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National Association for Home Care & Hospice
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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

Heath 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

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

Supplemental Comparative Billing Report for Hospices

October 17, 2013 12:50 PM

SafeGuard Services released Supplemental Report for CBR027:  Hospice Services Findings from a Retrospective Cohort Study.  For this report, the claims data of 15,797 hospice patients who died over a seven day period in May 2013 was analyzed for the type of services utilized, the diagnosis at time of death and the length of stay. 

In June 2013, a Comparative Billing Report (CBR) was disseminated to 3,459 hospice agencies in the country.  The report compared individual hospice utilization data to regional and national utilization measures.  The CBR study, however, did not provide data on overall length of stay in hospice per beneficiary or the top diagnoses among hospice patients. Moreover, according to the report, Centers for Medicare & Medicaid Services (CMS) hospice subject matter experts (SMEs) indicated that General Inpatient Care (GIP) might be insufficiently offered by hospice agencies. This supplemental report takes a look at these areas of hospice care delivered to Medicare patients. 

The report compared the average number of days a patient is receiving hospice care to the average number of days between the first date a patient ever enrolled in hospice to the time of death while enrolled in hospice. The supplemental report found that, on average, a hospice patient utilized hospice services for 80.34 days and, on average, the lapsed time between first enrolling in hospice to dying while enrolled in hospice was 110.21 days. 

There was a significant difference of almost 30 days between these two measures of length of stay meaning that, on average, a patient received hospice care for 80.34 consecutive days prior to the date of death but due to a previous enrollment and subsequent revocation/discharge a total of 110.21 days lapsed between the patient’s initial enrollment in hospice care to the day of death and the patient almost 30 days of non-hospice care over the course of the 110.21days.

The report cites CMS data indicating that the primary diagnosis at time of enrollment in hospice and at time of death remained the same and is consistent with other reported data on diagnosis at time of death.  The top 20 diagnoses at time of death continue to move toward more neurological diseases and less cancer diseases.  In accordance with this shift, the average number of days in hospice has also increased.  The supplemental report data specifically shows an average length of stay for “debility” to be 117 days while CMS’ data for debility in 2009 was 83 days.

Of the 1,294,480 hospice days of service for the 15,797 hospice patients reviewed, the majority of services were billed under the Routine Home Care revenue code. The next largest revenue code used was General Inpatient Care at only 1.95% of all revenue codes used.  The site of service for the majority of the patients (70.1%) was within their home (private and assisted living).  Almost 20% of all hospice days occurred in a long term nursing facility followed by 6.83% in a skilled nursing facility.  Over 50% of all hospice days are devoted to the care of “Debility”, “Dementia”, “Alzheimer’s” and “Adult failure to thrive”.  The average length of stay in hospice for all diagnoses was 160.64 days, but overall hospice patients in this cohort had Alzheimer’s as a primary diagnosis for 181.96 days on average.

SafeGuard Services indicated in this report that it has been implied that GIP care is not sufficiently available for hospice patients. The data showed that only 25,276 (1.95%) hospice days were delivered to this group of hospice patients and the majority of these occurred in an inpatient hospice facility (70.22%).

To be clear, this is a supplemental report and hospices will not be receiving an additional CBR comparing their performance in the areas studied in this report.  It is interesting to note that in gathering data for the report, SafeGuard Services found that one fifth of hospices agencies active in 1999 had closed by 2009.




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