Hospice merger and acquisition (M&A) activity is anticipated to be more effervescent in 2026 compared to a slow-churning quagmire that marked most of last year. Compliance, quality and care collaboration are among the significant propellants in strategic deal-making.

Hospice News recently sat down with a mix of hospice providers and health care consulting and M&A advisory firms to examine the key considerations in deal-making this year.

Important factors in hospice transactions include considerations around sustainability, program integrity, technology investment and navigating changes in regulation, reimbursement and patient needs.

Hospices’ strategic focal points

Hospices’ greatest strategic opportunities in 2026 will come from partnerships that strengthen continuity across the care continuum, according to Andy Johnston, president of hospice, palliative and personal care services, AccentCare.

AccentCare is backed by the private equity company Advent International and provides hospice, home health and personal and palliative care. The company’s growth strategy has historically focused on joint ventures and de novo activity.

Hospice deal-making this year will focus on the ability to improve access and efficiency, whether through targeted acquisitions, joint ventures with health systems, or collaborative models, Johnston said.

“The organizations that succeed will be those that balance innovation with operational discipline and choose partners who share their commitment to quality, compliance and patient-centered outcomes,” Johnston told Hospice News in an email. “It’s a year that will reward thoughtful alignment rather than aggressive expansion.”

Person-centered care partnerships could proliferate in the coming year amid rising demand and a deepened regulatory focus on quality and compliance, said Monica Escalante, chief strategy and information officer at Hospice of the Chesapeake, now part of Chesapeake Health Partners.

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

Partnership-based transactions in the hospice space have increasingly focused on ways to address a host of unmet needs among underserved populations, particularly across vast rural and remote regions, Escalante indicated. Isolation, depression and a lack of family caregiving support and clinical resources are among the challenges pushing more collaborative mergers, joint ventures and partnerships to the forefront, she stated.

The next year could bring more deals between hospices and other home-based care providers as recognition grows around the positive impacts of collaboration, Escalate said. This includes more timely access, reduced health care spending at the end of life and improved outcomes. Hospices could also increasingly join forces with primary care providers and senior living communities to expand their patient reach and better address issues such as food and housing insecurity, she said.

Increasing regulatory scrutiny, reimbursement pressures and workforce shortages represent significant obstacles to navigate in hospice deal-making, according to Escalante. These three factors are also at the crux of increased consolidation moves in the hospice space, she added.

“As we look toward 2026 … What matters most isn’t the deal structure. It’s the shared values and the genuine commitment to reaching every person who needs us,” Escalante told Hospice News in an email. “The reality is that mounting regulatory pressures, shifts in how we’re paid for the care we provide and the struggle to build strong teams are pushing us to be more resourceful and intentional. This is why meaningful partnerships and thoughtful consolidations matter now more than ever.”

Investors are seeking high-quality hospices and increasingly recognizing that a strong compliance record can be a significant driver in valuation, according to Matt Griffith, chief development and strategy officer at New Day Healthcare LLC. However, record-high valuations in prior years have resulted in variations between seller and buyer expectations, a trend that could continue in coming years, Griffith stated.

“When hospices start to go south or slip backwards, it can be the hardest service line to fix for a number of different, complex reasons,” Griffith told Hospice News. “What used to be deemed and labeled as a high-quality hospice that could warrant a premium price, that same operation is not being graded out as high quality anymore. Buyers have elevated their expectations, which naturally has a butterfly effect into valuations if [sellers] can’t support the premium with quality assets. It’s creating a disconnect between buyers and sellers.”

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

The next year could see fewer large-scale hospice deals at national levels and more regional transactions that expand both geographic reach and scope of services, according to Griffith.

While larger acquisitions led the charge in previous years, organic growth moves could make up more of the strategic picture for several publicly traded companies active in the hospice M&A space, he said. Smaller to mid-range deals are predicted to reign this year, Griffith indicated.

“Deal making has always been separate from organic growth, but I think we’re going to see those strategies really blend together [and] play a role in 2026 deal making,” Griffith said. “We saw de novos become very popular across the majority of the publicly traded assets with hospice services reporting year-over-year, same-store growth. We should see an uptick, but I don’t think we’ll see a pop, with few significant deals happening at the national platform level. What’s going to ignite the market a little bit more is getting more aggressive for the smaller to mid-size deals in 2026.”

Propelling forces

The relatively quiet M&A front of 2025 has served as a window into the deal-making horizon, according to Les Levinson, partner at the firm Robinson+Cole LLP. Much of the transaction activity occurred in the middle to lower range, he stated. Predominant themes included more interest in picking up bolt-on assets in new geographic service regions or partnerships that formed new service lines.

Many of the few large-scale hospice deals that took place in the last year involved more than one purchasing entity, Levinson indicated. This trend is anticipated to persist amid rising reimbursement and financial pressures across the health care continuum.

Additionally, size and scale may hold less weight among buyers than quality and compliance, he said.

“Transactions of size aren’t always an accurate barometer,” Levinson told Hospice News. “There’s still plenty of space in the $30, $40 and $50 million hospice transactions. Those are going to be more impactful over the course of 2026. The industry is still pretty fragmented and most of the transactions are going to occur in that mid-market landscape. We’ll see more purposeful, more targeted deals and less of a stampede for scale. We’re seeing more companies being broken up with multiple acquirers, which makes risk tolerance more manageable.”

Quality will play a significant role in determining both valuation and activity levels in the hospice M&A climate throughout the next year, said Howard Young, partner at the firm Morgan, Lewis & Bockius LLP.

Program integrity issues in the hospice space have resulted in heightened regulatory oversight and a more careful and cautious approach in deal-making, Young indicated.

Interest in hospice among prospective buyers isn’t anticipated to abate anytime soon, particularly among private equity investors, he stated. However, these buyers have dug deeper into the ways that hospices ensure sustainable, high-quality care delivery, including technology investments.

Increasingly drawing investors’ attention are hospices that leverage technology and artificial intelligence (AI) tools to strengthen compliance, increase operational efficiency, revenue cycle management and workforce capacity, Young said. Buyers have also deepened AI utilization to identify and analyze the return on investment of quality hospice assets.

“It’s a connection between how AI is affecting hospice and home-base care, but also how it can be used in connection with due diligence,” Young told Hospice News. “I think we’ll see a continued interest among investors to figure out how to deploy AI to make processes around acquisitions and diligence more efficient, and help identify and assess good [hospice] opportunities.

The hospice regulatory climate is among the significant uncertainties in M&A activity in the next year, according to Joe Widmar, director at the consulting firm West Monroe Partners LLC.

Increased regulatory scrutiny has slowed the speed and volume of hospice transactions amid widespread audits and instances of fraud, waste and abuse in the space. Investors have taken a more conservative, “wait and see” approach to investments, quantifying operational and compliance risks in new ways, Widmar indicated.

Nevertheless, vast opportunities in the hospice industry exist, particularly in the realm of home-based and disease-specific collaborations, he stated. Hospice has increasingly become an attractive service line in terms of the ability to strengthen outcomes and improve care continuity, two keys in value-based reimbursement, according to Widmar.

Patients are living longer with multiple comorbidities, a trend driving up health care costs across the board and driving more collaborative, strategic deal-making in the hospice space, Widmar indicated. Transactions that expand service diversification while improving access and quality will be front and center in 2026, he stated.

More innovative platform deals could take shape between hospices, hospitals and health systems, a trend born out of an evolving value-based reimbursement environment, according to Widmar. The ability to compete and take on financial risk involves a heavy focus on person-centered care models, a strong suit of hospices, he said.

“There is a prospect of more bullish expanding service lines that cover more of the continuum, and hospice offers a way to subsidize and coordinate service lines,” Widmar told Hospice News. “We’ll see more home health and hospices coming together to cover larger swaths of the continuum. There is a huge opportunity to not only drive internal referrals between service lines, but also to offer a different type of service delivery in terms of payer contracting and pursuing value-based arrangements. I wonder whether we’ll see hospice start to take shape in coming years in terms of mixed innovation and increased partnerships with risk-bearing care providers.”