Private Equity Pathways into Home Care: The Case of New York State

This paper traces private equity’s growing footprint in New York State’s home care industry over the past decade. We document how financial actors’ dealmaking in publicly-financed long-term care can drive instability and reshape the care system, leading profiteering to drive decisions and overshadow the healthcare mission. In tracing the federal and state policy landscape, we demonstrate how financial actors’ profit extraction has been enabled by weak federal and state regulation of health and labor policy as well as opaque public and private payment systems. A primary pathway of wealth extraction occurs through the exploitation of a workforce with historically poor wages and working conditions, thereby perpetuating the long-standing effect of structural racism on women of color in healthcare and the labor market.

• While private equity has been quietly but steadily carving out a foothold in New York State home care over the past decade, its presence sharply expanded in 2025 to control around half of the state’s home care delivery.
• This level of dealmaking, debt refinancing, and dividend recapitalizations reveals how private equity firms have used home care agencies to extract wealth for themselves and their investors, while loading excessive debt—and therefore risk—on the agencies.
• Our analysis suggests that PE-backed home care agencies in New York State derive most of their home care revenue from Medicaid.
• Our analysis indicates that PE-backed agencies in New York State received over $2.32 billion in Medicaid revenue in 2022.
• Private equity firms’ drive to generate outsized profits as quickly as possible raises concerns about cost-cutting measures that may diminish care quality, job quality, and overall compliance with regulations. New York’s home care industry is rife with labor and compliance violations, including rampant wage theft that puts the industry among the worst violators in New York City and the state. PE-backed home care agencies in New York have perpetuated some of these alarming practices. 
• In some cases, agencies have been penalized for harmful practices—including wage theft, fraud, and serious safety violations—while under private equity ownership, both locally and across the national chains. In other cases, private equity firms have acquired NYS home care agencies with egregious records of labor and compliance violations, raising sharp questions about the implications of private equity firms—who have exceptional due diligence processes—buying up home care agencies known for violating and driving down standards.
• Financial actors’ wealth extraction in the home care industry has been enabled by weak federal and state regulation of health and labor policy as well as opaque public and private payment systems.