Home Care Companies to Watch in the Final Months of 2021

Non-medical home care was on the rise prior to 2020, as Medicare Advantage plans and health systems began investing more heavily around social determinants of health and activities of daily living. The COVID-19 pandemic, however, has arguably made home care the hottest corner of the senior care world.

There are dozens of home care companies disrupting the traditional in-home senior care model through their embrace of technology, innovative approaches to care or unique business structures, but a handful currently stand out as aging-in-place pioneers. Following up on our “Home Health Providers to Watch in 2021” list, Home Health Care News identified five home care organizations set up to make the most waves over this year’s final months and into 2022.

The home care companies featured on this list are a mix of independents and franchisers, with some really not falling into either category. The list likewise includes a mix of established home care giants and rapidly growing, but fairly young, businesses.

Senior Helpers

With its investments around tracking “micro-social determinants of health” and commitment to better understanding the needs of older adults, Senior Helpers would have found itself on this list anyway. It ends up being a lock, though, thanks to its spring deal with Advocate Aurora Enterprises.

On April 1, Advocate Aurora Enterprises announced it had closed a deal to acquire the Maryland-based Senior Helpers, which, at the time, had 320 franchised and corporate-owned home care locations in 44 states and two other countries. Financial terms of the deal weren’t immediately disclosed, but multiple reports had the price tag at $187 million — or $62 million more than what private equity firm Altaris Capital paid for Senior Helpers in 2016.

This deal makes Senior Helpers a home care company to watch for two main reasons.

For starters, having a backer like Advocate Aurora Enterprises — the investment arm of Advocate Aurora Health — gives Senior Helpers some serious health system muscle. One of the 12 largest not-for-profit, integrated health systems in the nation, the 26-hospital Advocate Aurora Health generated $13.1 billion in total revenue for 2020.

“Senior Helpers furthers our transformation into a destination health company that goes beyond sick care to provide wellness offerings,” Jim Skogsbergh, the health system’s president and CEO, said when the deal was announced. “The ultimate goal here is to give people more healthy days within the comfort of their homes doing the activities they enjoy. This aligns with our purpose of helping people live well.”

Under the Advocate Aurora Health umbrella, Senior Helpers and its hundreds of franchisees can become turn-key partners within hospital-at-home models, SNF-at-home programs and more. Health systems often have a tough time finding reliable home care partners with scale, simply because of the highly fragmented nature of the industry.

“This opens a lot of opportunities for us, thinking about what we can be in the broader health care continuum,” Senior Helpers co-founder and CEO Peter Ross previously told HHCN. “How do you control the overall continuum? How do you own it? It’s very hard for one person, one company or one organization to have all of the parts.”

In addition to the benefits of being linked to a large health system, Senior Helpers will also have advantageous connections to current and future Advocate Aurora Enterprises portfolio companies. Led by President Scott Powder, the group focuses on aging, parenthood and wellness, with its other investments including telenutrition platform Foodsmart.

“We realize there’s a whole range of things outside of medical care itself that contributes to a person’s health, wellness and well-being,” Powder told HHCN. “We want to more actively participate in that whole ecosystem, hence the creation of Advocate Aurora Enterprises, which is a vehicle to do that.”

In addition to setting up Senior Helpers, the Advocate Aurora Enterprises deal has implications for home care M&A activity more broadly.

In recent years, PE buyers have driven home care dealmaking. Advocate Aurora Enterprises’ play likely gives strategic and alternative buyers the confidence to get back into the home care game.

Home Instead and Honor

Launched in 2014, the San Francisco-based Honor is a technology-centric home care enterprise that has made a name for itself by partnering with traditional operators in half a dozen states. Founded more than 25 years ago in Omaha, Nebraska, Home Instead Inc. is a national, privately owned home care franchiser with 90,000 caregivers and 1,200 offices in its global network.

The two organizations shook the home care landscape on Friday, when Honor revealed it had acquired Home Instead for an undisclosed sum. Home Instead was technically “not for sale,” but founder and CEO Paul Hogan apparently found Honor’s pitch too good to turn down.

“We were not for sale, and that was the direction from my board,” Home Instead CEO Jeff Huber told HHCN last week. “But [Hogan] said, ‘If there is some sort of opportunity that you think really propels our mission and vision forward, and can really enhance the way we care for people, then that’s something we should know about and you should bring it forward.’”

The combined Home Instead-Honor business will represent $2.1 billion in home care services revenue, according to a joint press release from the companies.

Honor and Home Instead will be worth following throughout the rest of 2021 to see how they successfully execute when it comes to integration. Home Instead isn’t a small business to swallow, so it’ll be interesting to see how Honor positions its assets within the startup’s growing Honor Care Network.

Currently, the plan is for Home Instead to keep its branding and operate as a subsidiary of Honor, while the Honor Care Network maintains its name as well. Honor’s Seth Sternberg will keep his role as CEO of Honor, while Huber will continue to lead Home Instead as its CEO, reporting to Sternberg.

It’s not entirely clear whether Home Instead franchisees will be asked to adopt Honor’s platform, but the idea behind the acquisition was obviously to marry Honor’s proprietary technology with Home Instead’s vast footprint.

“Nobody has been able to figure out how we deliver high-quality care at scale, until now,” Marc Andreessen, co-founder and general partner at venture capital firm Andreessen Horowitz, said in a press release announcing the news. “This acquisition fundamentally transforms the senior care space, flipping it from analog to digital. Technology will drive operational efficiency and personalization at scale, which is the only way to meet the skyrocketing needs of the baby-boom generation.”

Along with Andreessen Horowitz, Honor investors include Baillie Gifford, Rock Springs, Prosus Ventures, Thrive Capital and 8VC, plus a fund advised by T. Rowe Price Associates Inc.

“This acquisition fundamentally transforms the senior care space, flipping it from analog to digital.”

Marc Andreessen, co-founder and general partner at Andreessen Horowitz

Up until now, “fundamentally transforming senior care” with technology hasn’t worked out as planned. Multiple startups with the dream of Uber-izing home care have failed, both domestically and abroad. Honor itself even had to switch up its core business model to remain competitive.

If Honor and Home Instead get their new relationship right, it could pave the way for a totally new era of home care.

“Never before in the history of the world has a company had this much reach or this much investment in technology to solve caring for aging adults, their loved ones and those who care for them,” Sternberg said in the release.

Right at Home

Similar to Senior Helpers and Home Instead, Omaha, Nebraska-based Right at Home is a home care franchise giant. Yet unlike its peers, Right at Home has been relatively quiet of late, which is somewhat unusual for a company known for taking big swings, particularly in the form of creative partnerships.

“Right at Home is poised for rapid revenue growth via their strong national alliances being built much faster than other home care brands,” one long-time home care executive told HHCN. “Its recent alliance in place with Encompass is the latest example of their ability to truly ‘connect and collaborate’ with larger home health, SNF and senior living networks, setting the success example that other home care brands are still trying to emulate.”

At the start of 2021, Right at Home had more than 500 home care offices across the U.S., in addition to locations in seven other countries.

Birmingham, Alabama-based Encompass Health (NYSE: EHC) and Right at Home jointly announced a national preferred provider relationship in March. While the two companies already had an informal relationship for years, their leaders wanted to work closer together in order to get ahead of adverse health events and keep people out of the hospital.

That’s an operational priority for home health providers, which are judged on their ability to reduce preventable re-hospitalizations, especially in states where the Home Health Value-Based Purchasing (HHVBP) Model is active.

“It all comes down to being able to better predict needs, so the ‘post-acute’ industry can be more ‘pre-acute,’” Kerin Zuger, chief of strategic growth for Right at Home, previously told HHCN. “We want to know client drivers for needing home care and home health. How could we have gotten to the patient sooner? This partnership gets us closer to answering that question.”

Two years before its partnership with Encompass Health, Right at Home had also announced a preferred provider relationship with Kindred at Home.

Last October, it also unveiled a partnership with TruBlue Total House Care, a home-modification franchiser.

In many ways, all three moves embody Right at Home’s mission to become the one-stop shop for all things related to aging in place. Similar to using a contractor when custom-building a home, CEO and President Brian Petranick wants seniors to use Right at Home when designing their care plans.

“The contractor becomes the middleman and coordinates all of those other things,” Petranick told HHCN in January. “All you have to do, as the homeowner, is decide on design, your choice of your tile, your carpet, your paint. I think there’s going to be more of a demand for that type of service in home care.”

Help at Home

The Chicago-based Help at Home has undergone a significant leadership overhaul over the past year. Some believe that could be, in part, due to an internal effort to take the company public.

A public exit, in fact, could come as early as the end of 2021, a June report from Bloomberg News suggested.

If Help at Home did go that route, it would become a rare example of a non-medical home-based care provider becoming a part of the public markets, joining the likes of Addus HomeCare Corporation (Nasdaq: ADUS) and ModivCare Inc. (NYSE: MODV). That could trigger future public exits for home care providers while giving Help at Home the bandwidth to expand far past its current footprint.

Help at Home is a provider of home- and community-based services (HCBS). It operates nearly 170 locations across 13 states, leveraging its 30,000 caregivers to do so. The Vistria Group and Centerbridge Partners acquired majority ownership in the company last November.

In March, Help at Home named board member Chris Hocevar as its CEO. Last month, it announced an additional eight executive hires, including Tom O’Rourke as the new home care president, and Elina Onitskansky as the new chief growth and strategy officer.

“Right now, we don’t see barriers to growth. We only kind of see those opportunities,” O’Rourke recently told HHCN. “We’re just incredibly excited about the future of this business.”

After it acquired Community Care Systems — an Illinois-based home care provider — the company expressed its appetite for more growth, even outside its current footprint, moving forward.

“We annually provide over 40 million hours of care to clients,” O’Rourke said. “With our strong organic growth engine, we’re excited about using those millions of hours to create even more meaningful moments and a difference in our clients’ lives. And we believe we can do that in many other geographies across the country.”

Nova Leap

Back in June 2019, Nova Leap had big plans for breaking into the U.S. home care market and becoming a dominant force in the in-home dementia care space.

“We’re early on in our evolution,” Nova Leap President and CEO Chris Dobbin told HHCN, shortly after the Canadian home care company had completed its ninth acquisition in under three years. “We plan to continue with our growth and are always looking for more opportunities.”

While Nova Leap remains bullish on its growth trajectory, its M&A pipeline had slowed down a bit because of the COVID-19 pandemic — until recently. On Aug. 4, the company announced it finalized a deal for an Oklahoma home care agency, marking its first since buying an Ohio agency in December 2020.

There’s a good chance that Nova Leap’s recent transaction restarts its dealmaking engine. It’s in a strong position to make further moves as well, as its second-quarter revenues were the highest in the company’s history.

What’s more, as of June 30, Nova Leap had a cash balance of nearly $6.5 million, as well as full access to a revolving credit facility of $825,000.

“While we didn’t close an acquisition in Q2, that shouldn’t be taken as a belief that we weren’t active in evaluating opportunities,” Dobbins said as part of his company’s Q2 2021 earnings results. “We raised funds with a view that we would be in a good position to deploy the capital in a meaningful way. We have evaluated several opportunities and I believe we will be quite active the remainder of the year.”

Nova Leap currently has operations in seven different U.S. states within the New England, South Central and Midwest regions, as well as Nova Scotia, Canada. If the company does go back to its highly acquisitive ways, it would further make the home care M&A environment even more competitive.

Honorable mentions

There are plenty of other home care companies worth highlighting on this list. Here are just a few.

Family Resource Home Care: In June, Family Resource announced plans to acquire two independent home care providers in Oregon, bringing its overall network to 24 locations across three states. Led by CEO Jeff Wiberg, the provider has turned itself into a regional home care powerhouse.

HouseWorks: Michael Trigilio took over as the new CEO of HouseWorks in early 2021. He’s already made a mark on his new organization, spearheading different technologies investments plus the purchase of a care management company in May.

ModivCare: ModivCare acquired the large personal care services provider Simplura Health Group for $575 million last September. In July, it followed that up by announcing plans to buy CareFinders Total Care LLC for $340 million. President and CEO Daniel Greenleaf has previously said his goal is to build a $1 billion home-based care player with a true national footprint.

Additional reporting by Andrew Donlan.