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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

Medicare Spending Peaks for Beneficiaries in their Mid-90s

January 16, 2015 04:23 PM

A new study in the journal Health Affairs found that Medicare per capita spending for beneficiaries with traditional Medicare over age 65 peaks among beneficiaries in their mid-90s and then declines. The study also found that spending varies by type of service with advancing age. Between 2000 and 2011 the peak age for Medicare per capita spending increased from 92 to 96. In contrast, among decedents, Medicare per capita spending declines with age.

According to the study, conducted by Patricia Neuman, Juliette Cubanski and Anthony Damico:

“As the US population ages and more people on Medicare live into their 80s, 90s, and beyond, analysts and policy makers are examining the impact of these trends on the federal budget and the Medicare program. At the same time, geriatricians and other providers who care for older patients are paying greater attention to the question of how best to meet the needs of an aging population.

By 2050 the number of people on Medicare ages 80 and older will nearly triple; the number of people in their 90s and 100s will quadruple. To inform discussions about Medicare’s role in providing coverage for an aging population and to assess the relationship between Medicare spending and advancing age, this…analysis of Medicare per capita spending among beneficiaries over age 65 in traditional Medicare, by age and type
of service.”

Below is a synopsis of the study’s key findings from Health Affairs:

Per Capita Spending By Age. In 2011 Medicare per capita spending increased with age. Spending peaked at age 96 and then declined gradually for the relatively small number of older beneficiaries. Average Medicare per capita spending for beneficiaries age 96 ($16,145) was more than double that for beneficiaries age 70 ($7,566). This spending pattern persisted even when we excluded decedents from the analysis:

Among beneficiaries who lived a full year in 2011, Medicare per capita spending also increased with age and peaked at age 96 ($14,278)
before falling.

Since 2000, the age at which Medicare per capita spending has peaked has increased, from 92 in 2000 to 96 in 2011. The amount of Medicare per capita spending at the peak age has also increased, from $9,557 in 2000 (adjusted for inflation) to $15,015 in 2011 if Part D is excluded, and to $16,145 including Part D (trend data not

Share Of Beneficiaries And Share Of Spending. Medicare beneficiaries ages 80 and older accounted for a disproportionate share of traditional Medicare spending. In 2011 people in this age group accounted for 24 percent of beneficiaries in traditional Medicare but 33 percent of traditional Medicare spending. In contrast, people ages 65–69 accounted for 26 percent of traditional Medicare beneficiaries but just 15 percent of spending.

Per Capita Spending By Service. The relatively high per capita spending among beneficiaries in their mid-to-late 90s in 2011 was influenced by
spending on skilled nursing facility, hospice, and (to a lesser extent) home health services.

When we excluded spending on these services, we found that per capita spending peaked at age 89.
Medicare per capita spending for inpatient care in 2011 plateaued between the ages of 84 and 97, peaking at age 89, before declining. For Part B provider, services, and supplies and hospital outpatient services, per capita
spending peaked earlier, at age 83, before declining. In contrast, per capita spending for skilled nursing facility and hospice services increased dramatically at older ages. A larger share of older beneficiaries used these services, and older users had higher per capita spending on them.

Despite a gradual reduction in Medicare per capita spending for Part B providers, services, and supplies for beneficiaries beginning in their mid-to-late 80s, per capita spending continues to climb into the mid-90s as a result of persistent levels of inpatient hospital spending and a sharp rise in skilled nursing facility and hospice spending in the late 80s and 90s. Between ages 86 and 96, Medicare per capita spending on skilled nursing facility services increased by more than 50 percent (from $2,043 to $3,149) while per
capita spending on hospice tripled (from $706 to $2,299).

In percentage terms, as beneficiaries age, a larger share of Medicare per capita spending was devoted to skilled nursing facility and hospice services and a smaller share to Part B providers and prescription drugs

Spending on inpatient hospital services was a relatively constant share of per capita spending until beneficiaries reached their late 90s.

Spending On Decedents. Spending on decedents affected our estimates of Medicare per capita spending by age. However, the age-related spending increase was not entirely attributable to end-of-life care or to higher death rates among older beneficiaries. The pattern of Medicare per capita spending by age was similar with or without decedents in our analysis, although average spending was higher at all ages when decedents were included. This is because average Medicare per capita spending was significantly greater for decedents than for those who lived the entire year, both overall—$33,486 versus $8,647 - and at every age. Because of higher death rates among older beneficiaries, average per capita spending among beneficiaries who died at older ages exerted a greater influence on estimates of average Medicare spending among older beneficiaries.

In contrast to the pattern of Medicare per capita spending observed generally, per capita spending on decedents in traditional Medicare declined steadily with age. In 2011 per capita spending declined from about $43,000 for decedents age 70 to about $20,000 for centenarians who died. The change was largely attributable to a reduction in inpatient spending.

To read the full report, pleaser click here.




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