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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

USA Today Reports on the Effects DOL’s New Overtime Rules will have on Home Care

Article first appeared in Pew’s Stateline Newsletter, NAHC’s Vice Chair Lucy Andrews is Quoted
April 29, 2014 09:56 AM

A recent USA Today article, first reported by the Pew Charitable Trusts’ Stateline newsletter, focuses on the Department of Labor’s new overtime rule change. NAHC’s Vice Chair Lucy Andrews was quoted in the article.

A full reprint of the article is included below:

States Wary Home Care Worker Rules Could Cost Millions

USA Today, Apr. 25, 2014

A new rule from the Obama administration designed to provide better pay and working conditions to 2 million home care workers is forcing many states to rethink how they look at Medicaid payments and may result in higher Medicaid costs.

Starting Jan. 1, home care workers in 29 states will, for the first time, be eligible for the federal minimum wage of $7.25 an hour and overtime pay, under a new regulation from the U.S. Department of Labor. These workers go to homes of the elderly and the disabled to help with cooking, bathing and other daily tasks, and are paid by the clients or through Medicaid.

Fifteen states already had applied state minimum wage and overtime protections to home care workers, also called "direct care" workers, while six others and the District of Columbia offer just state minimum wages.

Many states have never considered Medicaid payments to be wages, said Sarah Leberstein, a staff attorney with the National Employment Law Project, which advocates for higher pay for the poor. "It's a new mindset. The states will have to shift their thinking and take another look at their reimbursement practices and guidelines with the new wage rules in mind."

In most cases, Medicaid pays home health care agencies to supply health care workers in the homes of beneficiaries who need long term care. It is the agencies that set workers' hourly rates and the terms of their labor, including overtime and travel time pay. Because of this, Medicaid agencies are usually unaware of direct workers' wages.

The U.S. Department of Labor estimates the rule will cost $6.8 million a year over a 10-year period, with private businesses and state Medicaid programs picking up the tab. But critics contend that number is too low. Supporters say the rule will reduce turnover and improve quality of care while opponents contend that the new rule will force employers to cut home care workers' hours.

Workers in nursing homes, who often do similar work as home care workers, are already covered by federal wage and overtime requirements. But for the past 40 years, home care workers were exempted from federal minimum wage protections largely because they were lumped in the same job category as babysitting, which Congress said should not be eligible for minimum wage and overtime.

"That's just wrong. In this country, it's inexcusable," President Barack Obama said in 2011 when he announced the Labor Department would update the regulations. The final rule was published two years later, but won't go into effect until 2015 to give employers and state Medicaid programs time to understand and adapt to the new requirements. State Medicaid directors, however, say they will need more time and are asking the Labor Department to delay the effective date by 18 months.


The home care sector is among the fastest growing but not highly paid. Nationwide, the number of home health aides is projected to increase by nearly 50% from 2012 to 2022. The median annual wage for home health aides was $20,820 in 2012. Home care workers typically earn $8.50 to $12 an hour, above the federal minimum wage, but until this rule did not get paid overtime.

"Many direct care workers (are) forced to rely on public assistance (programs) despite long hours of challenging, often heroic work," Labor Secretary Thomas E. Perez told a congressional panel last month. Organized labor says nearly one out of two home care workers are in households that rely on public assistance, such as Medicaid or food stamps.

Medicaid, the federal-state health insurance program for low-income people, is affected by the rule because Medicaid is typically the single largest payer of spending on long-term service, including nursing homes, and home-based care.

In 2009, Medicaid paid more than $126 billion for this kind of care, according to the National Association of Medicaid Directors, a bipartisan group of all 50 state Medicaid directors. While the majority of Medicaid long-term services and support dollars still go toward institutional care, the national percentage of Medicaid spending on home and community-based services has more than doubled from 20% in 1995 to 45% in 2011.

The new rule does not cover home care workers who are employed solely by household or family members and who primarily provide "fellowship," which includes reading or playing games with clients or taking them on walks or to social events.The industry and advocates say most home care workers already earn at least the equivalent of the current federal minimum wage of $7.25. The big difference is that these workers will now be eligible for time-and-a-half pay when they work more than 40 hour a week. These workers also will be compensated for time spent traveling to and from clients' homes.

Because the new protections are contained in a regulation, and not a law, the Obama administration didn't have to go through Congress to enact the new policy. Republicans on Capitol Hill have balked at the president's proposal to increase the federal minimum hourly wage to $10.10


The home care industry has grown dramatically over the last several decades as more Americans choose to receive long-term care at home instead of in nursing homes or other facilities. And the need is expected to grow. The number of Americans requiring help with daily living, either at home or in an institution, is expected to more than double to 27 million by 2050 from the current 12 million.

State Medicaid programs worry about the costs, and also about unintended consequences of the new requirements, such as prompting more seniors and disabled to move into expensive institutional settings because in-home care in no longer a more affordable option.

Some states, such as Connecticut, have backed the new rule. "This federal rule change will ensure nationwide that these hardworking employees enjoy the basic rights that many of their colleagues already do," Democratic Gov. Dannel Malloy wrote to the Obama administration last year.

Others states are looking at its costs. While the rule was being drafted, Illinois told the Labor Department that 10,000 home health care workers in the state worked close to 3 million hours of overtime, and the cost of overtime compensation would exceed $32 million.

California, which already applies its $8 minimum wage to home care workers, but not overtime, estimates the new overtime requirements will cost the state more than $600 million in 2015-2016.

Democratic Gov. Jerry Brown has proposed prohibiting home care workers from working overtime, an idea that unions and disability groups have criticized.

"It is a proposal that is unfair to hard working, low-wage workers and could create chaos," said Gary Passmore, vice president of the advocacy group Congress of California Seniors. "One of the sad ironies of the proposal is that those who will suffer most are those in greatest need … frail people who require the maximum level of assistance to live at home."

"Make no mistake. Certain provisions of this rule present a heavy lift for some states," Matt Salo, executive director of the National Association of Medicaid Directors" said earlier this year. "We expect this to be a lengthy and very involved process as each state works with the administration to assess the type and scope of changes that may be required."

The U.S. Department of Labor has held a series of webinars with state Medicaid officials and the public to help affected parties know what the requirements are.


Lucy Andrews, vice chair of the National Association for Home Care & Hospice and owner of a small home care company in California, predicts she will either need to restrict her workers' hours or increase what she charges clients, including Medicaid. "This new rule will force me to make some very hard decisions," she told a U.S. House panel last year.

Joseph Bensmihen, president of United Elder Care Services, Inc., a caregiver referral service in Boca Raton, Fla., said the most likely alternative for most of his clients, besides moving into a facility, will be to rotate caregivers to ensure that none works more than 40 hours a week. "This means that one of the most cherished benefits of home care among the elderly, disabled, and infirm, namely continuity of care, will be lost."

Supporters question whether firms will have to cut hours, noting that industry-wide, more than half of home care aides already work part time and that less than 10% report working more than 40 hours a week.

"Rising worker compensation costs, higher gas prices, and reimbursement rates that have not kept up with the cost of living are a far greater threat to profitability than paying minimum wage and overtime," said Karen Kulp, president of Home Care Associates in Philadelphia, an agency that employs 200 home care workers.

The home care industry, with revenues of $93 billion last year and an average growth rate of 8% per year from 2001 to 2011 "is a thriving industry that can afford to pay home care workers minimum wage and overtime," according to Kulp, who also is a board member of Paraprofessional Healthcare Institute, a group that aims to improve working conditions for home care workers.

The National Employment Law Project says say the changes in the final rule will "correct a decades-old injustice that has fueled poverty wages and destabilized an increasingly vital industry."

To see more on the NAHC’s response to the Department of Labor rule change, please click here.

To read Ms. Andrews’ full testimony, which was quoted in the article, please click here and here.




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