The home-based care industry has seen several notable CEO transitions in recent history, but new leaders report the same core challenge: growth without losing frontline culture.

For new top executives at Elara Caring, LiveWell Partners and Freedom Senior Services, top strategic priorities include building density, expanding service lines and maturing systems — but the leaders are balancing new initiatives with the character of the organizations they inherited.

Ananth Mohan, who became CEO of Elara Caring in June 2025, inherited the role after spending four years as chief operating officer.

“So in that sense [I] had a hand in creating what we built and — probably created some of the problems too,” he said at Home Health Care News’ recent FUTURE conference.

After he assumed the CEO role, he wanted to preserve the company’s culture, including its focus on innovation and integrated, high-acuity care. Leadership transitions offer an opportunity to consider initiatives and leadership alignment. He saw some areas ripe for change, including the potential to secure new investment. In February, Ares Private Equity Group (NYSE: ARES) and DaVita (NYSE: DVA), a kidney care provider, made a strategic investment in Elara.

Dallas-based Elara Caring provides home health, personal care, hospice and behavioral health services across an 18-state footprint with 200 locations.

For new CEOs who enter from outside the organization, some details change, but the focus on culture persists.

At LiveWell Partners, the focus on culture is aided by the continuation of the founder on the executive team. Founder Jason Growe now serves as the company’s chief development officer after holding the CEO role for three years.

In March, Stacie Bratcher assumed the CEO position.

“Jason did a great job of really establishing the culture, footprint and foundation for the business to be able to step into its next chapter, and for us to be able to focus on how we continue to grow organically, build density in our markets, but also through M&A and product line expansion,” Bratcher said at FUTURE. “We’re just evolving to our next phase.”

St. Louis-based LiveWell Partners is a home health and hospice platform backed by the investment firm Camino Partners. It operates across Illinois, Kansas, Michigan, Missouri and Ohio.

CEOs taking over from founders must preserve the soul of the company, Dr. Brian Holzer, the new CEO of Freedom Senior Services, said at FUTURE. Holzer took the helm in March following Gemspring Capital’s acquisition of the company. According to Holzer, he was hired to professionalize the organization and develop the foundation for scale.

To protect company culture, Holzer said he has spent his first few months building trust and communicating with the organization’s team. Approaching discussions about change is tricky, he said, because the company will be transformed in the next three years.

“It ultimately comes down to retaining the soul of the company,” Holzer said. “That is what makes some of these founder transitions so difficult.”

Louisville, Kentucky-based Freedom provides non-medical home care services in Kentucky, Ohio, Pennsylvania, Indiana and Tennessee.

New leaders set new goals

As this new cohort of top company leaders works to preserve company culture while moving their organizations into the future, they must contend with specific challenges.

Bratcher named clinical capacity as the force most shaping her decision-making at LiveWell. To overcome caregiver shortages, LiveWell must balance being the employer of choice with meeting its other initiatives.

Holzer cited regulatory-level forces as most impactful to his strategy. For Holzer, it is critical to be prepared for changes in regulatory oversight in non-skilled home care. To handle regulatory shifts designed to crack down on fraud, waste and abuse, Holzer said an approach to compliance that does not kill the company culture is essential.

“You absolutely can over-engineer HR and compliance,” he said. “The goal is not to be the industry leader in compliance, but the goal is to do it as well as the best in class in your space.”

Reimbursement is a key factor shaping Mohan’s decisions. The reimbursement environment is volatile across Medicaid, Medicare Advantage and Veterans Affairs (VA), he said. Also top of mind is the moratorium on Medicare home health enrollment, which limits providers’ de novo growth potential. These forces make investing, planning and predicting progress difficult, he said.

While grappling with regulatory challenges, Mohan is continuing to execute the goals he set early in his tenure, including expanding high-acuity care and driving innovation, and setting new priorities.

After the investment from Ares and DaVita, Elara is now prioritizing expanding its footprint to improve access to care. Mohan sees growth as the answer to challenges related to reimbursement and rising costs.

“Scale and sophistication are really what matters and what’s going to win going forward,” he said.

LiveWell, which has historically expanded largely through M&A, will continue to grow by acquisition but will prioritize organic growth.

“The reason that we’re doing that is not just for dots on the map, but because we truly believe that we can build density that enables us to more maximally perform from a clinician capacity perspective,” Bratcher said.

Density allows LiveWell to have more influence on hospital system partners, work with partners with higher-acuity patients and better coordinate across a geography, Bratcher said. Part of the CEO’s strategy is expanding palliative care and hospice services across its home care and skilled home health platform.

For Holzer, creating an infrastructure is critical to achieving growth goals.

“I’m fortunate to have taken over at the time of the transaction on a growth buyout with a PE firm that’s looking to expand aggressively,” he said. “That becomes easier when you have a home base, a platform and an infrastructure in place to allow you to do it the same way repeatedly across your markets.”

For all three executives, navigating expansion requires an above-all emphasis on the frontline experience.

“Ultimately, this comes down to a caregiver and a participant,” Holzer said. “And if you deploy dollars that do not help enhance or optimize that interaction, they’re wasteful.”