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Ownership Concentration in Home Health and Hospice
Corporate-family structure reaches half of skilled nursing and about one in seven home health agencies. 2,897 of the 5,805 Medicare-certified skilled nursing facilities in the seven covered states sit inside a resolved multi-entity corporate family (49.9%). For home health the figure is 1,137 of 7,398 (15.4%), and for hospice 705 of 2,816 (25.0%). Chain ownership is not simply less concentrated in home health and hospice: it is far less prevalent.
How Far Corporate Ownership Reaches into Each Care Setting
| Care setting | Medicare-certified providers | In a resolved corporate family | Reach | Median family size | Families holding one provider |
|---|---|---|---|---|---|
| Skilled nursing | 5,805 | 2,897 | 49.9% | 3 | 7.9% |
| Home health | 7,398 | 1,137 | 15.4% | 2 | 43.3% |
| Hospice | 2,816 | 705 | 25.0% | 1 | 52.4% |
Within the resolved base the ten largest families hold 22.1% of skilled nursing, 24.7% of home health and 28.9% of hospice. Those shares look similar, and they are the figure most often quoted, but they describe different fractions of each market: the resolved base is half of skilled nursing and a seventh of home health. The reach column is the comparable number.
Largest Home Health Companies by Agency Count
| Corporate family | Home health agencies | Share of the resolved base |
|---|---|---|
| Bayada Home Health Care, Inc. | 44 | 3.9% |
| Centerwell Health Services Holding Corp | 42 | 3.7% |
| AHM Texas LP, Inc | 38 | 3.3% |
| Pediatric Services of America LLC | 35 | 3.1% |
| Maxim Healthcare Services Holdings, Inc. | 27 | 2.4% |
| TVG NP Homecare Acquisition, Inc. | 26 | 2.3% |
| Choice Rehab Holdings, Inc. | 20 | 1.8% |
| Integracare Intermediate Holdings Inc | 19 | 1.7% |
| Afam Holding Co LLC | 15 | 1.3% |
| Kaiser Foundation Hospitals | 15 | 1.3% |
Largest Hospice Companies by Provider Count
| Corporate family | Hospices | Share of the resolved base |
|---|---|---|
| HHCS Managers LLC | 37 | 5.2% |
| Odyssey Healthcare Inc. | 29 | 4.1% |
| Vitas Hospice Services, LLC | 24 | 3.4% |
| Heart To Heart Hospice Holdings LLC | 23 | 3.3% |
| Cornerstone Healthcare Inc | 22 | 3.1% |
| Care Hospice, Inc. | 16 | 2.3% |
| Suncrest Health Services LLC | 15 | 2.1% |
| Kaiser Foundation Hospitals | 14 | 2.0% |
| Southerncare Holdings, Inc. | 12 | 1.7% |
| Three Oaks Hospice, Inc. | 12 | 1.7% |
What This Means for Screening a Counterparty
In skilled nursing, finding the corporate family is usually the work, because most facilities have one. In home health and hospice the more common answer is that there is no family above the operator: 43.3% of resolved home health families and 52.4% of resolved hospice families hold a single provider, and the median resolved family holds 2 agencies and 1 hospices respectively. Diligence heuristics carried over from skilled nursing will expect a parent that frequently is not there.
Counts are Medicare-certified providers in California, Texas, Florida, Ohio, Illinois, Pennsylvania and New York. A provider outside the resolved base is not necessarily independent; it is a provider for which no multi-entity family is resolved from the integrated filings.
Full state coverage is in the state ownership dataset. Free hubs: home health agency ownership and hospice ownership.