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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

Long Term Commission Issues Final Report to Congress

September 20, 2013 08:49 AM

On September 18, the Commission on Long-Term Care (the Commission) issued a Report to Congress providing recommendations for long-term care reform.  This follows a September 13 press release by five dissenting commissioners issuing alternative recommendations.  The following is a synopsis of the issues discussed relevant to Medicaid, Medicare and/or home and community-based services (HCBS).

Key Points

Rebalancing: The Commission, in its recommendations, is very pro-home care. It recommends that Congress provide incentives to states to give people more options of care for those who prefer to live in the community.  The Commission recommended that this care should be 1) the most integrated possible; 2) person-centered in nature; and 3) based on objective needs assessments.  To achieve these goals, the Commission advised that:

  • CMS should prioritize access to HCBS when devising systems of care;
  • Individuals and family caregivers should have sufficient information to “enable them to make informed choices between institutional and HCBS services”;
  • CMS should streamline the Medicaid waiver process, specifically with regard to HCBS provisions;
  • CMS should give states technical assistance to encourage rebalancing; and
  • A study should be commissioned that analyzes cost savings resulting from: 1) increased access to HCBS; 2) more successful transitions into HCBS; and 3) fewer unnecessary admissions and readmissions into institutions

Quality: The Commission stressed the importance of quality measures in long-term care to promote quality and appropriateness of HCBS, specifically advising Congress to:

  • Develop HCBS quality measurement tools; and
  • Develop mechanisms and procedures for these tools

Payment Reform: The Commission recommended Medicare payment reforms, but did not mention Medicaid payment reforms.  Among the Medicare payment reforms is the elimination of the homebound requirement to qualify for home care benefits – a proposal long-supported by the National Association for Home Care & Hospice (NAHC)

Financing: The Commissioners did not agree on the proper approach to financing and thus did not make a recommendation.  They issued two alternative approaches of financing long-term services and supports (LTSS) reform: 1) via private options and 2) via a public, social insurance option.  The two public options were 1) creating a comprehensive Medicare LTSS benefit or 2) creating a basic LTSS benefit as part of Medicare Part A or in a new public program.

Workforce:  The Commission recommended the following with regard to the home care workforce:

  • States should allow nurses to delegate/supervise some HCBS tasks to direct care workers – a provision long advocated by NAHC;
  • Have national criminal background checks for all LTSS workers;
  • Encourage states to develop certification for home care workers; and
  • Have CMS explore the idea of national training standards for direct care workers, using Medicaid as an incentive.

To see the full Report, click here

To see a PowerPoint presentation of the Report, click here

For previous articles from NAHC’s Medicaid Council on each of the Commission’s four hearings, click here, here, here, and here

For a link to the Commission’s website, click here.

Upon release of the Commission’s Final Recommendations, NAHC’s President Val J. Halamandaris stated that:

“There are Commission recommendations that NAHC supports including reconsidering the requirement for receiving home health services under Medicare that the individual be ‘homebound,’ and promoting services for persons with functional limitations in the least restrictive setting appropriate to their need—building a system, including Medicaid, with options for people who would prefer to live in the community.”

To read NAHC’s statement on the Final Recommendations of the Commission, please click here.

Alternative Recommendations

On September 13, five of the Commissioners issued alternative recommendations to the Commission’s Report.  In the press release, these commissioners expressed concern that no meaningful LTSS reform can take place “without committing significant resources, instituting federal requirements, and developing social insurance financing.”  Specifically, these commissioners advocated strengthening Medicaid through extending and streamlining financial incentives for states for HCBS.  This would, in turn, aid in rebalancing.

To see the full press release, click here.


Rebalancing: The National Council on Medicaid Home Care – a NAHC affiliate - welcomes the Commission’s emphasis on the need for rebalancing, as promoting HCBS over institutional care wherever possible and whenever it makes sense ethically, clinically, and financially.  For further reading on HCBS utilization among states, see the Council’s brief on Senator Harkin’s recent report to Congress entitled Separate and Unequal: States Fail to Fulfill the Community Living Promise of the Americans with Disabilities Act, here.  The Council also supports easing the bureaucratic burden of states looking to invest in HCBS, and to that end supports the streamlining of the Medicaid waiver process as proposed by the Commission.   

Additionally, the Council notes that while the Commission discussed the HCBS waitlists, citing that they currently comprise an estimated 500,000 people nationally, it did not propose recommendations to reduce and eventually eliminate these waitlists. 

For previous Council articles on the waitlists in Kansas, click here and here.

Payment Reform/Financing: The Council finds it unfortunate that the Commission did not agree to a financing solution to the proposed LTSS reforms, specifically when one exists in a more robust Medicaid program.  The Council agrees with the alternative recommendation to strengthen Medicaid, above.  The Council favors giving states the flexibility over resources to the extent that they will increase, not decrease, HCBS utilization.  In that vein, the Council supports programs like Money Follows the Person and Balancing Incentives Payments Program (BIPP) to the extent that they incentivize states to expand HCBS access.




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