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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


Peanut Butter, Plaques, and Prevention:
Recent Findings on Alzheimer’s Disease

By Lisa Yarkony

CARINGDecemberYarkonyLgCould peanut butter help you sniff out Alzheimer’s disease? Yes, according to a team of researchers at the University of Florida in Gainesville. Led by Jennifer Stamps, a graduate student at the school, the team conducted a pilot study and tested subjects’ smell sensitivity in each nostril while they had their eyes, mouth, and opposite nostril closed. Using a ruler, Stamp measured the distance at which patients were able to smell peanut butter on an exhale. Ninety seconds later, she tested the other nostril. After administering the test about 100 times, the team noticed that patients in the early stages of Alzheimer’s weren’t able to smell as well from their left nostril. It makes sense because Alzheimer’s usually affects the left part of the brain first, meaning the test shows promise to be a valuable tool. “At the moment,” Stamp said, “we can use this test to confirm diagnosis. But we plan to study patients with mild cognitive impairment to predict which patients are going to get Alzheimer’s disease.”1

There should be lots of them because Alzheimer’s is on the rise. Deaths and the risk of dying from Alzheimer’s have soared in the U.S. over the past decade, according to two recent reports. Data from the Centers for Disease Control and Prevention (CDC) showed that the risk of death from the degenerative brain disease rose 39 percent from 2000 to 2010 while mortality rates for other conditions like cancer, heart disease, and stroke showed significant declines. Drawing on CDC data, the Alzheimer’s Association looked at actual deaths and found that mortality was up 60 percent over the same decade.2 We don’t know for sure how many people will develop Alzheimer’s, but the Alzheimer’s Association predicts that the number of people aged 65 and older with Alzheimer’s may reach 7.1 million by 2015, a 40 percent increase from the 5.2 million who have it today.3

“It’s going to swamp the system,” said Dr. Ronald C. Peterson, chairman of the Alzheimer’s Disease Research Center at the Mayo Clinic.4 Medicare and Medicaid are already overwhelmed and may change in ways that will affect costs. If these programs reduce coverage for long-term care of Alzheimer’s victims, expenditures on these services will fall. Even more of the burden would fall on family caregivers, who provided 17.4 billion hours of care in 2011, the Alzheimer’s Association points out. The impact on caregivers’ earnings, quality of life, and health is already tremendous. Yet estimates tend to overlook such informal costs, suggesting that the current estimate of $200 billion downplays the true economic toll of the disease.5 And an added problem is that there may be fewer family caregivers in coming years, according to Dr. Richard J. Hodes, director of the National Institute on Aging. “As we have the baby boomer generation group maturing, there are going to be more older people with fewer informal caregivers for them, which is going to intensify the problem even more.”6

The economic and emotional costs of Alzheimer’s will only grow, so it’s urgent for science to find ways to change the course of the disease. We do know the brains of those with Alzheimer’s have high concentrations of abnormal protein deposits, beta amyloid plaques and tau tangles. We also have drugs that ease the symptoms of Alzheimer’s but don’t cure the disease or halt its progress. Many treatment studies have used medications and vaccines to rid the brain of amyloid plaques but haven’t succeeded thus far. Studies to flush out tau tangles are also underway but haven’t yet led to any breakthroughs.7 At present, detection advances outpace treatment options, so our best hope lies in early diagnosis and prevention.8 “We’re trying to go earlier and earlier in the course of the disease,” said Neil Buckholtz, chief of the Dementias of Aging Branch at the National Institute on Aging. “The idea is to locate how people move through these stages and what indications there are of each stage.”9

We now understand that Alzheimer’s precursors are evident in the brain at an early age. Last year, research on an extended family of 5,000 people in Colombia with a genetically driven form of Alzheimer’s found that signs of the disease began even earlier than previously thought. According to a study, the brains of people destined to develop Alzheimer’s show clear changes at least 20 years before they have any cognitive impairment. In the Colombian family, these changes occurred in people as young as 18, leading to symptoms of mild cognitive impairment at 45, and of dementia at 53. These brain changes occur earlier than the first signs of amyloid plaques. They include higher-than-normal levels of amyloid fluid in the spinal fluid, signs that the memory-encoding parts of the brain are already working harder than in normal brains, and indications that brain areas known to be affected by Alzheimer’s may be smaller than in those who don’t have the Alzheimer’s gene.10

Many people with a family history of Alzheimer’s also carry the ApoE4 protein, a genetic factor associated with a 10-fold higher chance of developing the disease. Typically high-risk patients have shied away from genetic testing, but that may change because new findings point to a potential pathway for early intervention. Researchers at the Buck Institute for Research on Aging analyzed ApoE4 cell cultures and found that ApoE4 was also associated with a dramatic reduction in SirT1, a protein that promotes anti-inflammation, anti-aging, and longevity. As SirT1 decreases, it affects a protein crucial to the storage of memories — the amyloid precursor protein (APP). By reinserting SirT1 proteins back into cells already affected by ApoE4, the researchers restored the cells to a healthy state, suggesting that treatment might be possible even for those already in the early stages of the disease. “Most people today don’t want to know if they have ApoE4 because what can they do about it?” said lead researcher Dale Bredesen. “This could change the landscape where we say everyone should know, just like high cholesterol or high blood pressure, because you can do something about it.”11

Researchers made a similar claim after finding that Alzheimer’s is tied to a mutation harming the immune response. The mutation of the gene TREM2, researchers say, may interfere with the brain’s ability to prevent the buildup of plaque. When the gene is not mutated, white blood cells in the brain spring into action, gobbling up and eliminating the proteins that form toxic plaque. As a result, Alzheimer’s can be staved off or prevented. But when the gene is mutated, the brain’s white blood cells are weakened. People with the mutated gene have a threefold to fivefold greater likelihood of developing Alzheimer’s disease in old age, as researchers found after searching the genomes of 2,261 people in Iceland. “It points very specifically to a potential metabolic pathway that you could intervene in to change the course of Alzheimer’s disease,” said William Thies, chief medical and scientific officer of the Alzheimer’s Association. If a drug could be developed to enhance the gene’s activity, it might allow the brain’s white blood cells to do their work before Alzheimer’s sets in.12 And before is the key word in recent work on Alzheimer’s, including the Alzheimer’s Prevention Registry for those with a family history of the disease.

The Banner Institute, based in Phoenix, coordinates the registry and has enlisted 20,000 healthy people who are willing to be studied in long-term trials aimed at Alzheimer’s prevention. The institute ultimately hopes to create a list of 250,000 people who are available for study by researchers nationwide. One of the first studies will be for a Banner-led trial funded in part by $33 million from the National Institutes of Health and designed to track the progress of 650 people who carry two copies of the ApoE4 gene. “Only 2 to 3 percent of the population is in that category, and such individuals have about a 20 times higher risk than the rest of the population of developing Alzheimer’s,” said Eric Reiman, Banner’s executive director. The idea is to follow those 650 people after age 65 while administering a drug that shows promise to eliminate amyloid plaques, Reiman explained. “A procrastination treatment that delays onset of the disease by five years could cut the number of people diagnosed with Alzheimer’s in half.”13

There’s more chance of success if you catch Alzheimer’s before symptoms start, so doctors are working on new methods of detection. Researchers at Johns Hopkins University compared ratios of proteins found in the cerebrospinal fluid (CSF) of Alzheimer’s patients with those of healthy people to see if the fluid could signal the onset of the disease. Preliminary results show that differences in CSF protein ratios suggested future impairment as early as five years before symptoms appeared. “It has been hard to see Alzheimer’s disease coming, even though we believe it begins developing in the brain a decade or more before the onset of symptoms,” said Marilyn Albert, Johns Hopkins professor of neurology.14

It follows that the best cure may be early detection, as it is for other serious conditions. Medications for Alzheimer’s typically fail, researchers believe, because symptoms have progressed to the point where it’s hard to repair the damage. “When we see patients with high blood pressure and high cholesterol,” Albert explained, “we don’t say we will wait to treat you until you get congestive heart failure. Early treatments keep heart disease patients from getting worse, and it’s possible the same may be true for those with pre-symptomatic Alzheimer’s.”15

There are some apparent signs that you may already be at risk, as recent findings point out. Do you need a reason to floss? Alzheimer’s is linked to gum disease and poor oral hygiene, though it’s not clear there is a causal association.16 The disease is also linked to higher blood sugar, another connection that scientists can’t explain.17 The connection between poor sleep and Alzheimer’s is clearer, according to recent studies showing that brains flush toxic waste while we are asleep. “Sleep puts the brain in another state where we clean out all the byproducts of activity during the daytime,” said University of Rochester neurosurgeon Maiken Nedergaard. Those byproducts include the amyloid proteins that are a hallmark of Alzheimer’s, offering new hope for those at risk of the disease.18 “These findings are important in part because sleep disturbances can be treated in older people,” said Adam Spira, professor at The Johns Hopkins Bloomberg School of Public Health. “To the degree that poor sleep promotes the development of Alzheimer’s disease, treatments for poor sleep or efforts to maintain healthy sleep patterns may help prevent or slow the progression of Alzheimer’s disease.”19

It may also help to keep an eye on your mental health and level of stress. Depressed adults over 50 are 65 percent more likely to develop Alzheimer’s than their cohorts who aren’t depressed, researchers say. The reason may be that people who are depressed produce high levels of the hormone cortisol, which has an adverse effect on the hippocampus, a part of the brain responsible for short-term memory and new learning.20 And higher levels of cortisol may also raise the risk of Alzheimer’s for middle-aged women. Researchers in Sweden say that women who reported stress in midlife from ordeals like divorce or a family member’s illness were more likely to have Alzheimer’s in old age. This may be because chronic stress also boosts cortisol, contributing to the risk of heart disease, depression, and memory problems, among other ills.21

So seek early aggressive treatment for mental issues because it may give you a fighting chance against the disease. Other possible defenses may include giving yourself a brain boost through regular exercise, a proven way to enhance memory creation.22 Or use caffeine to keep your mental faculties abuzz. In a 2012 study, Florida researchers tested the blood levels of caffeine in older adults with mild cognitive impairment and then re-evaluated the seniors a few years later. Participants with little or no caffeine flowing in their bloodstreams were far more likely to have progressed to full-blown Alzheimer’s than those whose blood indicated they’d had about three cups worth of their daily Joe.23 Similarly another common drink, red wine contains natural compounds that keep the mind young by sweeping out the pesky plaques linked to Alzheimer’s disease.24 It can also help you feel less stress, another signal of the condition. So relax, enjoy in moderation — and don’t try the peanut butter test for Alzheimer’s at home. Having slight differences between your nostrils is completely normal, so you might wind up getting stressed out over nothing at all.25


  1. Maanvi Singh, “Why a peanut butter test for Alzheimer’s might be too simple,” 11 October, 2013, NPR,
  2. Reuters, “Risk of Alzheimer’s has increased, reports say,” New York Times, 10, March 2013,
  3. Julie Zissimopolis, “Alzheimer’s is on the rise: what are the long-term costs?” Aging Today 34 (3): 9.
  4. Pam Belluck, “Dementia care cost is projected to double by 2040,” New York Times, 3 April 2013,
  5. Julie Zissimopolis, “Alzheimer’s is on the rise: what are the long-term costs?” Aging Today 34 (3): 9.
  6. Pam Belluck, “Dementia care cost is projected to double by 2040,” New York Times, 3 April 2013,
  7. Gary Small, “Alzheimer’s, the age boom, and the search for a cure,” Aging Today 34 (3): 1.
  8. Gina Kolata, “For Alzheimer’s, detection advances outpace treatment options,” New York Times, 15 November 2012,
  9. Pam Belluck, “For edge on Alzheimer’s, testing early treatments,” New York Times, 10 March 2010,
  10. Pam Belluck, “Alzheimer’s precursors evident in brain at early age,” New York Times, 12 November 2012,
  11. Amanda Woerner, “New Alzheimer’s discovery could hold key to preventative treatments for high-risk patients,” Fox News, 22 October, 2013,
  12. Gina Kolata, “Alzheimer’s tied to mutation harming immune response,” New York Times, 14 November 2012,
  13. Gary Rotstein, “Alzheimer’s research focusing on the before,” Pittsburgh Post-Gazette, 21 October 2013,
  14. “Detection is the best cure for Alzheimer’s,” Huffington Post, 17 October 2013,
  15. Ibid.
  16. Kate Santich, “Need a reason to floss? Alzheimer’s linked to gum disease,” Orlando Sentinel, 21, October 2013,,0,
  17. Paula Span, “High blood sugar linked to dementia,” New York Times, 9 August 2013,
  18. Meeri Kim, “Brains flush toxic waste in sleep, including Alzheimer’s-linked protein, study of mice finds,” Washington Post, 19 October 2013,
  19. Nicole Ostrow, “Poor sleep linked to Alzheimer’s,” Bloomberg News, 22 October 2013,
  20. Judith Graham, “Does depression contribute to dementia?” New York Times, 1 May 2013,
  21. Nancy Shute, “For middle-aged women, stress may raise Alzheimer’s risk,” NPR, 1 October 2013,
  22. Gretchen Reynolds, “Getting a brain boost through exercise,” New York Times, 10 April 2013,
  23. Gretchen Reynolds, “This is your brain on coffee,” New York Times, 6 June 2013,
  24. Karina Toffee, “Buck scientists find link between red wine and lower risk of Alzheimer’s,” Santa Cruz Patch, 22 October 2013,
  25. Maanvi Singh, “Why a peanut butter test for Alzheimer’s might be too simple,” 11 October, 2013, NPR,

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