Aveanna CEO: Hospice Multiples Still Too High

As Aveanna Healthcare Holdings (Nasdaq: AVAH) considers potential acquisitions, hospices are not on the menu due to their high price tags.

Hospice multiples skyrocketed during the boom M&A years of 2019 through 2022, reaching as high a 26x, sometimes more. As transactions slowed down between 2023 and 2025, one contributing factor was a disconnect between sellers’ and buyers’ expectations regarding valuations.

Now hospice deals are picking up steam. The fourth quarter of 2025 saw the industry’s highest deal volume since 2021, and one reason is that sellers’ and buyers’ expectations are becoming more aligned. However, this trend hasn’t yet gone far enough, according to Aveanna CEO Jeff Shaner. 

“[Hospice multiples] are all north of 10x. We’ve seen some trade north of 15x. We’ve stuck our nose in a couple of small [transactions] just to see, and we’ve just gotten politely thanked very early on, but anything from 10x to probably 16 or 17x,” Shaner told Hospice News at the Home Care 100 conference in Scottsdale, Arizona. “It’s just an ecosystem where we were not successful. We like mid to high single digits. If you pay 10x or something, that’s a great quality asset, but that should be about the top that you’re paying.”

Consequently, the company is leaning into its home health and home care businesses, using a five-pronged approach.

These efforts include strengthening relationships with payers, finding opportunities to reduce costs, modernizing its medical solutions services, optimizing capital structure and cash flow, and increasing engagement among staff and leadership.

Aveanna’s preferred-payer and government affairs strategies has already increased revenue in its hospice and home health divisions, and the company intends to replicate this approach to drive growth in its medical solutions segment, CEO Jeff Shaner said at the Bank of America Home Care Conference.

As far as hospice growth, the company is pursuing home health and hospice de novo locations, with two or three expected this year, according to Shaner. Going forward, Aveanna will likely open two to four de novos annually, he said.

Two key goals are building density across Aveanna’s footprint and filling in gaps in markets where its payer partners are operating.

“It’s continuing to fill out those other areas and states where we don’t have meaningful coverage,” Shaner said. “Key states like Ohio, West Virginia, Tennessee, Kentucky, for us, we just need to fill those in, because our payer partners are relevant in those markets.”