Consolidation among nonprofit hospices has ramped up in recent years. The trend is not anticipated to abate any time soon amid rising costs and regulatory oversight.

This is according to Mark Kulik, senior managing director at the Pennsylvania-based merger and acquisition advisory firm The Braff Group. Hospice consolidation activity has increased over the past few years, particularly among nonprofits, Kulik said during a Hospice News ELEVATE podcast.

“It’s one of the most under-reported stories,” Kulik told Hospice News during the podcast. “Of late, it’s been significant … when you look at the total number of hospice and home health transactions. We’re looking at somewhere approximately one out of every four transactions has involved a not-for-profit seller over the past handful of years. Go back 25 years [and] that was never the case. It has manifested quite dramatically.”

Nonprofit hospice consolidation has climbed during the last four years, Kulik stated. The trend began in 2022, when 45% of the 20 deals involved the sale, merger or consolidation of a nonprofit hospice to a nonprofit buyer, according to data from The Braff Group. The volume of similar nonprofit deals rose to 58% by 2023 before hovering around 57% in 2024, the data indicated.

As of the second quarter in 2025, nonprofit deals represented 33% of hospice and home health transactions, The Braff Group reported. Half of these hospice assets were picked up by nonprofit buyers, meaning that half of the market is choosing to sell to for-profit companies, Kulik explained.

A main driver pushing more nonprofits to choose private equity or for-profit buyers is the significant potential for improved financial sustainability and growth, according to Kulik.

Staffing shortages, rising labor rates, low reimbursement increases and inflation all serve as large challenges for nonprofit hospices, particularly smaller organizations, Kulik indicated. These issues have driven more nonprofits to the sellers table.

Another factor has been increasing competition for philanthropic support as more nonprofit organizations come to fruition across various business sectors during the last decade, he stated. The trend has resulted in a “far more difficult” fundraising environment for nonprofits who rely on this support and who often provide higher levels of hospice care at no cost to patients and their families who are unable to afford their services, Kulik said.

Nonprofit consolidation has also been impacted by enhanced regulatory oversight amid program integrity concerns in the hospice space, he stated. The issue has come with increased expenses related to compliance and quality, resulting in greater financial strain among nonprofits.

Greater consolidation will take place across nonprofit hospices seeking to remain open in today’s financial and regulatory landscape, Kulik said.

“You’ve got to keep on growing, and that feeds into the consolidation theme,” he told Hospice News during the podcast. “If you look at just the risk of staying in business, you have to take into account the level of sophistication in financial stability. This not-for-profit transaction continues to make the statement that you’ve got to keep on scaling, you have to keep on getting bigger, because it’s difficult to stay small. We’re going to see continued, sustained levels of consolidation among not-for-profit agencies.”