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Testimonials

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. 

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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.

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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

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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 element...it’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

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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.

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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.

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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.

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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.

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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.

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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.

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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. 

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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.

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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.

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Frank E. Moss, former U.S. Senator

Anyone working on health care issues in Congress knows the name Val J. Halamandaris.

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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.

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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.

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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.

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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.

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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.

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Former President Bill Clinton

13-CARING_MAST

90-day transition plans: a safer journey to living safely at home

By David Baiada

14CAR03-Bayada

Transitional care is complicated. For any patient, the journey from acute hospital stay to living safely at home is fraught with hundreds of complex and interdependent variables. Discharge is just the first step on this journey, yet the health care providers that participate in transitions are primarily focused on discharge plans (which are really a way to get someone “out of my care and into yours”). A better route is the 90-day transition plan, which provides a road map families can follow through the maze of post-acute chaos to independence at home.

A familiar story

Anyone who has spent time in the transitional care field knows a story like this one: A client is admitted to the hospital for the third time in a year—in this case for exacerbation of heart failure (HF). She wants to go home, so her case manager provides a list of home health agencies (HHAs) — which would be helpful, except that many are no longer in business and the list includes no information about each provider’s ability to manage a successful transition. Suddenly the family decides that the client will go to her daughter's house, but that house isn’t ready yet. They agree instead that the client will regain strength in a sub-acute setting, so she is discharged to a skilled nursing facility (SNF) with a lot of confusing paperwork, pamphlets about HF, and a few new medications (despite some confusion about what pills she's already taking).

After 10 days of rehab at the SNF, she receives a new list of HHAs from her social worker. The list is based only on the social worker’s personal relationships and experience, rather than proven outcomes and capabilities. The client picks a home health provider and is discharged to her daughter’s house.

Day 2: While the client is being bathed, the home health nurse (RN) shows up without an appointment. It’s not a convenient time for the family, so she leaves.

Day 3: The RN returns and engages the family in developing a care plan that includes continued teaching about HF risk factors. She also gathers all the medications from the client's purse and the hospital bag, plus the new scripts from the SNF, and puts them on the kitchen table. (WOW, what a confusing pile of pills!) When the RN calls the client's primary care physician (PCP) to discuss and reconcile the medications, she learns that the PCP hasn't seen the client in 18 months and didn't know the client had been in the hospital. The PCP and RN have a quick chat to determine appropriate medications and verify the RN's care plan, which will include three visits per week for three weeks, and also continued physical therapy (PT) at home.

Day 4: The PT calls to tell the client he'll be making a home visit on day six. This worries the daughter because her mom is starting to lose some of the strength she regained at the SNF. The daughter calls the SNF social worker and the hospital case manager for advice. They explain there's not much they can do, as therapy staffing can be very difficult for home health agencies, even if they promise quick availability.

Day 5: Forgetting the RN’s advice, the client has a bowl of chicken soup for dinner. When she starts to experience some edema in her ankles, she calls the home health agency to talk to the RN, but gets their answering service. After 15 minutes no one has called her back. She calls her PCP, but can only talk to the physician on call (who isn't familiar with her care). Given the status of her HF exacerbation, the on-call physician recommends that the client go to the emergency department. She is admitted for a hospital stay to get her heart failure symptoms back under control. And so the cycle continues…

A safer solution

As we collaborate with over 1,000 acute and sub-acute facilities from coast to coast, helping to facilitate transitions for more than 10,000 clients each week, BAYADA Home Health Care has a unique opportunity to view incidents of success and failure. What we see most often are great people with good intentions, who work hard to help clients and families during periods of crisis. But the multiple handoffs, along with unpredictable and changing environmental, social, and clinical variables, make it very difficult to achieve consistently successful transitions.

Recognizing these challenges, the Alliance for Home Health Quality and Innovation has compiled current research and best practices to identify the five core elements of an effective Care Transition model. Any transitional care plan should include these five components:

  1. Patient-centered focus
  2. Medication management
  3. Communication and care coordination
  4. Timely follow-up by the health care team (including the primary care physician and home health agency)
  5. Patient-activated education and coaching

We agree that these five elements are essential to any post-discharge care plan. Additionally, what BAYADA has learned in nearly four decades of home health care experience is that industry-wide change is needed to achieve optimal results in transitional care.

First, discharge plans must be replaced with 90-day transition plans. Handoffs from one provider to the next in the chain of care are often insufficient, and more importantly, they can be confusing to the patient and family. Providers must come together to develop an effective transition plan, initiated at the hospital bedside, that coordinates services from all players in the process. The plan must include:

  • Clear assignment and communication of each provider participating in the plan (i.e. hospital, SNF, skilled HHA, non-skilled HHA, and others as needed), and confirmation that the client/family were given a choice of providers consistent with all regulatory requirements
  • Clear and correct contact information for each participant in the plan, including the above providers, plus physicians, pharmacy, insurance company, and other community resources

Next, preferred providers should be established based on service level commitments and performance. Personal relationships are no longer enough; our shared clients and families expect high-quality services, and our outcomes are increasingly driving reimbursement. The following steps help ensure high-quality service:

  • Preferred providers meet quarterly to review data, process, and goals
  • Monthly reporting of clients re-hospitalized within 30 days
  • HHA services initiated within 24 hours for at least 90% of clients
  • HHA ensuring PCP appointment within 14 days after arriving at home

The future of health care requires that we reframe the transitional care experience. Successful collaboration between providers participating in the journey of transitional care is critical to producing great outcomes, reducing costs, and supporting clients and families throughout a very challenging time in their lives. At this important moment in time, we should work together to transform the transitional care experience by developing more integrated preferred relationships focused not on simple discharge handoffs, but on comprehensive transition plans that guide shared clients through the continuum.

 

About the Author: David Baiada is division director for BAYADA’s Home Health Specialty Practice. You can reach him at 856.380.1801 or dbaiada@bayada.com. Learn more about BAYADA Home Health Care at www.bayada.com.











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