Services for the Elderly and Persons with Disabilities (NAICS 624120)

A Histometrics industry primer for public- and private-market investors

1. Overview

The North American Industry Classification System (NAICS) code 624120 covers the businesses that help older adults and people with disabilities live outside of an institution — in their own homes or in the community — through non-medical support. Think help with bathing, dressing, meals, medication reminders, housekeeping, errands, companionship, and supervised adult day programs. It is the "person" (custodial and social) half of long-term care, as distinct from the "clinical" (skilled-nursing and therapy) half.[1]

This is a labor-intensive, low-capital, locally delivered industry. Demand is recurring and need-driven, but profitability turns on caregiver availability, reimbursement rates, service utilization, and compliance — not on pricing power. The money is overwhelmingly government money — mostly Medicaid — so returns are shaped less by what an operator can charge than by what the state pays, whom it can hire, and how well it stays inside the rules.

Why it matters: this is one of the most demand-durable service industries in the U.S. economy. The population is aging, families increasingly want to "age in place" rather than enter a nursing home, and federal policy has spent two decades deliberately shifting long-term-care dollars from institutions into the home. Home health and personal care aides are already one of the largest occupations in the country and the one projected to add more new jobs than any other through 2034.[7]

Public vs. private ways in. There are very few pure public-market plays; the cleanest is Addus HomeCare (Nasdaq: ADUS).[18][19] Most of the industry is owned privately: nonprofits, county and municipal programs, tens of thousands of small independent agencies, private-equity-backed roll-ups (Help at Home, Sevita), and franchise networks (Home Instead, Comfort Keepers, Visiting Angels). Private investors reach it through those platforms, franchise ownership, private credit to operators, or the enabling-technology and staffing vendors around it. The long-term demand case is strong; returns will depend more on operating execution and reimbursement discipline than on broad industry growth alone.

2. What it is, and what it excludes

In scope (624120): establishments providing nonresidential social assistance to improve daily life for the elderly or for people with intellectual and/or developmental disabilities (I/DD). That includes:

• Non-medical assistance with activities of daily living (ADLs) — bathing, dressing, meals, housekeeping, errands.
• Homemaker, personal-care, companion, and respite services that help people remain at home.
• Adult day-care and adult day-services centers, senior activity centers.
• Disability and community-based support, self-help and support organizations.[1]

Explicitly excluded — and this is the key to sizing the industry correctly:

These boundaries matter because the adjacent industries have different staffing, reimbursement, licensing, and financial profiles. It is also why big "home care" names like Amedisys, Enhabit, and much of Aveanna are only partly relevant here: they are largely medical home health (621610), and senior-living operators like Brookdale are residential care (623), not 624120.[1]

Ownership mix. The industry is a patchwork: for-profit agencies (single-office operators to national roll-ups), nonprofits and faith-based providers, government-operated Area Agencies on Aging programs, franchised networks, and — very importantly — individual providers, including family members paid to care for a relative through Medicaid "self-directed" (consumer-directed) programs. The federal statistics do not provide a clean public/private/nonprofit ownership split.

3. How big it is

Our ground-truth federal figures for the employer side of 624120:

(The two Census products carry different reference years — CBP 2023 for the employer counts, Economic Census 2022 for firms/receipts/concentration — so treat them as adjacent snapshots, not a single year.)

Read the concentration numbers carefully. On the standard Herfindahl-Hirschman scale of 0–10,000 (where a single-firm monopoly scores 10,000), an HHI of 7.3 and a top-4 revenue share of just 3.4% describe one of the most fragmented industries in the entire economy. The fifty largest firms together hold under 16% of revenue.[3] There is no dominant national provider. The Small Business Administration (SBA) $15 million size standard is a federal-program threshold, not an estimate of typical company revenue.[4] Reported payroll is well over half of receipts, underscoring how labor-intensive the work is.

The undercount caveat is large here. These business statistics count establishments with paid employees, and they materially understate the true footprint of the service:

• County Business Patterns (CBP) covers only establishments with payroll — it excludes the self-employed, employees of private households, and most government employees.[5] Nonemployer statistics are published separately and are not in our figures.[6]
• That omits the enormous self-directed workforce — often family members paid directly through Medicaid fiscal intermediaries — who are not organized as "establishments," plus much government-run and nonprofit activity.
• For scale, the Bureau of Labor Statistics (BLS) counts on the order of 3.8 million home health and personal care aides economy-wide — far more than 624120's ~1.5 million payroll employees — because that occupation also spans medical home health (621610) and residential care (623).[7]

A better gauge of the dollars in motion is public spending. Roughly 4.5 million people receive Medicaid home-care services in a year,[9] and Medicaid home- and community-based services (HCBS) spending reached about $145.9 billion in 2023 — roughly 64% of all Medicaid long-term-services-and-supports (LTSS) spending, up more than 50% since 2019.[10] In 2021, HCBS already represented 86.2% of LTSS users and 63.2% of LTSS expenditures.[8] Non-medical personal care is one of the largest slices of that. Third-party research firms size the broader U.S. home-care market well into the hundreds of billions, but those estimates blend medical and non-medical care and use looser definitions, so treat them as directional rather than official.

4. The investable universe

There are few public pure-plays, and that is the single most important fact for a stock-market investor here. The industry's economics — Medicaid-dependent, low-margin, labor-limited — have kept most of it private. Public operators almost always span multiple NAICS codes, so separate the 624120 revenue from clinical, residential, pharmacy, and landlord businesses before assigning an industry thesis.

Public companies with 624120 exposure

Note: Amedisys is primarily home health and hospice (adjacent, not 624120). Enhabit was acquired by Kinderhook Industries and taken private in May 2026, so it is no longer a listed option — and it too was mainly clinical home health/hospice.[33]

Major private and other owners

• Help at Home — among the nation's largest personal-care providers; owned by Centerbridge Partners and The Vistria Group; almost entirely Medicaid-funded.[29]
• Sevita — a major U.S. provider of home- and community-based services for people with I/DD (roughly 50,000 individuals across ~40 states, on the order of $3B revenue); held through a Centerbridge continuation vehicle with Vistria among the investors. Its acquisition of BrightSpring's Community Living (ResCare) I/DD business was subject to a Federal Trade Commission (FTC) consent order finalized in 2026.[26][27][28]
• Franchise networks (mostly private-pay): Home Instead (~1,100 locations, owned by Honor Technology), Comfort Keepers (~700, Sodexo), Visiting Angels (~600–700 territories), Right at Home (~500+), plus BrightStar Care (acquired by a Peak Rock Capital affiliate with founder Shelly Sun Berkowitz), Interim HealthCare / Caring Brands International (Wellspring Capital), Senior Helpers, Griswold, and Synergy HomeCare.[30][31][32][34]
• Nonprofit, county, and Area Agency on Aging programs, and tens of thousands of independent local agencies.

Bottom line: the public menu is thin and small-cap; the deepest exposure lives in private equity and franchising.

5. How the money works

This is a reimbursement-and-labor business, not a pricing business. Owners make money on a spread, and the two levers are rate and volume.

Revenue = billable hours × effective reimbursement rate (in-home personal care), or participant-days × per-diem rate (adult day centers). Volume is governed by the hours a payer authorizes per client and by how many clients an agency can actually staff.[18] The core margin is the spread between what a payer pays per hour and what it costs to deliver that hour — mostly the caregiver's wage plus payroll taxes and benefits, then mileage, recruiting, training, scheduling, supervision, insurance, and compliance spread across volume. Because the work is labor — not buildings or equipment — the business is capital-light; the main balance-sheet item is Medicaid receivables (payroll is paid before reimbursement is collected), which is why roll-up acquirers can grow largely on operating cash flow and debt.

Payer mix defines the model:

• Medicaid and Medicaid MCOs are the dominant payer for personal care and I/DD services. States set eligibility, service authorization, rates, and waiver design, so this is a rate-taker business with thin, policy-sensitive margins.[8][37] As a concrete illustration, Addus reported its 2025 personal-care revenue as 50.8% from state/local/other government programs, 46.0% from MCOs, 2.6% private pay, and 0.5% commercial.[18]
• Private pay is the model for most franchise brands (families paying out of pocket, often $30+/hour). Higher rate, but demand is discretionary and capped by household wealth.
• Original Medicare generally does not cover long-term custodial help with bathing, dressing, eating, and similar daily activities — an important limit on the payer set.[13] Veterans Affairs (VA) programs, the Older Americans Act, and some long-term-care insurance fill smaller niches.

The binding constraint is labor, not demand. Agencies routinely turn away authorized clients because they cannot hire and keep aides. The median home health/personal-care aide earned about $34,900 a year (May 2024), and turnover runs very high.[7] So "same-store sales" matters less here than the operating metrics that actually govern the spread:

• Authorized hours versus hours actually filled (fill rate).
• Revenue per billable hour and wage cost per billable hour.
• Caregiver retention, turnover, and vacancy rates.
• Client retention and service hours per client; census/occupancy for adult day centers (participants per day against licensed capacity).[36]
• Payer mix and reimbursement-rate changes.
• Denials, recoupments, and days sales outstanding (DSO).
• Quality incidents and complaint rates; organic vs. acquired growth.

Regulation now shapes the margin directly. The federal 80/20 rule (Section 7) will require 80% of Medicaid payments for homemaker, home-health-aide, and personal-care services to flow to direct-care-worker compensation — capping the share available for overhead and profit once phased in.[14]

6. What drives demand

• Aging. The U.S. population age 65 and older reached 61.2 million in 2024 (18.0% of the population), up 3.1% in a single year, as the Baby Boom ages; the 85-plus cohort — the heaviest users of care — grows fastest. This is the most reliable tailwind in the industry.[11]
• Disability prevalence. The Census American Community Survey (ACS) reports 13.3% of the U.S. population has a disability, and people with I/DD are living longer and being served in community settings.[12]
• Aging in place. Older adults consistently prefer to stay home, and home care is far cheaper per person than a nursing home, which aligns families, payers, and policymakers.[9]
• The institutional-to-home policy shift. Medicaid explicitly frames HCBS as an alternative to institutional care; HCBS was already 86.2% of LTSS users and 63.2% of expenditures in 2021 and has grown far faster than institutional spending since.[8][10]
• Workforce demand. BLS projects employment of home health and personal care aides to grow 17% from 2024 to 2034 — among the fastest of any occupation.[7]
• Family-caregiver strain. A shrinking ratio of working-age relatives per older adult pushes families toward paid help, including Medicaid self-directed programs that pay family caregivers.[9]

The demand ceiling here is not need — it is funding and workforce. HCBS waiver waiting lists are long in many states, meaning demand routinely exceeds what budgets and staffing can serve.[9] The industry is less cyclical than discretionary consumer services, but private-pay demand is sensitive to household income, and Medicaid demand is sensitive to state budgets and rate policy.

7. Regulation

Regulation is primarily at the state level (licensing, Medicaid rate-setting, waiver design), layered on federal Medicaid and labor requirements.

• Medicaid HCBS waivers (1915(c) and 1115). States run hundreds of distinct home-care programs; most personal-care and I/DD funding flows through 1915(c) waivers, so rules, rates, and eligibility vary widely by state, alongside person-centered service plans and health-and-safety protections.[37]
• The "80/20" Access Rule (CMS-2442-F, 2024). The Centers for Medicare & Medicaid Services (CMS) will generally require that at least 80% of Medicaid payments for homemaker, home-health-aide, and personal-care services go to direct-care-worker compensation. The compensation threshold applies beginning July 9, 2030 (with earlier reporting requirements and specified flexibilities/exemptions). It is designed to raise wages and stabilize staffing — but it also compresses the overhead-and-profit envelope, and its long runway leaves it exposed to policy change.[14]
• Electronic Visit Verification (EVV). The 21st Century Cures Act requires states to electronically verify Medicaid personal-care visits (since 2020) and home-health visits (since 2023) — caregiver clock-in/out, service, and location. This is a compliance cost and a data/technology requirement for every Medicaid provider.[15]
• Program integrity. CMS separately flags personal-care services as a program-integrity risk area because of billing and documentation vulnerabilities, so claims, timekeeping, record-retention, and incident-reporting controls carry real audit and recoupment exposure.[16]
• Labor and wage-and-hour rules, background checks, and state training/certification standards for aides.

8. Competitive dynamics and consolidation

The industry is hyper-fragmented (CR4 of 3.4%, HHI 7.3), which makes it a classic roll-up target.[3] The strategic logic: buy small local agencies, plug them into shared scheduling, compliance, recruiting, and billing infrastructure, gain density within a state's Medicaid market, and negotiate from a larger base with managed-care payers.

• Private equity is the dominant consolidator. Centerbridge and Vistria built Help at Home (personal care) and Sevita (I/DD) into national platforms; KKR built BrightSpring.[26][29] In 2025–26, Sevita acquired BrightSpring's Community Living (ResCare) I/DD business — a deal notable enough to draw an FTC consent order, a reminder that even in a fragmented national market, competition is intensely local and antitrust attention can attach to regional concentration.[28]
• Addus grows the same way in the public market — acquiring personal-care agencies to build state density.[18]
• Franchising consolidates the private-pay segment under a handful of brands (BrightStar to Peak Rock; Caring Brands to Wellspring) while leaving unit ownership local.[31][32]

Competition is less about price (rates are set by payers) and more about caregiver supply, referral relationships (hospitals, MCOs, physicians, case managers, discharge planners), operational compliance, and technology that reduces missed visits and admin cost. The firm that can staff the hours wins the contract. The consolidation thesis is a platform-and-local-density thesis, not a national-monopoly thesis.

Note on scrutiny. The private-equity roll-up wave has drawn state-regulator and journalistic attention over care quality, staffing, and dividend recaps at Medicaid-funded providers — a reputational and political risk factor for the segment.[35]

9. Risks

• Medicaid rate and budget risk (the dominant risk). Revenue is a policy variable — rates, authorization rules, waiver limits, MCO contracts, and state budgets can change faster than providers can adjust. Because HCBS is technically "optional" Medicaid spending, it is a prime target when states must close budget gaps. Analyses of the 2025 federal budget-reconciliation law estimate roughly $990 billion in federal Medicaid funding cuts over a decade plus new work requirements (the Congressional Budget Office scored ~$326 billion of the savings from work-requirement provisions), which could pressure HCBS rates, eligibility, and waiver waitlists.[17]
• Labor shortage and turnover. Low wages (~$34,900 median), hard work, and high turnover make hiring and retention the perennial ceiling on growth; wage inflation can erase the reimbursement-to-cost spread.[7]
• Margin compression from the 80/20 rule. Mandating 80% pass-through to worker pay squeezes overhead and profit for providers that can't offset it with scale.[14]
• Payer concentration. Agencies dependent on one state, waiver, MCO, or referral source have limited negotiating power and slow-paying receivables.[18]
• Regulatory/compliance and program-integrity risk. EVV, licensing, background checks, and billing/documentation oversight raise the cost of doing business — and of a misstep (recoupments, sanctions, lost contracts).[15][16]
• Private-pay cyclicality. The franchise segment depends on household budgets and can soften in a downturn.
• Acquisition and capital-structure risk. Roll-ups can overpay, inherit compliance liabilities, or fail to integrate; PE ownership adds leverage and refinancing exposure.
• Measurement/purity risk. Federal statistics undercount nonemployers and household-based work, and listed companies mix 624120 with clinical, pharmacy, residential, or REIT businesses — weakening the cleanliness of any public-market exposure.[5]

10. How to invest, and the outlook

Public routes. The most direct listed exposure is Addus HomeCare (ADUS), a small-cap whose Personal Care segment is a genuine 624120 business (~76.6% of ~$1.4B revenue; roughly $2.0B market cap at ~19x earnings in mid-2026).[18][19][20] BrightSpring (BTSG) offers indirect exposure through its All Ways Caring personal-care line, but is mostly a pharmacy-and-provider conglomerate.[21] Aveanna (AVAH) is a mixed home-based platform. Pennant (PNTG) and Brookdale (BKD) are adjacent/residential, and Welltower/CareTrust/Ventas are landlords, not operators.[23][24][25] There is no broad, clean ETF for this niche; investors approach it through healthcare-services or home-care baskets that mix in medical providers.

Private routes — where most of the capital actually sits:

• Direct acquisition of a local/regional personal-care agency.
• Participation in private-equity roll-up platforms (the Help at Home / Sevita model).
• Franchise ownership in a private-pay brand.
• Private credit to agencies or consolidators.
• Enabling software and staffing vendors (EVV, scheduling, caregiver recruiting, Medicaid billing) that every agency now needs — and, adjacently, senior-housing real estate leased to care operators.

Key underwriting questions (private or public): What share of revenue is Medicaid vs. MCO vs. private pay? How often have rates changed in the relevant states? Are authorized hours actually being filled? What are caregiver turnover, wage, and vacancy trends? How concentrated are clients, payers, referral sources, and geography? Are EVV, billing, background-check, and licensing systems clean? What audits, denials, or repayment claims exist? Is any acquisition priced on durable cash flow or optimistic synergies — and does debt stay serviceable if reimbursement growth slows?

Near-term drivers to watch:

1. The 2025 Medicaid law's rollout — how states translate ~$990B in federal cuts into HCBS rates, eligibility, and waiver waitlists is the swing factor for the whole industry.[17]
2. The fate and phase-in of the 80/20 rule — enforced as written, it lifts wages but caps provider margins; watered down or delayed, the reverse.[14]
3. Wages and caregiver supply — any easing of the labor shortage directly unlocks stranded, already-authorized demand.[7]
4. Consolidation pace — continued PE roll-ups and public-company M&A in a fragmented field.[3]

The judgment. Demand for this industry is about as secure as any in the economy — the demographics are locked in and policy favors home over institution. But it is a government-funded, labor-constrained, low-margin business, so the investable upside is less about riding a growth wave than about operational execution and reimbursement navigation: staffing the hours, running compliant and dense, diversifying payers, and buying well in a fragmented market. The likely winners combine local density, high caregiver retention, disciplined billing, and careful M&A. For public-market investors that means a short, small-cap list led by Addus; for private investors it is a deep, hands-on, roll-up-and-franchise opportunity where scale and staffing — not pricing — determine who wins. The principal threat to returns is not lack of demand; it is the inability to convert demand into adequately reimbursed, reliably staffed, compliant service hours.

---

Sources

1. U.S. Census Bureau. "North American Industry Classification System — 624120, Services for the Elderly and Persons with Disabilities." 2022. https://www.census.gov/naics/?details=624120&input=624120&year=2022
2. U.S. Census Bureau. County Business Patterns 2023, NAICS 624120 (establishments, paid employees, annual and Q1 payroll). https://data.census.gov/table/CBP2023.CB2300CBP?codeset=naics~624120&g=010XX00US
3. U.S. Census Bureau. 2022 Economic Census — Concentration of Largest Firms, NAICS 624120 (firms, receipts, CR4/CR8/CR20/CR50, HHI). https://data.census.gov/table/ECNSIZE2022.EC2200SIZECONCEN?codeset=naics~624120&g=010XX00US
4. U.S. Small Business Administration. Table of Small Business Size Standards (NAICS 624120 = $15M receipts). 2023. https://www.sba.gov/document/support-table-size-standards
5. U.S. Census Bureau. "County Business Patterns Methodology" (coverage: excludes self-employed, private-household, most government employees). https://www.census.gov/programs-surveys/cbp/technical-documentation/methodology.html
6. U.S. Census Bureau. "Nonemployer Statistics, 2022," NAICS 624120. https://data.census.gov/table/ABSNESD2022.AB00MYNESD01B?codeset=naics~624120
7. U.S. Bureau of Labor Statistics. Occupational Outlook Handbook, "Home Health and Personal Care Aides" (median wage $34,900, May 2024; +17% projected 2024–34). https://www.bls.gov/ooh/healthcare/home-health-aides-and-personal-care-aides.htm
8. Medicaid.gov (CMS). "Home & Community-Based Services" (HCBS = 86.2% of LTSS users, 63.2% of LTSS expenditures, 2021). https://www.medicaid.gov/medicaid/home-community-based-services
9. KFF. "Medicaid Home Care (HCBS) in 2025" (~4.5 million people; aging-in-place; waiver waitlists). 2025. https://www.kff.org/medicaid/medicaid-home-care-hcbs-in-2025/
10. MACPAC. "Spending and Utilization for Medicaid Home- and Community-Based Services" ($145.9B, 2023; ~64% of LTSS). July 2025. https://www.macpac.gov/publication/spending-and-utilization-for-medicaid-home-and-community-based-services/
11. U.S. Census Bureau. "Older Adults Outnumber Children…" (65+ = 61.2 million / 18.0%, +3.1% 2023–24). 2025. https://www.census.gov/newsroom/press-releases/2025/older-adults-outnumber-children.html
12. U.S. Census Bureau. "Disability — American Community Survey" (13.3% of population). https://www.census.gov/acs/www/about/why-we-ask-each-question/disability/
13. Medicare.gov. "Nursing Home Care" / custodial-care coverage limits. https://www.medicare.gov/coverage/nursing-home-care
14. CMS. "Ensuring Access to Medicaid Services Final Rule (CMS-2442-F)" — 80/20 payment-adequacy provision, effective July 9, 2030. 2024. https://www.cms.gov/newsroom/fact-sheets/ensuring-access-medicaid-services-final-rule-cms-2442-f; Medicaid.gov, "Access Final Rule — HCBS Payment Adequacy Slides," July 2024. https://www.medicaid.gov/medicaid/access-care/downloads/access-final-rule-slides-july-2024.pdf
15. Medicaid.gov (CMS). "Electronic Visit Verification" (21st Century Cures Act, Sec. 12006). https://www.medicaid.gov/medicaid/home-community-based-services/guidance/electronic-visit-verification
16. Centers for Medicare & Medicaid Services. "Personal Care Services" / program-integrity risk area. 2025. https://www.cms.gov/medicare/medicaid-coordination/states/personal-care-services
17. KFF and Justice in Aging. Analyses of Medicaid provisions in the 2025 federal budget-reconciliation law (HCBS, work requirements; CBO scoring). 2025. https://www.kff.org/medicaid/tracking-the-medicaid-provisions-in-the-2025-budget-bill/
18. Addus HomeCare Corp. Form 10-K, FY2025 (segment and personal-care payer detail). U.S. SEC, 2026. https://www.sec.gov/Archives/edgar/data/1468328/000143774926005352/adus20251231_10k.htm
19. Addus HomeCare. "Fourth Quarter and Year-End 2025 Financial Results." 2026. https://addus.gcs-web.com/news-releases/news-release-details/addus-homecare-announces-fourth-quarter-and-year-end-2025-0
20. CNN Markets / Public.com. "Addus HomeCare (ADUS) market capitalization and price." Mid-2026. https://www.cnn.com/markets/stocks/ADUS
21. BrightSpring Health Services, Inc. Form 10-K, 2025 (Provider Services and personal-care revenue). https://ir.brightspringhealth.com/static-files/2ed2f042-7de1-4ecb-b388-276e8719e580
22. Aveanna Healthcare. Form 10-K, 2024 (2024 payer mix). https://ir.aveanna.com/static-files/d92986f7-1142-480e-a23f-a6652d5968e3
23. The Pennant Group. Form 10-K, 2025 (agency and senior-living counts). SEC, 2026. https://www.sec.gov/Archives/edgar/data/1766400/000176640026000014/pntg-20251231.htm
24. Brookdale Senior Living. Form 10-K, 2025 (584 communities; 93.9% private-pay resident-fee revenue). SEC, 2026. https://www.sec.gov/Archives/edgar/data/1332349/000133234926000032/bkd-20251231.htm
25. Welltower, CareTrust REIT, and Ventas. Form 10-K, 2025 (senior-housing real-estate exposure). SEC, 2026. https://www.sec.gov/Archives/edgar/data/766704/000076670426000010/well-20251231.htm
26. Sevita. "About Us" (I/DD home- and community-based services). 2026. https://sevitahealth.com/about-us/
27. The Vistria Group. "2024 Impact Report" (Sevita / Help at Home ownership). 2024. https://vistria.com/wp-content/uploads/2024/12/2024_Vistria_ImpactReport_sml.pdf
28. Federal Trade Commission. "FTC Finalizes Consent Order in Sevita-BrightSpring Acquisition." 2026. https://www.ftc.gov/news-events/news/press-releases/2026/06/ftc-finalizes-consent-order-sevita-brightspring-acquisition
29. Centerbridge Partners. "Help at Home Acquired by Centerbridge Partners and The Vistria Group." https://www.centerbridge.com/news/help-at-home-acquired-by-centerbridge-partners-and-the-vistria-group-from-wellspring
30. Honor. "Honor Acquires Home Instead." 2021. https://www.honorcare.com/news/honor-acquires-home-instead/
31. BrightStar Care. "Peak Rock Capital Affiliate Completes Acquisition of BrightStar Care." 2025. https://www.prnewswire.com/news-releases/peak-rock-capital-affiliate-completes-acquisition-of-brightstar-care-302389490.html
32. Interim HealthCare / Caring Brands International. "Wellspring Capital Management Acquires Caring Brands International." 2021. https://www.prnewswire.com/news-releases/wellspring-capital-management-acquires-caring-brands-international-301407211.html
33. Kinderhook Industries. "Enhabit Completes Acquisition by Kinderhook Industries to Become a Private Company." May 2026. https://www.kinderhook.com/press-release/enhabit-completes-previously-announced-acquisition-by-kinderhook-industries-to-become-a-private-company/
34. Home Health Care News. Home-care franchise rankings (Home Instead, Comfort Keepers, Visiting Angels, Right at Home). 2025. https://homehealthcarenews.com/2025/10/14-home-based-care-companies-earn-spots-on-the-franchise-times-top-400-list/
35. Disability Scoop, Stateline, and Private Equity Stakeholder Project. Coverage of Sevita / Help at Home ownership, scale, and Medicaid dependence. 2025. https://www.disabilityscoop.com/2025/05/12/idd-providers-increasingly-swallowed-up-by-private-equity/31407/
36. National Adult Day Services Association (NADSA). "About Adult Day Services." https://www.nadsa.org/about/about-adult-day-services/
37. Medicaid.gov (CMS). "Home & Community-Based Services 1915(c)" (waiver authorities). https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities/home-community-based-services-1915c