Skip to Main Content
National Association for Home Care & Hospice
Twitter Facebook Pintrest


In the various roles he has undertaken through the years, Val J. Halamandaris has been a singular driving force behind the policy and program initiatives resulting in the recognition of home health care as a viable alternative to institutionalization. His dedication to consumer advocacy, which enhances the quality of life and dignity of those receiving home health care, merits VNA HealthCare Group’s highest recognition and deepest respect. 

VNA HealthCare Group

I have the highest respect for them, especially for the nurses, aides and therapists, who devote their lives to caring for people with disabilities, the infirm and dying Americans.  There are few more noble professions.

President Barack Obama

Home health care agencies do such a wonderful job in this country helping people to be able to remain at home and allowing them to receive services

U.S. Senator Debbie Stabenow (D-MI) Chair, Democratic Steering and Outreach Committee

Home care is a combination of compassion and efficiency.  It is less expensive than institutional care...but at the same time it is a more caring, human, intimate experience, and therefore it has a greater human’s a big mistake not to try to maximize it and find ways to give people the home care option over either nursing homes, hospitals or other institutions

Former Speaker of the U.S. House of Representatives Newt Gingrich (R-GA)

Medicaid covers long-term care, but only for low-income families.  And Medicare only pays for care that is connected to a hospital discharge....our health care system must cover these vital services...[and] we should promote home-based care, which most people prefer, instead of the institutional care that we emphasize now.

Former U.S. Senator Majority Leader Tom Daschle (D-CD)

We need incentives to...keep people in home health care settings...It’s dramatically less expensive than long term care.

U.S. Senator John McCain (R-AZ)


Home care is clearly the wave of the future. It’s clearly where patients want to be cared for. I come from an ethnic family and when a member of our family is severely ill, we would never consider taking them to get institutional care. That’s true of many families for both cultural and financial reasons. If patients have a choice of where they want to be cared for, where it’s done the right way, they choose home.

Donna Shalala, former Secretary of Health and Human Services

A couple of years ago, I spent a little bit of time with the National Association for Home Care & Hospice and its president, Val J. Halamandaris, and I was just blown away. What impressed me so much was that they talked about what they do as opposed to just the strategies of how to deal with Washington or Sacramento or Albany or whatever the case may be. Val is a fanatic about care, and it comes through in every way known to mankind. It comes through in the speakers he invites to their events; it comes through in all the stuff he shares.

Tom Peters, author of In Search of Excellence

Val’s home care organization brings thousands of caregivers together into a dynamic organization that provides them with valuable resources and tools to be even better in their important work. He helps them build self-esteem, which leads to self-motivation.

Mike Vance, former Dean of Disney and author of Think Out of the Box

Val is one of the greatest advocates for seniors in America. He goes beyond the call of duty every time.

Arthur S. Flemming, former Secretary of Health, Education, and Welfare

Val has brought the problems, the challenges, and the opportunities out in the open for everyone to look at. He is a visionary pointing the direction for us. 

Margaret (Peg) Cushman, Professor of Nursing and former President of the Visiting Nurses Association

Although Val has chosen to stay in the background, he deserves much of the credit for what was accomplished both at the U.S. Senate Special Committee on Aging, where he was closely associated with me and at the House Select Committee on Aging, where he was Congressman Claude Pepper’s senior counsel and closest advisor. He put together more hearings on the subject of aging, wrote more reports, drafted more bills, and had more influence on the direction of events than anyone before him or since.

Frank E. Moss, former U.S. Senator

Val’s most important contribution is pulling together all elements of home health care and being able to organize and energize the people involved in the industry.

Frank E. Moss, former U.S. Senator

Anyone working on health care issues in Congress knows the name Val J. Halamandaris.

Kathleen Gardner Cravedi, former Staff Director of the House Select Committee on Aging

Without your untiring support and active participation, the voices of people advocating meaningful and compassionate health care reform may not have been heard by national leaders.

Michael Sullivan, Former Executive Director, Indiana Association for Home Care

All of us have been members of many organizations and NAHC is simply the best there is. NAHC aspires to excellence in every respect; its staff has been repeatedly honored as the best in Washington; the organization lives by the highest values and has demonstrated a passionate interest in the well-being of patients and providers.

Elaine Stephens, Director of Home Care of Steward Home Care/Steward Health Systems and former NAHC C

Home care increasingly is one of the basic building blocks in the developing system of long-term care.  On both economic and recuperative bases, home health care will continue to grow as an essential service for individuals, for families and for the community as a whole.

Former U.S. Senator Olympia Snowe (R-ME)

NCOA is excited to be part of this great event and honored to have such influential award winners in the field of aging.

National Council of Aging

Health care at home…is something we need more of, not less of.  Let us make a commitment to preventive and long-term care.  Let us encourage home care as an alternative to nursing homes and give folks a little help to have their parents there.

Former President Bill Clinton

Department of Labor Issues Final Rule of Companionship Exemption

September 18, 2013 10:13 AM

The U.S. Department of Labor issued the Final Rule setting out changes to the longstanding regulations on the companionship services exemption from minimum wage and overtime compensation under the Fair labor Standards Act (FLSA). The Final Rule is available at:

NAHC continues to analyze the 358-page rule and will provide a more detailed review in the days to come. As a summary, the Final Rule:

  • Is effective on and after January 1, 2015. DoL delayed the effective date to provide for time for employers and funding sources to adjust.
  • Redefines “companionship services” to be limited to “fellowship”, “protection”, and limited direct care. Care related services are limited to no more than 20% of the hours worked.  This definition means that the vast majority of Medicaid personal care services will be subject to minimum wage and overtime requirements. Private pay home care impact will vary on a client-specific basis.
  • Excludes employees employed by home care agencies (“third-party employers”) from any remaining exemption.  The exemption will remain for workers directly employed by the client or a family member. However, that exemption will apply only if the services are within the new, limited definition of companionship.
  • Requires minimum wage and overtime for individuals with “joint employers”, e.g. individuals directly employed by the person receiving the services and a Medicaid public authority that has some control over pay, work schedule, work activities, or other indicia of an employer. This standard will likely mean that much of the Medicaid consumer directed care is subject to minimum wage and overtime even if it the services qualify as companionship under the new definition. Home care registries will need to do a operation-specific evaluation as some may be considered joint employers based on how they function.
  • Eliminates third-party and jointly employed live-ins from the live-in domestic services exemption.

The Labor Department justifies its action as a modernization of the exemptions to reflect the great growth in use of home care through organized businesses. DoL estimates that the rule will an annualized impact of $321.8 million over the next ten years that will be a  “transfer of income” from home care agencies and their funding sources (Medicaid, consumers, etc.) to workers.

Andrea L. Devoti, Chairman of the National Association for Home Care & Hospice said of the ruling:  

"Like many things that emanate from Washington, the repeal of the companionship exemption is not what it seems.  While ostensibly intended to help hard working caregivers, it will have the very opposite effect. Also, according to the advocates for persons with disabilities, it will trigger great harm to many of this nation’s most vulnerable citizens.

It will mean that people will receive less care.  Home care companies will have little choice but to employ workers part time rather than full time as Medicaid payment rates and consumers with limited incomes cannot afford higher costs.  Caregivers will in the end receive less pay.  The term "companionship," which is found in the statute, is being reinterpreted and narrowed in new rules released today by the U.S. Department of Labor. 

The revised rules limit the exemption from overtime pay requirements for those caregivers who spend 80 percent or more of their time on fellowship activities.  To put this another way, it bars a caregiver from spending more than 20 percent of their time on hands-on care.  The new rules also narrow the interpretation of what is known in the industry as "live in" domestic help.  Families will have a much more difficult time affording the costs of “live in” care for their disabled loved ones.

Federal programs such as Medicaid will end up paying a great deal more with no material improvement in access to care or in its quality.

Like the disability community, we believe it is better policy to affirm the decision of the U.S. Supreme Court which unanimously sustained the validity of the companionship exemption as it had been applied for over 35 years.  We believe that there is much that Congress can do to put this matter right—which means helping people to receive the quality care they need and at the  same time giving caregivers a fair and honorable wage. 

The federal wage and hour laws were written when most health care was received in institutional settings. Today, more and more care is delivered in the home setting. These laws need to be re-evaluated by Congress in total rather than in piecemeal fashion.  The central focus of this review should always be what is best for the people needing care"

NAHC, Private Duty Home Care Association, and the National Council on Medicaid Home Care are all exploring further advocacy efforts on the rule change including congressional legislation and federal court litigation.




©  National Association for Home Care & Hospice. All Rights Reserved.