Skip to Main Content
National Association for Home Care & Hospice
Twitter Facebook Pintrest


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



How to Have Compassionate End-of-Life Conversations with Your Patients

By Carleen Rogers


End-of-life conversations aren’t easy. Fear of blame or harming patients emotionally can build stigma around these conversations, but there’s reason for that to change. Seventy percent of people in America say they’d prefer to die at home and only 25 percent get their wish.

In our society, accepting death is often seen as accepting failure. As clinicians, our priority is offering hope and solutions for patients. Yet providing false hope or over treatment can get in the way of planning compassionate end-of-life care. 

This is not only a heavy burden for both patients and their families; it’s costing the health care industry billions of dollars. In 2011, Medicare spent $170 billion on patients’ last six months of life. Much of the spending shortened patients’ lives rather than extending them since patients’ family members can put pressure on physicians to take heroic measures to keep patients alive, even when the possibility of prolonging life is small.   

But here’s the good news. Post-acute caregivers are uniquely positioned to facilitate effective and compassionate end-of-life conversations since they are often caring for patients towards the end of life. This is the time when patients need to learn about their end-of-life care options. They and their families have the right to conversations that help them weigh the benefit against the burden of treatments and make a decision based on quality as well as quantity of days.

Further, post-acute caregivers know their patients. While acute caregivers also interact with patients who may benefit from hospice care, they typically deliver care for a shorter period of time. Meanwhile post-acute providers spend months or even years with their patients and this longer time frame allows deeper relationships to form.  When caregivers are more familiar with a patient, they are often more in tune with the patient’s thresholds and therefore can more easily detect any declines. So in the event of a serious decline, how exactly should post-acute caregivers go about an end-of-life conversation?

First, clinicians know that discharge planning begins at the time of admission.  Admission to services is the time to begin conversations about a patient’s and family’s expectations and end-of-life wishes. This discussion should always happen sooner rather than later, so watch out for certain prompts. When a patient is admitted to services, take an honest look at the trajectory of the patient’s condition. Is the patient showing a consistent decline instead of improvement? Is the patient verbalizing fatigue with the treatment process of frequent hospitalization? These are triggers to knowing when the patient may be ready to have a real conversation about their end-of-life choices.

Next, set up a time and place where all those who need to be involved can be present. Ensure privacy and strive for a quiet, calm environment. Include a hospice nurse, medical social worker, and counselor or spiritual advisor who can provide additional information or perspectives.

Most importantly, the patient should decide which people they want involved in the conversation. Remember that the initial discussion should be just that — an opening to a larger, more in-depth conversation. The first conversation isn’t usually a decision-making one.

Additionally, hospice care should always be discussed as an option or a choice — because it is and patients need to know that. By addressing the options in an unbiased manner, you, as a clinician, are enabling patient choices which improve outcomes and quality of care.

As caregivers, most of us realize the important of facilitating appropriate end-of-life care conversations. Still, it’s easier said than done. Initiating the conversation is typically the most difficult part. So I always recommend beginning with a personal pronoun and compassionate statement such as “I’m concerned for you. Although we’ve been working on your breathing, you don’t seem to be improving.”

Oftentimes, a patient has already realized that they are stagnating or degrading. Beginning the conversation this way allows you to start with the facts and avoid being too harsh.

Then, introduce the concept of having hospice by saying something like “I want to discuss some details about your progress and health. Who would you like to include in the discussion?”

Once you embark on the conversation about the patient’s end-of-life preferences, here are five questions Dr. Atul Gawande suggests to help guide the end-of-life conversation:

  • What is your understanding of where you are and of your illness?
  • What are your fears or worries for the future?
  • What are your goals and priorities for the end of your life?
  • What outcomes are unacceptable to you? What are you willing and not willing to sacrifice?
  • What would a good day look like?

End-of-life conversations will never be easy, but if you arrive well prepared with compassionate, yet relevant, questions for your patient, the outcome will be the best possible one for them and the ones they love.



About the Author: Carleen Rogers, RN, BS, CHPN, serves as in-house hospice consultant at Medalogix. Carleen brings nearly 20 years of health care experience to her role, with experience in hospice clinical and operational leadership, health care informatics management and consulting. 







©  National Association for Home Care & Hospice. All Rights Reserved.