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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

New Data Shows Slight Reduction in Hospice Utilization for 2014

Represents First Decline in a Decade
April 14, 2016 11:23 AM

Editor’s Note: Special thanks to by Rich Chesney, President and Founder of Healthcare Market Resources (HMR) for permission to reprint the following blog posting that was authored by him and released under the title “Hospice Utilization: A new year but no new business.” We believe it provides valuable information about recent trends in hospice utilization and are reprinting it here. Please also note that HMR has historically tracked hospice utilization by the percent of Medicare beneficiaries receiving hospice services rather than the percent of Medicare patients that died on hospice care in a given year (a statistic tracked by the Medicare Payment Advisory Commission). Using the percent of Medicare beneficiaries receiving hospice services figure allows for consideration of patients with hospice services that were discharged live from hospice care.

Filed under Blog

It may be a new year, but that doesn’t mean a lot of new business for hospices. We [Healthcare Market Resources] took a look at hospice (and home health, but that’s another blog) utilization over the last decade, only to find that, for the first time in ten years, hospice utilization has declined. Granted, the decline is only by 1%, but hospice has been at a pretty steady utilization rate of 2.6/2.7% for the last five years.

When you consider that we measure hospice utilization by dividing the number of hospice patients served by the total Medicare eligible population for each state (this ensures that we capture live as well as expired discharges), that number should be in a steady state if not slightly growing, given the increasing awareness of hospice services, the ubiquitous availability of its services and favorable demographics. Has all the regulatory scrutiny bent the utilization curve downward?


Worse yet, regardless of where you are in the country, all hospice growth is relatively flat or in decline.

  • Just three states experienced utilization growth in 2014 and that growth was only 0.1%.
  • Eight states experienced utilization declines in excess of 0.1% with the highest decline at 0.3%.
  • 15 states experienced no change with the remainder declining at just 0.1%.
  • Still, breaking it down into quartiles, we do see that there is some variation from state to state, possibly indicating that there is room for growth at the individual state level.


2016 and Beyond

Overall, it’s a very flat market with no data to suggest any light at the end of the tunnel. So what does this all mean for the future growth of hospices? Not much in the way of new growth for hospice, unless something changes.

Unfortunately, the immediate prospects are not good. Increased regulatory pressure and a new payment system which dis-incentivizes long term patients could result in lower utilization rates, as length of stay shortens for these longer stay patients (180 days+). MedPAC and Medicare have gone on record as these type of patients are subject to questionable justification of services. Another ticking time bomb in the short term is the Senate Finance committee proposal to move the hospice benefit into Medicare Advantage. This added level of supervision at the micro level can only mean fewer patients accessing the benefits or stable patients being discharged sooner.

While long term prospects are strong given the need to control end-of-life (EOL) costs becoming more important as more providers go at-risk, this requires significant structural and attitudinal changes in the healthcare delivery system. The goal is achievable as seen by the experience of La Crosse Wisconsin and the Gundersen Health System which has shown that 30 years of community effort can pay off in lower EOL costs. However, hospice may not be the sole beneficiary of these efforts as Medicare is testing other forms of palliative care with the Medicare Care Choices Model.

If the prospects for organic market growth are poor, hospices can look to geographic expansion, taking away market share from competitors or adding complimentary services to increase their revenues. Each alternative poses its own challenges.

Local Impact

To understand what is happening at the local level, hospices must calculate the utilization for their particular service area by dividing patients served (found in the Market Share 2 Report) into the Medicare fee-for service enrollees (as found in the Managed Care/Dual Eligible report). Based on this figure, you can see if your market has upside or downside in its future.

State-by-State Utilization Chart

If you would like to see the 2005 – 2016 state-by-state utilization chart used for this blog, just contact Healthcare Market Resourcesto request a complimentary copy.




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