SAVE THE DATE: OWL-SF Holiday Party December 16



OWL-SF is very proud to announce this year’s holiday party!

WHEN: Saturday, December 16, 2 p.m. to 4 p.m.

WHERE: Savor Café, 401 Irving Street (@5th Avenue)

We are very excited to let OWL Members know that this year’s Holiday Party will be at a restaurant with five stars on Yelp, from over 170 reviews—and customers praise the location and atmosphere almost as much as the delicious Arabic vegetarian food!

Stay tuned for more details, and RSVP by December 11th at:
(415) 712-1695, or


NOVEMBER: After a bountiful year of membership meetings, OWL is taking a break for November since our usual date for membership meetings in the 4th Saturday, which in November is Thanksgiving weekend!

NAVIGATING THE MEDICARE MAZE – A Detailed, Informative Report

OWL Presentation: Saturday, Sep’t. 23, 2023 11a
Navigating the Medicare/Medi-cal Maze

by Chris Dillon

My professional credentials:
*Licensed Nursing Home Administrator; State and Federal Licensures
*Licensed Residential Care Facility Administrator/State of Ca.
*Certified Eden Alternative Associate: Culture Change facilitator
*Certified Social Services Designee/SNF Level
*Member of the employee/ownership team of Foresight Management Services.
* I ended my career in LTC as a consultant to the Foresight Management
Services buildings statewide.
*Current: District 11 appointee to Disability and Aging Services Advisory Board

My theme: Keep It Simple, Stupid!
Not as easy as it should be in the convoluted world of long term care!

    I. Understanding your care options
    II. Understanding the payor source

Acronyms commonly encountered:
SNF: skilled nursing facility. (medical model of care)
● Licensed through Ca. Dep’t of Public Health (CDPH) &/or Center for
       Medicare and Medicaid Services (CMS)
● Includes: Rehab. Facilities, Sub-acute Facilities, Distinct Part Facilities
(these are special units within SNFs and Acute hospitals which receive higher Medi-cal reimbursment due to severity         of diagnosis and clinical care requirements)
You can learn more about this designation here:
This level of care receives strictly limited/tightly controlled Medicare A Reimbursement.

RCFE: Residential Care Facility for the Elderly

A.L.: Assisted Living Facility

CMS: Center for Medicare and Medicaid Services

CDPH: Ca. Dep’t of Health Services

D.S.S.: Ca. Dep’t of Social Services

    I. RCFE & Assisted Living

Options are rooted in your specific needs
1). This is Custodial Care – not clinical

a). Residential Care for the Elderly
This licensure is not clinical.
It is licensed through the state Dep’t. of Social Services & is a social model.
RCFE inspection/surveys are mandated to be unannounced
and performed annually by Department of Social Services.

b). Assisted Living (AL): these facilities offer assistance with some activities of daily living (ADLs).
              This is custodial care.
The staff member providing the service is not required to be
licensed or certified.

IMPORTANT: these facilities may not administer or assist a resident with actually taking their medications. They may not change dressings or provide wound care, etc.
*They may remind and encourage, but cannot put the med into a residents mouth, administer injections, etc.
*They may contract with a Medicare licensed Home Health Agency to provide preparation and/or administration of meds, wound care, etc.
*Services provided by a licensed home health agency must be ordered by the attending physician and are billed under Medicare Part B.
This link will provide an explanation of assisted living facilities:,well%20as%20much%20larger%20facilities.

The above types of care are not covered by Medicare or Medi-cal. Some ‘Board and Care’ coverage may be provided by SSI assignment.
A board and care is a small home like facility, usually consisting of 6 to 8 beds, many in 2 bed shared rooms. It is licensed as an RCFE.

2). This link will take you to the overview of custodial levels of care.

3). This link will take you the search engine which you can use to research the licensing record for facilities which you may be interested in learning more about:

II. Continuing Care Retirement Community (CCRC)
This designation refers to a spectrum of services including both custodial
and skilled nursing.

1). You can learn about this type of care here:,usually%20for%20a%20resident’s%20lifetime.

a). a caveat: be very careful of this designation at present. Read and understand the contract well, before signing. You may want to consult an elder care attorney. The skilled nursing facility component is changing rapidly at this level of care (LOC)

III. Skilled Nursing Facility (SNF)

A). The majority are licensed through Ca. Dep’t of Public Health (CDPH) &/or Center for Medicare and Medicaid Services (CMS) California licensing and certification is rooted in Ca. Title 22 Federal licensing and certification is rooted in OBRA ‘87
(the nursing home reform act)

1). Includes: Rehab. Facilities, Sub-acute Facilities, Distinct Part Facilities (these are special units within SNFs and Acute hospitals which receive higher Medi-cal reimbursment due to severity of diagnosis and clinical care requirements).
You can learn more about this designation here:

This level of care receives strictly limited/tightly controlled Medicare A Reimbursement. The majority of payment for this LOC is private or Medi-cal.

2). This is a clinical/medical model of care.
a). You must have a physician order to be admitted
*a facility may not admit anyone for whom it cannot provide the mandated quality of life and quality of care. Involuntary discharge from the level of care is almost impossible.
b). Care is rooted in your diagnosis & related physician orders. Care is provided by licensed and certified staff.
c). Assessment of the quality of care is rooted in your resident care plan (RCP) and your progress in attaining the interdisciplinary care plan goals
d). Data is gathered in strictly defined protocols and reviewed a minimum of quarterly or at change of condition.
*the resident &/or the resident’s agent must be included in this review and must approve of their care plan.

2). Medicare will cover a maximum of 100 Part A days in a SNF. To qualify, you must be admitted to an acute facility and remained there for ‘3 midnights’. Be careful: many acutes now hold elders on ‘observation’ for the regulatory capped 2 midnights…if this happens to you, you do not qualify for Medicare Part A coverage in the SNF.
a). Day 1-20 is covered at 100% of the cost, as determined by an assessment system known as the Minimum Data Set (MDS). On day 21 a co-payment of $200 per diem is required.
b). The MDS covers all aspects of the clinical care required. A resident must show measurable progress toward their Resident Care Plan goals in order to be medicare covered. With the exception of some types of G-tube feedings, ostomy care, wound care, etc which require clinical assessment, very few residents qualify for 100 days of coverage.
c). When a resident no longer qualifies, the resident &/or their agent will receive a m-care cut letter 72 hours prior to end of coverage. They have the right to appeal the finding. During the interim of the appeal, they cannot be billed privately. If they lose the appeal, they must then
pay the retroactive amount due.
d). Discharge planning is mandated to begin at the date of admission and be included in the Resident Care Plan.
3). Medi-cal is the major source of funding for most SNFs. At present, it’s re-imbursement rate is beginning to fall below the per diem cost of care.
4). Surveys for this LOC are in the purview of Ca. DPH/Licensing and Certification. They are mandated to be within a 15 month window and unannounced, inc. a certain percentage of which must be launched on the PM or midnight shift.
● CMS may also perform surveys for OBRA ‘87 compliance separately.
so as to confirm the accuracy and objectivity of the state survey process.

Further background information:


LTC cost fact sheet: (this is from CAHF, the for profit nursing home advocacy org.)

Medi-cal overview of costs and eligibility:

Medi-cal well spouse impoverishment program: (there will be significant changes in the program in Jan. 2024. I’ll update the link/info as it evolves).

Licensing Reports:



Resources to assist in making care choices:

You can access the quality of life/quality of care survey outcomes & complaint files for SNFs at this site:
This site is difficult to navigate but contains important information. It is worth visiting and working with to the best of your ability.

You can access the survey outcomes and complaint files for RCFEs at this site:

My preferred resources:

CANHR (California Advocates for Nursing Home Reform): this is an advocacy program which has often taken an adversarial stance toward SNFs. That being said: I’ve collaborated intermittently with the founder, Pat McGuiness, for 30 years. Most recently, I worked on a team led by CANHR, seeking mental health funding for SNFs. We were not successful, sadly. Pat and I respect each other and seek to collaborate, even when we disagree. This organization fills an important role in our complex long term care terrain! This organization can link you to elder care attorneys, as well.

The Long Term Care Ombudsman Program:

This is a federally mandated program which is administered differently in each county in the nation. The ombudsman is essentially a problem solving resource for residents, and their families/friends, in long term care facilities. I found their services indispensable. When tours of our facility occurred, if I was present, I always encouraged the visitors to check in with the ombudsman before making a final choice. They have a different perspective and experience of the nursing homes to which they are assigned and can be an excellent resource.

Legal Services for the elderly:

HICAP: Understanding your health insurance, includingMedicare, Medi-cal, Medicare Advantage Plans, et al. This is an important, invaluable resource:

Information and Referral
Area Agencies on Aging:

For San Francisco residents:

The HUB: this one site will assist you in navigating all aspects of the aging services sector in our city. All I&R personnel and case managers have a minimum of a masters degree in social work or its equivalent. It is easy to access via Muni &/or BART. You can make an appointment or drop in. There is a small parking area.

ADRCs (aging and disability resource centers)
These are ‘mini-HUBs’ scattered throughout the city:

Community Living Campaign (CLC) – Aging in Place programs


OWL-SF Member Meeting
September 23, 11:00 a.m. – 12:30 p.m. via Zoom

  • What will Medicare pay for?
  • How do I know if this injury or illness or condition calls for rehab, assisted living, skilled nursing or in-home care?
  • How do I find the “good places”?
  • Where can I go to find guidance for myself or my loved one in this crisis time?

 I just cannot navigate all this online stuff. I need a real human being helping me.

If you have not experienced this kind of panic, chances are that you or someone you know will in the future. Don’t wait until You are in a crisis to gain this knowledge.

Chris Dillon, a retired nursing home administrator who serves on the Advisory Council of DAS, will give us information about the free resources provided through HiCap and The Hub of the Dept. of Aging and Disability Services. She will be joined by a representative from HiCap, a non-profit providing individualized guidance.

Zoom information to follow.
For more information:
call (415) 712-1695, or email

OWL-SF July 22 Gathering: LET’S DO LUNCH!

It’s time for our in-person luncheon where we
connect with new and longtime friends!

Please join us: 

When: Saturday, July, 22, 11:30 AM – 1:30 PM


RSVP : no later than Saturday, July 15th

  • Complimentary vegetarian or non-vegetarian lunch and beverages (RSVP should specify vegetarian/non-vegetarian meal)
  • Book swap – bring a book or two to trade
  • Guest speaker: Paul Drexler, author of Notorious San Francisco: True Tales of Crime, Passion and Murder, and creator of “Crooks Walking Tours,” exploring some of SF’s notorious and mayhem-filled neighborhoods
We are proud to hold the OWL luncheon in
St. Mark’s beautiful Heritage Hall
St. Mark’s Lutheran Church

1111 O’Farrell Street, San Francisco, CA
(Between Franklin and Gough)
Some Parking available, MUNI 38-Geary, 49 Van Ness,
Wheelchair accessible
Tour of the historical St. Mark’s Church available after lunch

Don’t forget to RSVP:
  • Call (415) 712-1695
  • or email
  • include your meal preference of vegetarian or non vegetarian
Let OWL know if you need a ride,
and we will try to find one for you! 



Getting Back to Basics for an Active Summer!

Zoom video and call-in meeting
Saturday, June 24, 11 AM to 12:15 PM

Coach Kyra returns to OWL for a much-needed session to wake up our bodies, increase our endurance, and sharpen our awareness of safe and mindful movement

  • Workout for our entire bodies
  • Gentle exercises done sitting or standing
  • Exercises and stretches for daily and at-home use
  • No special equipment or abilities needed!

Coach Kyra is a well-known exercise trainer and coach who regularly works with the Community Living Campaign and other San Francisco senior facilities, helping older people stay fit and active according to their individual abilities.

For more information call (415) 712-1695     email:



Saturday, May 27, 2023
11 AM to 12:30 PM Zoom Meeting 


Speaker: Ruth Borenstein, Brady United Against Gun Violence, Past Legislative and Policy Chair for Brady California.

  • Update on status of SF & CA gun laws.
  • What are most pressing needs: local, state, national?
  • How gun violence affects women in particular.
  • Getting our voices heard on state and national levels.
For more information, contact OWL-SF
Call:  (415) 712-1695                            Email:

OWLSF April 22, 2023 Meeting on Laguna Honda: Video and Additional Resources


— Here is a link to the current Grey Panthers Call to Action on Laguna Honda: Laguna Honda Call to Action April 2023

— Here is a link to a San Francisco Chronicle article about Laguna Honda, published April 13: These 26 ‘original sins’ brought S.F.’s Laguna Honda to the brink of closure

— Here is an article in neighborhood newspaper Westside Observer, published April 10: Root Cause Factors Refute DPH Claims Minimizing LHH’s Violations 

OWLSF MEETING April 22: LAGUNA HONDA–Issues, Current Events, Actions to Take

TO SAN FRANCISCO’S OLDER WOMEN?Saturday, April 22, 2023
11 AM to 12:30 PM Zoom Meeting
  • What are the problems?
  • How did we get here?
  • Where do things stand now?
  • What can we do to ensure the future of this much needed skilled nursing facility? 

Speaker: Dr. Teresa Palmer, geriatrician and family physician working in San Francisco for over 30 years, 15 of them at Laguna Honda Hospital.

ZOOM link and call-in information to follow

For more information email or call:                   415-712-1695

ART WITH ELDERS Social Connection Event April 1

AWE-SFAC Art & Social Connection Event

Sat. Apr. 1, 12-2p

Art With Elders uses the power of art, creativity, and community to enrich the journey of aging.

The Role of the Arts in

Building Social Connection:

The Art With Elders Senior Bridge Project

Sat. April 1, 12-2p (Free and open to the public)
SFAC Main Gallery (War Memorial Veterans Building)

401 Van Ness Ave. Ste. 125SF, CA 94102


Please join us for this special event! 

Free Registration on Eventbrite


Listening to our seniors and hearing their need for social connection.

Art With Elders program participants discuss their experiences moving from isolation to connection by engaging in group creative practice. This event will be presented in English and Spanish.

Cover art: “Untitled” by Irene Higgins – On Lok PACE

Also coming soon:

San Francisco Cares:

Inclusivity and Accessibility in Senior Arts Programming

Tue. May 23, 12-2p (Free and open to the public)

SFAC Main Gallery (War Memorial Veterans Building)
401 Van Ness Ave. Ste. 125SF, CA 94102


Please join us for this special event!


Arts programming provides participants with a forum for expressing themselves while cultivating a sense of identity and belonging.

San Francisco senior service providers discuss the role arts programs play in the lives of the older adults they serve, and will share their strategies to address the need for inclusivity and accessibility among marginalized older adults and people with disabilities.

Cover art: “Solitary Confinement” by Kim Ringle – Openhouse

OWLSF Member Meeting March 25: PEDESTRIAN SAFETY


What can we do to make our lives as pedestrians safer?

Saturday, March 25, 2023, 11AM to 12:30 PM

Zoom in and join OWL for a panel discussion on what is being done to make us safer as pedestrians, what more can be done, and what we can do to make a difference.

  • Jodie Medeiros, WalkSF. As Executive Director she is responsible for leading Walk San Francisco’s strategic work. 

  • Jamie Parks, SFMTA Livable Streets Director. His organization leads the projects focused on creating safe and inviting streets and sidewalks for all who walk and use a bicycle

Note: The last 10 minutes of the meeting will be devoted to the re-election of the current OWL-SF Board

Zoom Link and telephone information to be provided 

For more information, Call: (415) 712-1695;  Email:



Update on Protecting and Improving
Social Security & Medicare


SPEAKER Jodi Reid, Executive Director of California Alliance for Retired Americans (CARA) returns to OWL with important updates:

  • The facts on how Social Security & Medicare are funded
  • Ongoing threats toward privatization
  • Improving Social Security and expanding Medicare
  • Action items for Members of Older Women’s League 

DATE & TIME: February  25, 2022, 11 AM to 12:30 PM

Check out CARA’s video on Social Security
ZOOM Link to Follow
(415) 712-1695 



Saturday, January 28, 2023
11 AM to 12:30 PM Zoom Meeting 

Let’s make OWL more relevant, inclusive, and vibrant than ever!

Help us plan:
  • Informative, inspiring activities and programs
  • Political actions that support our mission to improve lives of midlife and older women
  • Membership meetings featuring speakers who bring you the health information you need
  • An outlet for our idealistic and creative spirit
  • Opportunities for friendship, community and support
Email or call for Zoom or other information:                  Phone 415-712-1695