Hospice has emerged as a growth engine for publicly traded home-based care companies, several of which are on the hunt for acquisitions.

Hospice has buoyed growth for several companies as they battle home health-related headwinds, including reimbursement pressures. Companies like VITAS Healthcare, which only provide hospice and palliative care, also saw substantial growth. VITAS is a subsidiary of Chemed Corp. (NYSE: CHE).

VITAS’ current geographic service region spans 15 states. The company’s average daily census rose 13.1% to 22,244, and admissions were up 7.3% to 18.139. VITAS has seen 10 consecutive quarters of ADC growth. Overall, the company brought in $407.4 million in net patient revenue, a 15.1% increase year over year. 

VITAS attributes the revenue growth to an 11.9% increase in days-of-care and a geographically weighted average Medicare reimbursement rate increase of approximately 3.2%.

Hospice is also fueling growth at Addus Homecare (Nasdaq: ADUS). The company expects to achieve 5% to 7% hospice growth during 2025, according to a first quarter earnings call.

The company’s hospice business is emerging from the shadow of the pandemic, which hurt that business segment considerably more than it did Addus’ home health and personal care service lines. Early and sudden deaths among COVID patients significantly reduced national hospice utilization for several years.

“We expect a 5% to 7% revenue growth for hospice. We exceeded that in Q1. COVID had the biggest impact on hospice of any of our segments …,” CEO Dirk Allison said at the Bank of America Healthcare Conference. “Hospice was the one that has taken the longest to recover, and you’re now starting to see the favorable demographics of the aging population start to come back.”

Texas-headquartered Addus provides personal care, home health and hospice services in 23 states. Hospice represents 18% of Addus’ business, with the remainder made up by its personal care and home health segments. The company saw 9.9% year-over-year organic revenue growth during the first quarter, as well as higher average daily census, patient days and revenue per patient day.

The company’s net service revenues were $337.7 million for the first quarter of 2025, a 20.3% increase compared with $280.7 million for the prior year’s quarter. The Addus hospice segment earned more than $61 million in Q1 compared to $55.8 million in the first quarter of 2024.

A consistent trend

Similar trends exist for other publicly traded companies, including Aveanna Healthcare (Nasdaq: AVAH), Enhabit Inc. (NYSE: EHAB), The Pennant Group (Nasdaq: PNTG) and BrightSpring Health Services (Nasdaq: BTSG).

Amedisys Inc. (Nasdaq: AMED) reported revenue growth on a consolidated basis but did not report segment-specific financial results for Q1 2025.

Atlanta-headquartered Aveanna’s geographic footprint spans 34 states. The company provides adult and pediatric hospice, home health private duty nursing and medical solutions, among other services.

Aveanna saw growth across all of its business lines. Its home health and hospice segment revenue reached $56.7 million, a 3.9% year-over-year increase. Aveanna’s private duty services revenue hovered at $460 million, seeing a 16.5% million increase compared to Q1 last year. Its medical solutions segment brought in $42.5 million revenue, a 3.6% year-over-year rise.

Aveanna’s home health and hospice revenue growth was predominantly driven by patient census increases. The company saw 9,700 home health and hospice admissions in the first quarter. Its home health and hospice Q1 gross margin reached 54.2%, up 1.1% compared to the prior year’s period.

Aveanna’s overall revenue reached $559.2 million during the first quarter, a 14% year-over-year increase. Its adjusted EBITDA for Q1 was $67.4 million, a 93.1% rise compared to the same period in 2024.

“We’re pleased with our [results], and representing our continued focus on cost initiatives to achieve our target and margin profile,” Matt Buckhalter, CFO at Aveanna said during a Q1 earnings call. “This really gives us the underpinning to grow home health and hospice of that nature and get back to organic growth of our business. We’re really excited about where we are on the preferred payer strategy, and how it’s flowing through our clinical and financial outcomes … and just making us a stronger company.”

The Pennant Group saw record-high growth in its home health and hospice segment in Q1 2025. The company’s home health and hospice services segment revenue for the first quarter was $159.9 million, an increase of $43.4 million or 37.2% over the prior year quarter.

Hospice average daily census for the first quarter was 3,794, an increase of 832 or 28.1% year over year.

The company’s total Q1 revenue reached $209.8 million, up 33.7% over the first quarter of 2024.

“Our home health and hospice segment performance is at all time highs as we add quality acquisitions to robust organic growth,” said John Gochnour, the company’s president and COO, in a statement. “Our senior living segment is anchored by solid leaders whose results continue to improve. We are pleased to begin the year with a quarter that significantly exceeded our targets and commitments across the company.”

Average daily census growth propelled Enhabit to have a strong quarter for its hospice segment in early 2025.

With shortfalls in its home health business, hospice is a prime growth driver for Enhabit. The company’s hospice ADC rose 12.3% year over year to 3,809, up from 3,391 in Q1 2024. Enhabit also saw an 8% increase in admissions over the prior year’s quarter. Enhabit’s ADC has grown sequentially in every month since January 2024.

These successes can be attributed not only to increased referrals, but also to a timely response by the company’s hospice team, which is accelerated by the company’s case management model and regional consolidation of its admissions departments, according to CEO Barb Jacobsmeyer.

Enhabit operates more than 225 home health locations and 110 hospice locations across 34 states. For growth, the company is highly reliant on its de novo strategy. Enhabit opened one new location so far in 2025, with 13 more in the works, Jacobsmeyer said. Enhabit opened five new hospice operations during 2024, building on seven that were established during 2022 and 2023.

The company’s Q1 net service revenue reached $259.9 million, down from $26.4 million year over year, with the decline attributed to challenges in its home health business. Meanwhile, hospice revenue rose 20.5% to $59.3 million, up from $49.2 million in the prior year’s quarter.

“Our referrals were up in the first quarter year over year, about 3% but if you recall, last year, we put in regional admissions departments so that we can have a very quick and timely answer to our referral sources. I do think that has helped the conversion rate,” Jacobsmeyer said in a Q1 earnings call. “Our conversion rate was up 310 basis points. Our conversion rate is 79%. It is a combination of the referrals, but also some of the work that we put into that timely response.”

An appetite for acquisitions

Acquisitions are also on the menu for several of these companies, including VITAS, Addus and Aveanna.

Addus’ acquisition strategy focuses on pairing its clinical services with its personal care business across its existing markets. Its $350 million purchase of Gentiva’s personal care business line in December 2024 marked the largest acquisition in the home-based care provider’s history, according to CFO Brian Poff.

As it seeks for opportunities, expanding in Texas has “moved towards the top of the wish list,” according to CEO Dirk Allison

“We have a little bit of hospice more around central Texas today, but we definitely could use some home health and some additional hospice,” Allison said during the Bank of America Healthcare Conference. “Potentially, some of the managed Medicaid plans in the state have expressed interest in doing some things with us on the value-based front, so we can add clinical services that should definitely be helpful.”

Aveanna’s expanding hospice and home health business has largely included a focus on organic growth and tuck-ins across its existing geographic markets. Acquisitions could make up a larger portion of its strategy on the near horizon, according to CEO Jeff Shaner.

Aveanna’s acquisitions this year have included the purchase of Thrive Skilled Pediatric Care (SPC) in April for an undisclosed amount. Acquiring the pediatric home-based care provider expanded Aveanna’s presence across seven states, two of which were new geographic service regions for the company. The transaction is expected to close in the second quarter and anticipated to enhance Aveanna’s strategic growth plans in home-based care, he indicated.

Strategic acquisitions, quality improvement and organic growth will each play a role in the company’s home health and hospice outlook, according to Shaner.

“This [acquisition] fits the spirit of what you should think about us doing in the future,” Shaner said. “We will do as many Thrive-type acquisitions as we could do, both in home health and hospice as well as private duty services. Our clinical outcomes are off-the-charts fantastic in our home health and hospice [with] a 99.8% [Consumer Assessment of Healthcare Providers and Systems (CAHPS)] rating. It’s just a great place for us to be. We are at the top of the clinical ladder in both hospice and home health, and incredibly proud of it. It’s really just now about growing smart admissions.”

VITAS last year began to pick up steam in its M&A activity. The company purchased Covenant Health and Community Services for $85 million in 2024. The transaction included Covenant’s hospice assets and marked an important milestone for VITAS, including its entry into the assisted living space and in the Alabama market while extending its geographic footprint across northern Florida.

The Covenant Health transaction has pushed growth forward for VITAS, according to CEO and Chairman Nick Westfall. Acquiring its hospice assets has yielded growth of VITAS’ hospice revenue, average daily census and admissions. Covenant Health contributed approximately $11.5 million to $12.5 million of VITAS’ revenue in the first quarter of 2025, which reached $407.4 million.

The Covenant deal has helped move the needle toward similar transactions on the horizon, according to Michael Witzeman, vice president, CFO and controller at Chemed Corp.

“Our overall philosophy hasn’t changed,” Witzeman said at the Bank of America conference. “We’ve always been interested in acquisitions in the right location, at the right valuation. On a more practical basis, the VITAS team [has] started really reaching out to Covenant-sized providers that we would be interested in talking to us about an acquisition. Historically, what we did was more so wait for people to call us. We’re being a little more proactive, particularly based on how well Covenant went for us.”