What Strategic Buyers Really Look For in Home Care M&A: Insights from Help at Home
- Emin Beganovic
- 40 minutes ago
- 7 min read
As part of our Behind the Curtain webinar series, we’re committed to giving agency owners a transparent, unfiltered view of what drives M&A activity in home-based care. In this session, we welcomed Rich Tinsley, Chief Development Officer at Help at Home, to share how one of the nation’s largest personal care providers thinks about acquisitions, integration, and value.
Hosted by Michael W. Lloyd and Cory Mertz of Mertz Taggart, the conversation covered everything from culture and compliance to rate stability, integration, and why some deals never make it past the finish line.
The Help at Home Playbook
Help at Home is a 50-year-old company founded in Chicago, now operating in 11 states with more than 60,000 clients and over 60,000 caregivers. The company focuses almost exclusively on personal care services in the home and has more than doubled in size over the last four years through a mix of organic and acquisition-driven growth.
Tinsley emphasized Help at Home’s density-driven strategy:
“We believe in density… we are one, two or three in every state that I mentioned. Probably one in 80% of them and then two or three in the others. That’s by design.”
That density is designed to make Help at Home a stronger partner to states and payers, and to support higher-quality, more consistent care at the local level.
What Makes a Deal Attractive?
When evaluating acquisitions, Help at Home focuses on three core attributes: culture, compliance, and economics.
1. Culture: The First Gate
Across small tuck-ins, mid-sized platforms, and larger transactions, culture is the starting point.
“Culture is the number one thing we look at.”
Help at Home is looking for owners who are caregiver- and client-focused, not just chasing short-term financial results. That shows up in the way sellers talk about why they started, why they’re exiting, and what they find hardest about the business.
“We are very focused on customers and caregivers. We believe that our business is very, very hard… But the reality is the P&L… is pretty simple. The secret behind that is the culture and being caregiver and client focused.”
When culture is weak at the top, Tinsley noted, it tends to bleed into compliance, operations, and even caregiver behavior.
2. Compliance: Intent and Discipline
The second lens is compliance — both on the client side and the employee side:
Regulatory adherence
Hiring and onboarding
Documentation and file quality
Help at Home audits client and caregiver files and expects clear evidence that the organization is trying to do things the right way.
“We want people to want to be compliant. We want them to do their best. We understand people make mistakes… but we want to make sure the quality is there.”
Systematic caregiver pay issues or improper treatment of employees are particularly challenging because of the long-tail liability they create.
3. Economics: Performance and Sustainability
Only after culture and compliance clear the bar does Help at Home focus on economic performance:
Revenue and margin profile
Rate environment
Growth trajectory
High margins can be attractive, but not if they’re clearly temporary or disconnected from caregiver wages:
“When you start talking about 20 to 30% margins, those aren’t sustainable right long term… we’ll give you some credit for it… but we also will perform it at what we think is a longer window of what we think the rates really will be.”
In other words, they’re buying the sustainable business, not a short-term spike.
How Help at Home Evaluates States and Markets
Beyond the individual agency, Help at Home pays close attention to state-level dynamics:
Payer structure (managed care vs. traditional Medicaid)
Historical rate behavior and predictability
Support for home- and community-based services
Labor environment and ability to recruit at viable wage levels
“We like stability or at least a plan. It’s okay to have changes… we like that. But the more stable in the way it’s planned… that makes it hard or easier for us to get our density and do what we want to do.”
Even when a first acquisition in a state is compelling, Help at Home wants to know whether it can double or triple its presence over time. Opportunistic entry — such as inheriting a smaller footprint in a new state as part of a larger deal — is common, but follow-on density still matters.
Deal Flow, Filtering, and LOIs
Help at Home evaluates far more deals than it closes, with a dedicated development team of six to seven professionals screening opportunities before they ever reach LOI.
“We look at more deals than we can do. We look at more deals than we want to do, right? But you’re trying to find the right ones.”
The team:
Reviews each opportunity
Brings it to Tinsley in weekly calls
Runs multiple rounds of questions and analysis before issuing an LOI
Pre-LOI work can take a week to several months, depending on how prepared and responsive the seller is. Internally, Help at Home also secures approvals at the same level that would ultimately sign off at closing, to minimize surprises later.
On volume, Tinsley estimated:
“Somewhere between 5 to one and 10 to one. It depends on the market.”
Common Deal Snags — and What Actually Kills Deals
Tinsley underscored that Help at Home does a lot of work up front and tries hard to avoid mid-process price reductions. When issues arise, the biggest recurring problems are:
Undisclosed compliance issues uncovered in diligence
Caregiver pay or employment missteps that carry tail risk
Non-responsiveness and delays from sellers
Operational decline once a sale decision is made
“Selling your business is a full-time job… businesses that are declining or start to decline once they decide to sell, that sometimes is really hard for us to get over.”
He summed it up bluntly:
“Declining businesses are tough.”
Help at Home will typically look for ways to solve around issues when a seller is reasonable — through structure (escrows, reps and warranties) and a practical view of risk. But if performance slides and information is slow or incomplete, the probability of closing drops quickly.
Deal Structure Preferences: Cash Up Front, No Earnouts
On structure, Help at Home’s position is clear:
Tuck-ins: almost always 100% acquisition of the business
Larger transactions: more flexibility on keeping owners involved or structuring payouts
Earnouts: essentially off the table
“We don’t do earnouts, right? They’re just hard… I find that earnouts, no one’s happy at the end.”
That doesn’t mean sellers can’t stay involved in the business — especially in larger transactions — but it does mean Help at Home prefers clean economics at closing rather than long, subjective earnout tails.
What Happens After the Sale? Integration and People
For many owners, the biggest concern isn’t just price, but what happens to their team and legacy. Help at Home’s integration approach depends on size, market, and performance:
Small in-market tuck-ins: often integrated in weeks, with a quick move to the Help at Home brand and centralized back-office functions.
Larger or new-state platforms: integration is more gradual; dual branding can remain for a time, and the pace adapts to what’s working locally.
Back-office functions like recruiting, billing, and collections are centralized to free up front-line leaders:
“The first rule is don’t do any harm.” And on people, Tinsley was explicit: “I don’t have a barn full of good people.”
Help at Home is acquiring clients, caregivers, and the teams who support them, not trying to replace them:
“The assets that we buy are really clients and caregivers, right? I mean, that is the business.”
For employees who want to stay and grow:
“The runway here is really long because we’re growing and you can grow within our company.”
The Current M&A Environment: Strong, But Different from 2021
From Tinsley’s vantage point, today’s home-based care M&A market is:
Stronger than long-term historical norms
Clearly below the peak valuations seen during and immediately after COVID
“I think buyers have lowered their prices. I think sellers have lowered their expectations, but I still think there’s a gap.”
He believes the COVID/post-COVID period may have been a “once in a lifetime” pricing environment for this sector, and that owners waiting for those multiples to return may be disappointed.
Uncertainty around policies such as the 80/20 rule and other reimbursement changes is a bigger drag on deal volume than cuts themselves:
“It’s not necessarily the cut. If we knew what the cut was… it’s easy for somebody to model that… When things are changing, that uncertainty just creates… it’s hard to pull the trigger.”
Advice for Sellers: Preparation That Actually Matters
Asked what owners should focus on 8–12 months before going to market, Tinsley cautioned against cosmetic, last-minute changes:
“Last minute changes don’t tend to work, right?”
Instead, he highlighted a few practical steps:
Professional financials – ideally monthly, with clear visibility into revenue, pay rates, bill rates and margin.
Clean records – organized client and caregiver files, compliance documents, and contracts ready to share.
Integrated past acquisitions – if you’ve bought agencies, get them fully integrated (systems, reporting, processes) and let that stability show up in your numbers.
Operational consistency – keep running the business like you’ll own it for years; buyers want to see stability, not a short-term pre-sale push followed by decline.
“Being ready to sell and answering those questions is really important. It really speeds up the process.”
Looking Ahead: Demand Isn’t Going Anywhere
Despite policy shifts and reimbursement debates, Tinsley is confident about the long-term fundamentals of home- and community-based personal care:
“My services aren’t going away… the demand for my services, the desire to have it in their home isn’t going away.”
Help at Home’s strategy is built around that reality: dense local markets, strong culture, compliant operations, and disciplined acquisitions that can be integrated and grown over time.
Final Thoughts
Rich Tinsley’s session offered a clear view into how a scaled, strategic buyer in personal care services thinks about value, risk, and partnership. His emphasis on culture, compliance, sustainable economics, and preparation aligns closely with what we see across the broader M&A market in home-based care.
Whether you’re actively preparing for a transaction or simply planning for the next 3–5 years, these are the levers buyers are looking at long before they ever submit an LOI.
👉 To watch the recording of the full webinar, visit: https://www.mertztaggart.com/behind-the-curtain
Are you contemplating a sale of all or a portion of your healthcare services company?
Arrange a confidential discussion with our M&A experts via info@mertztaggart.com.
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