Private equity targets Americans with intellectual disabilities for profit, threatening care

Private equity interest in providers of services for the nearly 10 million people in the United States with an intellectual or developmental disability (IDD) poses a significant shift in the operation of critical support for this population at varying levels of healthcare. This business shift represents a potentially radical change, moving from non-profit and religiously affiliated providers to profit-driven interests.

In January 2026, Illinois Sen. Javier Cervantes and Rep. Laura Faver Dias introduced two bills, SB3118 and HB 4728, to update regulatory frameworks and establish guardrails to safeguard services for people with developmental disabilities from asset managers such as private equity firms. The bills require more transparency from disability services agencies owned by private equity firms about their ownership structures, intentions to sell licensed providers, and prohibits firms from engaging in certain financial activities and transactions that have a reasonable likelihood of causing the agency to become financially distressed, among other things.

These bills represent an important opportunity for Illinois to rein in the concerning growth of private equity buyouts in a crucial sector whose patients and their families should not have to bear the brunt of the pursuit of cost cutting for the sake of huge short term profits for private equity executives. 

Private equity firms have increasingly set their sights on companies which provide a wide range of IDD services and supports, from residential facilities, home care, and fiscal intermediary services to adult day programs and occupational and physical therapy, quietly acquiring and consolidating what were previously small, independent firms. Through recent buyouts and consolidation, several large private equity-owned companies have emerged with tens of thousands of employees at numerous locations across the United States. In some cases, these companies have achieved regional market concentration obscured by complex ownership structures and disparate branding.

In recent years, a number of private equity-owned providers of services for individuals with IDD have faced criticism, investigations, and in some instances closures over poor patient conditions, garnering attention of legislators that seek to create guardrails around private equity’s worst practices to protect patients and workers. 

In March, 2025, PESP released a detailed report on private equity in intellectual and developmental disability services that highlights the concerning track records of multiple private equity-owned IDD providers across the United States, including three firms operating in Illinois. 

Lawmakers, journalists, and regulators have honed in on private equity firms, because the industry’s business model is driven uniquely by high profit-seeking combined with a very limited level of disclosure or regulation. Firms typically seek to double or triple the value of their investment in 4-7 years, which is challenging to do in IDD services without cutting costs in a way that compromises the quality of care. In a sector where companies provide such encompassing and essential services, private equity’s entrance threatens to exacerbate the social and health inequalities that people with IDD already face.

Private equity firms are increasing acquisitions in the IDD services market primarily for its growth due to increasing demand, a high level of fragmentation, overall increases in expenditures on care, and for its recession-resistant nature. A few factors driving increasing demand are: increased life expectancy for people with IDD; family members currently caring for relatives at home that are aging and may soon be unable to continue with those responsibilities; and closure of state-operated facilities with a resultant dependence on private sector agencies.  Fragmentation in the sector provides opportunities for private equity firms to consolidate companies through roll-ups, whereby a private equity firm uses a platform company it owns to acquire multiple other companies in a similar market and combine them.

The case studies below emphasize the risks of private equity growth in the sector and the need to update regulatory frameworks with legislation such as SB3118 and HB 4728 in Illinois and across the US. 

Case Studies: Sevita, Help at Home (Centerbridge Partners and Vistria Group) and Broadstep Behavioral Health (Bain Capital)

Sevita and Help at Home

Two of the largest private equity-owned IDD providers, Sevita and Help at Home, are both owned by the same pair of private equity firms: Centerbridge Partners and Vistria Group. They acquired Sevita in March 2019 and Help at Home in November 2020. Together, Sevita and Help at Home have over 100,000 employees across almost every US state. Since Centerbridge and Vistria Group’s buyout in 2020, Help at Home hasacquired at least 20 providers across nine states, including Community Care Systems Inc., which operates 13 branch locations throughout Illinois.

Sevita pointed out in 2017 financial filings that its ability to grow through acquisitions is a key part of its business strategy: 

“we are well positioned as an acquiror of choice for small operators in a highly-fragmented industry. This dynamic leads to a number of attractive acquisition opportunities that can drive returns. We continue to maintain a robust acquisition pipeline and deploy capital in a disciplined and opportunistic manner to pursue acquisitions.”

Centerbridge Partners and Vistria Group have siphoned hundreds of millions of dollars out of Sevita and Help at Home to pay themselves through “dividend recapitalization” transactions. Dividend recapitalizations are deals whereby a private equity firm directs its portfolio company to take on new debt and use the proceeds to pay the private equity owner a cash payout. These transactions can unnecessarily load healthcare providers with debt. While the private equity firm in these situations makes money, the provider often does not receive all of the proceeds from the loan and still must pay it back, leaving it more vulnerable to market conditions and with fewer resources to support operations. Centerbridge and Vistria have collectedover 737 million dollars in debt-funded dividends from Sevita and Help at Home over the course of their ownership. 

Centerbridge and Vistria engaged in these extractive financial maneuvers even as investigations of both Sevita’s and Help at Home’s services showed instances of understaffing, inadequate training, documentation errors, medication mismanagement, and other care and oversight deficiencies across the country. These deficiencies in some cases contributed to instances of material harm to people under their care, including substantiated instances of abuse and neglect. 

In December 2020, US Senate Finance Committee Chairman Chuck Grassley (R-IA) and Ranking Member Ron Wyden (D-OR) released two investigative reports regarding Sevita’s services for people with IDD in Iowa and Oregon. The reports found recurring critical incidents and a consistent pattern of substandard care by Sevita. These issues persisted through the duration of the Senate investigation; for example, just weeks before the final report was completed, state regulators in Oregon discovered so many violations at a Sevita home that they shut it down.

In 2023, the Human Rights Authority of Illinois (HRA) opened an investigation into Sevita after receiving complaints of possible rights violations involving the provider. The HRA found that allegations of inadequate communication and inadequate treatment/service planning were substantiated. Another HRA investigation covering a period in late 2024 also substantiated allegations of “Sleeping on the job with residents who may not be left unsupervised and not collecting various data as directed by personal, implementation and behavior supports,” stating that these substantiated allegations “fail to meet the Code’s standard of providing adequate and humane care and services pursuant to this resident’s plans.” The HRA investigation noted that the “problems were already identified and remedied by bringing in new staff and a trainers and reinforcing the need to carry out their duties accordingly. No recommendations are required.” Quality failures at Sevita providers have been documented across eight states, including Illinois. 

A Help at Home residence in Kankakee, IL was shut down after the family of a resident there alleged that “an employee convinced two other developmentally disabled residents to beat [the resident] in July of 2021, as the employee recorded it all on his cellphone.”

Broadstep Behavioral Health

Bain Capital’s Broadstep Behavioral Health illustrates how aggressive growth may undermine quality of care. Broadstep Behavioral Health provides residential and community-based services for children and adults with IDD, mental illness, and co-occurring disorders. Bain Capital acquired the company in May 2020. Under Bain’s ownership, Broadstep’s reach has accordioned – in just over a year after Bain’s acquisition, Broadstep acquired five other companies and operated in at least seven states, including Illinois. As of February 2026, the company lists only South Carolina on the “locations” section of its website, but still lists Illinois as one of three states it operates in on the “about us” section of its website. It is unclear if and for how long Broadstep will be able to continue operating in Illinois, since state regulators revoked its license to operate group homes in July 2024.

Broadstep was one of the largest providers of Community Integrated Living Arrangement (CILA) in Illinois; between 2021-2023, the state paid Broadstep over $23.6 million for CILA services.  An audit of reports by the Office of the Auditor General for Illinois Department of Human Services (DHS) reviewed the state’s investigations of CILA program providers, including Broadstep. The audit found that “Broadstep appears to have violated both State law and State rule in the [OIG] investigations of the cases,” including 22 instances of noncooperation. In July 2024, the Illinois Division of Developmental Disabilities (DDD) revoked Broadstep’s license to operate as a CILA provider after repeat violations of the state’s quality standards.

In the revocation letter sent to Broadstep, the state regulator wrote: 

“Despite multiple plans of correction and corrective action plans and personalized assistance from DDD, the deficiencies continue. Every effort has been made with Broadstep to not only address these deficiencies but to implement a system to maintain compliance.” 

In the same revocation letter, DDD cited Broadstep’s ongoing medication administration issues, including repeatedly failing to secure medications, no evidence of training for new medication, and no policies and procedures around medication administration. Sound medication administration is essential to providing care for individuals with IDD given that the medical complexity and need for complex pharmacy services for this population tends to be high. They also found significant deficiencies in staff training and screening and repeat violations in regarding deficient safety drills and inspections, deficient safety/cleanliness.  

In the fall of 2024, Broadstep shut down a private school it operated in New Jersey, submitting a WARN Act filing stating it planned to lay off 56 Broadstep Academy employees. Following the closure, Broadstep Academy’s former Principal and Chief School Administrator, Lisa Corliss, stated that “Despite our success, Broadstep Academy was closed due to a change in corporate vision by the parent company, leaving many students with IDD and complex behavioral needs in the area without viable educational options.” 

In 2022 Broadstep lost its license to operate a facility in Georgetown, SC after police requested that the city decline to approve its license renewal, claiming that they had received around 150 calls for service and 70 incident reports related to the facility between 2020 and 2022. The same year, Broadstep paid $275,000 to settle a lawsuit claiming that staff members broke a resident’s arm. Broadstep did not admit liability. In early 2024 Broadstep closed a facility in Pickens, SC and “consolidated” operations upstate in Simpsonville, SC, where it operates Broadstep-Venice.  Local police said that there were roughly 100 patient escapes in the 13 months leading up to the closure.