FOR IMMEDIATE RELEASE: July 15, 2025
CONTACT: Carter Dougherty, carter@ourfinancialsecurity.org
Private Equity Taking Over Key Parts of Home Care System
WASHINGTON, D.C. – The private equity industry has tapped into the multibillion dollar home and community based services (HCBS) sector, and has already made millions by implementing its routine playbook of extracting valuable company resources from providers of these crucial services while making life harder for care workers, clients, and communities most in need, according to a new report released by Americans For Financial Reform Education Fund.
Read the full report here.
If left unchecked, private equity’s extractive business model may damage HCBS infrastructure at a moment when its stability and the continuation of care are of the utmost importance, with huge Medicaid cuts now pending. Several of the nation’s largest home care chains are private equity owned, and private equity-owned intermediaries control self-directed care in several states. To make HCBS a social good that provides sustainable livelihoods and is accessible, affordable, and responsive to client and family needs, advocates and policymakers need to design programs that aim to keep care investments focused on serving community needs, not lining Wall Street executives’ pockets.
“Home and community based services are a critical part of the care economy” said Aditi Sen, managing director of research and campaigns at Americans for Financial Reform Education Fund. “At a time of looming budget cuts, we need guardrails to make sure funding goes to where it is needed most. Without regulation, older adults and people with disabilities in need of responsive care, the majority women of color workforce, and the entire HCBS system will suffer the same negative outcomes at the hands of private equity owners as other parts of our care ecosystem.”
Home based care allows for people who are in need of support services to manage their lives and daily activities to be done in the comfort of their homes or community settings. An aging population and disability justice advocacy have raised the demand for home care services, with estimated spending on these services expected to rise to over $280 billion by 2032, much of it public dollars.
In addition to clients, workers are also directly negatively impacted by private equity’s foray into home care, through depressed wages, a lack of access to hours, a failure to prioritize worker safety, and the possibility of sudden closures. And smaller providers are crowded out from providing these services in culturally appropriate ways.
Key Takeaways:
- Private equity firms have taken over hundreds of small home care and home health chains and consolidated them into three dozen flagship brands
- Private equity-owned chains have different levels of dominance in different subparts of the industry. For example, they are the largest national providers of specialized disability and pediatric care in home and community settings
- Private equity firms are taking millions of dollars out of the HCBS system through financial engineering tactics and excessive cost cutting, leaving less money for those who need care and the workers who provide it
- Private equity firms are eroding family and client self-determination by taking over family caregiving, self-directed programs, and needs assessments
“Private equity firms’ foray into home care is pulling directly from their usual playbook, putting clients, workers and providers at severe risk and economic disadvantage, all to turbocharge profits,” said Oscar Valdés Viera, private equity and capital markets policy analyst at Americans for Financial Reform Education Fund. “We need better job standards, worker protections, and more responsive care, not depressed wages at the expense of people’s care and workers’ livelihoods.”
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