Home-Based Care Public Company Roundup Q1 2026
- Apr 16
- 9 min read
Mertz Taggart follows the publicly traded home-based care companies and reports on their earnings calls each quarter. As a group, public company performance and share price serve as a proxy for industry performance and investor sentiment, respectively. Historically seen as the “ultimate consolidators”, the publicly traded home-based care trading multiples have a downstream effect on lower middle market home-based care M&A.
Addus Homecare (Nasdaq: ADUS)
Highlights
Addus posted revenue of $363.6 million for the quarter, up 7.7% from Q1 2025. Growth was led by the Personal Care segment, which represents 77.3% of the business and grew 8.8% overall and 6.5% on a same-store basis, supported by rate increases in Illinois and Texas, the company’s two largest markets. The Illinois increase of 3.9%, effective January 1, adds approximately $17.5 million in annualized revenue, while Texas implemented a 9.9% increase effective September 1.
The Hospice segment, representing 18.1% of quarterly revenue at $65.8 million, grew same-store revenue 7.7% year-over-year, with average daily census increasing 8.2% to 3,804 and a median length of stay of 23 days. The Home Health segment, representing 4.6% of the business at $16.7 million, saw a same-store revenue decline but improved operating income both year-over-year and sequentially. Over 25% of the company’s hospice admissions in New Mexico and Tennessee now originate from its own home health operations through its bridge program.
Adjusted EBITDA came in at $44.5 million, a 9.7% increase over the prior year quarter, with adjusted EBITDA margin of 12.2%. Adjusted earnings per share rose 14.1% to $1.62, and gross margin was 31.9%, consistent with the first quarter of 2025.
Key Financial Figures
M&A Activity
On May 1, Addus closed the acquisition of the personal care operations of HomeCourt HomeCare, based in Fort Wayne, marking the company’s entry into Indiana, a state adjacent to its largest personal care market of Illinois. HomeCourt serves approximately 240 clients with annual revenues of approximately $9.7 million. The company has also entered into a definitive purchase agreement for a second Indiana personal care operation of similar size, expected to close later this year; together the two transactions represent just under $20 million of revenue.
Management pointed to a shift in the size of opportunities reaching the market. Asked whether the pipeline was skewing larger, CEO Dirk Allison said, “there’s already two or three opportunities out there that are of size that we’re looking at, I think it’s really something that changed probably in the last three months or so where we’re seeing processes begin on these larger opportunities,” and confirmed those assets are similar in size to Gentiva.
Guidance
Management anticipates gross margin will remain relatively stable and consistent with its historical annual pattern, and expects full-year adjusted EBITDA margin to remain above 12%. The full-year tax rate is expected to be in the mid-20% range.
Aveanna Healthcare (Nasdaq: AVAH)
Highlights
Aveanna reported Q1 2026 revenue of $647.9 million, a 15.9% increase over the prior year period, with year-over-year growth in all three operating divisions. Adjusted EBITDA rose 25.2% to $84.4 million, reflecting an improved rate environment, increased volumes and enhanced operational efficiencies. Consolidated gross margin was $205.4 million, or 31.7%.
The Private Duty Services segment, representing 83% of the business, grew 16.4% to approximately $536 million, driven by a 10.7% volume increase to approximately 12.1 million hours of care and a 5.7% increase in revenue per hour to $44.43. Cost of revenue per hour rose 8.1% to $32.05, leaving spread per hour of $12.38 as the company continued to pass wage adjustments through to caregivers.
The Home Health & Hospice segment grew 17.4% to approximately $66.6 million on 11,000 total
admissions, approximately 80% of which were episodic, and 14,900 total episodes of care, up 23.1% from the prior year quarter. Revenue per episode was $3,167 and segment gross margin was 53.7%. Medical Solutions grew 7.4% to $45.7 million on approximately 93,000 unique patients served.
The company’s preferred payor strategy continued to advance, with four agreements signed in Private Duty Services during the quarter. Preferred payor agreements now account for approximately 60% of total Private Duty Services MCO volumes, up from 57% at the end of 2025, against a 2026 goal of 38 agreements. In home health, Aveanna added four additional preferred payor agreements and is tracking ahead of its goal of 50 for the year.
Key Financial Figures
M&A Activity
Aveanna’s pending acquisition of Family First Home Care, a Florida-based provider of in-home
pediatric care, continues to work through the regulatory approval process and is expected to close in late Q2. CFO Matt Buckhalter said the transaction was valued at “about seven and a half times post-Synergy EBITDA,” with revenue “sitting around the $120 million mark,” and noted it takes approximately six months to reach a full run-rate basis on synergies.
Beyond Family First, Buckhalter signaled limited additional appetite for the balance of the year, noting there remains free cash flow available for “small token acquisitions, but beyond Family First this year, probably nothing monumental.”
Guidance
Management raised full-year 2026 guidance to revenue of $2.56 billion to $2.58 billion and adjusted EBITDA of $328 million to $332 million.
The Pennant Group, Inc. (Nasdaq: PNTG)
Highlights
Pennant Group reported total revenue of $285.4 million for the quarter, an increase of $75.5 million or 36% over the prior year quarter. Adjusted EBITDA grew 32.6% to $21.7 million, or $23.5 million prior to non-controlling interests, up 37.2%. Adjusted diluted earnings per share rose 18.5% to $0.32, while GAAP net income increased 9.6% to $8.5 million and adjusted net income rose 19.8% to $11.5 million.
The Home Health and Hospice segment, now reported on a combined basis, delivered revenue of $229.1 million, an increase of $69.2 million or 43.3%, with segment adjusted EBITDA of $33.6 million, up 33.7%, and $35.4 million prior to non-controlling interests.
The Senior Living segment grew revenue 12.6% to $56.3 million, with adjusted EBITDA up 30.6% to $6.4 million and segment adjusted EBITDA margin improving 190 basis points to 11.8%. Same-store occupancy rose 180 basis points to 81%, while all-store occupancy reached 78.6%.
Pennant added 101 CEOs in training to its development program in 2025 and 47 more year to date in 2026. The company now has 55 local CEOs and 92 other C-level leaders across its operations.
Key Financial Figures
M&A Activity
The transition of the 54 home health, hospice and home care operations acquired from
UnitedHealthcare in Tennessee, Alabama and Georgia is two of five waves complete, with the process expected to be finished by the end of the third quarter. Despite an EMR transition, lower seasonal admissions over the holidays and severe January weather, total census has increased above the levels at the time of acquisition.
In senior living, Pennant completed four acquisitions after quarter end. On April 1, the company acquired the operations and real estate of Lavender Lane Senior Living, which includes 43 assisted living and memory care units and 25 independent living units, strengthening its Phoenix area portfolio. On May 1, three additional communities joined through triple-net leases with capital partners: a 100-unit community in Glendale, Arizona now operating as Saguaro Senior Living, and two Wisconsin communities of 45 and 50 units now operating as Cardinal Lane Senior Living and Harbor Haven Senior Living. Management expects to remain an acquirer of senior living assets throughout the year.
President and COO John Gochnour said, “While integration remains our primary focus, we continue to evaluate a pipeline of home health and hospice tuck-ins and potential joint ventures with integrated."
Guidance
Management did not adjust guidance, but with only one quarter complete and substantial transition work ahead, directed investors to the upper end of its range.
BrightSpring Health Services, Inc. (NASDAQ: BTSG)
Highlights
BrightSpring posted total revenue of $3.6 billion for the quarter, up 26% year-over-year, with adjusted EBITDA of $190 million, a 45% increase, and adjusted EBITDA margin of 5.3%, a 70 basis point improvement driven primarily by mix and operational efficiencies. Adjusted earnings per share were $0.39. Results reflect continuing operations and exclude the divested Community Living business.
Pharmacy Solutions grew revenue 25% to $3.2 billion, with segment adjusted EBITDA of $169 million, up 46%. Specialty and infusion revenue grew 36% to $2.6 billion, driven by strength in specialty, market adoption of existing limited distribution drugs, new LDD wins, brand-to-generic conversions and growth in fee-for-service programs. The company added four exclusive and ultra-narrow LDDs in the quarter, bringing its total to 153.
▪ Provider Services grew revenue 28% to $442 million, with segment adjusted EBITDA of $66 million and a margin of 14.9%. Home Health grew 49% to $266 million on strong census growth, de novo expansion, preferred Medicare Advantage contracts and the ongoing integration of acquired branches, which contributed $79 million of revenue and approximately $9 million of adjusted EBITDA in the quarter. Rehab grew 7% to $75 million and Personal Care grew 4% to $102 million.
Key Financial Figures
M&A Activity
BrightSpring completed the sale of Community Living to Sevita on March 30, generating approximately $811 million of net cash proceeds before tax, with approximately $100 million of associated taxes payable in the second quarter. Proceeds are being used to strengthen the balance sheet through debt paydown and cash availability. Leverage declined to 2.27x as of March 31 from 2.99x as of December 31, or 2.40x on a pro forma basis for the tax payment.
The pending divestiture of the company’s Community Living business received FTC approval and is Integration of the acquired Amedisys and LHC branches continues, with management expecting approximately $30 million of adjusted EBITDA contribution in the first year.
Guidance
Management raised full-year 2026 guidance to total revenue of $14.725 billion to $15.225 billion,
including Pharmacy Solutions revenue of $12.85 billion to $13.3 billion and Provider Services revenue of $1.875 billion to $1.925 billion. Total adjusted EBITDA is now expected to be in the range of $795 million to $825 million, reflecting 28.7% to 33.6% growth over full-year 2025 excluding Community Living in both years.
Option Care Health, Inc. (NASDAQ: OPCH)
Highlights
Option Care posted first quarter revenue of approximately $1.4 billion, up slightly over 1% compared to the prior year, which did not meet management’s expectations. Adjusted EBITDA of $105 million declined 6% year-over-year but was in line with the company’s expectations, and adjusted earnings per share of $0.40 was flat with the prior year, including a two-cent uplift from share repurchases.
Acute therapy revenue grew in the high single digits, well above market growth, supported by stronger capabilities to transition patients onto service and broader referral source relationships. Chronic therapy revenue declined slightly, with the chronic inflammatory disease portfolio reducing total company revenue growth by approximately 600 basis points.
The CID shortfall reflected a significantly higher volume of patients with insurance plan, benefit design or formulary management changes, doubling the number requiring benefit re-verification and reauthorization versus last year. This elongated approval decisions into late March, reduced patient census more than anticipated and left a less favorable therapy mix among the remaining census. Management noted that given the recurring nature of chronic therapy revenue, an unfavorable census decline takes time to recover. The company was also notified of launch delays or slower ramps across several rare and orphan programs.
Ambulatory infusion clinic utilization continued to increase, with visits growing 14% year-over-year and 28 locations now operating with advanced practitioner capabilities. The company conducted 34% of its nursing visits in one of its suites or clinics during the quarter, and continues to add to a portfolio of more than 600 therapies. Patient satisfaction scores remained in the low 90s with net promoter scores in the mid 70s.
Key Financial Figures
M&A Activity
Capital allocation priorities begin with organic investments to drive revenue growth, capacity and cost structure optimization, followed by acquisitions focused on adjacencies and tuck-ins, with periodic share buybacks last. The company repurchased over $17 million of shares during the quarter and expanded its revolving credit facility from $400 million to $850 million to better align its capital structure with its capital allocation strategy. Net debt to leverage was 2.2x.
Guidance
Management lowered full-year net revenue guidance to a range of $5.675 billion to $5.775 billion, incorporating a negative 600 basis point revenue growth headwind, higher than the 400 basis points previously estimated, due to lower CID patient retention and therapy mix. Full-year adjusted EBITDA guidance was maintained at $480 million to $505 million. The CID gross profit headwind is now estimated at approximately $55 million for the year, up from a prior estimate of $25 million to $35 million, and is expected to be realized evenly through the year.
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