On the Medicare-certified home health side, one factor that may have made investors hesitant to enter the space is the challenging payment landscape.

Despite this, Kaltroco — a family-owned private investment company — is attracted to home health care due to the firm’s belief in the fundamentals of the sector.

“It’s clear that the population is aging,” Kenneth Hammond, chief investment officer at Kaltroco, said during a panel discussion of Home Health Care News’ Capital + Strategy conference last month. “It is clear that treating patients in the home is an efficient and effective way to ensure good outcomes. It’s expensive to have people in hospitals who don’t need to be there. It’s expensive to have people in nursing homes who don’t need to be there. Treating people in the home is an imperative.”

Kaltroco is an investor in New Day Healthcare, a rapidly growing home health provider that serves patients in Texas, Missouri, Kansas and Illinois.

Hammond pointed out that, as a family backed investor, Kaltroco has the luxury to take a long-term view around the businesses that the firm builds.

“Our focus is on building the best scale platform we can to accommodate the way the market works,” he said. “We don’t use a ton of leverage. We think in a very long-term way, and we trust that, over time, the government will recognize the value home health brings.”

Indeed, The Halifax Group is making similar bets across the home-based care sector.

The Halifax Group is a Washington D.C.-based PE firm that focuses on lower middle-market businesses. The firm acquired the home care franchise company Comfort Keepers in 2023.

Like Medicare-certified home health, private-pay home care has its own challenges. One of the main pain points for potential investors is that billing rates continue to skyrocket.

Comfort Keepers is largely a private-pay company, but the franchise owners that are part of the network have a certain amount of autonomy when it comes to payer diversification. Allowing franchise owners – in states with favorable environments – to structure their businesses to address Medicaid or VA populations has helped ease some of the impact of this ongoing challenge.

“The government profile payer has become more attractive for many of our franchisees,” Scott Plumridge, managing partner at Halifax, said during the discussion.

Because Medicaid, for example, is still subject to the sway of policymakers, Plumridge stressed the importance of having a balanced book of business.

Aside from payment structure, The Halifax Group is focused on letting franchise owners run their business versus a more corporate-owned model.

“Over the course of our ownership period, we are already in the process of doing a U.S. re-franchising effort,” Plumridge said. “About $70 million of sales that were corporate-owned under previous ownership, we’re going to return those to both franchisees and we’ve got some employees who are buying locations from us. We’re [also] going to have new folks, new blood coming into our organization through acquisition to take on some of those locations. Hopefully, over the course of the next few years, you’re going to see Comfort Keepers returned to a 100% franchise business model.”

Plumridge also noted that M&A isn’t top of mind for Comfort Keepers. Instead, the company sees a huge opportunity for organic growth within its existing portfolio of assets.

On its end, Kaltroco believes that Medicare Advantage (MA) has become a big factor when it comes to investing in home health care.

“The way we’ve approached the skilled [home health] business is we have tried to acknowledge the reality that Medicare Advantage is a growing piece of the population,” Hammond said. “We need to have a solution that deals with that reality. We’re in a world where the businesses we see being sold are packaged around the idea that they have a very large FFS population as a credential. When I look at those businesses, I don’t tend to agree. I think you’ve built a business that can’t grow. Over the next 10 years, it’s going to be imperative that really good skilled home health businesses can execute in an MA landscape.”

For context, 30.8 million people are enrolled in a Medicare Advantage plan as of 2023. This is more than half of the eligible Medicare population, according to data from KFF.

Ultimately, Hammond is doubling down on home health as an area of continued investment for Kaltroco.

“Building a business that serves a population that needs to be served — that’s a big focus for us as a family-backed organization,” he said.

The post PE Sponsors Of Comfort Keepers, New Day Healthcare Are In Home-Based Care For The Long Haul appeared first on Home Health Care News.

Transaction volume for home health, home care and other in-home care businesses dipped in 2023, with inflation, higher interest rates and global unrest contributing to the downturn.

Many home-based care stakeholders anticipated M&A to rebound in 2024, however, thanks to increased loan activity in January, greater buyer-seller consensus and private equity’s record-high levels of “mature” dry powder.

With 2024’s first quarter in the rear-view mirror, the home-based care dealmaking outlook still looks to be a bit of a question mark.

“Things can change in a short amount of time and have a profound impact on the marketplace,” Mark Kulik, senior managing director at M&A advisory firm The Braff Group, said last week at the Home Health Care News Capital + Strategy Conference in Washington, D.C.

While it may be too soon to call 2024 a bull or bear market for M&A, I am starting to notice a few interesting trends, many of which surfaced at the Capital + Strategy Conference. Some of those trends include:

– The 2024 forecast for home-based care transaction volume is cloudier than just a few weeks ago, with the Federal Reserve seemingly more wary of interest-rate cuts.

– Buyers and sellers are increasingly aligned, though some sellers are still holding out for 2020- and 2021-level valuations. Some are bridging the buyer-seller gap with earnout structures.

– Investors are more optimistic about the current in-home care staffing environment, with many seeing labor pressures alleviating compared to the historically challenging stretch coming out of the public health emergency.

– While some buyers remain focused on a particular care lane, others continue to pursue continuum and diversification strategies.

– More acquirers are touting their proprietary M&A strategies. Unsurprisingly, the No. 1 business characteristic buyers are targeting: quality.

In this week’s exclusive, members-only HHCN+ Update, I share some of my biggest takeaways from our conference.

Monetary-policy whiplash

Home-based care transaction volume plummeted in 2023, mirroring the broader global health care dealmaking trend. Some of the dip was a return to mean, with 2021 experiencing record M&A activity and 2022’s action robust as well.

The cost of capital was arguably the primary hindrance to dealmaking, with the Federal Reserve attempting to control inflation via its most impactful economic tool: interest-rate policy. From March 2022 through July 2023, the U.S. central bank has raised the fed funds rate by more than five percentage points, making no fewer than 11 individual hikes.

“This is akin to the Fed jamming the brakes on the monetary policy to help slow down the economy because inflation was occurring,” Kulik explained at the Capital + Strategy Conference.

Going into 2024, the Federal Reserve had signaled intentions to cut rates, with relief possible coming in the second or third quarter. That gave home-based care buyers and sellers reason for optimism.

That excitement has dissipated over the last week. As recently as Tuesday, officials explained that inflation remains more stubborn than they anticipated, meaning interest rate rates will likely stay high.

“Right now, given the strength of the labor market and progress on inflation so far, it’s appropriate to allow restrictive policy further time to work and let the data and the evolving outlook guide us,” Federal Reserve Chair Jerome Powell told a forum in Washington.

At the Capital + Strategy Conference, it felt like the discussions around the broader U.S. economic climate were giving buyers and sellers whiplash. In turn, I see buyers and investors operating with the same conservative mentality on display in 2023.

Still, one factor that could mitigate that is the ample dry powder that private investors are sitting on, according to Bain & Company data, which Kulik cited during a presentation at our event. With about 26% of global buyout dry powder now four years or older, some are feeling heightened urgency to get deals done.

“Investors gave them money to invest in buy, and they didn’t deploy it,” Kulik explained. “And there’s pressure on private equity to deploy that cash because investors want a return on their money. They don’t want to just let it park in a savings account in a bank.”

Narrowing the gap

Home-based care sellers in 2023 valued their businesses at 2020 and 2021 levels, when valuations for home health, home care and hospice providers were extremely high. There is still a gap between today’s more conservative buyers and hopeful sellers, but it’s beginning to shrink, multiple executives said at the Capital + Strategy Conference.

“I do feel like that gap between expectation and what buyers are willing to pay has come closer – considerably,” Cameron Cordts, corporate development manager for PurposeCare, said at the event.

Backed by Lorient Capital, PurposeCare is a home health and home care provider focused on building density in the Midwest. The provider has announced several acquisitions over the past couple years, including three at the start of 2024.

In some cases, the gap is closing because of segment-specific factors, such as fee-for-service Medicare rates or the looming 80/20 rule in Medicaid. These and similar industry-specific challenges become the final straw for some prospective sellers.

In others, sellers have finally come to realize that buyers aren’t willing to pay 2020 and 2021 terms. Having been on the market for an extended period, these sellers have now accepted their fate.

“It is starting to shift a little bit,” Mike Trigilio, CEO of HouseWorks, said at the Capital + Strategy Conference. “There are some [sellers] coming on the market in the last few months that probably waited through 2023, that weren’t around last year. We’re seeing tons of opportunity.”

The InTandem Capital-backed HouseWorks has been one of the most acquisitive home-based care companies since late 2021, with its purchases including the personal care division of Amedisys (Nasdaq: AMED), Elite Home Health Care and several others. Service and payer diversification have been two of the company’s core M&A pillars.

Some buyers are taking it upon themselves to bridge the divide between acquirers and sellers. One way to do so is through deal earnout structures.

Care Advantage – the home-based care company backed by Searchlight Capital – has been successful with this approach, according to Jaron Clay, the company’s VP of integrations. Care Advantage has completed close to two dozen transactions since 2018, with Nova Home Health Care one of its more recent acquisitions.

Four of its last five deals have included earnout structures, Clay noted.

“We’ve pushed a lot more toward doing earnout structures on a lot of our deals,” he said at the event. “That’s a way for us to have the certainty that we want around this business not falling off the cliff when the owner/operator leaves. But it also is a way for us to actually give that person more money – maybe not all on Day 1. They’re getting some of it 12 months or 24 months down the road.”

I do feel like that gap between expectation and what buyers are willing to pay has come closer – considerably.”

– Cameron Cordts, corporate development manager, PurposeCare

Staffing success paying off

Another frequent comment I heard during the Capital + Strategy Conference: Home-based care staffing challenges are leveling off.

“Across our portfolio, we’ve seen improvements,” Scott Plumridge, managing partner at the Halifax Group, said at the conference. “I think our operators would characterize it as easier, but still not easy.”

The Halifax Group in September acquired the worldwide home care division of Sodexo, including the Comfort Keepers brand.

Contextually, home health, home care and hospice agencies have long faced a staffing deficit. Demand for aging-in-place and end-of-life care services is increasing faster than supply – and that will remain true as baby boomers transition into their 65+ era.

But the overall labor market is improving, and home-based care providers are also getting better at attracting and retaining talent.

Altarum’s most recent Health Sector Economic Indicators brief supports this notion. In March, the seasonally adjusted change in employment was 8.5% for home health care services, up from the 24-month mark of 6.6%.

That’s among the strongest employment gains in all of health care.

Kenneth Hammond, the chief investment officer for Kaltroco, echoed Plumridge’s comments.

“2022 was the moment of the most intense [staffing] pressure,” said Hammond, whose organization is the investment partner of New Day Healthcare. “And certainly, the situation has gotten better.”

While overall labor-market improvement is helping the staffing situation stabilize, the provider-driven efforts making a dent include sign-on bonuses and other enhanced benefits, smarter scheduling, the automation of non-care functions and more.

The continuum of care

Although there are certainly still buyers that prefer to focus on one core service, forward-looking in-home care operators continue to build out a complete continuum of care. I view this strategy as a long-term trend propelled by value-based care and the consumerization of health care.

New Day is among the home-based care companies that consider the care continuum in M&A opportunities.

“We are open minded to good businesses across the board, from skilled home health, to Medicaid [personal care], to hospice,” Hammond said. “From a platform standpoint, as we enter new states, we like businesses that have begun to solve that [continuum] problem, right? We look for companies that have at least two of the three legs of the stool, so that we can deploy organic growth to go pursue that continuum strategy that we bring data into.”

Having a continuum of home-based care service lines allows providers to maintain longitudinal relationships with clients. An older adult may turn to non-medical home care for activities of daily living (ADL) support, but that could eventually turn into a home health or hospice relationship.

Payers also appreciate providers with diverse service offerings.

“Our goal is to create a continuum of care, primarily leading with home care on the non-skilled side, then supplementing with home health care,” Cordts said.

At the Capital + Strategy Conference, it was evident to me that continuum and diversification strategies included far more than just home care, home health and hospice. Companies such as Care Advantage, for instance, are working to build care continuums for specific populations.

“We’ve really been focusing on being disciplined around what we’re very, very good at, which is personal care,” Clay said. “How can we do some of those things that aren’t a hop, skip and jump away from that, but a step away from that?”

An example: Care Advantage has acquired home care providers that specialize in certain cultural demographics. This creates strong provider-client relationships while also differentiating Care Advantage in those markets.

“That has proven to be a very sticky business, a very profitable business for us,” Clay continued. “But most importantly, a really rewarding one.”

We’ve really been focusing on being disciplined around what we’re very, very good at, which is personal care. How can we do some of those things that aren’t a hop, skip and jump away from that, but a step away from that?

– Jaron Clay, VP of integrations, Care Advantage

Active acquirers tout DIY M&A

The M&A process can be a taxing one, so it’s not a shock that many buyers and sellers enlist the help of an expert dealmaking facilitator. That’s not always the case, though, with even some of the largest in-home care providers in the country previously touting their internal M&A efforts.

While at the helm as the CEO of Amedisys, Paul Kusserow was always keen on highlighting the provider’s proprietary M&A process.

“We built our own proprietary M&A function that can find these assets,” Kusserow told me in 2018. “We bought [Compassionate Care Hospice] way below what the market has been trading at for these assets. Hopefully this will start a trend where people are not overpaying for these things because some of the prices that have been out there are ridiculous.”

At the Capital + Strategy Conference, it felt like more providers were making similar remarks.

At HouseWorks, a majority of the company’s previous 10 deals were sourced internally, Trigilio said. Quality is usually the starting point in those processes, he added.

“The key ingredients are compliance and quality,” he said. ”The care delivery is always at the beginning of all these transactions.”

The same holds true for PurposeCare, according to Cordts.

“They’re not as competitive, but typically involve maybe a little bit more time for my team, and myself, bringing that seller along in the process,” he said. “That’s been the majority of our growth in the last year or so – harvesting those proprietary leads and educating sellers on where the market is at, and what those expectations can lead to.”

The post ‘We’re Seeing Tons Of Opportunity’: Home-Based Care Buyers Deploy DIY M&A, Earnout Structures In 2024 Dealmaking Strategies appeared first on Home Health Care News.

Thanks to impactful, large-scale transactions over the last decade, the collective face of home-based care has changed forever.

Traditional providers in both home health care and personal home care have merged. Payers became involved in the home-based care space like never before. Of late, retailers have too.

But it’s often easy to forget how the current landscape became what it is.

Below, Home Health Care News takes a look at some of the most important and impactful deals in home-based care over the last decade – deals that explain, in part, where the home health and home care industries are today.

‘Big time’ provider deals

This past decade’s first blockbuster remained one of the most impactful throughout the last 10 years.

In 2014, April Anthony’s Encompass Home Health & Hospice was acquired by HealthSouth Corporation for $750 million. HealthSouth took a swing at home health and hospice, merging an in-patient facility business with a post-acute care business.

Four years later, HealthSouth would rebrand completely, taking on the home health and hospice entity’s name. Encompass Health Corp. (NYSE: EHC) still exists today, but is again without post-acute care capabilities.

The HealthSouth-Encompass deal is like a few other deals in home health care, in that it set off a domino effect and a winding life cycle of a home health entity.

Anthony left Encompass Health in 2021, and after her home health and hospice company operated as a segment within the larger organization for nearly a decade, Encompass Home Health & Hospice was spun off into its own public company: Enhabit Inc. (NYSE: EHAB).

That happened in 2022, and two years later, Enhabit may land in the hands of a different owner after it concludes its own strategic review. Anthony now runs VitalCaring, which is backed by her, The Vistria Group and Nautic Partners.

Over the decade, larger health care organizations like Encompass Health have also bundled up services, and also unbundled them.

For instance, Brookdale Senior Living (NYSE: BKD) had one of the largest home health footprints for a long time. After COVID-19 woes, however, it offloaded that to a health system eager to get into home health care: HCA Healthcare (NYSE: HCA). LHC Group would later acquire some of the assets jointly owned by Brookdale and HCA Healthcare.

Ascension Health, too, teamed up with TowerBrook to buy the home health and hospice provider Compassus in 2019.

A theme that has been a mainstay, and will likely remain a mainstay, is health systems changing course on their strategic planning – and deciding whether to own home health care themselves or focus on core operations and partner with home health care instead.

“You’re seeing a lot of these facility-based providers divesting or spinning off assets,” Chaz Bauer, director at Fifth Third Securities, told Home Health Care News. “They realize they have fundamentally two different businesses. They’re very related and intertwined. But fundamentally, you have these facility-based businesses that are very centralized models, very capital intensive. Whereas home-based care businesses, they’re very decentralized; they’re very capital-light. Part of the motivation there – in unbundling – is they can unlock value for their shareholders by splitting those businesses.”

But then there’s the M&A that has come from within the home health sector itself.

For instance, “the merger of equals” that turned LHC Group into a true home-based care powerhouse.

In late 2017, LHC Group agreed to merge with Almost Family in a $2.4 billion transaction. A straight line can be drawn from that deal to UnitedHealth Group’s (NYSE: UNH) acquisition of LHC Group, which was finalized in 2023.

LHC Group and Almost Family’s merger is not an anomaly, either. Not long after, Great Lakes Caring, National Home Health Care and Jordan Health Services combined in a three-way merger to create another one of the largest home health companies in the U.S.: Elara Caring.

That deal was powered by the PE firms Blue Wolf Capital Partners and Kelso & Company.

PE money in home-based care has turned a lot of sizable providers into powerhouses. The aforementioned PE firms – Blue Wolf, Kelso, Vistria and Nautic – have all played a part in that, in the transactions mentioned already and otherwise.

That will also continue, particularly as some of the holding periods of the largest companies turn over. There’s also a chance, however, that PE firms direct more attention to other parts of home-based care – like personal care – given the uncertainty surrounding home health payment rates.

In home care, Vistria and Centerbridge Partners uplifted Help at Home, turning it into one of the largest providers of home- and community-based services (HCBS) in the country.

Waud Capital recently acquired the large home care franchise Senior Helpers. Wellspring Capital Management acquired Interim HealthCare’s parent company Caring Brands International in 2021. Last September, The Halifax Group acquired Comfort Keepers from Sodexo.

PE has always been involved in home care. Bain Capital’s 2018 creation of Arosa, one of the largest non-franchised home care companies in the country, is one past example.

In the future, it’ll be interesting to see if PE will drive more large-scale, impactful deals like it has in home health care over the last decade.

Payers enter the fold

Any commentary on the biggest deals in home-based care over the last decade needs to note increased payer involvement.

Enter Humana Inc. (NYSE: HUM).

When people think of the company’s home-based care investments, most go straight to its takeover of Kindred at Home.

But let’s take a step out of the last decade, just for a second.

In 2011, Humana acquired the home-based care provider SeniorBridge, which was doing just $72 million in annual revenue at the time. When that deal was announced, it was not exactly frontpage news. But one could argue that kickstarted a chain of investments that changed the M&A landscape in home-based care forever.

“SeniorBridge fills a growing market need and is consistent with Humana’s focus on delivering clinical care for seniors in their homes,” Michael B. McCallister, Humana’s chairman and CEO at the time, said in a statement. “Acquiring SeniorBridge will immediately expand Humana’s existing clinical capabilities with the addition of SeniorBridge’s national network of 1,500 care managers. The company does a terrific job of reducing hospital readmissions and emergency-room utilization, all while helping seniors achieve lifelong well-being.”

Humana’s home-based care thesis was already there, but the SeniorBridge deal was likely the deal that set the stage for what eventually became CenterWell.

“The deal was a game changer. I was initially surprised by the size of the transaction. It was pretty small by Humana standards,” Mertz Taggart Managing Partner Cory Mertz told HHCN. “It didn’t take long for Humana to tout the savings SeniorBridge created for their membership, saving it billions of dollars within the first couple years of the deal, by keeping their members at home and out of the hospital.”

Nearly 13 years later, Humana is one of the largest home health providers in the country through CenterWell Home Health.

The company, with the help of the PE firms TPG Capital and Welsh, Carson, Anderson & Stowe (WCAS), acquired and merged Kindred at Home and Curo Health Services. Yet another home health and hospice powerhouse was formed, this time under the watch of one of the largest payers in the country.

In 2021, Humana opted to take over a remaining 60% of the enterprise (it had previously owned 40%), which was worth over $8 billion at the time.

In 2022, it divested the hospice and home care operations of Kindred to Clayton, Dubilier & Rice (CD&R). Those divested assets became what is now known as Gentiva, led by David Causby, the former CEO of Kindred at Home.

The home health assets Humana held onto are now under CenterWell Home Health. CenterWell, overall, includes primary care, pharmacy and home health services.

In 2024, most large payers – namely the ones with large MA memberships – have some sort of home-based care capabilities. That was not the case when Humana acquired SeniorBridge way back when.

“This has been an ongoing development, and it’s really just vertical integration,” Bauer said. “The thought is: why not get into that downstream, and then be able to more directly control those costs and quality outcomes on the payer side?”

The other heavily involved payer is the only one that has a leg up on Humana in MA: UnitedHealth Group.

UnitedHealth Group’s Optum already had a variety of health care provider assets, but it decided to make its first big home-based care splash early in 2022 when it announced the $5.4 billion acquisition of LHC Group.

While payers liked the thought of vertical integration, large providers like LHC Group were also recognizing an existential threat to home health business: MA penetration. More MA beneficiaries meant fewer traditional Medicare beneficiaries, which meant a less sturdy financial leg to stand on.

UnitedHealth Group further cemented its interest not long after, when it made a $3.3 billion all-cash offer for Amedisys. That deal was agreed to in June of 2023, but is still pending.

Though UnitedHealth Group may have to divest some Amedisys assets to finalize the deal, the company will most likely have the largest home health market share when that deal closes. Estimates suggest Optum will have about 10% of the U.S. home health market under its belt.

Not only are payers now involved in the home health industry, but they are also creating scale.

“You can make an argument that Optum acquiring LHC group, and now Amedisys, is a scale transaction, like ones we’ve seen before,” Bauer said. “Because it puts together two of the largest providers to make an industry leader.”

New kids on the block

Like payers before them, another group of companies is now firmly involved in home-based care investment: retailers.

In fact, they’re so invested, they may not be labeled as just retailers five to 10 years from now.

CVS Health (NYSE: CVS) has a new health care services segment dubbed CVS Healthspire. Walgreens Boots Alliance (Nasdaq: WBA) has the same with its U.S. Healthcare segment.

Both of those segments are arguably the future of their respective parent organizations. And both include home-based care services.

Payers and retailers have different business models, but tend to want the same thing: pharmacy, primary care and home-based care services.

In 2020, Walgreens made an over $1 billion investment in VillageMD, a home- and community-focused primary care provider. After subsequent investments, it has backed VillageMD with over $6 billion.

After that, Walgreens found its next health care services asset in the health-at-home solutions platform CareCentrix. Though he is no longer in the position, CareCentrix’s former CEO, John Driscoll, was the initial leader of Walgreens new U.S. Healthcare segment.

“We continue to see strong results and potential for growth from our partnership with CareCentrix. Our full acquisition further accelerates our transformation to become a consumer-centric health care company, leveraging innovative platforms that extend our capabilities into fast-growing segments of health care,” former Walgreens CEO Roz Brewer said at the time. “CareCentrix is key to offering services to our patients at every stage of the care continuum, and to driving long-term, sustainable growth as part of our U.S. Healthcare strategy.”

Not to be outdone, CVS Health agreed to acquire the home- and value-based care enabler Signify Health in 2022 for $8 billion. Shortly after that, it got its primary care provider, too, with the over $10 billion acquisition of Oak Street Health.

While none of these assets are traditional home health or home care assets, this retailer involvement represents a seismic change in U.S. health care – and home-based care is a major part of it.

These companies could go after more assets in the future, or they could become major partners for those traditional providers.

Honorable mentions

It’s impossible to highlight every deal, but there are some that don’t fit perfectly into “themes” that are still worth mentioning.

The home care technology company Honor acquired the home care franchise brand Home Instead in 2021, for instance. In lieu of strictly partnering with providers to see its vision through, Honor opted to purchase Home Instead to speed up the process. The jury is still out on that deal, however.

Prior to agreeing to become a part of Optum, Amedisys also made plenty of deals that turned it into a multi-billion-dollar business.

It acquired the hospital-at-home platform Contessa Health in 2021 for $250 million.

It acquired Compassionate Care for $340 million in 2018, and AseraCare Hospice in 2020 for $235 million. Those two deals significantly bolstered its hospice arm.

Modivcare (Nasdaq: MODV) entered into the personal care game in a real way with its $575 million acquisition of Simplura Health Group in 2020 and its $340 million deal for CareFinders Total Care in 2021.

BrightSpring and PhaMerica completed a merger in 2019 that eventually led to today’s BrightSpring Health Services (Nasdaq: BTSG), which is now a public home-based care company.

Finally, Aveanna (Nasdaq: AVAH) – formerly a pediatric provider – entered into the home-based senior care world with its $345 million acquisition of Comfort Care Home Health in 2021 and its acquisition of Accredited Home Care for about $200 million later that year.

Addus Homecare Corporation (Nasdaq: ADUS) has executed several high-profile transactions of its own, most recently acquiring Tennessee Quality Care in a $106 million deal.

The post The Most Game-Changing Home-Based Care Blockbusters Of The Last Decade appeared first on Home Health Care News.

Overall, more than 700 home-based care locations across the world are included in the deal.

The transaction is expected to close in the fourth quarter. Financial details were not disclosed.

“We just love the [home care] space and and wanted to want to continue to be active there,” Halifax Managing Partner Scott Plumridge told Home Health Care News.

The Irvine, California-based Comfort Keepers is one of the largest personal home care providers in the U.S. A franchise, the company has more than 700 locations across eight countries. Sodexo originally acquired the brand in 2009.

Specifically, Halifax will now have a home care footprint across the U.S., U.K., Ireland, France, Denmark, Norway, Sweden and Brazil.

“There’s a long-term trend, where the fastest part of the population growth is with the elderly,” Plumridge said. “For most countries, the most cost-effective place for them to age is in their own home setting versus institutional.”

Based in Washington, D.C., Halifax is a private equity firm that generally invests in lower middle-market businesses with enterprise values between $100 million and $300 million. It was an investor in the home-based care company Interim HealthCare from 2012 to 2015.

Halifax acquired the U.K.-based Bluebird Care and Australia-based Just Better Care during that investment period, eventually pairing the two with Interim to form Caring Brands International in 2013.

Its portfolio also includes mobility and accessibility equipment companies, Harmar and 101 Mobility. It previously invested in PromptCare Companies, which is a provider of specialty respiratory and infusion-therapy services.

“In our learnings over the years, home care also tends to be the preference,” Plumridge said. “That seems to be a fairly common characteristic. There’s kind of a natural push for folks to age in place moving forward.”

Comfort Keepers’ portfolio includes 535 franchised territories and 105 company-owned territories. Though it provides clinical care abroad, its focus in the U.S. is personal care, primarily of the private-pay variety.

The company recently named the Sodexo veteran Ramzi Abdine as its next CEO. He replaced Carl McManus, who had served in the role since 2017.

“We look forward to working with the leadership team to build on the company’s impressive market position and accelerate its growth,” Halifax Vice President Molly Fitzpatrick said in a statement. “Halifax has a long history of investing in home care services as well as franchisors, and we understand the advantages for all stakeholders of providing these care services in the lower-cost and comfortable home setting.”

The post The Halifax Group Acquires Home Care Franchise Comfort Keepers appeared first on Home Health Care News.

Founded in 2004, Bluebird Care has more than 180 franchise operations which provide non-medical care services in England, Wales, Scotland, Northern Ireland and the Republic of Ireland. 

The acquisition of Bluebird Care will increase Interim’s global presence to approximately 500 locations and 250 franchise owner groups in six countries, for a combined network sales of more than $850 million.

Last fall, Interim had its sights set on international expansion as one of the company’s “high priority growth opportunities,” according to Kathleen Gilmartin, president and CEO of Interim HealthCare, Inc.

“Bluebird Care mirrors our mission and core values with a solid culture of care and a scalable business model delivered by a strong network of franchisees and we are very excited about our future together,” Gilmartin said. 

Both Interim and Bluebird will continue to operate as separate companies, each under their own brand names and in their respective countries, Gilmartin noted. 

Additionally, each company will also continue to operate with their leadership teams to drive their initiatives and growth strategies, with Bluebird Care founders, Paul and Lisa Tarsey, along with Simon Dalziel, continuing their leadership roles with the company. 

“Our growth has been aggressive since we bean franchising in 2006,” said Paul Tarsey, Bluebird Care founder and managing director. “We are very excited by this strategic partnership with such an experiences healthcare franchise as Interim. Bluebird Care will now have access to knowledge and shared best practices in care delivery, training, marketing and financial benchmarks to fuel innovation and improve efficiencies in both brands.”

Interim’s acquisition comes a year after the company entered a strategic equity partnership with The Halifax Group, a private equity firm that reenergized a plan to expand services and grow Interim HealthCare’s footprint in the worldwide home healthcare market.

The Halifax Group works to partner with managers and entrepreneurs to recapitalize and grow lower middle-market businesses across a variety of industries, including health and wellness, infrastructure, business and government services and franchising. 

The firm maintains offices in Washington, D.C.; Dallas, Texas; and Raleigh, North Carolina. 

Written by Jason Oliva

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