The Hospice M&A Locomotive Gains Momentum in 2025

The winds have changed in the hospice merger and acquisition landscape in 2025. Activity slumped as the year began, but picked up steam as more strategic acquisitions unfolded, particularly in the fourth quarter.

A number of factors created a lull in M&A activity in the beginning of this year, with uncertainty a common thread woven among issues related to economic, reimbursement, regulatory and operational challenges. Another commonality was the careful approach in strategic deal-making taken among both buyers and sellers alike.

Hospice merger-and-acquisition activity saw a significant rebound in the fourth quarter, delivering the strongest deal volume the industry has experienced since 2021. The M&A advisory firm Mertz Taggart reported 16 hospice transactions to date in Q4, a notable increase from six deals in Q3 and five in Q2.

Hospice News recently sat down with a range of hospice providers and health care consulting and M&A advisory firms to uncover the dynamic mix of forces propelling this year’s transaction environment.

Predictions vs. outcomes

Hospice deal-making slowed throughout last year, and that trend trickled into 2025. The cooling period began in 2023 following a flurry of deals that came in 2021 and 2022. Driving forces included valuations in hospice soaring to record highs in 2019 at 26x, reaching 29x by the following year. Subsequent years saw many companies taking the time to focus on integration and value creation for their newly acquired assets.

This year brought more small or regional transactions, according to Joe Widmar, director at the consulting firm West Monroe Partners LLC.

“I would characterize this year as a combination of sellers coming to terms with normalized valuations at the same time as prospective buyers were reluctant to move on deals,” Widmar told Hospice News. “It was sluggish. The dynamic is playing out with either more medium-sized platform or regional opportunities that haven’t been able to close for a number of reasons. Tuck-in activity has been the bulk of what’s occurred this year.”

Large platform transactions have been rare amid a slowdown in hospice mergers and acquisitions. Much of the deals in the hospice space involved more middle-range and smaller-scale assets.

Many assets acquired by private equity firms during the peak roughly four years ago are now reaching maturity and are expected to return to the market. However, the M&A activity through much of the year has been less frothy than anticipated, according to Les Levinson, partner at the firm Robinson+Cole LLP.

“Coming into 2025, I think the general consensus and expectation was that it was going to be a strong year for transactional work,” Levinson told Hospice News. “But there’s been a lot of bolt-on or additive transactions. We’re beginning to see — not a ground swell — but more platforms exiting hospice for various reasons, whether they have held those assets for long enough to transact. Folks are looking at opportunities in a strategic and laser-like way as interest rates come down a bit, which is very important particularly in transactions involving private equity. There’s lots of dry powder and pent up demand.”

A volatile economic climate created uncertainty at the start of 2025, with several hospices tapping the brakes on M&A activity, despite expectations for a more active year. The second half of the year also fell short of predictions for ramped up activity — until the Q4 resurgence.

Other factors dampening M&A activity included labor headwinds, a new presidential administration, increased reciprocal tariffs, uncertainty around interest rates, rising care delivery costs and inflation, as well as intensifying regulatory activity and gaps between sellers’ expected valuations and the amounts that buyers were willing to pay.

Hospices have also sought organic growth routes, expanding with more de novos to reach patients across wider geographic regions. The organic growth has hospices seeing increased census volumes as well as improved referral relationships and revenue results, according to Andy Johnston, president of hospice, palliative and personal care services, AccentCare.

Transactions churned more slowly in 2025 amid more cautious and selective decision making in the hospice space, Johnston said. AccentCare is backed by the private equity company Advent International. The hospice, home health and personal and palliative care provider’s strategic growth has historically focused on joint ventures and de novo activity.

Buyers and sellers have been taking extra time to align on valuations, integration readiness and long-term sustainability, Johnston said.

“While transactions are still happening, they’re more selective and focused on strategic fit rather than scale alone,” Johnston told Hospice News in an email. “Against that backdrop, AccentCare made a deliberate decision to concentrate on strengthening our organic growth engine. We’ve seen steady month-over-month improvement as our teams deepen referral relationships and enhance the overall care experience.”

Hospice deal-making was anticipated to pick up in Q3 2025, but fewer transactions occurred than predicted, with economic and regulatory uncertainty main reasons, said Howard Young, partner at the firm Morgan, Lewis & Bockius LLP.

The hospice industry saw an uptick of regulatory oversight and enforcement activity, which damped deal progression, Young indicated. Transactions across the health care space saw higher levels of regulatory due diligence in an effort to strengthen program integrity, he indicated.

“The marketplace in terms of acquisitions was off to a slower start than anticipated, in part because of the uncertainties associated with a new presidential administration,” Young told Hospice News. “There were a lot of things occurring including changes to tariffs and seeing what was going to happen with interest rates. Strategic companies that might acquire were taking a cautious approach to see what would happen in the broader marketplace. We are now seeing increased activity.”

5 significant hospice M&A moves in 2025

Despite the slow activity for much of the year, several significant deals did occur.

1. This year brought the solidification of one of the largest transactions in hospice and home health with UnitedHealth Group (NYSE: UNH) subsidiary Optum’s acquisition of Amedisys. Optum in June 2023 agreed to acquire Amedisys in an all-cash transaction of $101 per share, or roughly $3.3 billion.

The deal faced antitrust concerns raised by the U.S. Department of Justice (DOJ), which resolved this year through a final judgment requiring divestitures of some of Amedisys’ home health and hospice locations and the company’s payment of a $1.1 million civil penalty. Two buyers in the divestiture included BrightSpring Health Services (Nasdaq: BTSG) and The Pennant Group (Nasdaq: PNTG).

The Optum-Amedisys deal represented a significant milestone in the hospice M&A landscape. The transaction followed UnitedHealth Group’s acquisition of LHC Group in 2023 for $5.4 billion. The “payvider” is now among the largest home health and hospice providers.

2. Another significantly-sized transaction came later in 2025 as deal-making ramped back up in Q4. Traditions Health was acquired by four hospice providers in December for an undisclosed amount. Tennessee-headquartered Traditions provides hospice, home health and palliative care as well as consulting services across 18 states.

The Care Team, VitalCaring, LifeCare Home Health Family and Mission Healthcare each purchased a portion of Traditions Health’s locations. Traditions was formerly a portfolio company of the private equity firm Dorilton Capital Partners. Each of the four buyers is also backed by various private equity firms, continuing on a trend of more of these investors stepping into the hospice space.

The transaction is unusual due to the involvement of multiple buyers and the rarity of large platform deals taking place. The deal represents a growing trend of larger platform companies being acquired by more than one entity.

3. A notable deal came with the acquisition of Agape Care Group by the private equity firm Linden Capital Partners in July for an undisclosed amount. Formerly owned by Ridgemont Equity Partners, the purchase marked a significant move for Linden, a large investment firm focused in the health care space.

Agape provides hospice and palliative care to more than 5,700 patients daily across 10 states. The provider has since rebranded to Agape Care Group Hospice (ACG Hospice) and acquired Community Hospice of Alabama in November for an undisclosed amount.

The Agape-Linden deal represents a “roll-up” strategy typically employed by private equity investors, in which they grow their assets through a large platform purchase and leverage it as a foothold to absorb smaller companies. Ridgemont applied this methodology while Agape was under their ownership. Between 2019 and 2024, the company completed at least seven transactions.

4. The appetite for acquisitions has swelled among hospices of varying sizes, geographic scale and tax status.

New Day Healthcare was among the active companies on the acquisition front in 2025. This year the Texas-based home health and hospice company acquired Dunes Hospice in Indiana, its 16th transaction to date. New Day Healthcare also picked up New Mexico-based Heritage Home Healthcare LLC in June, marking its entry in that state. Additionally, the company acquired the home health agency Patient Recovery Home Healthcare Services in Houston in March.

Another active company was Bristol Hospice, which acquired Alabama-based DaySpring Hospice in December. Bristol Hospice also picked up St. Agatha Comfort Care in Las Vegas in February. Utah-headquartered Bristol Hospice is a portfolio company of the private equity firm Webster Equity Partners. The company offers adult and pediatric hospice, palliative care across 25 states.

Additionally, St. Croix Hospice made two acquisitions at the start of 2025. The Minnesota-headquartered hospice acquired both Hospice of Siouxland in Iowa and some of Mayo Clinic Health System’s (MCHS) hospice assets in its home state in January. A second transaction with MCHS came when St. Croix purchased its hospice operations in northwest and southwest Wisconsin in August. St. Croix Hospice is a portfolio company of the private equity firm H.I.G. Capital.

Meanwhile, Uplift Hospice acquired Tucson, Arizona-based Grace Hospice & Palliative Care and Grace Medical Group in October, marking its third transaction in 2025. The organization also acquired Stoneridge Hospice in Arizona in September and picked up Star of Texas Hospice in March. Uplift provides hospice care in the home, respite care, bereavement services and continuous home care across three states — Arizona, Nevada and Texas.

5. Alongside greater private equity interest in hospice has come more deal-making activity among nonprofits.

Case in point, Hospice of the Chesapeake acquired the senior services organization Partners in Care of Maryland in October. Financial terms of the deal were undisclosed.

Partners in Care offers a suite of non-medical services to aid seniors, including transportation, home modifications and other offerings. Hospice of the Chesapeake is Maryland’s largest independent nonprofit hospice organization. The two combining organizations will comprise a new, larger entity known as Chesapeake Health Partners.

Georgia-based Inspire Hospice and Palliative Care affiliated with Cadre Hospice in December.

Meanwhile, Chapters Health System expanded through two affiliations with California-based companies. The health system’s affiliation with Hospice East Bay completed in October, announced days after its completed affiliation with Hospice of Santa Cruz County. Chapters Health affiliated with Oregon-based Willamette Vital Health in June, which preceded its affiliation with Las Vegas-based Nathan Adelson Hospice.

2025’s market drivers

Hospices have taken a more cautious strategic approach in recent years, whether seeking to buy or sell assets, said Monica Escalante, chief strategy and information officer at Hospice of the Chesapeake, now part of Chesapeake Health Partners.

Among the significant forces are the more difficult end-of-life journeys that patients and their families are traversing, according to Escalante. Today’s hospice patients are more medically complex, while family caregivers are often stretched too thin due to lack of supportive home-based resources, she said. These factors are particularly pivotal for community-based and smaller hospices, reshaping how organizations think about growth, Escalante indicated.

“Our goal isn’t simply about growth for growth’s sake — it’s about being there for more families in their most vulnerable moments,” Escalante told Hospice News in an email. “We’re moving toward partnerships that honor our mission and help us reach people earlier, before a crisis hits. We’re focusing on relationships that address the profound isolation so many seniors face and the unique challenges of serving rural communities where every mile matters.”

Sustainable growth in the hospice space this year has taken a multifaceted strategic approach, according to Matt Griffith, chief development and strategy officer at New Day Healthcare LLC.

Founded in 2020, New Day provides care across six states. The company seeks three kinds of deals, which it describes as tuck-ins, market expansion and transformational. Tuck-in are smaller deals the company pursues within its existing markets and co-locating its multifaceted business lines, including home health, hospice, personal care, private-pay nursing and therapy services.

“We’re much more disciplined not to chase deals,” Griffith told Hospice News. “If you’re always chasing deals and integrating, you never have time to step back, reflect and reposition the playbook for the future. New Day has developed a nice balance of deal-making with platform development and maturation. When you bring it all together, that leads to a high-quality value creation model.”