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A Hospital In Your Home


Home healthcare companies look to capitalize on aging Boomers.


As Baby Boomers become senior citizens, a number of investment opportunities will come to light. One that few have yet to realize: Home nursing.

When patients recover from injury or illness at home instead of the hospital, they can actually save money. This is surely an attractive option today, with reports of cash-strapped consumers postponing or waiving medical care because they lack -- or simply can't afford -- health insurance.

With home healthcare, services provided to the aged and those with chronic illnesses are considered non-discretionary and are reimbursed by Medicare and Medicaid. A Democratic government is unlikely to curb these entrenched social programs.

The landscape for home nursing is dominated by many small fiefdoms. The top 4 publicly traded companies -- Amedisys (AMED), Almost Family (AFAM), Gentiva Health Services (GTIV) and LHC Group (LHCG) -- only control 15% of the entire market. So these companies have been hunting for smaller grabs.

Almost Family is the smallest of the bunch, but it's aggressively challenging those bigger guns. It also has the most soothing name. Almost Family, based in Louisville, Kentucky, provides home healthcare in 11 states - all concentrated in the eastern half of the US. Earlier this month, the company reported an 84% rise in third-quarter revenue. And in October, Forbes magazine ranked Almost Family twenty-fourth in its list of the 200 Best Small Companies in America.

At the beginning of August, Almost Family completed its biggest buyout ever: The $45 million purchase of Patient Care. That deal will bring in $47 million in annual revenue for a company that earned less than 3 times that in 2007. It also allowed Almost Family to add locations in Connecticut, New Jersey and Pennsylvania. The last 2 states are new frontiers for the company.

A big macro trend helping Almost Family and its competitors is the nationwide shortage of nurses. The American Association of Colleges of Nursing estimates the shortage of registered nurses could reach half a million by 2025. Home healthcare operators will be able to charge more for their services because of this scarcity.

Visiting nurses help patients ease their way back to independence over a finite period. The other business, for the debilitated, is long-term custodial care. Until recently, these 2 segments were roughly the same in size and revenue for Almost Family. But visiting nursing now comprises 80% of its revenue.

Visiting nursing has another major selling point over hospital stays: Patients aren't confined to 4 channels and lousy food.

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