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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


Building Rapport with your Patient: Positive Case Management Outcomes

By Peggy S. Barkley


It can take just a few moments to build rapport. This small investment of time can also lead to large dividends in patient compliance and positive case management outcomes.

Trust and compliance improve when you connect with your patient.

Patients who do not feel a connection with their nurses are unlikely to trust them and follow their instructions. The time nurses spend with patients and their family members is important for forming relationships based on trust and respect. A patient must feel that the nurse understands their condition and has their best interests at heart. Just spending two or three minutes totally focused on your patient can reap benefits and build rapport. So never make a patient feel as if you are rushing when you are with them. Take the time to let the patient know you care for them. Interact with them. And remember, you begin building rapport the minute you meet a patient.

Approach your patient as both a medical expert and as someone who understands their life. Seek collaboration. Think of yourself as a coach, not a dictator. The idea that “I know what is best” is dead. Encourage patients to be change agents in their own treatment because patients are best served through a collaborative team approach in which patients are members of the team. Patients who are encouraged to talk will often reveal clues about their health. Nurses who listen carefully can enlist patients in making the best treatment plans and getting patients to follow their instructions.

A positive partnership with your patient has a great impact on their outcomes.  So take some steps to create rapport. First, the nurse needs to know more about their patient than just that patient’s disease process. Find other patient information to relate to. For example, ask the patient about hobbies, children, or other interests to put them at ease and lessen the anxiety of the visit. When discussing treatment options or care plans, listen carefully, make eye contact, and respond to the patient’s comments.

To build rapport you don’t have to like the other person’s model of the world, or agree with it, but you have to at least understand it.

Make a genuine effort to know what is important to the patient. Ask the patient for their perspective on a problem. Be careful to listen actively because too often we are so busy thinking about what we are going to say that we don’t concentrate on what our patients are saying.  Chat with the patient, look for some common interests, and use the information the patient is giving to get to know them. Start by understanding them instead of expecting them to understand you first. Remember that trying to plan care for the future without any sense of a patient’s past is like trying to plant cut flowers.

Try to see things from a patient’s perspective, and empathize with their emotions. Patients who feel they have been heard and understood are more likely to have positive case management outcomes. As nurses, we need to be sensitive to patients’ needs and feelings, so make one empathic statement during each visit with a patient. For example, you might say, “This has to be painful.” Also be sure to have emotional, difficult, or personal conversations in private, and always follow the basics of good communication.

In my years of nursing, I have found it is important to make eye contact with patients and use positive body language. You communicate through your body language, tone of voice, and words, which means that patients don’t simply judge you by what you say. When you do speak, remember to use simple, everyday words instead of medical jargon. A patient’s language level and reading skills may not match their intelligence, so provide language assistance services, such as bilingual staff and interpreters, at all points of contact for patients.  It is important to become familiar with the cultures in your community. Keeping an open mind with patients will make them feel more comfortable telling you about other treatments they are trying or any problems they have complying with the treatment plan. Most importantly, it is vital for the entire health care team to remember that the patient is a whole person. Our health has spiritual, psychological, and physical components.

Building patient rapport is critical for creating positive case management outcomes.

As noted above, active listening and positive body language make up a large part of communication. Studies have shown that 6 percent of communication is through words, 38 percent is through tone of voice, and 55 percent is through body language. When patients have the opportunity to talk, you will often learn much more about their health. Patients and their families must be included in the team because effective collaboration results in the best care options and case management outcomes. By asking, looking, listening and learning, nurses can help patients feel they have their best interests at heart.

Following up on patients also builds credibility and sends the message “we care.” So follow through with what you said you were going to do. For example, if you tell a patient you are going to mail them a list of private pay caregivers, do it! The patient will know you care and they will trust you. Another way to show you care is to make a follow-up phone call after visiting the patient. It, too, will make the working relationship stronger and lead to positive case management outcomes.

Open communication is the cornerstone of rapport between nurse and patient. The patient wants to know what is going on and will appreciate it when the nurse keeps them informed. More simply put, keep your patient “in the loop.” For example, explain the “why” of change or delay. Patients like to have a “say” in their care and value the opportunity to actively participate. Give the patient information, explain your role, describe the treatment plan, and what will happen next. Contact the patient often and give them a sense of control by involving them in scheduling appointments.

Keep in mind that some patients have cultural beliefs that can affect compliance with treatment plans, and do become familiar with cultures in your community. The number of immigrants from the Middle East has grown steadily in the U.S. over the past decade. Statistics show approximately 500,000 persons from the Middle East obtained permanent resident status in the United States from 2001 to 2010. Nurses need to be sensitive to the beliefs and practices of this large group, and they should look to online resources for advice and help.


Rapport is critical for building patient loyalty and deserves attention at all levels of customer service. Besides excellent case management outcomes, patients have the same basic needs: they want to be heard, they want to be cared about, they want to collaborate, and they want respect. It is vital to remember that the patient is a whole person and not just the sum of their conditions. Keep the patient’s specific needs in mind. Be sensitive to cultural diversity, and remember you don’t just build rapport on the first visit. You need to reestablish it on an ongoing basis.



“Essentials for Building Rapport,” Resident Assistance Program Newsletter 6.3 (September 2009).

Jennifer Ward, “Creating a Partnership: Building Rapport with Your Patients,” NurseTogether, 2 April 2012.

Judith S. Young, “Resources for Middle Eastern Patients,” Home Healthcare Nurse 13.1 (January 2013): 18-26.

“Making the most of Clinicals Part 3: Building a good rapport with patients.” Nursefrances Guide 2 September 2012.

Tami Borneman, “Assessment of Cancer-Related Fatigue,” Journal of Hospice & Palliative Nursing 15.2(April 2013): 77-84.

TeeJay Dowe.”How to Build Rapport with Anyone Instantly!” Pharmaceutical Press 2012. 4 July 2013.


About the Author: Peggy S. Barkley, BSN, RN-BC, COS-C, is a member of HPNA and ANA, and serves on the Home Health and Hospice Advisory Committee for CHC Home Health and Hospice. She is board certified in nursing case management, OASIS specialist-Clinical certified, and designated as preceptor for nursing field staff at CHC. She can be reached at

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