Overview
This research project explored financialization in home care, tracing private equity’s growing footprint in New York State’s home care industry, the conditions that enabled it, and the impact of private equity ownership on home care workers’ jobs and the care they are able to provide.
Our focus on the home care industry was motivated by the aim of understanding how financialization affects a workforce that is disproportionately made up of women, people of color, and immigrants.
Reports
The culmination of our work on home care resulted in two reports. Our June report focuses on the nature of private equity's incursion into home care in New York State, as well as the policy and regulatory framework that makes the incursion possible. Our September report details findings from our two-year study to better understand the relationship between private equity ownership of New York State home care agencies and the quality of work and care.
Research Highlights
Report 1 Highlights
- 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.
Report 2 Highlights
- Private equity perpetuates poor wages and working conditions for home care workers, taking advantage of the existing business models of for-profit home care agencies that depend on workforce exploitation. The problems that persisted both before and during private equity ownership included the following:
- Home care workers’ already low wages were compounded by different forms of uncompensated work, wage theft, and payroll errors.
- Unstable schedules and insufficient hours per week exacerbated home care workers’ financial insecurity and uncertainty.
- The nature and quality of benefits varied greatly—from no employment benefits that workers were aware of, to high-quality benefits at the one unionized home care agency included in the study.
- Management routinely neglected its responsibility to provide the support that workers needed to do their jobs well. Managerial neglect or incompetence manifested itself in two ways: severely deficient communication and coordination channels between management, workers, and clients; and agencies’ failure to respond to workers’ complaints about harassment and/or discrimination.
- Lack of access to agency staff often meant worse care for clients: agencies failed to adequately and accurately communicate the care needs of new clients, leaving workers to arrive with unclear, insufficient, and sometimes incorrect information about the client’s condition or care plan.
- Under private equity ownership, agencies often implemented new technologies designed to automate administrative processes and streamline worker-client coordination and communication with management. This increased automation and use of technology depersonalized workers’ and clients’ experiences, exacerbated the problems with managerial negligence described above, and undermined workers’ ability to provide quality care to clients.
- Our research also surfaced other financial actors—especially managed care organizations—whose actions appear to negatively affect job quality and standards of care.
