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

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Home-based care executives say buyers are looking beyond EBITDA to sustained organic growth, clinical quality and cohesive leadership when evaluating acquisitions. Some buyers are also keeping sellers involved after closing through executive roles, operating partnerships or continuing ownership.

Home-based care acquisitions are increasingly extending beyond the closing table, with buyers weighing sustainable growth, clinical quality and leadership alongside earnings, executives said at Home Health Care News’ FUTURE conference. Some buyers also seek to retain sellers as executives, operating partners or minority owners, making a sale a continuing relationship rather than an automatic 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 sellers strengthen their case by showing organic growth, infrastructure and a team capable of supporting the business. He urged operators not to settle into a plateau, saying that apparent staleness can weigh on a company’s perceived value.

Clinical quality is another consideration, according to Aveanna Healthcare CEO Jeff Shaner. He said he would favor a slower-growing business with stronger quality over a faster-growing company that lacks the same commitment to care. Shaner argued that financial results are connected to clinical outcomes, framing quality as a long-term business consideration rather than a trade-off against performance.

Leadership and culture also shape buyer confidence, said Bill Mixon, an executive partner at private equity firm Waud Capital. A management team that appears divided can shift early discussions toward whether the company has the leadership needed for its next stage, he said. The conference comments describe executives’ views on dealmaking; they do not establish a single valuation formula or prove that every buyer is changing its approach.

Post-deal arrangements vary by company. Shaner said Aveanna seeks to make sellers equity owners and leaders in acquired operations. Distefano, a co-founder of A Place At Home, remained with the company as chief operating officer after its acquisition by Dovida in February. A Place At Home also uses joint ventures in which franchise owners can retain minority stakes and continue as general managers.

Growth and Quality Shape Deal Value

The reported shift matters to prospective sellers because a strong earnings figure may not tell buyers whether the company has durable growth, effective management or care quality they can maintain after a transaction. Sellers may need to show how operations, staffing and leadership support future performance, not just present financial results.

Continuing roles can also change what a sale means for founders and local operators. Retained equity or leadership positions may give sellers an ongoing stake in the company’s results, while giving buyers continuity in management and operations. These arrangements can align interests, but they also mean that closing may not mark the end of a seller’s involvement or responsibilities.

For care organizations, quality remains part of the business case in the executives’ account. Shaner’s comments suggest that growth achieved without comparable clinical commitment may be less attractive to his company. That is a stated buyer perspective, not evidence that all investors prioritize quality in the same way or that any particular outcome is guaranteed.

Recent Deals Illustrate Retained Roles

Aveanna’s acquisition of Family First Homecare provides a recent example of continued expansion in the sector. The company closed its $175.5 million purchase in June, adding 27 locations across seven states, according to the source report. Shaner’s conference remarks on quality and seller involvement came as the company was expanding its footprint.

A Place At Home’s ownership change also involved an ongoing leadership role. Dovida acquired the company in February, and co-founder Distefano was named chief operating officer after the deal closed. The company provides non-medical in-home care, care coordination and other services across 22 states, the report said. Its franchise joint ventures can also allow owners to keep minority ownership and remain general managers.

The comments came from a conference panel featuring executives connected to a care provider, a private equity firm and a franchise business. They offer a snapshot of how those participants view current deal considerations, rather than a comprehensive survey of transactions across the home-based care market.

“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 Is the Deal Shift?

The conference discussion does not quantify how common these practices are across home-based care transactions. The report provides examples and perspectives from executives, but no market-wide data on seller retention, minority ownership, valuation methods or the share of deals that use these structures.

Specific transaction terms were not detailed for the examples discussed. The report does not set out how long former owners remain in leadership, what equity stakes they may hold, or how those roles affect governance and operating decisions. It is also unclear how buyers balance earnings, growth, care quality and leadership when those measures point in different directions.

Future Deals Will Test the Model

Prospective transactions will show how widely buyers use these priorities in practice. Sellers and buyers will still need to negotiate valuation, management responsibilities and post-close ownership terms deal by deal; the conference comments do not announce a new industry-wide rule or standard.

Further details may emerge as companies report acquisitions and operating plans, including whether founders remain in leadership and how buyers assess growth and clinical performance after closing. For now, the panelists’ remarks point to an evolving approach, while the prevalence and long-term results of retained-seller arrangements remain undetermined.

Key Questions

What are buyers reportedly considering beyond EBITDA?

Panelists cited sustained organic growth, clinical quality, infrastructure, leadership and company culture as factors that can inform how buyers view a business. The remarks describe their perspectives, not a universal valuation formula.

Do sellers always leave after a home-based care acquisition?

No. Shaner said Aveanna seeks to keep some sellers involved as leaders and equity owners. Distefano stayed on as A Place At Home’s chief operating officer after its acquisition, but the source does not say that all sellers remain after a deal.

Which recent acquisitions 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, with co-founder Dustin Distefano taking a leadership role after closing.

Is there evidence that all buyers now use these criteria?

No market-wide evidence was provided. The report recounts comments by executives at a conference and gives selected company examples. It does not quantify how common these priorities or post-sale arrangements are across the sector.

Source: rss