Long-term care for aging and disabled people is increasingly provided in the home, given individuals’ preferences for community living and aging in place coupled with the rebalancing of government spending toward home- and community-based services rather than nursing home care. As more government spending has focused on home-based care and the system has simultaneously become dominated by for-profit agencies, it has increasingly become an attractive target for financial actors seeking new sectors for deal-making and extracting profit. Private equity firms, among other financial actors, have accelerated their financial activity in home-based care. As part of a broader research project examining the presence of private equity in home care in New York State, this paper sets the foundation for understanding the implications of private equity acquisitions for job quality and quality of care in this sector. Our focus on the home care sector is designed to understand how financialization affects a low-wage workforce that is disproportionately made up of women, people of color, and immigrants. A growing body of research already demonstrates the negative effects of new financial actors—including private equity (PE) firms, insurance conglomerates, and other types of investors—buying up healthcare organizations. Their growing penetration into home care specifically has raised the specter that poor working conditions and low pay may be perpetuated or deteriorate even further.

The first section of this paper provides a brief overview of private equity’s incursion into healthcare and home care in the United States, while the second part maps how private equity’s footprint in New York State home care has grown over the past 20 years. The third part explores the policy and regulatory context that has enabled the expansion of private equity into home care. In examining the policy and regulatory context, this paper explores both health and labor market policies to demonstrate how they are closely intertwined and together create the context that has enabled the proliferation of new financial actors extracting wealth from the home care system. This paper therefore links the complexity and opacity of the U.S. healthcare system and weak labor protections to structural racism and the rise of financialization. We demonstrate how financial actors’ profit extraction has been enabled by weak federal and state regulation of health and labor policy as well as opaque public and private payment systems. A primary pathway of wealth extraction occurs through the exploitation of a workforce with historically poor wages and working conditions, thereby perpetuating the long-standing effect of structural racism on women of color in healthcare and the labor market. As private equity’s footprint sharply expanded in 2025 to control more than half of New York State home care delivery—as described below—it has become ever more urgent to examine the implications of private equity ownership for job quality and care quality.