Non-Medical Senior Care

A $50–65B agency market.
No operator holds more than 5%.

The U.S. non-medical in-home care industry serves 61.2M seniors through 507K providers. The top 14 brands combined hold under 15%. Forty-thousand independents hold the rest.

Regional Explorer

The U.S. market, state by state.

Click any state for market size, private-pay rate, top city breakdowns, and Cornerstone's current share.

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Top Markets
State Detail

All 50 markets, sorted.

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State 65+ Pop. ADL Market Providers Rate/hr Largest City CS Offices Growth
Sources: IBISWorld 2025 · CareScout 2025 Cost of Care Survey · U.S. Census Bureau · World Population Review 2026 · Colliers TX H1 2025.
Market Sizing

How the $50–65B breaks down.

Top-down IBISWorld segmentation, cross-checked with a bottoms-up population model.

TAM · Total Addressable
$155.9B
All U.S. home care. Includes skilled nursing (Medicare-certified), therapy, home hospice, and non-medical ADL. IBISWorld 2025.
SAM · Serviceable Addressable
$50–65B
Agency-delivered non-medical ADL/IADL. The Cornerstone product. Excludes skilled, hospice, direct-hire. IBISWorld segment + market.us.
SOM · Single Office
$1.5–3.5M
Realistic revenue ceiling for one office at 0.5–1.5% penetration of a 25–40K 65+ radius at market bill rates.
Bottoms-up sanity check · U.S. SAM
61.2M Americans 65+Census 2025
× ~22% using paid in-home care≈ 13.5M seniors
× ~55% served through agencies≈ 7.4M clients
× ~$7,200 avg annual spend18 hrs/wk × $35/hr × 42 wks
Bottoms-up SAM≈ $53B
$50–65B
Agency-delivered ADL (SAM)
IBISWorld · market.us 2025
$155.9B
Total home care (TAM)
IBISWorld 2025
61.2M
Americans 65+ (+3.1% YoY)
Census Vintage 2024
7%
Projected CAGR through 2030
Fortune Business Insights
Market Structure

Who holds the $50–65B.

Three operator tiers. The long tail does most of the revenue.

<15%
Top 14 national brands combined. Franchise and company-owned, including Cornerstone.
~20–25%
Regional multi-office operators (10–50 locations). Most PE-backed or family-held.
60%+
~40,000 single-office independents. Typical AUV $500K–$1.5M. The roll-up thesis lives here.
Unit Economics

The spread per billable hour.

National medians. Private-pay, non-medical ADL.

Client Bill Rate
$35
CareScout 2025 · national median per hour
Caregiver Wage
−$19
BLS 2024 · avg agency caregiver wage
Gross Spread
$16
~45% gross margin before overhead
Net Margin
8–22%
After G&A, scheduling, insurance, compliance
Per-Office Math

What one office can realistically own.

The math to run before every new-market open or acquisition.

15–20mi
Service radius
Typical non-medical home care office
25–40K
65+ population
Suburban / mid-metro radius
0.5–1.5%
Agency penetration
Realistic of 65+ in a mature market
40–80
Active clients per office
Cornerstone avg ~55
$1.5–3.5M
Revenue ceiling
Per single office at full penetration
$830K
Cornerstone avg (est.)
Per-office revenue today
2–4×
Same-office headroom
Before a new-market open is higher ROI
~40K
Roll-up targets
Single-office independents, U.S.
Implication. The ~$830K average AUV sits well below the $1.5–3.5M single-office ceiling. That's 2–4× same-office headroom before a new-market open becomes the higher-ROI move. Drive density first, then new rooftops.
Competitive Framework

The competitive set, by model.

Public lists lump every home care brand together. Only two actually compete for Cornerstone's client. The rest are adjacent, different payor, or different ops model.

Lane 1 Pure ADL · Company-Owned
Cornerstone's home lane. Cornerstone Caregiving (426) · TheKey, fmr. Home Care Assistance (110+ regions, 31 states). Both company-owned, both premium ADL-only.
2 brands
Lane 2 Pure ADL · Franchise
Home Instead · Comfort Keepers · Visiting Angels · Synergy · Senior Helpers · Home Helpers · FirstLight. Adjacent lane, different ops model, usually lower rate band.
7 brands
Lane 3 Blended ADL + Skilled
BrightStar Care (RN-led) · Right at Home · BAYADA (non-profit). Nursing alongside ADL. Higher bill rate, higher compliance burden, different referral source.
3 brands
Lane 4 Medicaid Scale
Addus HomeCare (NASDAQ: ADUS · ~75% Medicaid). Different payor, different client — not a direct competitor in most Cornerstone markets.
1 brand
Lane 5 Niche · Specialty
Amada (70%+ LTCi) · Griswold (1099 referral model) · Always Best Care (ADL + placement fees) · ComForCare (DementiaWise) · Touching Hearts. Narrow positioning, limited Cornerstone overlap.
5+ brands
Lane 6 Independents
~40,000 single-office agencies. 60%+ of the SAM. No named brand to fight. The opportunity is consolidation, not displacement.
~40,000
National Share

Top 14 brands, ranked by estimated U.S. share.

Combined under 15% of the $50–65B ADL market. No single brand clears 4%.

Competitor Profiles

Who they are. How they compete.

Filter by model. Every brand profiled with ownership, footprint, rate band, payor mix, and the specific way they win (or don't) against Cornerstone.

Revenue Channels

Four payors, different economics.

Private pay drives the business. VA, PACE, and LTCi diversify it. Pick a payor to see rate, terms, client profile, and strategic read.

Primary Revenue

Private Pay

Out-of-pocket from client or family. Agency-set rate, weekly ACH, no prior auth. The business.

65–75%
of non-medical ADL revenue mix · ~$35B addressable
Rate Economics
National median bill rate$35/hr
Rate range$24 – $48/hr
Texas median$27–32/hr
Annual · 44 hrs/wk$80,080
Live-in / 24-hr$320–$450/day
Rate growth '24→'25+3.0% YoY
Labor Spread
Avg caregiver wage$17–20/hr
Gross spread$14–17/hr (42%)
Wage growth '24→'25+4.9% YoY
Margin trendWages outpacing rates
Annual compression~130 bps
Net margin8–22%
Client Profile
Avg client age82 · 8–14 mo
Decision makerAdult daughter 55–65
Typical triggerDischarge · fall
Top referral sourceHospital discharge
Inquiry → start30–45%
Avg CAC$400–900
Margin watch. Caregiver wages grew +4.9% in 2025. Bill rates grew +3.0%. Without annual rate discipline, gross margin compresses ~130 bps per year.
Direct Contract

VA H/HHA Program

Direct VA contract via the Community Care Network. VA pays the agency, vet pays nothing. Separate from Aid & Attendance pension.

~$2.0B
annual VA HCBS spend · growing ~12% YoY · +40% since MISSION Act
Rate & Auth
Reimbursement$25–32/hr
Rate settingRegional · 18 VISNs
Typical auth4–28 hrs/wk
Revenue per vet$13K–$45K/yr
Payment termsNet 30–45 days
Operating Model
Contract vehicleCCN · Optum/TriWest
EVV requiredYes · all visits
Front doorVAMC HBPC · social workers
Compliance burdenModerate · high docs
Cornerstone readinessEVV-capable
Demand Base
U.S. veterans18.5M
Receiving H/HHA~45–60K/yr
MISSION Act (2019)Expanded private access
HCBS growth since 2019+40%
Penetration~0.3% of vets · upside
Secondary Revenue

Long-Term Care Insurance

Private policies reimbursing home care once 2+ ADL triggers hit. Shrinking pool, sticky claims. Most in-force policies were written 15–25 years ago.

10–15%
of ADL agency revenue mix · $16.8B claims paid in 2024
Benefit Math
Avg daily benefit$150–250/day
High-end$300–400/day
Elimination period30 / 60 / 90 days
Claim trigger2+ ADL · cognitive
Avg claim duration3.2 years
Operating
Billing methodAssignment of benefits
Payment termsNet 30–60 days
Top carriersGenworth · Hancock · Northwestern
Paper-intensiveHigh
Family handlingTypically outsourced to agency
Pool Outlook
U.S. active policies~6.9M
2024 claims paid$16.8B
New policy sales<55K/yr
Channel trendFlat-to-declining 10 yrs
Strategic readCapture while pool shrinks
Fastest-Growing

PACE

Capitated Medicare + Medicaid for dual-eligibles 55+ at nursing-home-level care. PACE orgs subcontract ADL to agencies at premium rates. Most franchises still ignore it.

~$7B
2025 program revenue · growing ~15% YoY · 87,750 participants
Rate & Cap
Avg capitation$6,500–8,500/mo
Funding split60% Medicaid · 40% Medicare
Subcontracted rate$26–35/hr
Auth pattern12–40 hrs/wk
Rev per participant$18K–60K/yr
Program Scale
U.S. PACE orgs194 · 33 states + DC
Participants~87,750
Dual-eligible share84%
Enrollment growth+12–15% YoY
Key operatorsInnovAge · Trinity · WelbeHealth
Entry Path
Sales cycle60–120 days to first case
Contract typeNetwork subcontract
RequiredEVV · documentation
TX presenceBienvivir (El Paso)
Franchise coverageLargely absent
Capital Flows

M&A, PE platforms, and segment multiples.

2025 home care M&A hit 105 deals, up 25% year-over-year. Private equity is pushing multiples to cycle highs.

TowerBrook → TheKey
2021 acquisition of Home Care Assistance · rebrand to TheKey in 2022 · largest wholly-owned premium ADL platform.
PE Platform
Honor Technology → Home Instead
2021 acquisition · ~$2.3B deal value · tech-enabled caregiver matching rolled across 1,200 global locations.
Tech Roll-up
Peak Rock → BrightStar
2022 PE recap · RN-led franchise · heavy on tuck-in acquisitions of independent agencies.
PE Platform
Best Life Brands → ComForCare
PE platform consolidating senior services franchises (ComForCare, Blue Moon Estate Sales, Caring Transitions).
PE Platform
Addus HomeCare
NASDAQ: ADUS · $1.42B 2025 revenue (+23% YoY) · 262 offices · 15+ tuck-ins since 2020 · trades ~1.5× revenue.
Public Comp
Segment multiples · 2026
Non-medical personal care: 5–8× EBITDA · 1.0–1.5× revenue. Premium to 10× for scaled multi-state operators. Hospice leads at 7.5–12×.
Benchmark