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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

Olmstead at 15: The Legacy of a Landmark Case

June 27, 2014 09:31 AM

Overview of Olmstead

June 22 marked the 15th anniversary of the Supreme Court decision, Olmstead vs. L.C.

Facts of the Case. The Plaintiffs, Lois Curtis and Elaine Wilson, had developmental disabilities and mental illness. The Plaintiffs had originally been admitted voluntarily to state-run Georgia Regional Hospital, in the psychiatric unit. After receiving medical treatment, state mental health employees recommended that both Plaintiffs should be treated in a community, rather than institutional, setting. However, both remained in Georgia Regional Hospital for several years, and in 1995 both sued Georgia under the Americans with Disabilities Act (ADA) for their release.

Holding. On June 22, 1999, the Supreme Court held that Title II of the ADA requires persons with mental disabilities to be placed in community settings and not institutions when

  • “Such action is in order when the State’s treatment professionals have determined that community placement is appropriate,
  • [T]he transfer from institutional care to a less restrictive setting is not opposed by the affected individual, and
  • [T]he placement can be reasonably accommodated, taking into account the resources available to the State and the needs of others with mental disabilities.”

Subsequent Litigation

Despite the Olmstead decision, many cases regarding unwarranted institutionalization and denial of home and community-based services (HCBS) are still being litigated. The following are some of the cases that have been litigated in the past year alone.

Florida. In July 2013, in U.S. v. Florida, the Department of Justice (DOJ) filed a lawsuit against the State of Florida in the United States District Court. The DOJ alleged Florida violated the ADA and the Olmstead decision by placing nearly 200 disabled children in nursing homes, when less restrictive HCBS would have been more appropriate. According to the Complaint, factors contributing to an increase of institutionalization included declining HCBS reimbursement, a lack of HCBS openings in programs, the growth of the HCBS waitlist, and Florida’s reductions in necessary care. Factors contributing to a decrease in HCBS utilization included a lack of “meaningful opportunities” to move to HCBS, as well as insufficient screening for HCBS.

Georgia. In September 2013, in Hunter v. Cook, the United States District Court for the Northern District of Georgia Atlanta Division, issued an order to the Georgia Department of Community Health (GDCH) to prevent it from providing less than 18 hours per day of skilled nursing care to two severely disabled children (the Plaintiffs). This followed attempts by Georgia to cut hours for the Plaintiffs. The Plaintiffs are beneficiaries of Early and Periodic Screening, Diagnostic and Treatment services (EPSDT). Additionally, they are enrolled in the Georgia Pediatric Program (GAPP), which the Order defined as “a Georgia Medicaid program that provides continuous skilled nursing care to medically fragile children.” The Court found that Georgia had participated in “unjustified institutional isolation” in violation of the ADA and the Olmstead decision.

New Hampshire. In December 2013, in Amanda D., et al. v. Wood Hasan, et al. (formerly Lynn E. v. Lynch), the State of New Hampshire entered into a class action settlement agreement with the DOJ and mental health care recipients and advocacy organizations to provide new community mental health services. As a result, New Hampshire must expand community mental health services over the next six years, including mobile crisis teams, housing and employment services. In February 2014, the settlement was approved by presiding judge Steven J. McAuliffe of the U.S. District Court.

New Mexico. In January 2014, in Waldrop, et al v. New Mexico Human Services Department et al, seven adult plaintiffs and their legal guardians, along with Disability Rights New Mexico and the Arc of New Mexico, filed a lawsuit against New Mexico. Specifically, the Complaint alleged loss of services for beneficiaries of the state’s Home and Community Based Waiver program for people with developmental disabilities following New Mexico’s overhaul of the DD Waiver. The parties held a settlement conference in April, and efforts to settle the case are ongoing.

Illinois. In February 2014, in N.B., et al., v. Hamos, the United States District Court for the Northern District of Illinois granted class action status to nine children with behavioral or emotional disorders who were denied HCBS. In the Amended Complaint, the Plaintiffs allege that Illinois violated provisions of the Social Security Act, the ADA, and the Rehabilitation Act. Specifically, the Plaintiffs allege that that Illinois denied medically necessary services through EPSDT, and that the Plaintiffs face unnecessary institutionalization.

New York. In March 2014, in U.S. v. New York, presiding judge Nicholas Garaufis of the United States District Court of the Eastern District of New York approved a settlement agreement entered into January 2014 between New York and the DOJ. As a result, New York must transition all residents with serious mental illness out of New York City “impacted” adult homes and into community housing and supportive services over the next five years. In April 2014, New York disclosed that it has allocated $30 million for implementing this settlement.

For more Olmstead-related cases, click here.

Olmstead Plans

Olmstead vs. L.C. suggested that the state could comply with Title II of the ADA, if, among other things, it “were to demonstrate that it had a comprehensive, effectively working plan for placing qualified persons with mental disabilities in less restrictive settings.” In the wake of this decision, many states developed such “Olmstead plans.” As of May 2013, twenty-seven states had Olmstead plans, with an additional eighteen states having alternative strategies.

Waiting Lists

Olmstead vs. L.C. also suggested that the state could comply with Title II of the ADA if, among other things, it “were to demonstrate that it had…a waiting list that moved at a reasonable pace not controlled by the State’s endeavors to keep its institutions fully populated.” According to sources cited in a January 2014 study released by the Department of Health and Human Services (HHS) and Mathematica Policy Research, while there were currently 3.3 million 1915(c) HCBS waiver enrollees nationwide in 2009, by 2011, “a little over half a million people” were on waiting lists nationally, with an average wait time to receive services at approximately two years.

Rebalancing Statistics

Overall. Despite the Olmstead decision, many states have a long way to go to rebalance their long-term services and supports (LTSS) expenditures and populations into home and community-based services (HCBS). According to an April report by the Centers for Medicare and Medicaid Services and Truven Health Analytics (the Report), in federal fiscal year (FFY) 2012, Medicaid spent nearly half (49.5 percent) of its $140 billion LTSS spend on HCBS. HCBS expenditures as a percentage of total LTSS expenditures remained relatively constant from 2010 and 2011, which both had rates of 48 percent. HCBS expenditures as a percentage of total LTSS expenditures had risen from 24 percent in 1997, to 30 percent in 2002, and to 41 percent in 2007. For the full 1995-2012 trend, see figure 3, here.

Most rebalanced states. The Report also reflects that, during FFY 2012, 23 states (including Washington, D.C.) saw Medicaid HCBS expenditures account for over 50 percent of total Medicaid LTSS expenditures, while seven of those states saw such rates at over 60 percent, and two of those states saw rates over 70 percent. The states with the top five rates were Oregon, Minnesota, Alaska, Vermont, and Arizona.

Most rebalanced population.  In FFY 2012, rebalancing was the most pronounced among the developmentally disabled population; 70 percent of Medicaid LTSS spending in this group was in HCBS. The states that had rebalanced the most successfully with regard to their developmentally disabled population were Arizona, Michigan, Oregon, and Maryland (each with 100 percent rebalancing rates), and Vermont with a 99.2 percent rate. For a synopsis of the Report’s rebalancing statistics, see a recent Council brief,here.

Since the release of the CMS/Truven report mentioned above, AARP released its 2014 Long Term Scorecard. In it, it ranked states according to the percent of new Medicaid Aged/Disabled LTSS users first receiving services in the community in 2009. According to the Scorecard, the highest performing states were Alaska (81.9 percent), Minnesota (80.3 percent), New Mexico (78.8 percent), District of Columbia (74.2 percent), and Idaho (73.0 percent). For the full list, see Exhibit A10 on page 75, here.   

For information on Senator Tom Harkin’s Community Integration Act, introduced this month in the wake of the anniversary ofOlmstead, click here.


The Olmstead decision made home care a civil right. While Olmstead was a significant victory for the disabled community and for home and community-based services generally, subsequent litigation and statistics of states that have not achieved rebalancing towards HCBS show that the full potential of Olmstead has yet to be realized.

These trends give a greater urgency to providers to continue advocating for mechanisms to improve access to HCBS services through their state associations, as well as through state and federal governments. Stakeholders should give special attention towards HCBS reform for the elderly and physically disabled populations. 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.

For more on the 15th anniversary of Olmstead, please see NAHC Report, June 25, 2014.




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