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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

Study Profiles HCBS Trends Among the Intellectually and Developmentally Disabled

December 13, 2013 04:35 PM

In 2013, The University of Minnesota’s National Residential Information Systems Project (RISP) released a study titled Residential Services for Persons with Intellectual or Developmental Disabilities: Status and Trends Through 2011 (the Study)The Study’s major findings as they apply to home and community-based services (HCBS) and rebalancing are below.

HCBS Waivers: The number of people with intellectual and developmental disabilities (IDD) that are recipients of HCBS waivers increased dramatically, from 1,381 in 1982, to 62,429 in 1992, to 373,946 in 2002, and to 616,491 in 2011.  Total IDD HCBS waiver expenditures increased from $10.9 billion in 2001 to $26.3 billion in 2010 to $27.9 billion in 2011. From 2001 to 2011, the degree of expenditure increase varied significantly across states, with Illinois, Mississippi, New York and Ohio experiencing increases above 500%, while California, Michigan, New Hampshire, Oklahoma, and Rhode Island seeing increases from 25% to 73%.  HCBS waiver recipients accounted for 69.0% of the national IDD population in 2010.    

Rebalancing: The Study provided several statistics demonstrating the success of rebalancing of the IDD population.  The average daily population living in either psychiatric or large state-operated IDD facilities decreased from 187,305 nationally in 1965 to 103,629 in 1985 and to 29,809 in 2011.  Relative to the general population, the institutionalized IDD population declined as well.   The proportion of those with IDD living in either psychiatric or large state-operated IDD facilities as compared to the general population fell from 115.8 per 100,000 nationally in 1965 to 49.3 per 100,000 in 1985 and to 9.6 per 100,000 in 2011.

Further evidence of rebalancing is demonstrated when comparing the proportion of IDD population residing in Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IDs) (27.2 out of 100,000), versus those receiving HCBS (197.9 out of 100,000) in 2011.  The utilization levels of HCBS relative to the population varied significantly among states.  Eight states had over 350 out of 100,000 receiving HCBS (Arizona, Iowa, Minnesota, New York, North Dakota, South Dakota, Vermont, and Wyoming), while five state had fewer than 100 per 100,000 receiving HCBS (Delaware, Michigan, Mississippi, Nevada, and Texas).

Cost-Effectiveness of Rebalancing: The Study confirmed the cost-effectiveness of HCBS compared to institutional care.  In 2011, annual Medicaid expenditures per person in ICF-IDs was $148,146, versus only $45,294 per person for IDD HCBS. 

For the full Study, click here.


The Study’s findings echo those of a recent AARP Solutions Forum on HCBS of the relative success in rebalancing of the IDD population.  The Council supports greater HCBS utilization and rebalancing as prudent win-win solutions for states for both economic and beneficiary rights reasons.  The Council supports rebalancing in favor of home care and supports HCBS waivers so long as they do not reduce existing benefits.  For details, see pages 16 and 22 of the Council’s Blueprint for action, here.

The National Council on Medicaid Home Care – a NAHC affiliate - encourages providers to continue advocating for mechanisms to improve access to HCBS services through their state associations, as well as through state and federal governments.  Home care providers are encouraged to keep abreast of HCBS developments in their states, and nationally, and to contact the Council with any questions or concerns.




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