?

"The defining moments in our lives often don’t come with advance warning. They can arise in scenarios we would have never expected, and don’t come with the luxury of a lot of time for you to go inside yourself for some serious introspection."

Former acting Attorney General of the United States, Sally Yates


The Joys of Nursing a Grudge

Sure, you could give it up and move on...but that might ruin the fun

By Marcia DeSanctis

José Luis
Illustration by José Luis Merino/

Not long ago, I wrote an essay in a British magazine about turning 50. The basic premise was how blissful life had become – how unencumbered and light – now that I’m too old to give a damn. How I toss off criticism, slights, disappointment and vile Internet commenters with a so-what? shrug and move on to the real business of my day: cleaning the lint trap and perusing the web for black suede ankle boots.  

If only.

The sad truth is that though they’ve thickened my waist, the years haven’t much thickened my skin. In fact, I’m not sailing weightlessly through middle age; I’m lugging a satchel full of grudges, some of which date back to middle school. Yes, 45 years later, I’m still salty about not getting to play one of the March sisters in our Girl Scout production of “Little Women.” Instead, due to my height and mortifying pixie cut, the Mom/director cast me as Laurie, the boyfriend. When I think about it – which is rarely, but still – the sting is fresh, as if I endured the flesh wound last week.

Consider the people I’ve not managed to let off the hook and the grievances, compounded by time, that have soured like old cream over the years. Professional ones: the colleague at ABC who told a damaging lie about me to my boss. Emotional ones: the girl my boyfriend cheated with late one Saturday night senior year of high school, while I bawled into the cushions of the couch. Social ones: the woman who canceled on my dinner gathering with a sob story, and showed up on Facebook the next morning in a party hat. Even deeper, perhaps, is what lingers on behalf of my family. I still bristle at the mere mention of a girl who relentlessly picked on my daughter in third grade, the one who told her that only a loser would wear a pink snowsuit. I see her mother occasionally at the grocery and am at pains to ask how little V. is doing in her sophomore year of college. It’s telling to note that my daughter put this behind her a decade ago.

Chock it up to life on earth that everyone on it is occasionally hurt, ignored, dissed, dismissed, humiliated, offended, slighted, excluded, and completely – frustratingly – misunderstood. We’ve been passed over for a promotion by a less deserving jerk, blamed for something we didn’t do, disliked or gossiped about for no logical reason. Sometimes, grudges spring up, toxic and whole, from the helpless wreckage of pain and anger, for us to hide in or hoard in some perverse facsimile of self-protection.

Maybe it offers some dark, twisted satisfaction to clutch onto grievances, these imaginary vials of poison poised to deploy against those we perceive to have wounded us. But I’m not a Soprano (or a Montague, a Capulet, or a bilious president). I’m a nice middle-aged woman, neither capable of nor interested in seeking payback on those who have crossed me. What am I going to do? Pistols at dawn with the person who declined to blurb my book? No, the only one getting poisoned is me.

These days, occasionally I assess what I can do to lift my overall mood and stem the forces that drain me. Even with chemical peels and Pilates, life isn’t getting any longer for those of us moving through our sixth decade, and it’s worthwhile to recognize when we have a death grip on what makes us miserable. It took one of my old literary heroines to incite a reckoning. While re-reading “Jane Eyre,” I got riled up by what I saw as her blindness to the injustice she suffered – from her abusive aunt Sarah Reed and from Mr. Rochester, who lied to her and otherwise acted like a total creep. “Where’s your sense of outrage?” I wailed to the pages. “Have you no fight in you?” It was exhausting.

Jane was no simpleton, but I think she knew something I need to accept: that grudges are a colossal waste of emotional space. They are clutter in the clean chamber of the mind. They root you in the past and block the ability to exist unfettered in a soft, gentle place. Holding on is corrosive on the stomach lining and sometimes on a good night’s sleep. Above all, lingering resentment takes a toll on my sense of morality, forged as a little girl in Sunday school at St. Mary’s Parish, where I was taught from the cradle to forgive those who trespass against me.

Forgiveness is what enlightenment is all about. War and destruction are about avenging grievances. The payback fantasy is not healthy for our tender souls. When we nurse a grievance, we’re picking a fight with someone we never intend to confront. How pointless is that? What’s worse and even more inexcusable is that a grudge makes us embrace an exaggerated or false sense of victimhood. This annihilates the control we actually have over our own well-being.

Unless there was an actual crime or an irreversible emotional wound, claiming victimhood can be a cop-out. And yet, even in the aftermath of a brutal crime, sometimes people choose forgiveness over fury and hate. The families of those massacred at the Emanuel AME Church in Charleston gave us a lesson in grace when, incredibly, they showed compassion towards the gunman who slaughtered their relatives. And who can forget the image from Steubenville, Ohio, when a mother embraced and forgave her 16-year-old daughter’s rapist in the courtroom? These episodes of soaring humanity make a mockery of our everyday petty grievances.

I’d hate to think that someone out there nurses a grudge against me, but they do, and I know of at least one. One friend, I gather, is still furious that I didn’t invite her to my intimate wedding in Paris, 25 years ago. I get it and regret it. I should have explained back then why I kept it small. There is a reason for most bad behavior and usually it’s a trifle, a misunderstanding, mistake, or very human lapse in judgment.

Ann Landers said, “Hanging onto resentment is letting someone you despise live rent-free in your head.” Isn’t there enough out there in this complicated, troubled world to disquiet our minds? Besides, I’m willing to believe that grudges also cause wrinkles and bad posture. I don’t need any help aging, thank you. And I shudder at the prospect of being a cranky old lady, still harping on about the time I got stiffed in Girl Scouts. Instead, maybe I can talk about my brilliant gender-busting portrayal of a young man in “Little Women” back when I was a teenager. That, my grandkids might want to hear.



  1. Lizzie Funk

    Oh How I LOVE this! And that Ann Landers bit at the end? Here’s to good posture! xxxx

  2. Julianne Pressman

    Have always loved your writing! This is just so human, this article. And so me! Good luck searching for the boots!

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Hot flash!

A new Generation Gap? According to Merrill Lynch, 70% of 51-69 year olds believe inheritance should be divided equally among recipients while 54% of Millennials feel distribution should be based on age, readiness and need.

Secrets to Her Success

She Turned Her Shopping Obsession Into A Business

Designer Leslie Hsu loved picking clothes for friends. Then she began to charge for it.

By Lesley Jane Seymour

Photo of Leslie Hsu
Photo by Marika Alzadon

Becoming a personal shopper wasn’t exactly the plan for Leslie Hsu, a first-generation Chinese American. She started her career doing fabric research for Calvin Klein and worked her way up to licensing & designing handbags for UGG and True Religion, then launching handbags for interior designer Jonathan Adler.

“I was at dinner with seven girlfriends and each one was wearing something I’d picked for her. They were laughing: ‘Leslie got me this scarf!’ I said, ‘I find so much great stuff [on the internet] and I don’t need it all.’ They said, ‘We’ll buy it!’”

The next morning, Hsu opened an Instagram account and filled it with items she loved. Three people signed up immediately and began buying. Today she runs LesliesFinds–a personal shopping service solely operated on social media, namely Facebook and Instagram. She has about 1,500 followers nationwide and hundreds officially subscribed to buy, including several who buy items from her weekly.

“I order every item [first] and try it on,” she says. “Everything looks good online—not just because the model is six feet tall and 110 pounds but because the clothing is pinned and tucked. And they mess with the color [in post-production]. I also find that things sometimes run big or small or the fabric quality is bad. I’ll let you know if something feels like the softest fabric ever, or if a pair of joggers is really tight around the ankles–you can’t really read that [in the site’s copy]. But I tell you everything you need to know about it [in my post].”

I first met Hsu at a table of strangers at a fancy New York restaurant dinner arranged by uber-connector Ulrika “Red” Nilsson. Looking at Leslie, with her long, black hair, impeccably tailored Prada-esque jumpsuit, and smart, red-rimmed glasses, we all guessed she was a lawyer. When she admitted that she paid around $150 for the jumpsuit, I was in fashion awe and knew we were so wrong. “I dress a little immature,” the 45-year-old admits, in an effort to explain the quirky, trendy edge to her style.

When it comes to buying for clients, Leslie tries to choose things that will command compliments. “I am attracted to things that are unique in some way,” she says. “Like denim stilettos or a white tee with only one sleeve.” And she won’t share an item that she doesn’t absolutely love herself. “I only posted white jeans after trying on about 40 pairs myself. I’m really picky and want the pieces to have a universally good fit. I don’t get paid by anybody but [my customers].”

Prices generally range from $20 to $300. Hsu says her customer sweet spot is women 35 to 55, many of whom share the looks with their teenage daughters. “My girls who are 16 and 14 literally get dressed in my closet,” she says. “I love that they do that because I don’t have to buy them their own things!”

LesliesFinds has caught on so much that now her services are expanding to personal shopping for individuals (some of whom she’s never even met in person) and home decor. “It’s amazing what Facebook and photos can do. I can literally personally shop for people anywhere and get to know them, their style, and their bodies from photos and some lovely conversation.” When it comes to home organizing, she says that spending some time simply moving things around can give your space a new look. “If you can trust my taste and eye and judgment on a good price, then I can personalize and style just about anything for you.”

Here’s how her service works: Click this Facebook link or this Instagram link to sign up. Email to fill out the form with your credit card, billing, and shipping info. When you see an item you like on her social media pages, go to the comment feed and express your interest and your size. Leslie will respond and order them for you. She will bill you separately an additional 15 percent to cover her scouting and processing services.

“If this continues to take off, it would be my dream: I’m getting messages from people I haven’t heard from since sixth grade. I can order for people while I’m on vacation on the beach in Anguilla. It makes people feel good about themselves—and they haven’t spent a zillion dollars.”



How to Dress After 40: Leslie Hsu answers your most pressing style questions


Want more expert style tips? Join Leslie Hsu and Tania Sterl, founder of Sterl on Style, on Wednesday, June 6th at 8PM EST. You can join from anywhere in the world and ask the experts your questions directly. Reserve your spot today!


  1. Shari

    Love ! I love fashion and don’t believe in spending a lot when there are so many places to find quality at a discount. I will be joining Leslie’s instagram account momentarily! Great idea for a business, too. Hmmmm.

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Woman of Passion & Purpose

Say No to Work/Life Balance

Tiffany Dufu orders you to shrink that to do list!

By Lesley Jane Seymour

Video by Geoffray Barbier

Tiffany Dufu says she already knows what’s going on her tombstone! And it’s all about helping women to bring sanity to the work/life balancing act.  When the ball is passed to you, she says, just drop it!  Not surprisingly, that’s also the name of her book, Drop the Ball: Achieving More by Doing Less which happens to have a forward by Gloria Steinem. Listen in as she explains how to downsize your life and upsize your happiness.

Below is a transcript of Tiffany Dufu’s story from our discussion with her.

One of the most important things to know about Tiffany Dufu is that my life’s work is advancing women and girls. That’s pretty much why I’m on the planet, so my life is really simple. I already know what’s on my tombstone, and I’m just project managing it backwards. I feel really lucky that I get to execute my purpose right here with you. I’m just the cumulative investment of a lot of people — mostly women who took the time to mentor me and sponsor me and give me advice all along my career, and life, and essentially have passed me from one woman to the next.

My father was stationed at Fort Lewis Army Base in Tacoma, Washington, so that’s how I came to be from there, and after I graduated from college I was pretty committed — still even at that stage in my development — to women and girls, so I was on the ground floor of launching a girls’ school, a girls’ middle school that focused on math, science, and technology. It’s called Seattle Girls’ School, it’s a magical place that I highly recommend.

Everything that I have ever done is connected to women and girls in some way, like literally every job that I’ve had. What I love is that I have this passion and this purpose and I execute whatever needs to happen at the time, so right now I have what I would call a “portfolio career” which I think is the future of work. I’m Chief Leadership Officer at Levo, which is a platform for millennial professionals to help them elevate their careers. I love it because I really believe that this next generation of women leaders has so much opportunity if we could just help them figure out how to not get overwhelmed by all of their choices.

I write, I just finished my first book [Drop the Ball] — it’s a book for women, like everything that I do. It means that I spend a lot of time talking to women every Tuesday and Thursday mornings, sometimes Friday mornings so I meet with six to seven women a week. Over the course of four years, I’ve met with nearly a thousand women, and I’m obsessed with their stories.

There are, in the course of my day, really specific things that I do: making sure that meetings are 45 minutes, asking a very simple question every time someone invites me to a meeting, you know in these days of technology you’re always getting these email invitations, and I like calling someone or walking to someone’s office and saying, “Hey I noticed that you sent me an invite to that meeting. Why do you need me in that meeting, is there something specific— is there a specific role you’d like me to play?” You wouldn’t believe the number of times someone says, “Tiffany I’m so sorry, you don’t need to be at that meeting.” But really the key to having it all is not doing it all, and that’s what Drop the Ball is all about.

I think it’s great that as we get older we get so much more efficient about funneling the negative messages. Quite frankly, we just get more comfortable with who we are in the world, which is really important to me.

Note: Tiffany recently left Levo league and is now CEO of soon to launch

  1. Ruth Sutcliffe

    She is inspiring, and gives some great advice to women of all ages about keeping things simple and focused. How can women find her? What is her email address? Website?

  2. judith coyne

    hmmm. This is not my favorite kind of piece. Maybe others will see it as a quick glimpse of an interesting to woman. To me, however, it was utterly self promotional on Tiffany D’s part. She praised herself endlessly (and repetitively) without giving the reader much sense of what she has ever done to help any particular woman or group of women. The only example she gives is the girls’ school in Seattle, for which she gives herself full credit. But since she was a recent college grad when she worked on it, I’m guessing there were a lot of other people involved in making that school happen, which suggests TD may be over-congratulating herself. “Drop the Ball” sounds as if it could be interesting (unless it is just a variant of the 8 zillion already-published articles about how women need to learn to say no more often). But there was very little about the book in this piece, so I didn’t learn anything new.

  3. Pamela Baxter

    I would have liked hearing more about the girls and women she has helped and their success stories because of that mentoring experience

  4. Christine Kmieczak

    I appreciate when there is some reference to how old she is (even ballpark is fine) for context. More did this regularly and it was somewhat unique yet it was so useful in grounding me as the reader with the “okay, she is my age or okay, she is 10 years older: here is her story.”

  5. Debra

    “I already know what’s on my tombstone, and I’m just project managing it backwards.” What a playful way to see and apply our purpose in life!

    I’m also a “cumulative investment of a lot of people” and am grateful for the wisdom and support each has shared.

    Thank you for a great interview. I look forward to reading Drop the Ball!

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Navigating the Sandwich

How Medicare Stole My Mother’s Health and Life Savings

My very independent mom was aging right. Until she checked into the hospital

By Cat Stone

Photo of Marion Geoghegan Campbell

Some days it’s impossible to believe mommy’s gone.

But every day, it’s impossible to believe that she went the way she did: penniless and in pain—on every level. She spent her final years beating herself up for making the biggest mistake of her life. She wanted to support herself with the money she’d taken a lifetime to save. Instead, mom died embarrassed and heartbroken knowing the government had stolen her entire life savings and more because of a Medicare loophole.

Mom was puttering around her Florida apartment late in the spring of 2012 when without warning, she heard, then felt, a loud crack. Her hip fractured and sent her flailing backward onto the floor. In agony, she called out to her dear friend next door who dialed 911. She was rushed to the hospital.

My brother and I both lived out of state and mom didn’t want to worry us. So intelligent and capable (she had graduated from both high school and business school by age 16), she “took care of everything,” then called to tell us that she was already checked in.

Concerned about our mother’s health,  neither of us thought to ask how she had been admitted to the hospital.

In fact, we had no idea that there was a right or wrong way to be admitted.


Her American Dream
Born in 1924, my mother, Marion Geoghegan Campbell, began work in 1940 in the typing pool for Grace Shipping and quickly made her way up through the ranks, eventually leaving and becoming a paralegal. Marion helped set landmark cases in computer law.

She was also a Catholic who wrote her Pope annually. She trusted in the honor of our country, her fellow Americans, and the agencies that were meant to serve and protect her.

At 86 she was healthy and sharp and could sign her name with assistance (her eyesight was failing); she had all documents—from grocery lists to greeting cards—read to her. And she wasn’t shy about asking people to jump in to help.

Long before her vision deteriorated, Marion read everything she could about Medicare. She went into her senior years understanding how it worked. She even researched the skilled nursing facilities in town so she’d have a plan in case anything unexpected happened. She understood that with a three-day hospital stay, Medicare would pay for 100 days of skilled nursing or rehabilitation.

So when a doctor at the hospital told her that she had to sign the paperwork or leave, she signed. She told us that she was doing so well after the fracture that the hospital was just keeping her “under observation” and that she was relieved not to be “admitted.”

We all thought that was a good sign. Even though she was in pain, we assumed it meant she hadn’t been seriously injured.

The problem was that she was in no shape to understand or comprehend the hospital document she was signing. She was legally blind and a bit doped up, and it remains unclear whether or not anyone read her the fine print.

So my mother accidentally signed away her future because the papers she initialed said she understood Medicare’s special rule: that patients “under observation” do not qualify for skilled nursing care.


A Fateful Mistake
Six weeks later my fiancé and I sat in mom’s room at the rehabilitation facility to which she had been transferred. She had done her physical therapy daily and every afternoon we did  EFT (Emotional Freedom Techniques, a form of acupressure) together over the phone.

The doctors were impressed with her progress. She worked hard because she wanted to walk down the aisle at her daughter’s wedding! We were finally going to take her home.

My mother held my hand and joked that my new engagement ring was so shiny she could now see clearly. She called each of her nurses and the rehabilitation staff into the room to show off the ring and her handsome future son-in-law.

Reports of my engagement spread like wildfire. Which is, apparently, how the billing manager discovered I was in the building. She barged into the room waving a wad of papers and demanded to see “the checkbook.” She said she’d “hate to put mom in collections…”

Cat and her mother, Marion

“My mother is fully insured,” I shot back. “We’ll take care of the paperwork at a more appropriate time.”

Suddenly, my mother was crying.

The woman who’d survived a world war cowered behind me, whispering that she didn’t know what she was going to do because the billing manager had been mean to her about the money for months. Assuming that there had been a mix-up, I ordered the billing manager to leave the room. Just then I turned and saw that my mother’s roommate was crying, too.

When I asked to see the executive director, I was told she wasn’t available. I went to her office anyway.

Apologizing for being so pushy, I explained that the billing manager had terrorized not only my mother but also her roommate. The director replied very politely that she would look into the behavior and assured me it was not their policy to harass patients.

I then turned my attention to the billing error. The director explained that since my mother had not been fully admitted to the hospital, Medicare’s 100 days of skilled nursing care had not been activated.

“Clearly there is some mistake,” I insisted. “Why would your staff admit my mother if she didn’t have Medicare coverage?”

“Your mother knew what she was doing when she signed our admission forms,” the director said. “She told us she has a savings account. She will be billed for our services.”

The walk back to mom’s room took a century. How was I going to tell her she’d made such a huge mistake? By the time I got to the room, I had resolved that we’d fight the system and do all we could to correct this terrible injustice. Mom was horrified to learn she’d signed away her rights and possibly her life savings but she too was confident we’d win in court.


The Dream is Broken
A week later we sat in the office of the best elder care attorney in town. Shaking his head in dismay, he told us that he hears stories like this several times a week. He was compassionate and gentle but advised us that there was indeed no mistake and there was nothing we could do except negotiate a better payment schedule.

I worked out a $100-a-month payment plan for my mother to cover the five-figure bill. The accounting department continued to send her phone calls and threatening letters. Unbeknownst to me, her spirit broken, mom finally wrote out a check to the nursing home for everything she had in savings, except for $1,000. But even paying the nursing home in a bulk didn’t begin to cover the total she owed for all the extra equipment and therapies they had offered her–and she had accepted–thinking she was covered.

So, for four years, instead of using her Social Security check to buy food, she spent it on her debt to the nursing home

When we visited, her house looked spotless, her clothes clean; she did appear thinner and weaker, but we chalked it up to age. Mom never let on to us that she was starving herself and isolating herself to pay her bills.

She grew apart from her church community because she couldn’t afford the cab fare to services. She became frail due to malnutrition and had trouble caring for herself.

Finally, a visiting nurse found my 91-year old mother collapsed on her tile floor unable to get herself up. When the nurse phoned me after calling for the ambulance, I insisted mom be rushed to a hospital that I had researched ahead of time that had a history of caring for the elderly. Then I called her primary care doctor and insisted he have her fully admitted. He took over her case and signed the papers himself. Mom was going to require permanent, long-term care.

Next, I called the executive director of the nursing home that had treated her for the fractured hip four years earlier. It was still the best in town. I politely, but firmly, told her that mom wouldn’t be returning in her current condition had the system not failed her and stolen her money. Placing the blame on the system and not the nursing home, I concluded by telling her that it was the facility’s ethical duty to help mom now in her time of great need.

This time the executive director offered compassion and care: Mom was admitted that same day.


Her Last Wish: to Help Others
Mom spent two years in the nursing home, often joking that this or that was hers, because after all, she’d paid for it with her savings. The truth was she was horrified to be on Medicaid—the federal and state program for those with low or no income or assets. But it was the only way we could get her care. She’d worked for decades, saved, voted, fought and prayed but she ended up living “on the dole”—a burden to society—despite all her best efforts.

My mother was a fighter but this is how it ended for her.

One day mom began to talk about how this situation had impacted her emotionally. She apologized for her mistake and what it had cost her and what it had cost us—the tens of thousands of dollars we pitched in for housekeepers and nurses so she could remain at home. Mom lamented that she was too old and frail to do anything about it, so she made me promise I’d tell everyone I could about this horrible Medicare rule and help others avoid her fate. At least a dozen times before she died I called her to say, “Mom! You saved another one!” and gave her the details of some friend or family member who had used her knowledge, her mistake to protect themselves. And she would say, “Well then, dear, my prayers have been answered and my pain has meaning.”


1. Understand the loophole Tell everyone. Shout it from the rooftops. Make sure your parents, siblings, friends, colleagues, and neighbors understand about the Medicare “Observation” loophole. Remind them to insist on being fully admitted should they or anyone they love be hospitalized. The rule: Medicare only covers skilled nursing facility care with a “qualifying” inpatient hospital stay. A qualifying inpatient hospital stay means your loved one has been a hospital inpatient, formally admitted to the hospital after their doctor writes an inpatient admission order, for at least 3 days in a row (counting the day of admittance as an inpatient, but not counting the day of discharge).

2. Protect your rights You have time to understand what you’re being asked to sign. You always have the right to have your attorney review any paperwork before you sign. Tests, medications, and assessments can, and often must, be administered before the doctor can choose the correct designation, that is, whether your status is “under observation” or “admitted.” Advocate for yourself or your loved one.

3. Understand your signature is permanent Changing the hospital stay designation after the fact is nearly completely impossible. The time to get it right is at the beginning, so understanding the process and taking the right actions up front is your best protection.

4. Make decisions from a place of calm Emotions are painful and powerful in the midst of a parent’s illness or injury. The worst decisions are made in overly emotional states. Learn processing skills like EFT, a self-applied acupressure technique, to help process stress and painful emotions like fear so you can make decisions from a calm, secure position.

5. Be prepared Engage an elder care attorney early. You will need one to create your power of attorney document when you need to take over the decision-making process for an impaired parent, but also so you have someone in place to handle a legal challenge if one arises. The phrase “my attorney will need to review” can be amazingly effective in securing the cooperation of medical and billing personnel.

6. Involve your parent’s primary care doctor Discuss the Medicare loophole with your parent’s primary care doctor ahead of time and make sure they will help obtain the proper designation if the need arises. The physician of record can sway things and if they have hospital privileges they have even more power. Have the same conversation with any specialists such as your parent’s cardiologist, surgeon or oncologist. At the time of hospitalization, call in all the troops and reference whatever issues or list of symptoms you can to secure the proper designation.

7. Review your hospitals Research local hospitals to determine how cooperative they are with admitting. Hospitals and doctors have quotas to meet and guidelines to follow if the doctor or hospital wants to get Medicare reimbursement. They are penalized for not obeying the rules. But different hospitals have different concerns about the rules. Same for doctors–who might be wealthy enough to forgo the reimbursement. Ask friends, your physician and even contact hospitals directly. Some will advise you about their policies up front. Write down the name of your designated emergency hospital on a card your parent can keep in his or her wallet. Make sure your parents know that if you are not there to advocate for them, they should insist on being brought to the designated hospital.

8. Confirm, confirm, confirm Check your loved one’s patient status daily until s/he is discharged. Sometimes doctors change the status, but sometimes hospital administrators press the issue forcing doctors to downgrade a patient during the stay. Remember, patients need to be fully admitted into the hospital for three days in order for Medicare to kick in. If that admission status changes at any time, the clock restarts.

9. Learn the lingo By law since March 2017, hospitals must advise you what the patient’s designation is and exactly what that means in terms of financial obligations and how that designation affects the patient’s insurance. But remember: the hospital isn’t there to protect your parent’s rights; it’s there to protect their requirements under the law and their own management. Terms like “downgraded to observation” could make it seem like the patient is getting better when in fact it simply means the patient has been switched to a lower status under Medicare. If they need to go to skilled nursing, they’ll have to pay out of their own pocket.

10. Work the system If you don’t get the proper designation, try again by checking out of the hospital and then in again a day or so later. A new hospital, another doctor or a new administrator might make all the difference. Or, sadly, a few more days might mean the condition has progressed enough to truly require more care.

11. Try again Even if your loved one does end up in a nursing home after an “observation status” hospital stay, voiding Medicare coverage, you can try to have them sent back to the hospital for a new stay and insist they be fully admitted. Once they are fully admitted for a three-day stay, the clock begins again and they can access their full 100 days of coverage.

12. What to do if all else fails Realize that skilled nursing care isn’t a stay at the spa and often it’s nothing you can’t do at home yourself. Exercises for the elderly are very simple; it’s the repetition that counts. Provided your loved ones can make bathroom visits themselves you might find taking them to your home or getting them in-home nursing is a better answer. Plus, many people find they heal better in their own home environment. If your loved one has no assets, many home-care services will be completely covered by Medicare or even Medicaid. Services such as bathing, wound care, meal prep and housekeeping can be obtained with just a few phone calls.

Have you been through a similar issue with this Medicare loophole? Do you have research or resources you’d like to share with the Covey community? Add your information and links in the comment space provided below. We will gather up everyone’s additions and publish a fail-safe guide on the subject.

Cat Stone is an AAMET credentialed EFT practitioner and best-selling author. You can learn more about her, EFT and her work at

  1. Judy Brooks

    Two years ago, after passing out in my seat at my grandchildren’s holiday concert, I “awakened” shortly thereafter with three parametics hovering over me. I was taken to a hospital in Burbank, California—a major medical center. My daughter followed the ambulance by a few minutes.

    After hooking me up to monitoring devices in a small ER room, an employee arrived from the admissions office carrying a clipboard with many papers. She explained I was being admitted as an “observational” patient. I asked what that designation meant to me. She explained it meant Medicare would not pay for my medications while there. I was on many daily meds. Having gone over the details of numerous hospital bills my husband had amassed, I knew the price they assigned each pill—his admissions always involved surgeries so there was no question about his admission designation.

    I took a calculated risk but I was quite certain they wouldn’t let me check myself out at this point because of possible liability if something happened to me after leaving. (I was a publicist and knew the media attention I could easily bring to the situation.) I told the clipboard lady I had a 90 day supply of my meds at home—bought and paid for by Medicare Rx coverage—and unless they allowed my daughter to bring them to me, I would not agree to this admission and sign the papers. She left then returned in a few minutes and agreed to do this. I carefully went over the pages to confirm what she said.

    I remained overnight after multiple tests and monitoring with a diagnosis I could easily handle with no further treatment necessary. When the bill arrived several weeks later, my 30 hours in the hospital added up to $29,000, all of which was covered by Medicare and my AARP supplement through United Healthcare.

    Hopefully, in similar situations, I hope this proves helpful to others before signing on the dotted line…

  2. Joanna Myhre

    Please email me this article. I will be 77 in a few months and am in poor health. I need to share this with my daughter. Thank you.

  3. Michelle Arnold-Yeager

    In February 2019, I was admitted to a local hospital with kidney stones, after being sent to the ER from Urgent Care. They said they were, in fact, admitting me for the night. Midmorning next day, I was brought papers to sign where they randomly mentioned, ‘oh you were changed to “under observation” status sometime during the night…I was given no option not to sign the papers, saying I would have to contact Medicare and my insurance for information on what was covered and what was not. She came in when I was alone, on Oxycontin AND Fentynal and hardly any sleep the night before and shoved all the paperwork into my hand saying that most of it was drug information and directions on home care after release…

  4. Linda

    I dealt with this twice. Once when my husband was dying. He had been admitted several times through the ER. For what turned out to be his last visit, also through the ER, they wanted him to be admitted on observation. We had to pitch a fit.

    Then after he passed I ended up in the ER. I was in the hospital for 4 days. They wanted me on observation too. The billing lady showed up and I refused to sign the papers. When the hospitalist came around he found they had put me on observation. He corrected it. Then, when I asked the next day to have it checked the admin had defaulted it back to observation. Please keep in mind these doctors are under great pressure not to admit someone. And after 3 “Midnights” (This is also important – it is not just 3 days) it does not roll over to admitted.

  5. Michele Unruh

    I am a Medicare Agent this was great information that I will share with all of my clients. I knew about the Medicare loophole, but I did not know if they downgraded your status the clock reset. Thank You for sharing

  6. Peggy

    It’s not just for Medicare they are doing the same for insured. It just changed what felt like overnight. I was in for a gall bladder removal and the dr. Off handily said “oh, we admitted you.” I thought to myself “of course you did I am having emergency surgery!”

    That’s when it dawned on me something changed. My girlfriend’s parents were aging and going to the hospital. The first thing I said was “make sure she is admitted and not there on observation status.”

    So far I have been lucky, with gull bladder, appendix, surgeries they were emergency surgeries. My knee surgery was out patient. As our own advocates for healthcare we need to check our status as well.

  7. Jane

    The biggest argument to rectify this tragedy should have been that her mother was medicated when she signed the papers at the hospital. Most reputable hospitals will not allow someone pre-medicated or medicated for pain/anxiety to sign papers. The lawyer should have caught that.

  8. Gloria

    I’m a medical social worker and I’ve been in hospital case management for a little over 6 years where my role is solely focused on discharge planning. I agree with majority of what you’ve shared and nothing makes a hospital Case Manager and/or Social Worker happier than having involved family members to advocate for their loved ones. It’s the role of the case management department to ensure patients have a safe discharge plan as well as an understanding of the CMS guidelines (Medicare/Medicaid). So it thoroughly upsets me that your mother was not only failed by the macro system of Medicare, she was failed on a micro level of by both the hospital and SNF admissions process (skilled nursing facility-we love abbreviations in the medical world) to not have checked what status she was prior to admitting her. Not all hospital networks operate the same, but most all should have a case management department and/or social services, especially with the way changes in healthcare are happening at such a rapid rate. As well, the SNFs I’ve worked with over the years have had an admissions team to evaluate the patient’s medical and financial picture. So, I’m surprised that the facility had not caught that and allowed her to admit anyway, but it could also be that because of the timeframe scenarios such as this occurred that they started being more diligent.

    There are additional things I’d like to add, address, or that you simply need to know for Traditional Medicare only (not managed care like Humana/United Health Medicare etc):
    1. Yes, you can try and insist on the doctor “admitting” your loved one, but if their medical criteria does not meet Medicare guidelines then they simply cannot, otherwise it is fraudulent. If your loved one has been in the hospital for over 24 hours and they don’t plan to discharge, then at that point start pushing, especially if they are thinking they will need placement and can’t discharge home.
    2. Once a patient is changed from observation to “inpatient” aka “admitted, they are not then downgraded back to obs. To get technical, they can downgrade further from observation to “outpatient” which is essentially equivalent to sitting in an ER bed but in the main hospital tower.
    3. If the patient does not meet “inpatient” criteria but does need rehabilitation (which should mean they were evaluated by Physical Therapy and Occupational Therapy, sometimes even Speech Therapy), ask to be evaluated by an Acute Rehabilitation Hospital, especially if the patient was independent prior to hospitalization.
    4. If the patient is safe to discharge home then Home Health Care can be arranged for a nurse, PT/OT, an aide to help with bathing if that company offers that service, and a social worker if necessary.

    Those are just some of the ways we work around the “loophole” to ensure a patient with Medicare has a safe discharge plan.

    Hope that helps!

  9. Elizabeth Connor

    Good article, but the relationship between being admitted and skilled nursing is not a “loophole.” The system is designed that way so that Medicare is not subsidizing the skilled nursing industry for conditions that require only “observation.” One can argue the value of that feature, but it’s how the system works. There is grievous fault here, but it is mostly on the part of the hospital administrators who did not explain the papers she was signing and on the part of your mother who signed papers she did not understand. The American health care system is a nightmare, agreed, and the fault lies with everyone who is not actively working to reform it.

  10. Donna Frankiewicz

    There is another issue to be considered. If a doctor refers you to a skilled nursing facility after a 3 midnight stay in a hospital as an inpatient, he MUST send you to the skilled nursing facility for “rehabilitation”. Medicare does NOT pay for simple long term care no matter what the situation. So, be sure your doctor is an optimist who believes you can be rehabilitated with physical therapy before you let him refer you to a skilled nursing facility. Believe me, I understand about “observation” and 3 day stays, etc., but this factor must be taken into consideration as well!!!

  11. Rose Coveney

    I believe that doctors and hospitals know exactly what they are doing and that will always be to THEIR advantage, not the patient who they could care less whether you live or die. It’s what they can bring to the bank and to make their shareholders happy. Just business as usual.

  12. Esther

    I was a social worker in a hospital prior to retiring. Yes, it is important for patients and family to be aware of the Medicare rules and to talk to a doctor at admission about the basis for admission. However the form signed acknowledging knowledge of admission status was not the issue. The medical judgment had already been made at that point by the doctor/hospital. Medicare has criteria that has to be met for a patient to be admitted under inpatient status and it is the doctor/hospital who has to determine if the criteria are indeed met. If the criteria are not met, then the patient can still be admitted under observation status, which is officially an outpatient admission. Also some advantage plans under Medicare will waive the 3 day requirement, so it’s also important to understand if you have “straight” Medicare with a supplement or if you have an advantage plan and if the latter, their policy on funding rehab if the 3 day inpatient stay is not met.

  13. Gerry Draughon

    I was told once that Medicare would not pay for “any” services unless si stayed in the hospital overnight! Seems as if this is not true the? I would have to stay in the hospital over three days?

  14. Michaele

    This is great information, however, you cannot change the diagnosis you are being treated for, and lying or giving false information to obtain an admission versus an observation stay is insurance fraud and can get you into big trouble. Also, a physician won’t admit you if the diagnosis doesn’t fit the criteria for admission, he/she could be charged with insurance fraud as well and they are not going to put their medical license on the line. Be careful.

  15. Debbie

    I am 60 and I am really scared of starting Medicare. I have spoken with a girl my age at work that is my age, she says the same. Seems like if you have been under a Doctors care on traditional ins then go on Medicare, they want you to either lower your dose or stop taking. My son was a paramedic for over 10 years. He got tired of watching the elderly get abused so he started his own transport company. He has at least 40 dialysis patients, Medicare will deny payment on a patient that has no legs and is on dialysis 3 days a week, they actually said he has a good gate and can be driven in a car. He feels so badly for these patients and he loves his patients but Medicare will soon put him out of this business. He said some of his patients will not have a transport and they will die, seems like this is what is wanted in this country. Why do we not take care of our elderly. It is a crying shame.

  16. Jorge Assandri

    I believe you because this system is created for the rich. We don’t count. They think that we are disposable. Shame on this system.

  17. Barbara McCarthy

    What everyone is neglecting to recognize is the financial incentive that doctors and hospitals have. When a patient is admitted for 3 midnights or more, the charges for services rendered to Medicare patients are “adjusted” to the lower Medicare negotiated amount which can be considerably lower than actual costs. In some cases this means the doctors and hospitals lose money. Now no doctors or hospitals want to lose money so instead of admitting a patient they keep them under observation.

  18. Deena M. Taylor

    This is such valuable information. Anyone who thinks the government should take over healthcare ought to read it.

  19. Phil Church

    Oh, by all means, let’s turn over Medicare to the tender mercies of millionaire health insurance executives. If we want better Medicare get a Democrat back in the Wbite House.

  20. Shirley Gurganus

    Please email the whole story to me.
    Thanks so much for sharing and helping others.

  21. Tony Tran

    I work as a hospitalist, and unfortunately I see this dilemma all too often. This is a great post, and highlights many frustrations that we share as well. There are a few things I want to add…

    1) First to dispel a myth that doctors profit from denying patients “inpatient” status. Doctors and direct health care providers nowadays do not directly profit from inpatient vs observation. In fact, many who work as an employee of the hospital, or of a group contracted by the hospital are paid either hourly or by salary, and hence, the admission status of a patient has no direct impact on the decision making process of “observation” vs “inpatient”. In fact, majority of physicians and nurses who work strictly at a hospital (as oppose to running a private practice) are kept in the dark about hospital billing practices (whether intentional or unintentional is hotly debated).

    2) Certainly, some providers are more aware of and knowledgeable about the nuances of Medicare criteria, or more sympathetic than others in fully appreciating the financial constraints on patients. However, simply requesting admission instead of observation is not always that easy or straight forward. Families of loved ones can demand “inpatient” status all they want, but that determination has been set forth by Medicare guidelines. Patients must fulfill these established criteria to officially meet “inpatient” status. To admit as “inpatient” when there is no clear indications to do so will constitute Medicare fraud. However, these criteria are often quite black and white, and is often frustrating, both to the patient and their families, as well as the admitting doctor.

    An example:
    An elderly person living alone who had fallen, and has pain too severe to safely return home, but has no evidence of fracture or laboratory abnormalities may not qualify as “inpatient”. The sympathetic admitting doctor may try to advocate that patient has no support system, and will be in “grave harm to self” if she/he was to return home in such condition, and may still admit under “inpatient” when it is a shakey argument at best in the eyes of Medicare. If there is any question as to the status, the case goes to a secondary review, and that review can determine still that the patient in fact does not meet “inpatient” status. In these cases, utilization review can reverse the admission order to “observation”. It’s not impossible, just a difficult process that the hospital case management has to do to ensure it is not in violation of Medicare guidelines. This is known as a condition code 44, when hospital utilization review has determined that the “inpatient” admission was not “medically necessary”, regardless of how the admission doctor “dressed up” the admission diagnosis.

    3) I have worked at over 10 hospitals in 3 states for almost 10 years. My conclusion: ER doctors are good at what they do, but they are overwhelmingly bad at projecting inpatient vs observation status. (There are a few gems here and there). What does this mean? When majority of people present to the ER for their emergencies (as opposed to being directly admitted, by pre-approved process), there can be a lot of misinformation given, especially for those patients who may not clearly be “inpatient”. Often times, the ER doctors get this wrong as well. And it is easy to understand why. ER doctors are in the frontline. They stabilize, they treat. And they dispo: home, transfer to another higher hospital, or discharge home. They almost never deal with the hassle from the hospital utilization reviewers hounding them about a patient’s admit status. So they often give wrong info to patients and their families regarding this.

    All too often, a family can no longer care for their ailing and frail parent. They bring them to the ER. The patient may not have much more than an uncomplicated UTI that did not manifest in signs of sepsis ( hence, not an inpatient admission). The patient may “look dry” but vital signs and laboratory work are all normal (hence, no clear objective support for “dehydration”, a inpatient diagnosis). Nevertheless, family is expressing interest in placement to a SNF, and the hapless ER Doctor reassures the family the they can “observe” the patient overnight, and then case management can look to place them at a SNF the next day. I cannot even count how many times I had to correct the ER doctors about this error. So much so that I just instruct them not to tell the family anything about placement any more.

    The best way to inquire this is to ask the case manager and/or hospitalist to explain in what ways (by means of laboratory, hemodynamics and vital signs, and/or diagnosis by means of imaging studies). If the family is educated as to why or why not their loved ones meet or don’t meet inpatient criteria, and understand the potential financial consequences, then they can come up with more appropriate and informed solutions.

    • lesley

      Wow Tony. What a wonderful addition of information to this story. Everyone needs to read this. Thanks

  22. Steve Berner

    This sounds a bit fishy to me. I find more holes in the story than I do in Medicare (which I know is flawed). I would be happy to go through the problems with this story if there is any real intrest.

  23. BW

    Sadly this is true and happens often but the article implies doctors have a choice in the matter. Insurance companies set strict criteria for obs vs inpatient. As an ER doctor I’ve admitted patients to the ICU who don’t meet inpatient criteria. Fight for better laws for doctors to use their judgement – right now the admins call and tell us x patient doesn’t meet inpatient criteria

  24. Lorraine Wetherington

    I have a friend whose mother fell and broke a hip. She was admitted to a rehab center for physical therapy after hospital discharge. She was given papers to sign they could put a lien on her house for whatever the insurance didn’t cover. She signed them. This lady was elderly and didn’t understand. After she realized her house was going to be confiscated instead of being left for her adult children, she realized what she had signed. They all cried over this. She did have Medicare.

    • lesley

      What a terrible story. We just don’t understand how health care can strip people clean of all of their possessions.

  25. Gale

    Yes, you have to be admitted as inpatient to meet that qualifying three midnight rule, BUT you have to meet criteria for inpatient status. Both insurance companies and Medicare use criteria sets to determine the appropriate status for admission. And as someone mentioned above, knowingly allowing a patient to be admitted as an inpatient, when they do not meet inpatient criteria, is fraudulent. Sometimes the criteria can be difficult to meet. It would be great to see that three midnight rule removed, Inpatient and obs statuses eliminated and just stop playing this $ game.

  26. Kay

    You have failed the public by implying that the HOSPITAL determines this observation or inpatient status. In reality, it is a complicated list of criteria that the patient’s condition must meet before any Medicare, Medicaid, or insurance will pay. Physicians, hospitals, and patients have no choice in the matter.

  27. Carolyn Griffin

    I spent one night after surgery four weeks ago. I have not seen the bills yet, but wonder if it ends up as observation and I have to pay?

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The New (Un)Retirement

How to Stay Visible–Even After You’re Done

You no longer get a paycheck but that doesn’t mean you no longer have value

By Erica Baird and Karen Wagner

The day after we retired, just like the day before, we were smart, energetic, interested, engaged, stylish, collegial, problem-solving women. The only difference was that, after almost four decades of working full time, we had retired. But there was a problem. Everyone looked at us–if they could see us at all–as if we had morphed into little old ladies who had lost the power to think and the will to live. What was going on?

Our colleagues and friends congratulated us, and many expressed envy at our good fortune. That made us uneasy. What exactly was our fortune? One day, we were highly sought after, even powerful, lawyers. The next, we were—what? Did we no longer have value? We were anxious and scared.

We missed work, and we understood why. We liked having colleagues and a support staff and a reason to get dressed up in the morning. We liked saying “I am a partner in an amazing enterprise”—emphasis on “am.”   We liked having an office, business cards, scheduled calls, and meetings, and we even liked leftover to do’s from the days or weeks before. We loved our jobs and we needed to mourn for a while.

But we still did not understand why, overnight, we had vanished. Of course, we no longer had jobs, but to our minds, those jobs provided the crucial foundation for the next step–using our experience in different ways in the same larger world. We were surprised that instead there were no roles for us in a world that seemed unready for what we had to offer. It reminded us of when we started our careers. Then, we were part of a new cohort of professional women making our way in a man’s world, largely without role models. As we and a large cohort of other women moved forward, we invented the roles we wanted. Now, it seemed, we had to do it again.

We realized we were both feeling the same thing and decided to face it together. We talked to everyone we could find, we asked a lot of questions, and we listened hard. We read everything entitled “Retirement.” We met a retirement expert. We interviewed for new jobs. We came to understand that we did not want to work as we had before–especially as we could never get jobs as good as the wonderful ones we had had–but we wanted to be engaged in a purposeful relationship with the wider world. But we could not find a match. While there were new models for employment in the freelance economy, people did not seem to visualize retirees in those roles.

Our investigation invigorated us. We realized it was up to us to show the working world what we could do, and how we wanted to do it. Our circumstances have changed, but we have not. We are the same people we have always been. Our brains still work and our experience is valuable.

We have always liked a good challenge. Styling a modern retirement is the perfect next step.

Adapted from

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Marcia DeSanctis

Marcia DeSanctis

Marcia DeSanctis is the New York Times bestselling author of “100 Places in France Every Woman Should Go” and has received 5 Lowell Thomas Awards for excellence in travel journalism. Her latest grudge is against the machine that assigned her a middle seat on a flight to San Francisco, but she’s doing her best to work through it.

Geoffray Barbier

Geoffray Barbier

Geoffray Barbier produced and directed Early Light, Pardon Us For Living But The Graveyard Is Full, as well as the Encore Music Sessions. He has produced and directed promotional content for Dom Perignon, Fendi, Audemars Piguet, Bally, and Lancôme. As a line producer,  he worked with director Eugene Jarecki (Why We Fight) on the HBO segment Addiction, with Alyssa Bennett on The Pack, and with Matthew Modine on his Cowboy.  Barbier has directed music videos for Shivaree, Holly Miranda and Elliott Murphy.

Lauren Zalaznick

Lauren Zalaznick has devoted her career in media to transforming the cultural landscape. She began her career in independent feature film producing such landmark films as ‘Kids’ and ‘Safe,’ then crossing over to television overseeing iconic brands like VH1 and Bravo. Today, she advises and invests in the world’s leading digital media brands and curates the influential weekly newsletter The LZ Sunday Paper, for which she culls the most important news of the week by and about women in business, media, and pop culture.


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