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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

CMS Proposes a Falls Measure for Home Health Agencies

September 12, 2017 03:39 PM

CMS1-300x181The Centers for Medicare & Medicaid Services (CMS) published in the Federal Register on July 28, 2017 The Calendar Year (CY) 2018 Home Health Prospective Payment System Rate Update proposed rule.

A significant portion of the proposed rule is dedicated to proposals that update the Home Health Quality Reporting Program (HH QRP).The changes are many with the majority focused on cross setting quality measures and standardized assessment items that CMS is required to develop in accord with the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) (see NAHC Report article).

CMS is proposing a new Measure titled Application of Percent of Residents Experiencing One or More Falls with Major Injury. Major injury is defined as bone fractures, joint dislocation and closed head injuries with altered consciousness or subdural hematoma.  The term “application” is used to indicated that the measure will be used in a setting other than the setting for which it was endorsed by the National Quality Forum (NQF). Therefor, the measure has not been endorsed by NQF for the home health setting.  In order to collect the data require for the measure two new assessment items will need to be added to the Outcome and Assessment Information Set (OASIS).  

In October 2016, the measure developers issued a call for public comments on the above falls with major injury measure for which the National Association for Home Care & Hospice (NAHC) submitted comments. NAHC plans to issue similar comments to CMS’ call for public comments on the proposed measure.    

The main concern with the falls with major injury measure is that it is not risk adjusted. Although an unadjusted falls measure could provide valuable information regarding the overall rates of falls occurring within the agency, it has limited value when comparisons are made to other home health agencies. 

Home health agencies provide intermittent care to patients with varying care needs, living environments and caregiver support.  Agencies have limited control over a patient/caregiver’s ability or willingness to comply with fall prevention strategies. Additionally, home health patients are permitted to leave the home infrequently or for short duration, and are allowed unlimited absences for medical reasons. Therefore, a home health patient could encounter fall risks for which the agency could not be expected to mitigate. 

Without risk adjustment, the measure could present a distorted correlation between the rate of major injuries related to falls and the quality of care provided by the agency, and as previously mentioned, has limitations when making comparisons among home health agencies. Concerns over the inclusion of the measure into CMS’ public reporting system, and potentially in a home health value based purchasing program, could result in agencies avoiding caring for patients perceived as high risk for falls.

The measure developed in their response to the October, 2016 public comments rejected the request for risk adjustment claiming that falls with major injury are considered a “ never event.” Although this position might make sense for institutionalized patients, it does not take into consideration the uniqueness of the home health setting. NAHC still believes a request for CMS to risk adjust this measure is warranted.

CMS could include an unadjusted rate for falls with major injury on the agency’s confidential feedback reports along with a risk adjusted rate for the measure. This will allow the agency to see their actual fall rates, while risk-adjusted rates could be used for pubic reporting, when required.

Of equal concern,  is that the IMPACT Act requires the falls with major injury measure to be applied across other PAC settings; all of which are facility based  with  24/7 supervision and the ability to affect fall prevention through direct  interventions by the facility staff. The standard for fall risks and prevention that is applied to facility based care cannot be applied to community care settings.

Click here to view the data specifications for the Application of Percent of Residents Experiencing One or More Falls with Major Injurymeasure.  Comments are due September 25, 2017.




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