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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

IoM Reports on Challenges of Cancer Care in the U.S.: Urges Greater Emphasis on Informed Decisions in Advanced Cancer Cases

October 18, 2013 08:50 AM

The National Academy of Sciences’ Institute of Medicine (IoM) has completed a new study that identifies a crisis in cancer care in the United States stemming from a growing demand for care, a shrinking oncology workforce, rising costs of cancer care, and the complexity of the disease and its treatment.  The report, “Delivering High-Quality Cancer Care:  Charting a New Course for a System in Crisis,” offers several recommendations for addressing these challenges and improving cancer care, including by strengthening clinicians’ core competencies, shifting to team-based models of care, and communicating more effectively with patients.

In the early days of hospice coverage under Medicare, most individuals electing care were diagnosed with cancer.  While that has changed significantly over the last 30 years, patients with cancer diagnoses still make up approximately 30 percent of the beneficiary population.  The percentage of hospice users with cancer is likely a higher percentage than this, however, due to the widespread practice by hospices of including only a single diagnosis on hospice claims.  Over the last 15 months, the Centers for Medicare & Medicaid Services (CMS) has directed, in keeping with ICD-9-CM coding guidelines, that hospices provide the principal and all additional diagnoses related to the terminal condition on claims being submitted for payment.

A relevant part of the IoM report (Chapter 3:  Patient-Centered Communication and Shared Decision Making) addresses the need for greater engagement of patients in making “informed medical decisions that are consistent with their needs, values, and preferences”; this section references hospice with some frequency.  IoM recommends that the National Cancer Institute, CMS and other stakeholders improve the development and dissemination of this critical information, using decision aids where possible.  The study news release notes that, “Patients with advanced cancer face specific communication and decision-making needs, and cancer care teams need to discuss their options, such as revisiting and implementing advance care plans.  However, these difficult conversations do not occur as often as they should; recent studies found that 65 percent to 80 percent of cancer patients with poor prognoses incorrectly believed their treatment could result in a cure.”  The chapter offers a recommended list of Questions for patients with Cancer to Ask Their Clinicians (Box 3-1), examples of web-based information, resources and tools for patients, and a number of other tools that may help to improve the level of patient and family engagement in the care decision-making process; it also encourages timely referral to hospice for end-of-life care.

Following are the recommendations for Chapter 3 that are included in the report:

Recommendation 1: Engaged Patients

Goal: The cancer care team should provide patients and their families with understandable information on cancer prognosis, treatment benefits and harms, palliative care, psychosocial support, and estimates of the total and out-of-pocket costs of cancer care.

To accomplish this:

  • The National Cancer Institute, the Centers for Medicare & Medicaid Services, the Patient Centered Outcomes Research Institute, as well as patient advocacy organizations, professional organizations, and other public and private stakeholders should improve the development of this information and decision aids and make them available through print, electronic, and social media.
  • Professional educational programs for members of the cancer care team should provide comprehensive and formal training in communication.
  • The cancer care team should communicate and personalize this information for their patients at key decision points along the continuum of cancer care, using decision aids when available.
  • The cancer care team should collaborate with their patients to develop a care plan that reflects their patients’ needs, values, and preferences, and considers palliative care needs and psychosocial support across the cancer care continuum.
  • The Centers for Medicare & Medicaid Services and other payers should design, implement, and evaluate innovative payment models that incentivize the cancer care team to discuss this information with their patients and document their discussions in each patient’s care plan.

Recommendation 2: Engaged Patients

Goal:In the setting of advanced cancer, the cancer care team should provide patients with end-of-life care consistent with their needs, values, and preferences.

To accomplish this:

  • Professional educational programs for members of the cancer care team should provide comprehensive and formal training in end-of-life communication.
  • The cancer care team should revisit and implement their patients’ advance care plans.
  • The cancer care team should place a primary emphasis on providing cancer patients with palliative care, psychosocial support, and timely referral to hospice care for end-of-life care.
  • CMS and other payers should design, implement, and evaluate innovative payment models that incentivize the cancer care team to counsel their patients about advance care planning and timely referral to hospice care for end-of-life care.





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