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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


A Venue of Hope

By Melissa Jeremiah


Pictured are the psychiatric registered nurses from Hoosier Uplands Home Health Care: Lee Sanders, Michelle Shipman and Debbie Guthrie.

Alzheimer’s, depression and other psychiatric conditions affect persons from every gamut of life. They affect the person with the diagnosis, and all of their loved ones and friends. For the many people like these, home health psychiatric evaluation and training services are often an untapped resource. They are provided by home health psychiatric RNs and can be a venue of hope for both patients and their family members.

Educating patients on how to manage their symptoms allows them to remain in their homes longer instead of in institutions and not be frequent flyers to the ER. The key to success is in the hands of home health. Agencies can provide the needed education via therapy and psychiatric evaluation.

It is difficult to ascertain the exact number of home health agencies that provide these services. However it is an underserved — and needed — area of the field. The Centers for Disease Control and Prevention estimates that “twenty percent of people age fifty-five years or older experience some type of mental health concern.” They can get help from home health nurses with the right background and skills.

According to CMS Publication 100-2, Chapter 7, §, “Psychiatrically trained nurses are nurses who have special training and/or experience beyond the standard curriculum required for a registered nurse.”

In order for your nurses to participate in the Medicare psychiatric care program you must send a letter to your intermediary requesting approval for your agency to perform, psychiatric evaluation and therapy in the home. For Palmetto GBA you must also include the name of the RN who you wish to perform this service, along with a resume highlighting their experience as a psychiatric registered nurse. In addition, find out the requirements your intermediary may have. Put their letter of approval, along with all the other relevant data in your nurse’s personnel file. Also be aware of an added proviso when you send your nurse out.

CMS Publication 100-2, Chapter 7, §, states, “The law precludes agencies that primarily provide care and treatment of mental diseases from participating as home health agencies; psychiatric nursing must be furnished by an agency that does not primarily provide care and treatment of mental illness.”

This means that your home health agency is the perfect partner for other mental health agencies in your area. You can be the eyes and ears in the homes of patients who are at high risk of returning to an emergency room or in-patient unit.

Palmetto GBA has a local coverage determination for home health –psychiatric care (L31531), which is very helpful when you are setting up your home health agency’s policies and procedures. You should also refer to your intermediary for their specific coverage criteria.

As per CMS Publication 100-2, Chapter 7, § the following is an example of when home health psychiatric services are not appropriate:

Example 1:

A patient is homebound after discharge following hip replacement surgery and is receiving skilled therapy services for range-of-motion exercise and gait training. In the past, the patient had been diagnosed with clinical depression and was successfully stabilized on medication. There has been no change in her symptoms. The fact that the patient is taking an antidepressant does not indicate a need for psychiatric RN services.

On the other hand, CMS Publication 100-2, Chapter 7, § gives the following examples of when home health psychiatric services are appropriate:

Example 1:

A patient is homebound for medical conditions, but has a psychiatric condition for which he has been receiving medications. The patient’s psychiatric condition has not required a medication change or hospitalization in over two years. During a visit by the nurse, the patient’s spouse indicates the patient was awake and pacing most of the night and has begun ruminating about perceived failures in life. The nurse observes that the patient does not exhibit an appropriate level of hygiene and is dressed inappropriately for the season. The nurse comments to the patient about her observations and tries to solicit information about the patient’s general medical condition and mental status. The nurse advises the physician about the patient’s general medical condition, new symptoms, and behavioral changes. The physician orders the nurse to check the patient’s blood levels and the meds used to treat their mental conditions. Then the physician orders the psychiatric RN service to evaluate the patient’s mental health and communicate about the need for additional intervention to deal with the patient’s symptoms and conditions.

Example 2:

A patient was discharged after 14 days in a psychiatric hospital with a new diagnosis of major depression. The patient remains withdrawn: in bed most of the day, and refusing to leave home. The patient has a depressed affect and continues to have thoughts of suicide, but is not considered to be suicidal. A psychiatric RN is necessary for supportive interventions until antidepressant blood levels are reached and the suicidal thoughts are diminished further. The nurse also has the responsibility to monitor suicide ideation, ensure medication compliance and patient safety, perform suicidal assessment and teach crisis management and symptom management to family members.

In addition, psychiatric RNs can assist patients with areas such as: observation/assessment, teaching/training activities, medication management, lab draws, behavioral/cognitive interventions, and improving function. While the RN performs these functions, a home health aide may be required to perform personal care and occupational therapy visits may be indicated to help patients regain the ability to perform activities of daily living.

Psychiatric RNs will need to use tools that physicians are familiar with, so they are all speaking the same language. These tools will also help the RNs to show whether progress is being made or not. These tools include: PHQ – 9 for measuring depression, GAD – 7 for measuring anxiety, and the Patient Health Questionnaire/PHQ. You can obtain these screening tools free of charge from Pfizer at

MDWise Hoosier Alliance has a Behavioral Health Toolkit for Primary Care Physicians that has lots of useful information. This can be found at

Psychiatric evaluation and therapy can be provided under Medicare — and Medicaid, if it involves a hands-on skill — and many commercial insurance contracts.

Under Medicare, psychiatric RN care is not separately billable from non-psychiatric nursing care. Therefore, if a patient is being seen for a fractured hip and for severe depression, the payment rate is the same, as dictated by your OASIS.

Keep in mind that under Medicare patients must be confined to the home. And this is not an issue if patients have major depression.

CMS Publication 100-2, Chapter 7, §30.1.1 provides further clarification when it notes that a patient is considered homebound under the following circumstances: “a patient who is … senile and requires the assistance of another person in leaving their place or residence” or “a patient with a psychiatric illness that is manifested in part by a refusal to leave the home, or is of such a nature that it would not be considered safe for him/her to leave home unattended even if they have no physical limitations.”

Services must be reasonable and necessary for treating the patient’s psychiatric diagnosis and/or symptoms. The patient must have an Axis I Diagnosis as defined in the DSM-IV-TR. This diagnosis must match the diagnosis the attending physician is treating and/or for which the patient was hospitalized.

As you can see home health care agencies can provide a great deal of hope for those suffering from psychiatric illnesses, and their families. Home health agencies need to step up and begin providing this needed service for patients and their families who are so in need of someone to show them there is help available.


Melissa Jeremiah, RN, CHCE is the Director of Operations at Hoosier Uplands Home Health Care and Hospice in Mitchell, Indiana. Melissa serves on the Indiana Association for Home & Hospice Care Board of Directors, and is currently the Co-Chair of the Home Care Committee. Melissa has also served on the NAHC VHCAA Advisory Board since 2008. 

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