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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


The 2014 March on Washington & Exposition:
Protecting the Home Care of Today and Tomorrow

By Lisa Yarkony, PhD

Val J. Halamandaris, NAHC President

Health care spending growth hit a 10-year high this spring. Hospitals made more and consumers may have to pay more, but there is a solution to runaway health care costs. Members of the National Association for Home Care & Hospice (NAHC) marched for the answer when they urged Congress to protect and expand access to home care and hospice. They had come from all corners of the country to attend the March on Washington Conference & Exposition. They shuttled between Capitol Hill and the historic Mayflower Hotel where they heard from industry experts and NAHC staff. “Your being here helps makes history,” said NAHC President Val J. Halamandaris as he greeted the crowd.

They had come to advocate for their industry over four eventful days, one of them spent visiting members of Congress. As they talked to their senators and reps, they were guided by NAHC’s legislative priorities for 2014: secure the strategic role of home care and hospice in addressing the nation’s acute, chronic, and long-term care needs; ensure fair reimbursement for Medicare home health services and adequate access to it; protect the Medicare hospice benefit; expand access to home care whether it’s provided under Medicaid or paid for by commercial insurers, public payers, and individual persons.

Sunday General Session
Opening Keynote & Washington Update

Success in reaching these goals hinges on regulatory and legal developments in Washington DC, Halamandaris explained as he led a panel of NAHC’s legal and legislative staff. Joining him were Bill Dombi, vice president for law; Jeff Kincheloe, vice president for government affairs; Theresa Forster, vice president for hospice policy and programs; Mary Carr, vice president for regulatory affairs; and Rich Brennan, Jr., vice president for technology policy, along with NAHC counsels Mary Langowski and Colin Roskey. They all have experience dealing with federal agencies, members of Congress, and other policy makers. So they spoke from the front lines when they gave their take on providers’ top concerns and how they can put their points across on visits to members of Congress.

Federal Budget

Roskey: The Obama administration rolled out a two-year budget amidst a fair amount of cooperation. But this cooperation is temporary with a capitol T. I don’t see that bipartisan cooperation continuing. The budget agreement was met with bipartisan carrots. The rest of the year will be met with a bipartisan stick.

Kincheloe: The big item on the agenda this week is what to do with the SGR fix. They keep patching it and Senator Ron Wyden (D-OR) would like to get it permanently fixed. But the most likely result will be another patch. Another source of concern is a proposed copay for home care that begins in the community. I don’t think we’ll see one this year, but we can never rest as regards a home care copay.

Rebasing Medicare Home Health

Dombi: The climate favors a change in rebasing. Both the Democrats and Republicans agree with us that rebasing went too far. We’ve suggested delaying rebasing for one year so we can convince the Centers for Medicare & Medicaid Services (CMS) to come up with a different approach. We hope to get CMS to use better data and take account of all relevant costs when they calculate margins. In the first three months of rebasing, we’ve already seen some loss in the workforce, and that trend will only increase. CMS estimates that 43 percent of agencies will be under water by 2017. We, however, forecast that 56 percent of agencies will be under water. Congress sees the problem and that’s what’s driving them to address it.

Langowski: We have to remember that rebasing came out adjacent to the government shutdown. You have a credible case to make to CMS and you have a year to do it. We need to continue watching CMS on the regulatory side, and we need to keep something else in mind. When you go to the Hill, remember these staffers have been inundated by rules from CMS. We have to make sure our narrative breaks through.


Roskey: The operative term you’ll hear is down payment. There’s no consensus on how to pay for a bill that is so expensive.

Dombi: I think Congress will do another patch on the SGR. There is no agreement between Democrats and Republicans on how to pay the $150 billion cost. We have offered an amendment to the patch bill. It provides a fully offset period for evaluation of the home health rebasing adjustment. The cost of the one-year postponement would be covered by modifying the outlier budget payment from 2.5 percent to 2.0 percent for the period needed to cover the cost of the postponement, plus $100 million.


Brennan: Congress and the administration are in alignment on the need to rebalance the health care system away from institutional care. If you are trying to reduce rehospitalizations you need technology, so here’s the message you need to bring to Capital Hill: even if our agencies aren’t incentivized to use technology, we’re adapting to it at a tremendous rate. Smaller agencies that aren’t doing so will eventually drop away.

Langowski: The regulatory policy environment on telehealth is lagging behind. A lot of people are waking up to the fact that home is where patients want to be, and technology helps them fulfill their wish. Unfortunately, the regulatory environment is not enabling us to move ahead.


Forster: Hospice is undergoing tremendous change and expectations are high. Hospice payment reform has generated a desire for data that shows what government is paying for. Hospice is not the same old sleepy benefit it was before. We’re getting to a point where the accountability is increasing by leaps and bounds. The challenge ahead is how to maintain the character of hospice while operating in a more sophisticated field.

We also have concerns about the proposal to turn hospice over to Medicare Advantage. The Medicare Payment Advisory Commission (MedPAC) has logical reasons for bringing hospice under Medicare Advantage. But as representatives of hospice, we worry that patients will not have a choice of providers under Medicare Advantage. MedPAC included the proposal in a report to Congress, and now Congress has to consider it. Opposing the change is one of our top priorities and it’s something to bring up when you go on the Hill.

Face-to-Face Encounter

Carr: This is a very active regulatory environment, so we are working to assist agencies in making transitions to new regulations. There are indications that CMS has taken a broad brush stroke approach to fraud and abuse. But this approach doesn’t do anything to curb fraud and abuse. We’d like to see CMS do something more targeted.

Dombi: The face-to-face rule was built out of a 10-year effort by the Office of the Inspector General. They felt it was important for patients to see a doctor before they got care. But it’s a bad rule based on documenting by doctors who don’t have the time to do it. And now CMS is going after the legibility of the physician’s signature. We’re dealing with the problem that fully 85 percent of claims served by the biggest contractors are being denied. People don’t know what’s being captured, so we’re going to file a lawsuit against CMS on the face-to-face rule. We’re filing this lawsuit as a response to CMS and also as a plea for help so we can comply.

Employer Mandate

Roskey: One of the biggest problems we face in terms of the Affordable Care Act (ACA) is the parts that impose new burdens on employers. Any part of the law that causes employers to limit the number of employees’ hours is fundamentally flawed. We have a different industry than a widget maker. Our industry, which is personal and high touch, does not lend itself to the employer mandate.

2014 Congressional Election

Kincheloe: The House will stay Republican, but it will be a tight race in the Senate, especially since there are a lot of Democrats retiring. Most likely, Democrats will retain control of the Senate. Yet the Republicans will have a shot at it.

Roskey: One predictor is that a swing district in Florida was decided almost entirely on the basis of the claim that the ACA does not work. There’s a growing tide of anti-ACA rhetoric and a Republican trend toward blaming the ACA for everything that’s going wrong.


Dombi: We are seeing a revolution in Medicaid. It’s now a $60 billion a year program. In five years, it could be a $100 billion program. States are moving toward long-term services and supports. We’re looking forward to this as an opportunity to educate managed care.

Education was also a key word as the panel prepared NAHC members for their visits on the Hill. “Start by asking your lawmakers about their experience with home care and hospice,” Dombi said. “If they haven’t been on a home care visit, this is your opportunity to humanize your experience and say what it is like.” It’s important to personalize your experience when you talk to lawmakers, Langowski agreed. “Explain to them what rebasing is like and how it led to a flawed outcome. Tell them the home care narrative: how we’re managing costs and helping people stay in their homes where they want to be. Tell them we want to be constructive partners with you as home care continues to grow.”

Home Care & Hospice Exposition Hall: Grand Opening Reception

Some of home care’s partners manned booths at the exposition hall on Sunday night. This year, as always, the opening reception featured savory snacks and the latest in software for home care and hospice. Exhibitors included Allscripts, Cardiocom, Celltrak Technologies, Delta Health Technologies, Homecare Homebase, Sandata Technologies, Sansio-HomeSolutions. NET, Simione Healthcare Consultants, and Suncoast Solutions. A number of these exhibitors are also members of NAHC’s affiliate Home Care Technology Association of America (HCTAA), which leads the way toward more use of technology and telehealth in home health care. Besides the HCTAA exhibitors, there were other home health and hospice technology companies, providers of consulting services, marketing and data research firms, along with accrediting organizations that serve the home care and hospice industry. As attendees strolled through the room, they had a chance to get a hands-on look at the latest in services and products.

Exhibitors were happy to explain their products, give demonstrations, and discuss how they could help providers operate better. On display, you could find a full-service electronic health record that goes from point of care to billing, a market intelligence form to help agencies understand the market, competition, and referral sources, along with software that identifies inefficiencies and ways to automate paper processes. There was also a web-based portal that lets providers view all of a client’s clinical and demographic information from any PC, tablet or mobile device. There were coding services to help providers get ready for ICD-10 implementation. And there was general support for home care and hospice. The exhibitors in the room weren’t simply vendors. They were also advocates whose goal was to help agencies meet the challenge of keeping up in their business.

Monday General Session:
Mark Shields and Alex Castellanos on Caregiving and Political Campaigns

General Session speakers Alex Castellanos, CNN,  and Mark Shields, PBS NewsHour with Val J. Halamandaris, NAHC President.

It was a cold, wet, and dreary day for early spring. But Mark Shields and Alex Castellanos lit up the stage in a return appearance to the March on Washington Conference & Exposition. They were a highlight of the conference two years ago when they talked about the ongoing presidential race and revealed their own experiences with home care and hospice. Though they come from opposite sides of the political aisle, they share several traits: wit and wisdom, along with a wealth of insight into national politics and campaigns.

Shields is a nationally known commentator and columnist who has worked in Washington through the administration of nine presidents. He was an editorial writer for the Washington Post, where he began his column in 1979. Since 1988, he has provided weekly analysis and commentary on national campaigns for CBS NewHour, where he matched wits with the Wall Street Journal’s Paul Gigot and David Brooks of the New York Times. For 17 years, Shields was moderator and panelist on CNN’s Capital Gang. He is now a regular panelist on Inside Washington, which is seen weekly on ABC and CBS.

Similarly, Castellanos is also a familiar face to TV viewers as an integral part of CNN’s Best Political Team on Television. One of the Republican Party’s most-renowned political strategists, Castellanos has been credited with discovering the political “soccer mom” and called the “father of the attack ad.” He has written speeches, provided strategy, and created TV commercials for seven U.S. presidential candidates. He also helped elect over a dozen U.S. senators and governors, and he was among the first to bring winning strategies from the political world to corporate America. And he co-founded Purple Strategies, a public affairs communications firm that takes its name from the colors identified with Democrats (blue) and Republicans (red).

  • a beautiful warm spring. Hell has finally frozen over,” Castellanos joked grimly as he took the stage. “I’m a member of a beleaguered minority group. I’m a Republican. In a former life, I did political campaigns. It’s easier talking about them,” he said. And it was easy to listen as he summed up his experiences in a number of wise but whimsical laws:
  • Law of Politics. Run during the good years. 2014 will be a good for the Republicans. 2010 was a good year for the Democrats. Americans wanted health care reform though they were scared of it. Now in 2014 Washington is out of control. Think back to what’s been going on with the NSA, IRS, and sequester. The president’s party loses seats when the government is out of control.
  • Law of the Car Keys. If I’m going to give you my car keys, I want to know where we’re going and whether I can trust you to take me there. So in politics, it’s important who you are. We know who Hillary Clinton is, but we’re not sure who Jeb Bush is.
  • Elvis Law. Never run against a candidate who’s a star. Next election could be Jeb versus Hillary. The problem is this is not a contest that pits an Elvis against an Elvis.
  • Law of Completion. A few years ago, America elected its first black president — a good thing. We also made the decision not to elect a woman. When we do elect a woman, this will complete the cycle. It’s good news for Hillary, and that’s the card she has to play.
  • Oscar Wilde Law. If you tell people the truth, make them laugh. Otherwise they’ll kill you.
  • Law of the Desert. The Republican Party is the party of austerity. When they see a leader like Moses who says there’s a better place for them, they’ll go. That’s what politics is.
  • Coca Cola Law of Leadership. The most important thing you can do in politics is own an idea. For example, Hertz got there before Avis. And Hillary Clinton got there first as a female candidate. Hillary owns the idea of a chick president.
  • Law of the Lie. As Picasso said, art is the lie that tells the truth. Politics is about emotion. Good politics is something you feel.
  • Law of Jesus. If a church is empty, it’s a warehouse. Technology worked for Obama, not us, because he was the party of change.
  • Law of the Blind Man. A blind man was sitting on the sidewalk with a tin cup and a sign that said, ‘I am blind.’ Nobody dropped anything in the cup. An advertising guy walked by with a marker and wrote something on the sign. Then he went to the corner to watch and people started putting money in the man’s cup. Why? Because the advertising guy changed the message to say, ‘It is spring and I am blind.’”

The ad man used his talents to make something more powerful and poignant, Castellanos pointed out to NAHC members. “You have that power. I saw it when my dad was dying with hospice,” Castellanos recalled. He has never forgotten the caregivers who brought his dad some sunshine in the twilight of life. And now seeing a room full of caregivers warmed the son’s soul despite the bitter cold outside. “It is spring,” he said, “because you are here.”

Another sign of spring will soon be here despite the unseasonable temps outside. “The opening of the baseball season is upon us,” Mark Shields announced, “but it was so cold this morning on Capitol Hill that people gathered around Mitch McConnell to warm up.” And speaking of republicans, Shields was glad to see that Rick Perry may run for president again. “In the last presidential election, Perry said, ‘I like Mitt Romney as much as one good-looking guy can like another good-looking guy and not be in violation of state law.”

Chris Christie didn’t look as good, and that endeared him to Shields, whose rumpled appearance reflects a lifetime hitting the campaign trail instead of the gym. “I like anyone who’s in office who doesn’t have a 28-inch waist. But he’s not a serious candidate for president. The bridge ended that, especially when he started saying words like ‘these things were done.’ He was too passive when the bridge was down, and it’s incredible that he didn’t do anything.”

But Christie isn’t the only member of his party with a serious problem, Shields pointed out. “America is changing and the Republicans aren’t. Last year for the first time in a century, more whites died than were born. It’s a different America. Four out of five Latinos and blacks are Democrats. So are four out of five Asians, a fast-growing, educated, and entrepreneurial group who vote Democrat because the Republicans are not welcoming to immigrants. Out of 129 million Americans, 87 million voted in 2010. The ones who didn’t vote were young minorities. If they show up the Democrats win.”

This is especially true if Republicans don’t choose a better candidate than they did in the last presidential race. “In 2012 the Republicans had a chance to pick a candidate,” Shields recalled. “At the time, America was reeling from the stock market decline.” So what did the Republicans do? “They nominate an investment banker who said that 47 percent of Americans are takers. It was a terrible blow to the Republican Party when Romney was caught saying that.”

This year, the presidency is up for grabs based on the answer to a question: is the country headed in the right direction? A 2010 Wall Street Journal poll showed that six out of 10 Americans thought we were heading in the right direction, and three out of 10 thought we were heading in the wrong direction. In 2012, 63 percent though we were heading in the wrong direction and 26 percent thought we were headed in the right direction. The president’s job rating is below 50 percent.” But the Republicans in Congress aren’t doing much better, Shields explained. At a time when many Americans are struggling, the Republicans are still supporting tax cuts for the wealthy. And this bodes ill for them, he explained, since “the key to elections is an understanding of what people need.”

And the key to national greatness is actually fulfilling their needs, Shields pointed out. “The measure of a country is how much it gives to those who have too little,” he said to a room of people who give a great deal of themselves. “What you do for the aged and disabled is God’s work. We join in expressing our gratitude for what you do.”

Addresses by Invited Member of the U.S. Congress: Hearing from the Champions of Home Care and Hospice

The cherry blossoms weren’t out just yet, but NAHC members were as they were as they prepared for their day on Capitol Hill. “We’re very engaged and look forward to bringing our message to members of Congress,” said NAHC Chairman of the Board Andrea L. Devoti. Fortunately, many members of Congress have already gotten the message that home care and hospice cuts costs and improves lives. Some of them took time that morning to give NAHC members their guidance on advocating for both patients and employees. These lawmakers are leading voices with a history of supporting home care and hospice providers. And the room where they met with NAHC members has a history of its own.

Room 325 of the Russell Senate Office Building has been the site of major public hearings. For the past 80 years, it has served as the stage for some of the most dramatic Senate investigations, such as the sinking of the Titanic, the Teapot Dome scandal, Pearl Harbor, the Kefauver Crime Committee, the Army vs. McCarthy, the Vietnam War, and Watergate. In 2009, following the death of Senator Edward M. Kennedy, the Senate voted to name the room to honor the three brothers who served as senators: John F. Kennedy, Robert F. Kennedy, and Edward M. Kennedy, a strong proponent of home care and hospice. All three had participated in major hearings in the room, and John and Robert Kennedy announced their presidential candidacies in the room.

Senator Christopher Dodd of Connecticut proposed affixing the Kennedy name to the room “not just as a monument to the things these three brothers did as senators and as colleagues of us here, but in the spirit of compassion and compromise, the fierce advocacy and tender friendship that Teddy and his brothers brought to this body.” This spirit of compassion and compromise lived on in the champions of home care and hospice who now spoke to NAHC members about the 2014 legislation agenda and their experience with home care and hospice.

Rep. Greg Walden (R-OR)
 Senator Amy Klobuchar (D-MN)
 Senator Jean Shaheen (D-NH)
Senator Ben Cardin (D-MD)
Senator Susan Collins (R-ME)
Rep. Jim Langevin (D-RI)

Senator Greg Walden (D-OR): “I’m going to speak from the heart because you all do. My parents benefited from home care and hospice,” Walden said. The experience taught him the value of what providers do and also made him understand what family caregivers go through. “I know what it’s like to be part of the sandwich generation,” Walden said. And the experience showed him that “rebasing has to stop,” especially in his home state of Oregon where home care has low costs and great outcomes. “Cuts by CMS would cause 70 percent of home health agencies in Oregon to run in the red in 2016.” Part of the problem is the formulas CMS uses “treat Oregon like Baltimore” in calculating costs. But Oregon is a much bigger place, and people in Walden’s district may have to drive an hour each way to give care. The thought of all they — and all home care workers — go through inspired Walden to express his thanks. “Bless your hearts for what you do. Most of us will need your care, so we need to make sure we don’t destroy this wonderful network of caring providers.”

Senator Amy Klobuchar (D-MN): “I personally have experience of your wonderful care,” Klobuchar said. Her only child, Abigail, was born with a condition that kept her from being able to swallow. For three years she had to be fed through a stomach tube. “A number of home care workers came to care for Abigail, and now she is a freshman at Yale,” Klobuchar proudly said. Along the way, Abigail faced challenges, and home care does, too. “We need to work on long-term care,” Klobuchar said, “and home care is a big part of that. We need to establish telehealth pilots because it makes care more effective. We need to focus on reimbursement for hospice. And we need to give power to people who know patients best, so I’m supporting the Home Health Care Planning Improvement Act allowing nurse practitioners, clinical nurse specialists, certified nurse midwives, and physician assistants to certify home health services. In Minnesota, we believe in giving people high-quality care. Home care and hospice are part of that.”

Senator Jeanne Shaheen (N-NH): “We have to reorient ourselves in how we provide health care. As we think about the challenges going forward, home care makes so much sense,” Shaheen said. And she has acted on this belief. “When I was governor, we got a waiver for people to receive care in their homes instead of going into nursing homes. Now I’m proud to be a cosponsor of the Home Health Care Planning Improvement Act, a commonsense bill. And I’m proud of the work being done in New Hampshire. Home care agencies are at the table and working with accountable care organizations. In my state, home care has kept thousands of patients from being readmitted to hospitals. Home care saves money, provides quality care, and makes people happy. I will be fighting for you to make sure you’re reimbursed and we have a system that works for patients and providers.”

Senator Ben Cardin (D-MD): “Congress has a strange way of thanking you, so I want to personally thank you for all you do to help people and our country. Cutting up your reimbursement rates has got to end. It’s time we fixed the SGR and then talked about good health care policy. We should start by looking at what you do and follow your model of caring for people in their communities and homes. We need to talk about what is the right policy for this country, instead of politics,” and that policy should include hospice, as Cardin pointed out. “This week I had a friend who went into hospice, and we got a call from a hospice person who said my friend was happy. You keep people happy and give me hope that we will get health care policy right.”

Senator Susan Collins (R-NH): “This is the 16th straight year that I have joined you,” Collins said. “Issues affecting home care and hospice have been at the top of my list since I joined the Senate. As a ranking member of the Senate Committee on Aging, I’m aware that challenges facing our health care system are primarily demographic. The system will have to change if it is to survive the impact of the silver tsunami, and one of the ways we can do that is to change our focus from institutions to home and community-based care.” Most people want to receive care in their homes, but “our policies have not kept pace with our preferences. One woman told me that her mother, who suffered from Alzheimer’s, had to go into a nursing home because she couldn’t qualify for home care.”

Her example, Collins went on, shows that “Medicare beneficiaries face unnecessary barriers to getting home care” despite the savings it could bring. “It’s almost $2,000 a day for a typical hospital stay. It’s $550 a day for skilled nursing home care, and just $44 a day for home care — making home care a no-brainer at a time when Medicare is stressed. So I have introduced the Home Health Care Planning Improvement Act, which allows RNs and physicians assistants to order home care. These professionals play an important role, especially in rural areas, so it makes no sense that they can’t order less costly home care for their patients,” Collins maintained.

Then she gave attendees some words of advice. “As you make your visits today, describe the kind, compassionate, cost-effective care you provide. Describe the distance you have to travel if you live in a rural area. But most of all, I implore you to invite them on a home visit. That will open their eyes. The early visits I went on made me a committed, passionate activist. I look forward to our partnership to make sure our country’s aged and disabled have access to the quality, compassionate care you provide to them.”

Rep. Jim Langevin (D-RI): “Don’t be disturbed by the chair,” Langevin said from a wheelchair as he faced the room. He’s a paraplegic who’d had the benefit of home care, and he speaks for it with a powerful voice. “I commit to repeal the reimbursement formula,” he told the crowd. “Home care providers have had their rates reduced to unforgivable levels, so I was disappointed to see CMS impose maximum cuts.” The cuts are especially wrong, Langevin pointed out, because home care will only become more important as America ages. “It’s clearly a much better system than institutional care. It’s the care of the future, but it’s also the care of today. We must ensure that patients who need access to home care get it.”

Keynote Address: Creating a Culture of Caring

This closing session brought together NAHC President Val J. Halamandaris; NAHC chairman of the board, Andrea L. Devoti; and Elaine Stephens, head of the Home Healthcare Nurses Association. They were there to look back at the achievements of the meeting and look ahead at how to make it even better. Among this year’s successes was a reception for Senator Rob Portman (R-OH) who really listened to NAHC’s concerns. “His mother was a hospice supporter,” Devoti said, “and he is a believer. He showed it by promising to do what he could about rebasing and even bring a hearing on the face-to-face rules.”

He was also enthusiastic when Halamandaris told him that NAHC is planning a bus tour to visit patient and providers nationwide. “Portman thought a tour of the U.S. was a fabulous idea,” Halamandaris told the room. “It will call attention to the important work that home care and hospice does, especially in rural parts of the nation. We’re going to be visiting you, so come up with ideas for how we can get publicity,” he said. He was also looking for ideas to expand NAHC’s Annual March on Washington, and he already had come up with a few. “The session in the Senate needs to be mirrored on the House side, and we need to focus our guns on CMS. So why don’t we send delegations to CMS? And we have to get more of our nurses to speak because they have the most credibility.”

Highlighting their work is the aim of the Home Care & Hospice Nurse Recognition Program, Stephens explained. “Do you remember Dea Kuiper, last year’s Nurse of the Year, and her moving story of how she cared for a dying little girl? Our Nurse of the Year program is a way of honoring people like Dea. We need your help to identify more extraordinary nurses, and we’re helping them hone their skills by putting forward a track of programs that are specifically for nurses.”

Right now these nurses face challenges because we’re in a period that is difficult for home care and hospice. “So how do you survive?” Devoti asked. “Look at all sources. Don’t necessarily focus on cutting but on adding value. That means no more evergreen contracts. Instead find ways to increase value and performance. Ask staff how we can help them be more productive.”

And make the most of what you have, Stephens added. “Technology is critical, so we’re doing optimization studies of the technology we have. At the same time, most of what we do involves people. At these times when we can’t give raises, we have to do a lot of smiling and explain to staff some of the obstacles we face.”

We also have to show our employees that we care about them. “Some people coming into home care focus on the bottom line,” Halamandaris said, “but reputation is equally important. Your employees make you, so we have to be creators and enforcers of the culture of caring. It’s exceedingly important to promote a culture of caring,” he stressed. That means “we have to find ways of communicating with staff and finding ways to be present when they are in the office,” Stephens added.

When you’re there, address two other important facets of success: data and diversification. “Lately, every question I get has to do with what’s the data,” Devoti said. “My own organization asks me for data all the time.” Similar demands are made on highly successful Southwest Airlines. “Southwest instituted the importance of data when they closed their books every day,” Halamandaris pointed out.

Southwest also succeeded because it is committed to putting people first, a value it shares with home care and hospice. Providers can bring their warm, caring touch to even more people with help from NAHC, Stephens said. “During the hard times and the good times, NAHC is my toolbox where I get what I need to get through.” It’s also the voice of home care and hospice on Capitol Hill, as Halamandaris observed in conclusion. “Political action is needed to ensure providers get adequate reimbursement and patients get access to the services they need. We need to find ways to make people understand how important this is.



About the Author: Lisa Yarkony, PhD, is the managing editor of CARING Magazine. She has expertise in health systems both past and present. She can be reached at


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