Home-Based Care Deals No Longer End At The Closing Table

TL;DR

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Executives at Home Health Care News’ FUTURE conference said home-based care buyers are looking beyond EBITDA to assess sustained growth, clinical quality and leadership. Some buyers are also retaining former owners as executives or giving them equity stakes after a sale, making post-deal involvement part of the acquisition relationship.

Home-based care acquisitions are increasingly extending beyond closing, with buyers looking beyond earnings to sustained growth, clinical quality and leadership—and, in some cases, keeping sellers involved in the business, executives said at Home Health Care News’ FUTURE conference. The shift can affect how owners prepare a company for sale and whether a transaction means a complete exit.

EBITDA remains part of valuation, but panelists said it does not by itself show whether a company can keep growing. Dustin Distefano, chief operating officer of franchise operations at A Place At Home, said prospective sellers should be able to show organic growth, developed infrastructure and a team capable of supporting the business. He said a company with strong earnings but a prolonged growth plateau may be less attractive.

Clinical quality and leadership also factor into buyer decisions, according to Aveanna Healthcare CEO Jeff Shaner and Waud Capital executive partner Bill Mixon. Shaner said he would favor a slower-growing company with stronger quality over a faster-growing business without the same commitment to care. Mixon said a cohesive management team and clear culture help buyers assess whether a company can sustain its next phase of growth.

Some deals now include a continuing role for the seller. Shaner said Aveanna aims to give sellers equity ownership and leadership roles in acquired operations. Distefano, a co-founder of A Place At Home, remained with the company as COO after its acquisition by Dovida in February. A Place At Home’s joint venture approach can also let franchise owners retain minority stakes and serve as general managers.

How Sellers’ Roles Are Changing

A sale may no longer mean an immediate departure for a home-based care company’s founders or executives. Continued leadership and equity can connect sellers to the performance of the business after closing, while giving buyers access to people who know the operation. The approach also makes a company’s leadership depth and culture relevant to a transaction, alongside its financial results.

For owners considering a sale, the conference discussion points to a broader preparation challenge: demonstrating that growth is durable and that the organization can maintain care quality as it expands. These are views expressed by industry executives, not a formal market-wide valuation standard, and the panel did not provide data showing how commonly such arrangements are used.

Deals Behind the Conference Discussion

The comments came as home-based care companies continue to pursue acquisitions and expansion. Aveanna Healthcare, which provides home health care, hospice, private duty nursing and medical services across 39 states, closed its $175.5 million acquisition of Family First Homecare in June. The purchase added 27 locations across seven states, according to the source report.

A Place At Home was acquired by Dovida in February. Distefano, a co-founder, became COO after the deal. The Omaha-based company provides non-medical in-home care, care coordination and dementia-related services, among other offerings, across 22 states. These examples illustrate post-deal roles described by panelists but do not establish that every buyer or seller is adopting the same model.

“If you’re showing organic growth and infrastructure, and that you’re building your team, your value’s going with it.”

— Dustin Distefano, chief operating officer of franchise operations at A Place At Home

How Broad the Shift Is

The conference discussion did not quantify how widespread these practices are or establish that buyers across the sector use the same valuation criteria. The source report provided no market-wide figures on seller retention, post-deal equity arrangements or the weight buyers assign to organic growth, clinical outcomes and leadership compared with financial measures. It is also unclear how long sellers typically remain involved, or what terms govern their ownership and operational roles.

What Buyers and Sellers May Watch

For prospective transactions, buyers and sellers will need to define expectations beyond the closing date: who will lead the acquired operation, whether former owners will retain equity, and how growth and care quality will be evaluated. The executives’ comments suggest that management presentations and evidence of sustained performance will remain part of acquisition discussions, but no specific sector-wide rule or next policy milestone was announced.

Further deal announcements and disclosures may show whether continued seller involvement becomes more common. Until then, the examples discussed at the conference offer a view of how some operators and investors approach acquisitions, rather than a measured account of the full market.

Key Questions

What is changing in home-based care acquisitions?

Executives at the FUTURE conference said some buyers are looking beyond EBITDA to consider sustained organic growth, clinical quality and leadership. Some also keep former owners involved after closing.

Does EBITDA still matter to buyers?

Yes. The panelists did not say earnings no longer matter. Distefano’s point was that EBITDA alone may not show whether growth is sustainable or whether a company has the team and infrastructure to support it.

What can happen to a seller after a deal closes?

Depending on the transaction, a seller may leave, remain in an executive role, continue managing operations or keep a minority equity stake. The source report describes examples, but does not give a standard arrangement used across the industry.

Which transactions were cited?

Aveanna closed its $175.5 million acquisition of Family First Homecare in June, adding 27 locations across seven states. A Place At Home was acquired by Dovida in February, after which co-founder Dustin Distefano became COO.

Source: rss