PrintAddus HomeCare Q1 2026 Earnings Call: Complete Transcript
BY Benzinga | ECONOMIC | 10:25 AM EDTAddus HomeCare
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Summary
Addus HomeCare
The company reduced its bank debt to $94.3 million and has $103 million in cash, providing financial flexibility for acquisitions.
Addus HomeCare
Operational highlights include a 6.5% same-store revenue growth in personal care and 7.7% in hospice care, with positive hiring trends.
Management remains optimistic about future growth, supported by strategic acquisitions and favorable regulatory developments.
Full Transcript
OPERATOR
Good morning and welcome to the Addus HomeCare's
Drew Anderson (Moderator)
Thank you. Good morning and welcome to the Addus HomeCare Corporation
Dirk Allison (Chairman and Chief Executive Officer)
Thank you, Drew. Good morning and welcome to our 2026 first quarter earnings call. With me today are Brian Popp, our Chief Financial Officer, and Heather Dixon, our President and Chief Operating Officer. As we do on each of our quarterly earnings calls, I will begin with a few overall comments and then Brian will discuss the first quarter results in more detail. Following our comments, the three of us would be happy to respond to any questions. As we announced yesterday afternoon, our total revenue for the first quarter of 2026 was $363.6 million, an increase of 7.7% as compared to $337.7 million for the first quarter of 2025. This revenue growth resulted in an adjusted earnings per share of $1.62 as compared to adjusted earnings per share for 1Q25 $1.42, an increase of 14.1%. Our adjusted EBITDA was $44.5 million compared to 40.6 million for the first quarter of 2025, an increase of 9.7% for the first quarter of 2026. Cash flow from operation was $52.4 million as compared to $18.9 million for the same period in 2025. As of March 31, 2026, we had cash on hand of approximately $103 million. With our strong cash flow in the first quarter, we reduced our bank debt to $94.3 million, leaving us with the financial flexibility to consider larger acquisitions as we continue to pursue expansion of our market reach and creating geographic density. During the first quarter we saw an impact on revenue due to the widespread weather event that occurred towards the end of January. Our team did a good job of rescheduling affected personal care visits where possible. However, we could not make up for every weather impacted missed visit. While the amount of the revenue was immaterial to our company, overall, we did see a loss of revenue of approximately $1.5 million as a result of these storms. However, February and March returned to our normalized revenue expectations. As we announced on May 1, we closed on the acquisition of the personal care operations of Homecourt Homecare based in Fort Wayne, Indiana. This acquisition marks our entry into an attractive state which is adjacent to our largest personal care market of Illinois. We have been interested in Indiana for some time as over the past three years they increase rates and work to eliminate client wait lists. I'm excited to welcome all of our new team members from Homecourt Homecare. We have also entered into a definitive purchase agreement for an additional personal care operation in Indiana which will complement Homecourt Homecare. We anticipate that this additional Indiana acquisition should close in the coming months subject to customary regulatory approvals. These two acquisitions continue our strategy of entering new markets with scale and where we have the ability to expand our services. As we mentioned on our last earnings call, the State of Illinois increased our rates in personal care service effective on January 1, 2026, adding approximately $17.5 million in annualized revenues. This most recent rate increase continues to show the important support we are receiving from our state partners as we continue to provide these much needed services to to our elderly and disabled clients. We also understand the New Mexico Legislature included increased funding of $10 million for home and community based services in the budget for the upcoming fiscal year. We are waiting for communications from the New Mexico Medicaid Department regarding how and to which programs the funding will be expended. As we've stated before, we continue to believe that the 80:20 provision of the CMS Medicaid Access Rule will be eliminated in the near future. While implementation is still several years away and has no current impact on our business or financial performance, we believe this outcome would be an encouraging development for both our industry and our company. All our recent communications indicate that this part of the Medicaid Access Rule is expected to be eliminated this year. During the first quarter of 2026, we continued to experience positive hiring trends in our personal care segment. Our number of hires per business day in the first quarter of 2026 was 108, up sequentially from 103 hires per day in the fourth quarter of last year and consistent with the first quarter of 2025. We achieved this number in spite of the impact of the weather eventually. I mentioned earlier, as we have mentioned in the last few quarters, our clinical hiring remains consistent and has been mostly stable outside of a few of our urban markets. However, even in those markets we have been able to staff our operations appropriately. Now let me discuss our same store revenue growth for the first quarter of 2026. For our personal care segment, our same store revenue growth was 6.5% compared to the first quarter of 2025. During the first quarter 2026, we saw personal care same store hours increase by 2.2% compared to the same period in 2025, while our percentage of authorized hours served in the first quarter remained consistent with what we experienced in the fourth quarter of 2025. On a sequential basis, personal care same store census was down slightly, partially due to the weather we mentioned before. However, during the first quarter we saw growth in clients served in Illinois, our largest market, which is something we had anticipated for a while. This is important as we look to achieve year over year census growth during 2026. Turning to our clinical operations, our hospice same store revenue increased 7.7% compared to the first quarter of 2025. Our average daily census increased to 3,804 for the first quarter, up from 3,515 for the same period last year, an increase of 8.2% for the first quarter of 2026. Our hospice medium length of stay was 23 days as compared to 25 days for the fourth quarter of 2025 and 19 days for the first quarter of 202025 we are very pleased by the continued growth in our hospice segment over the past several quarters. While our home health same store revenue decreased when compared to the same quarter of 2025, our home health operating income improved over last year's first quarter and sequentially versus the fourth quarter of 2025. It is also important to understand that over 25% of our hospice admissions in New Mexico and now Tennessee are coming from our own ADDAS home health operations which overlap in these two markets. As we continue to focus on our BRIDGE program, we are pleased to see more patients receiving the benefit of the full continuum of post acute home based care and anticipate seeing similar clinical teamwork to be in Illinois where we also have both home health and hospice operations. We continue to believe that size and scale are important to healthcare services and have been the focus of our strategy for the past 10 years. We continue to evaluate opportunities which would increase both density and geographic coverage as well as seek to further strengthen our relationships with states and managed care organizations. Recently we have begun to see an increasing number of personal care opportunities. Due to our focus on maintaining a conservative balance sheet, we have the ability to actively pursue these transactions. Recently there appears to be more optimism around home health care due to the final home health rule for 2026 being more favorable than was originally proposed. While there is still some uncertainty about the future rate increases, there does seem to be more potential activity in home health care. While we will be open to home health opportunities, we will continue to be diligent as we evaluate possible transactions to further our strategy. Before I turn the call over to Brian, it is important that I thank the Addus team for the care they are providing to our elderly and disabled consumers and patients. We all have come to understand that the majority of this population prefers to receive care at home, which not only remains one of the safest but also the most cost effective places to receive this care. We believe the heightened awareness of the value of home based care is favorable for our industry and will continue to be a growth opportunity for our company. We understand and appreciate that our operations and growth are dependent on both our dedicated caregivers and and other employees who work so incredibly hard providing outstanding care and support to our clients, patients and their families. With that, let me turn the call over to Brian.
Brian Popp (Chief Financial Officer)
Thank you Dirk and good morning everyone. The first quarter of 2026 marked a solid start to a new year for Addus HomeCare
OPERATOR
Thank you. We will now begin the question and answer session. To ask a question, you may press star then one on your touchtone phone. If you're using a speakerphone, please pick up your handset before pressing the keys. To withdraw your question, please press star then two. In the interest of time, please limit yourself to one question and one follow up. this time, we'll pause momentarily to assemble our roster. Our first question comes from Brian Tankweloot from Jefferies. Please go ahead.
Brian Tankweloot (Equity Analyst)
Good morning, good morning, guys. Maybe I'll start Dirk when we think about the caregiver app rollout, I know that's something that you're working on in Texas. How do you think about the progress there and what it will take to get it to where you want it to be as quickly as possible? And then what are the expected benefits from that? I mean, how do we think about the P&L translation of this app rollout and why it's so important.
Heather Dixon (President and Chief Operating Officer)
Hi, Brian. Good morning. I'll start and then Dirk can add to anything that I see. So I'll start with just the progress that we're seeing with that caregiver app. We now have deployed it in all three of our three largest states. Illinois, as you know, has been deployed for a while and we're continuing to see really good utilization and uptick of that utilization throughout the state. In New Mexico, we have deployed it for a portion of our branches. We have some special nuances associated with the state Electronic Visit Verification (EVV) system there. So we're going to roll it out in two tranches. But we have deployed it and we expect to be deploying to the rest of the branches soon in the coming quarters. And then finally in Texas, we rolled it out during Q1 and we're seeing some really positive momentum in the utilization of that. And caregivers actually downloading that app, we saw even in the first few days to a week, we saw up over 10% of our caregivers had already adopted that app. So we're seeing really good momentum. And as we think about where we go from here, there are a couple of things. One, continue to roll it out to other locations and that's really going to enable our caregivers and help us focus on increasing our service percentage. And then two, we can use that to really drive communication and really create a good engagement, positive engagement with our caregivers.
Dirk Allison (Chairman and Chief Executive Officer)
Yeah, Brian and I think what Heather just mentioned, they're the, the two aspects that we really focus on and why we invested in the caregiver app. You know, you've seen positive momentum in Illinois for the percent of hours served that we believe a large part of that is directly attributed to the fact that there's that caregiver app out there which allows the particular caregiver to see how many hours are left on the authorization and make sure that we're serving to an appropriate amount. Also, we think it can allow us to be a little more sticky, as Heather said, with our caregivers, make it easier for them to know what their paycheck's going to be, to know their hours served and know also the ability for them if they want to pick up additional hours. We have this app out there that allows them to be able to do that in an effective manner. So those are really the benefits that we're looking for from this app.
Brian Tankweloot (Equity Analyst)
That makes sense. And then maybe my follow up, Heather, for you or maybe for Brian, as I think about the length of stay on the Hospice side, we've just gotten questions on CAP risk and how you're thinking about that. So just anything you can share with us just on the hospice cap concern? Thank you.
Heather Dixon (President and Chief Operating Officer)
Yeah, Brian, right now we don't really have any cap consideration. We actually are managing, I think our referral mix and our patient base pretty well. Discharge length of stay was a little higher this quarter, but again, those are just a factor of the people that actually discharged during the quarter and probably not indicative of how you would think about cap. Our median length of stay, as Dirk mentioned, was 23 days, which actually is probably a little bit low for us. But I think we've got a really good mix. So no cap concerns for us at the moment.
Brian Tankweloot (Equity Analyst)
Thank you.
OPERATOR
Our next question comes from Raj Kumar from Stevens. Please go ahead.
Raj Kumar (Equity Analyst)
Maybe just update on the sort of, the sort of budget from each of your states and curious on sort of Indiana more specifically. I know when you guys went into Texas with Gentiva that was sort of on the front of the state passing or sort of in the process of passing a rate update. So curious on the sort of Indiana rate backdrop and any commentary there?
Brian Popp (Chief Financial Officer)
Yeah, I think in Indiana specifically when you talk about some other states as well, Raj, you know Indiana as Dirk mentioned, we've seen some nice rate support from them over the past several years. I think if you wanted back, you know, about five years ago or so, I'm not sure it would have been probably quite as attractive for us. But we've seen nice support for them, a nice margin in that state, pretty consistent with where we are on a consolidated basis. I think the ability for us to do two acquisitions simultaneously or in close proximity gives us really good coverage. I think we've always wanted to have a pretty good footprint when we go into a new market. I think if we were to do one without the other, it probably wouldn't be quite as attractive. But I think doing both gives us a nice place to start in Indiana and the ability to continue to add either additional services or more density there. So one more place on the map where we have opportunities. I think just thinking about it from a budgetary standpoint, obviously Texas is every other year, so they're not going to meet this year. So nothing to really report on that end. Dirk kind of referenced New Mexico, which has finalized their budget. There are dollars allocated for home and community based services. We're just trying to determine and get the information on the logistics of how that will pass down to providers. Indiana I mean, I'm sorry, Illinois is our largest market, is still in session, has not been finalized their budget this year. Our understanding is there's conversations from the union, as we would expect every year about our services and rates, but nothing to report. We would expect them to probably finalize their budget over the next few weeks. So we'll know more then. But those are probably the three largest obviously that we keep our eye on.
Raj Kumar (Equity Analyst)
Got it. And then MA (Medicare Advantage)ybe looking at home health, I guess there was a shift in the payer mix trend, higher Medicaid year over year. I guess MA (Medicare Advantage)ybe anything to call out on that front. I guess more intentional or just kind of how it played out and I guess, you know, has it been paying better than MA (Medicare Advantage)? If it is intentional, I'm just kind of curious on the payer mix trend
Brian Popp (Chief Financial Officer)
for home health in the quarter. Yeah, I think in the quarter probably a little bit of anomaly. We had some rate updates and positive rate updates in one of our programs that kind of falls into that other bucket that you saw in our press release yesterday. So we saw that in the quarter. We'll probably revert back to more historical norms next quarter. Nothing intentional. I think obviously we're focused on making sure we try to get the best rate possible in the business that we take in home health, trying to make sure that it's profitable. Our guys on the payer side are having conversations consistently with folks on trying to get as many episodic rates as we can and looking at taking cases that make sense for us from a profitability perspective.
Raj Kumar (Equity Analyst)
Great, thank you.
OPERATOR
The next question comes from Matthew Gilmore from KeyBank. Please go ahead.
Matthew Gilmore (Equity Analyst)
Hey, good morning. Thanks for the question. Maybe following up on some of the census comments for personal care, I think I saw the census was down a little sequentially. You mentioned Illinois was up which is encouraging. I just wanted to confirm I heard that correctly. And then maybe more broadly, I know census for personal care oftentimes is lower in the first quarter and if Illinois was stronger, does that imply there was weakness elsewhere or would you just sort of categorize it as sort of normal seasonal trends? Just wanted to see if there was any other details to share on this topic.
Heather Dixon (President and Chief Operating Officer)
Sure, sure, I'll take that. Hi Matt. Good morning. So as Dirk mentioned, we did have some weather impact in the beginning of the quarter and that impacted our sequential census growth. That's what you saw as a slight sequential decline. But you did hear correctly. We had census improvements throughout the quarter and we saw gains as we exited the quarter. And I think very importantly March census exceeded both January and February census. So we're focused on those sequential gains and going forward that should lead to year over year gains as we move through the next couple of quarters. And then specifically in Illinois, we were very pleased to see that start the care exceeded discharges throughout the quarter and that led to sequential monthly improvement there as well. And so as we exited the quarter for Illinois, we saw a nice trajectory and frankly overall with census, and then we saw that trajectory really continue as we moved into the second quarter as well. There is nothing to point to. It's not that Illinois is masking anything else. It's just as our largest state and one that we're very focused on, we wanted to be sure that we shared the positive improvement that we've seen there.
Matthew Gilmore (Equity Analyst)
That's great. Appreciate it. And then maybe following up on some regulatory topics, CMS has made some comments
Dirk Allison (Chairman and Chief Executive Officer)
that have been skeptical of the self directed care model within personal care and sort of home and community based services broadly. Especially with some key states like New York, which I know you don't have exposure to. I was curious if the skepticism on the self directed care model created opportunities for addus more broadly, given your focus on the agency directed model. You know, self directed care does have an issue. You don't have anybody in between the patient and the caregiver, the caregiver and the patient to make sure that the service is actually being performed. So the state has a little more responsibility on themselves to do that. So we saw in New York that it was a program that was probably in our mind going to have issues and not really sustainable. That's why we left New York. There's also issues out in California. There's a large issue out there because it's self directed care. We don't participate in medi cal out there. Most of the business we have is VA and private pay. But as you look at it, we've been saying for years personal care is a great service and much needed and saves the states a lot of money.
Dirk Allison (Chairman and Chief Executive Officer)
But it needs to be done in the right way. And one of the things that is an advantage to having the companies like Addus and others sit out there hiring the caregiver and matching them with the patient is that we have responsibilities to do a lot of extra things to make sure that service is being provided. Whether that's supervisory visits, actually in person calls, on the telephone. We have evv. We have to make sure that the client shows up. I mean the caregiver shows up and stays the amount of time when they leave so that we're billing the proper number of hours. So there's a lot of compliance issues that are placed on companies like addas as opposed to the self directed care where there's very little if any of those. So we think it's a real encouragement to our industry from our standpoint. We agree with the fact that there needs to be a look and make sure that when you're paid for services, those services are being rendered. We think that will benefit a company like addus. Great. Thank you.
OPERATOR
The next question comes from Sean Dodge from BMO Capital Markets. Please go ahead.
Chris Charlton (Equity Analyst)
Thanks for taking our questions. It's Chris Charlton on for Sean here. Maybe back on personal care. You've again driven strong growth and same store available hours even amid a declining census. Can you just share some more detail on some of the dynamics behind the strength here and continuing to fill a strong percentage of the authorized hours and kind of how you anticipate that evolving throughout the year as you expect to return to some census code?
Heather Dixon (President and Chief Operating Officer)
Sure, sure. I'll take that. Hi Chris, I'll start with talking about billable hours and sort of what we're doing that really fuels that growth in billable hours. A couple of things specifically. One, you know, we're working on refining our operational processes, you know, from the support center and then also from the branch perspective and that's particularly with scheduling and and utilization of our authorized hours. And then as we talked about just a couple of minutes ago, we've been focused on creating tools and deploying them that will help our providers, actually the caregivers have access to those hours as well. And that's in the form of the app. What we have seen is improvement in that service percentage or fill rate. So the hours that we are posting are really a higher utilization of the authorized hours and we're seeing that in most of our states and we're seeing that specifically where we have deployed the app and we've had some really good usage and we would expect for that opportunity to improve the service percentage to improve as we move throughout the year, particularly as we deploy the app in Texas, one of our largest states. If you think about from Q4 to Q1, your question about even though census is down just a bit sequentially billable hours are up. I think that's just a function of the weather that we saw earlier in the quarter and nothing else really to point to there.
Dirk Allison (Chairman and Chief Executive Officer)
Let me jump in on census because I know everybody's focused on that number and it is an important number. It's not one that we get paid on billable hours. So we really focus on making sure we get the proper amount of hours per census as opposed to just census per se. You got to get the right senses, you got to get the right hours from that patient coming on board to make sure that it's something we can serve appropriately and profitably. That being said, we do understand that people are looking at that. And I think the important thing this quarter that's very exciting to us is Illinois made the turn. And Illinois is one we've really worked on the last four quarters to get it back into a growth mode. It just so happens this month Texas was a little soft coming out in January, really. And so we saw a little bit of effect in Texas, the census for the quarter. But by the end of the quarter, Texas was back, Illinois was continuing to grow. So the important thing is we believe most of our states now are in the situation where starts of care are exceeding discharges. Sometimes you're going to have a little bit of issue in a state maybe during a quarter. But the general trend is we think we've seen that change and now we think all three of our big states are in that particular situation where we should grow Census.
Brian Popp (Chief Financial Officer)
Okay, that's helpful. And then on home health, obviously there's some encouraging adjustments to the final rate from CMS there last year. As you kind of come up on their initial proposal for 2027 rates in the coming months, maybe just qualitatively, can you just share some thoughts on the backdrop and kind of what you would like to see initially just to kind of give everyone some clarity that the environment might be starting to stabilize and might be looking just to be a more favorable backdrop for some opportunities there? Yeah, I think I can take that one. And Dirk can add some color as well. I think, you know, Dirk's comments, you know, I think obviously saw some positivity in the final rule last year. I think we're interested to see what the rule will look like this year. It feels like maybe there's more appreciation coming out of CMS for, you know, what the industry has gone through the last few years, I think, and kind of focusing on some of the areas where there might have been some issues that might have impacted the way that they've looked at reimbursement last few years. And the industry, I think, has been lobbying for some time for them to see that in the way that some of the things in the fraud, waste and abuse area potentially have been used in the calculation. With those kind of maybe out of the mix and maybe identified, I think we're hopeful that means maybe there'll be more positivity in the rate that we'll see coming up this year. So, you know, small segment for us. We think there's a lot of synergies of having multiple lines of care. So something that we'll watch closely but things that we're still interested in looking at.
Matthew Gilmore (Equity Analyst)
Great, thanks again.
OPERATOR
The next question comes from Andrew Mock from Barclays. Please go ahead.
Jeffrey (Equity Analyst)
Hi, good morning, this is Jeffrey on for Andrew. So I appreciate all the color around the person personal care segment, but maybe I just wanted to better understand addis exposure to self directed personal care and the impact that's had on recent personal care segment results.
Dirk Allison (Chairman and Chief Executive Officer)
Yeah, you know, we don't really see an impact from self directed care. Most of our states, as we mentioned, there was some issues in New York. We left that state, California. We used to, if you go back 10, 15 years ago, we did business in California and California really decided to go self directed care and it wasn't something that we provided. So we focused on states that really understand the difference between self directed care and agency care. And that really goes back to what I said a few minutes ago, which was what you get with agency care is a compliance program. You get companies like Addis that are making sure that that caregiver who may or may not, just because it's called, you know, family caregiver, it may not actually be a family caregiver or family member, it may be somebody that knew the patient and is willing to serve in that market. So for that aspect, we still do all the things we do, all the training, we make sure that EVVs in place, we go through our complete compliance program to make sure that we are being paid appropriately and that we're providing the appropriate care that per the plan of care. So really from us, the self directed care does not have a direct impact, but we are glad to see that they're looking at self directed care to make sure that it is following the rules, just like agency care.
Brian Popp (Chief Financial Officer)
Okay, thanks. And maybe on the hospice side, I think revenue per patient day growth was negative for the first time in a while. Could you help us better understand the dynamics there, including any trade off with average length of stay? Thanks. Yeah. I think there's two elements to that this quarter. I think primarily, you know, we talked last year that we had some positive impact from the Implicit Price Concession or revenue adjustment, whichever term you want to use. And I think we had indicated we expected that to revert back to kind of historical norms. And I think, I think that's where we were this quarter. So that definitely was part of the consideration between last year and even Q4 right into Q1. I think there's a little bit of probably impact from just mix as well, but nothing really material there. But those are really the two factors.
Jeffrey (Equity Analyst)
Okay, thanks.
OPERATOR
The next question comes from Constantine Davides from Citizens. Please go ahead.
Dirk Allison (Chairman and Chief Executive Officer)
Dirk. You highlighted your balance sheet strength and ongoing debt reduction both in the quarter and post the quarter and I guess can you just comment a little bit on the size of the opportunities in the M and A pipeline, whether that's starting to skew up a little bit more in recent months? You know what we're starting to see this year and there's already two or three opportunities out there that are of size that we're looking at. I think it's really something that changed probably in the last three months or so where we're seeing processes begin on these larger opportunities. And that's one of the reasons, I think, Constantine, that we've worked very hard to keep our balance sheet clean. It's a reason we were able to do Gentiva very quickly and bring it on board. So we're looking at some of these bigger opportunities that because of our balance sheet we could do and bring on fairly rapidly without having to stress our balance sheet. So again, they are out there, they're in a process and we're looking at them. And when you say of size, something along the size of our scale of a gentiva. Yes. They're similar in size to Gentiva. That's correct. Great. And then a quick follow up on Indiana. You talked about that being that state being attractive and good rate momentum, I guess in recent periods, where do rates kind of compare to either other states you're in or your blended average? The rates are a little higher than some of the Midwestern states. I mean, obviously Illinois is going to be our highest market. But Indiana, if you look around the other states around there, the rates now are very, there are nice rates. They're rates that we can operate in very effectively. Also there seems to be a little less competition in Indiana in the number of providers of our care. So it's a state that we've been looking at and with, you know, I think it was in like the 2023 time frame is when they really raised their rates to make them more competitive. Ever since then we've been looking for opportunities to get into a state and that's what, you know, home court home care brought to us and the other acquisition that we announced allow us to get into that state and start looking for other opportunities to grow. Thank you.
Ryan Langston
The next question comes from Ryan Langston from TD Cowan. Please go ahead.
Brian Popp (Chief Financial Officer)
Hi. Maybe just a dovetailing off Indiana, you know, obviously strategy to enter states of size and scale. Do you know if you combine the two assets where that would put you in terms of market share in the state? And I just caught your comments on decent rates and competition dynamics. But anything else in particular that made Indiana attractive?
Dirk Allison (Chairman and Chief Executive Officer)
Yeah, I can start and then Dirk, to add some color. I don't know that we have enough detail to know exactly where we'd stand. I think it's going to be a good footprint for us from just a coverage standpoint. You know, all in the other acquisition is going to be similar size. So we're going to be, you know, just under 20 million in revenue, which is a pretty good, good start for us in the state. I think one of the things that made it attractive for us, in addition to what Dirk had kind of referenced, is the managed Medicaid component. Obviously a lot of the larger players there think united and those folks, we have good relationships with all of those guys, as everyone knows, kind of nationally. So I think it is a good fit for us as well. That's always been something that's been part of the profile that we like is again, the states that have managed Medicaid where we can have those relationships in place. So I'm excited about that.
Brian Popp (Chief Financial Officer)
Okay. And then I appreciate the commentary and response to Matt's question, but maybe just more broadly, obviously this administration is really focused on fraud, waste and abuse and have made some statements to that quite a bit over the past several months to a year plus, I guess just in general, what do you think any of that could mean for addas? Is that a potential benefit because you're so large and sophisticated maybe, versus some of your smaller, you know, competitors in your market? Just maybe more broadly, what do you think this administration sort of stance on fwa, you know, and how that could affect that. Thanks. Yeah, you know, one of the things that NADIS did, we participated with the alliance in talking to the current administration about the fact that fraud and abuse is out there and it causes companies to that are legitimate providers. It causes issues with various things you can talk about. And so from the standpoint of addis, we're glad to see the administration focus on fraud and abuse. We spend a lot of money on compliance we have for the last 10 years. We want to make sure that when we operate in a state that we're following the rules and we're doing what's proper. And, you know, at times that you find that maybe something was built improperly, we pay it back very quickly to stay in compliance with the state. So the fact that we are large, we spend millions of dollars into the compliance aspect, we think bodes very well for what the administration is trying to do. And that is take out the players, mostly smaller players, but take out the players that aren't doing the right thing. They're just billing and not following through with what they need to do to make sure that the rules are being followed. And more importantly, the most important thing is that the care is being given to the patient. There's a reason that patient has a plan of care that the state approved, and that is they need that care. And so for us, you know, calling out personal care, you know, we'd rather them just call out home care and talk about the fact that there's a lot of fraud and abuse in home health. There seems to be a lot in hospice from a personal care standpoint. We believe that we're a leader in the industry, and part of that being a leader is to lead the compliance effort. And so we're pleased with the fact they're focused on that. And we believe long term, it'll be a benefit to our company. Great, thank you.
OPERATOR
The next question comes from Jared Haas from William Blair. Please go ahead.
Jared Haas (Equity Analyst)
Hey, guys. Good morning. Maybe just one for the model. Appreciate all the detail you guys have given as far as hiring and some of the initiatives you have going on, like the caregiver application. You know that hours for census per month metric has been above 70 for a couple quarters now, I guess. Is there anything structurally that would cause that to decline? I think the typical seasonality would have that sort of continue to grow sequentially over the rest of the year. But just want to kind of make sure that's sort of the right expectation to level set how we're thinking about things for the model. Just given the moving parts as it relates to sort of census and volume trends.
Brian Popp (Chief Financial Officer)
Yeah, Jared, I wouldn't expect to see that. There's nothing structurally that's going to cause that to decline. I think you're always going to have a little bit of ebb and flow and mix in the states. But with the efforts that we're using in the Caregiver app and that rollout and thinking about our fill rate, we would actually probably expect that longer term to actually continue to grow, because we think there are hours that are available for clients under their care plan that we are currently not serving. So no, I wouldn't expect from Ollie Pursuit. I would not expect to see that decline for any structural reason.
Jared Haas (Equity Analyst)
Okay, got it. That's helpful. And then maybe just another one on Indiana as a new market for you guys. I'm just curious, do you get any sort of regional leverage in a market like Indiana, just given obviously the proximity to your largest market, Illinois? I don't know if there's any sort of infrastructure that you're able to leverage that would help you scale up and extract synergies a little bit more quickly than normal.
Brian Popp (Chief Financial Officer)
Yeah, I think if you look at it where we have markets around Indiana, obviously we're very large in Illinois, we're in Michigan, we're Ohio. So Indiana is kind of right in the middle of that geographically. So if you think about from just a regional or leadership perspective, there's not going to be a need for us to add any additional layers there. They should be able to just tuck under kind of what exists for us on the infrastructure today. Obviously you'll have people in those branch locations, but really that should be the limit of it. So from just from a leverage perspective on gna, that definitely should slide right into the operations that we have that kind of surround the state.
Jared Haas (Equity Analyst)
Okay, thank you.
OPERATOR
The next question comes from Clark Murphy from Truist. Please go ahead.
Clark Murphy (Equity Analyst)
Hey, good morning, guys. Thanks for taking my question. Had a follow up on labor. I appreciate all the commentary that you guys gave around the Caregiver app and hiring trends, but wanted to see if you guys are seeing perhaps any benefit on labor availability given some of the macro concerns that seem to have amplified over the last couple of months and the impacts that that's had on kind of a broader consumer environment.
Heather Dixon (President and Chief Operating Officer)
Yeah. Hi, good morning, Clark. I'll take that. You know, the short answer is that we're seeing positive hiring trends and we are seeing some of the leading indicators in terms of wage inflation and availability of candidates will trend in the right direction. And frankly, with wage inflation, we're back to sort of that normal roughly 3% base. You know, some are a little higher, some are a little lower. But in terms of candidates, we're seeing really good candidate flow across our markets. You know, as Dirk mentioned, we're always going to have small pockets where it's a little bit more difficult to staff. But that is is really limited to mostly rural locations and frankly just a couple of skilled categories in those rural locations. But we continue to work through those so that we can make sure we're hiring the right staff to drive growth and to serve our patients and clients. So really seeing some good trajectory there. Now, whether it's attributable to the macro environmental issues, that's really hard to say, of course, but I can tell you that we are seeing positive trends.
Dirk Allison (Chairman and Chief Executive Officer)
Got it, thanks. And then just switching gears to capital deployment. The other question I had was just if I think about your current pace of debt pay down relative to your debt balance suggests absent ma be kind of largely paid off by the end of the year. Just wanted to see absent any large scale M and A, how that would potentially impact your capital deployment priorities going forward. You know, we spent a lot of time talking about this at our board meeting. As you would expect, with the company in our position. I think the thing we see that maybe is not as apparent to outsiders is the number of deals that are now starting to come on board. We're starting to see some larger transactions, as we mentioned. And remember, with those larger transactions, there still are a number of smaller transactions that we just announced that are out there that we consider in most cases backfilled. And in this case it was entering into a new market. So, you know, we believe that before our debt is paid off, we will put to work a great deal of our capital in these opportunities that are out there. So it led us to decide that that's really what we understand we're going to use our capital for today. Now, if that didn't happen over the next year, you would see us maybe come up with a different decision on how we used our capital. But we believe right now that with the opportunities that are there for us, we'll be able to use our debt and our cash and debt to grow the company.
OPERATOR
The next question comes from Ben Hendricks from RBC Capital Markets. Please go ahead.
Michael Murray (Equity Analyst)
Hi, this is Michael Murray on for Ben. Thanks for taking my question.
Brian Popp (Chief Financial Officer)
You saw some pretty good leverage on adjusted sga even with the weather headwinds. Are there specific cost initiatives driving this improvement? Do you think the Caregiver app is helping there? And how should we think about SG&A ratio as we move through the year? Yeah, I would say first, the Caregiver app, you know, probably isn't going to really have an impact on gna. I think what we continue to see is kind of ongoing leverage, particularly on our corporate GNA as we grow our revenue base as we would expect. So we're not having to obviously add incremental costs there. I think, you know, on the labor side, you know, as we kind of mentioned earlier, you know, this year in this Cycle. We're back to kind of a, you know, 3ish percent kind of default rate there. So kind of back to, to norm, I think, you know, kind of going forward. We do give our merits on March 1st. So if you think sequentially in Q2, there's going to be, you know, a little bit of additional dollars in G and A in Q2 as those kind of flow through for the full quarter, but nothing else really from a seasonal perspective. So I think we would expect it to maintain, you know, pretty stable percentage of revenue and continue to see additional leverage as we grow.
Michael Murray (Equity Analyst)
And then just shifting gears to home health. Organic revenue declined 6.6. I think you previously indicated a return to growth in the second half this year. Again, some easier comps. So I just wanted to get an update on admission trends, the impact of your new leadership and your confidence in achieving that timeline.
Heather Dixon (President and Chief Operating Officer)
Sure. Hi, Michael. I'll take that one and talk about home health. Just start by reminding everybody it's less than 5% of our business. But you know, that said, we've made changes from a leadership perspective and then also from a sales perspective and how we go to market for that business. Recently in Q1, we saw our margins really where we want them to be. And so our focus is now on volume. We did see some positive trends in Q1. In fact, in Q1, 2026, new admissions, total volume and total visits all improved sequentially versus Q4, 2025. So that is the trend that we would like to see. That's part of what we're focused on seeing. And we continue to think that we'll see that certainly later this year and feel good about that statement. Just to just step back a little bit at a higher level, picking up on something that Dirk said earlier. The real value in our home health business is the interconnecting care that we provide and the correlation that we see in markets where we have multiple lines of service there and different levels of care between those lines of service. So, for example, I think it bears repeating in New Mexico and also Tennessee, where we have what we call the bridge program in place. And we really focus on creating referrals and admissions from home health into hospice for patients where that's appropriate. We've seen Those rates exceed 25% and we've also now begun that program in Illinois. Obviously, Illinois home health is a little bit earlier for us, but there is great opportunity there and opportunity to continue that pattern.
Michael Murray (Equity Analyst)
All right, thank you again.
OPERATOR
If you have a question, please press star then one. And our next question comes from A.J. rice from UBS. Please go ahead.
A.J. Rice (Equity Analyst)
Hi everybody. First I think at one point you were had said that you thought in the second quarter you'd still see above average growth in personal care and hospice and then it would moderate in the second half. Just wanted to give you a chance if there's any update. Excuse me, Kerry. Thinking about seasonality, what that might be or if there's any comments on it, thinking about the seasonal layout of the business for the rest of the year.
Brian Popp (Chief Financial Officer)
Yeah. A.J. this is Brian. I think maybe not so much seasonal but I think you start thinking about comps over prior year and some of the rate impact particularly in personal care. I think our prior comments that we expected to be probably at the at toward the high end of our kind of normal 3 to 5 range, if not above. So starting this year obviously at six and a half percent on a same store basis, you know, we would still expect that to be the case for the remainder of this year. I think once we kind of get get confirmation on New Mexico and that flowing through as well that obviously benefit the back half of the year. So I think we still feel pretty comfortable with that commentary thinking about kind of where we'll be on a same star basis for each quarter going forward in PCs, you know, home health, I mean, sorry, hospice, you know, has been, you know, double digit plus in same store. I think we had, you know, guided people to think that's probably not, you know, long term sustainable. You know, our ultimate, you know, expectation is probably, you know, upper single digits. So we're you know, just under 8% this quarter. I think we've seen some nice trajectory in ADC coming out of the quarter. We were a little bit softer coming off of the holiday. So I think that sets us up pretty well I think going forward to be in really good shape to continue to meet that as well for the remainder of this year. Okay, thanks on that. And then I guess to your comments about M and A and the pipeline and so forth, obviously these deals are more in the personal care arena. You sound like you're feeling a little better about the home health backdrop. Would that be something you would now sort of lean into again on M and A or is it still too early to do that?
Dirk Allison (Chairman and Chief Executive Officer)
You know, I think we would look at home health bills today as opposed to maybe a year ago. As you can understand, we'd be very careful in what we did, make sure it's strategically met for us the overlap with our hospice and personal care so that our bridge program can work. But yes we would start looking at home health care opportunities today. Okay.
A.J. Rice (Equity Analyst)
All right. Thanks a lot.
OPERATOR
The next question comes from Joanna Gadzuk from Bank of America. Please go ahead.
Joanna Gadzuk (Equity Analyst)
Hi, good morning. Thanks for squeezing me. So thank you. Four questions here. So on personal care same store hours per business day, I think through 2%, 2.2%. So what was it excluding whether I know you gave a revenue, I guess impact from that and what was it as you exited the quarter? So essentially what I'm trying to get at is kind of what was your growth in March and do you expect sort of reacceleration and a little bit higher the rest of the year on that metric?
Brian Popp (Chief Financial Officer)
Yeah, I think, Joanna, I think our target has always been, and we've been talking about it for some time now. If we can keep, you know, that same store hours per business day between 2 and 2.5%, we're probably going to be in a pretty good spot. We've been 2.4% each of Q3 and Q4, 2.2, but we were a little bit softer as kind of mentioned. And Heather, with some of the weather we saw in January, so we're probably not going to go into kind of a month by month metric on that. I think we feel pretty comfortable coming out of the quarter with where we were from just a census perspective and hours in March and going into Q2, that 2 to 2.5% range still feels very solid for us going forward.
Joanna Gadzuk (Equity Analyst)
It's great. So 2, 2.5% and then the gross margins. So Q1 is seasonally low.
Brian Popp (Chief Financial Officer)
Right. But can you help us kind of call out anything as we think about Q2 from Q1? Yeah, I think Q1, yes, seasonally is usually always our low watermark of the year with the reset of payroll taxes and our merits. I think traditionally what we see is usually you see a little bit of improvement with some of the payroll tax caps getting hit Q1 into Q2. So usually there's a little bit of benefit into Q2, Q2, Q3 usually pretty flat. I think Q4 usually is the best quarter for us from a margin perspective just with some additional benefit from payroll tax caps. But also our hospice rate increase kicks in in that quarter as well. I think, you know, if you look at the mix of our business, you know, personal care was a little over 77% this quarter as a comparison. You think about that versus hospice and home health. Hospice and home health have a higher gross margin. So if that mix gets back more to 75, 25 on skilled and non skilled that that would benefit as well. But mix is going to potentially play in as well. So I think we feel really good coming out of the quarter on the track for hospice and adc. So if that were to be a bigger part of our mix going forward, that would benefit our gross margin percentage as well.
Joanna Gadzuk (Equity Analyst)
And the last one on the quota, the stock comp was higher sequentially from Q4 either. Was there something kind of one time in nature? Is the $5 million essentially a good run rate or just something outside of just regular? Thank you.
Brian Popp (Chief Financial Officer)
Yeah, that's not our run rate. I mentioned in my comments. So with our former president COO retiring, there is some accelerated investing as part of this retirement that impacted the quarter, but should be one time and would not be continuing going forward.
Joanna Gadzuk (Equity Analyst)
All right, thank you so much. Thank you.
OPERATOR
This concludes our question and answer session. I would like to turn the conference back over to Dirk Allison for any closing remarks.
Dirk Allison (Chairman and Chief Executive Officer)
Thank you, operator. I want to thank each of you for taking the time to join us today on our call, and we hope that you have a great week. Thank you.
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