Private duty nursing (PDN) is one of the most specialized and highest-value niches within home-based care. Agencies serving medically complex patients — children and adults requiring skilled nursing many hours per day, often funded through Medicaid Technology-Dependent Children waivers, TEFRA programs, or Long-Term Care waivers — occupy a distinctive position in the M&A market.
High barriers to entry. Strong payer relationships. Medically essential care that is difficult to replace. These characteristics make quality PDN agencies attractive acquisition targets — when they are prepared and positioned correctly.
This guide covers what PDN agencies are worth in 2026, what drives valuations, who the buyers are, and how to position your agency for a premium transaction.
For M&A purposes, “private duty nursing” typically refers to agencies providing:
This is distinct from:
PDN patients typically receive 8–24 hours of nursing per day. The revenue per patient is extraordinarily high — often $150,000–$300,000+ per patient per year. And once a PDN relationship is established with a medically complex pediatric or adult patient, churn is extremely rare.
| Agency Profile | EBITDA Multiple Range |
|---|---|
| Small PDN operator (<$500K EBITDA, single state) | 3.5 – 5.5× |
| Mid-size PDN operator ($500K – $2M EBITDA) | 5.0 – 7.0× |
| Large multi-state PDN platform ($2M+ EBITDA) | 6.5 – 9.0× |
| Specialized pediatric vent/trach programs | 7.0 – 10×+ |
Note: Valuations reflect engaged, competitive M&A process; individual unsolicited offers run 20–40% below these ranges.
PDN multiples are generally higher than non-skilled personal care (EBITDA multiples of 2.5–4.5×) for the structural reasons discussed below.
PDN services are not discretionary. A vent-dependent child requires 16 hours of nursing per day to survive at home. This is not care that can be paused, reduced, or switched to a different provider without profound disruption. Once an agency is established as that family’s provider, the relationship is effectively permanent barring significant quality failure.
This characteristic — essential, high-stakes, relationships that typically last years — creates the kind of predictable, low-churn revenue that PE investors pay premium multiples to acquire.
A PDN patient generating $250,000 per year in revenue is worth dramatically more to a buyer than 20 personal care clients generating $10,000–$15,000 each. The revenue concentration in individual patients is high — but so is the stickiness, and the per-patient economics are far superior.
In many states, PDN providers must hold specific licenses — pediatric nursing, ventilator care certifications, clinical program accreditations — that take meaningful time and capital to acquire. States with strong waiver programs (Texas, Ohio, New York, Georgia, Illinois, Florida) have established provider ecosystems where starting a new PDN agency from scratch is exceptionally difficult.
Buyers pay for licensed, operating PDN agencies in part because they cannot easily build the equivalent.
A PDN agency’s nursing staff — particularly those with pediatric, vent, or trach experience — are scarce and highly specialized. An agency that has recruited, trained, and retained a clinical nursing staff of 20–50 skilled nurses has built something that is genuinely hard to replicate. Buyers recognize and value this.
Because individual PDN patients generate very high revenue, census stability at the patient level is the primary risk buyers underwrite. They examine:
For pediatric PDN specifically, buyers model the likelihood that patients will age into adult waiver programs rather than discharge. In states with robust adult Medicaid waiver programs, this transition typically sustains revenue — patients don’t “graduate” from needing care.
PDN agencies face the same nursing shortage as the rest of healthcare — amplified by the specialized skillset required. An agency with high nursing turnover faces referral source dissatisfaction, incident rate increases, and census instability.
Buyers ask:
The 1099 nurse risk: Many PDN agencies staff using independent contractors to reduce employment overhead. Buyers are increasingly cautious about agencies with predominantly 1099 nurse workforces, because IRS and state labor enforcement has increased scrutiny of nurse classification. Agencies that convert to W-2 prior to sale reduce this risk and typically see improved valuation.
Not all Medicaid waiver programs are equal. States like Texas (STAR PLUS, STAR Kids), Ohio (PASSPORT), and Florida (iBudget) have large, well-funded programs with established referral ecosystems. States with underfunded or highly bureaucratic waiver programs create revenue risk.
Buyers will assess:
In PDN, primary referral sources are typically:
Agencies heavily dependent on a single hospital system for referrals are at risk if that hospital changes its preferred PDN provider list or hires a competitor. Buyers discount for hospital concentration above 30–40% of referrals.
Large home care platforms that serve medically complex populations (e.g., BrightSpring Health Services, Sevita’s home nursing programs, LHC Group, Bayada Home Health Care) are strategic acquirers in this market.
PE-backed PDN-focused platforms are the most active buyers. Several PE firms have specifically entered the PDN space because of its premium characteristics.
Regional hospital system acquisition is a meaningful but sporadic buyer type — health systems that want to keep complex pediatric patients in-home as part of a broader care management strategy.
High 1099 nurse concentration. Regulatory risk from IRS and state labor boards is a material valuation discount factor.
Single hospital referral concentration. >40% of referrals from one source is a significant risk.
Open Medicaid audits or overpayment notices. PDN agencies often have large revenue per day of service, which makes Medicaid auditors attentive. Open audits create contingent liability.
Poor documentation practices. PDN care requires detailed nursing notes, physician orders, and prior authorization compliance. Agencies with documentation deficiencies face billing hold risk and compliance liability.
Lack of accreditation. CHAP or ACHC accreditation is increasingly expected by institutional buyers and by state programs.
PDN agency valuation is genuinely specialized. Advisors without specific PDN deal experience frequently misvalue these agencies — because they apply non-skilled personal care multiples to businesses with fundamentally different characteristics.
If you own a PDN agency and are considering a sale or explorer, request a preliminary valuation from advisors with demonstrated PDN transaction experience.
Contact Hendon Partners for a confidential PDN valuation →
Hendon Partners advises owners of home health, hospice, private duty nursing, personal care, and IDD agencies. Our team has experience in pediatric, geriatric, and medically complex care M&A.
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