Addus HomeCare (ADUS) 10-Q 31 Oct 23 2023 Q3 Quarterly report Financial data

Document And Entity Information

Document And Entity Information - shares	9 Months Ended
	Sep. 30, 2023	Oct. 24, 2023
Cover [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Sep. 30, 2023
Document Fiscal Period Focus	Q3
Document Fiscal Year Focus	2023
Entity Registrant Name	ADDUS HOMECARE CORPORATION
Entity Central Index Key	0001468328
Trading Symbol	ADUS
Current Fiscal Year End Date	--12-31
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Current Reporting Status	Yes
Entity Address, State or Province	TX
Entity File Number	001-34504
Entity Tax Identification Number	20-5340172
Entity Address, Address Line One	6303 Cowboys Way
Entity Address, Address Line Two	Suite 600
Entity Address, City or Town	Frisco
Entity Address, Postal Zip Code	75034
City Area Code	469
Local Phone Number	535-8200
Entity Common Stock, Shares Outstanding		16,214,653
Document Quarterly Report	true
Document Transition Report	false
Entity Interactive Data Current	Yes
Entity Incorporation, State or Country Code	DE
Title of 12(b) Security	Common Stock, $0.001 par value
Security Exchange Name	NASDAQ

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Current assets
Cash	$ 79,750	$ 79,961
Accounts receivable, net of allowances for credit losses	121,112	125,501
Prepaid expenses and other current assets	10,387	17,345
Total current assets	211,249	222,807
Property and equipment, net of accumulated depreciation and amortization	20,516	21,182
Other assets
Goodwill	662,981	582,837
Intangibles, net of accumulated amortization	93,799	72,188
Operating lease assets, net	47,183	38,980
Total other assets	803,963	694,005
Total assets	1,035,728	937,994
Current liabilities
Accounts payable	21,375	22,092
Accrued payroll	51,774	44,937
Accrued expenses	34,952	27,507
Operating lease liabilities, current portion	11,434	10,801
Government stimulus advances	7,836	12,912
Accrued workers' compensation insurance	12,268	12,897
Total current liabilities	139,639	131,146
Long-term liabilities
Long-term debt, net of debt issuance costs	163,917	131,772
Long-term operating lease liabilities	41,632	35,479
Other long-term liabilities	6,206	6,057
Total long-term liabilities	211,755	173,308
Total liabilities	351,394	304,454
Stockholders' equity
Common stock-$.001 par value; 40,000 authorized and 16,214 and 16,128 shares issued and outstanding as of September 30, 2023 and December 31, 2022, respectively	16	16
Additional paid-in capital	401,064	393,208
Retained earnings	283,254	240,316
Total stockholders' equity	684,334	633,540
Total liabilities and stockholders' equity	$ 1,035,728	$ 937,994

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - $ / shares	Sep. 30, 2023	Dec. 31, 2022
Statement of Financial Position [Abstract]
Common stock, par value	$ 0.001	$ 0.001
Common stock, shares authorized	40,000,000	40,000,000
Common stock, shares issued	16,214,000	16,128,000
Common stock, shares outstanding	16,214,000	16,128,000

Condensed Consolidated Statemen

Condensed Consolidated Statements of Income - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Income Statement [Abstract]
Net service revenues	$ 270,721	$ 240,495	$ 782,300	$ 704,070
Cost of service revenues	183,991	165,310	534,837	483,100
Gross profit	86,730	75,185	247,463	220,970
General and administrative expenses	60,271	54,228	174,028	162,476
Depreciation and amortization	3,620	3,441	10,449	10,571
Total operating expenses	63,891	57,669	184,477	173,047
Operating income	22,839	17,516	62,986	47,923
Interest income	(580)	(83)	(977)	(249)
Interest expense	3,199	2,472	7,991	6,278
Total interest expense, net	2,619	2,389	7,014	6,029
Income before income taxes	20,220	15,127	55,972	41,894
Income tax expense	4,809	3,584	13,034	10,631
Net income	$ 15,411	$ 11,543	$ 42,938	$ 31,263
Net income per common share
Basic income per share	$ 0.96	$ 0.73	$ 2.69	$ 1.97
Diluted income per share	$ 0.95	$ 0.71	$ 2.63	$ 1.94
Weighted average number of common shares and potential common shares outstanding:
Basic	16,012	15,872	15,988	15,846
Diluted	16,286	16,184	16,307	16,146

Condensed Consolidated Statem_2

Condensed Consolidated Statements of Stockholders' Equity - USD ($) shares in Thousands, $ in Thousands	Total	Common Stock [Member]	Additional Paid-in Capital [Member]	Retained Earnings [Member]
Balance at Dec. 31, 2021	$ 574,344	$ 16	$ 380,037	$ 194,291
Balance, shares at Dec. 31, 2021		15,940
Issuance of shares of common stock under restricted stock award agreements, shares		129
Forfeiture of shares of common stock under restricted stock award agreements, shares		(4)
Stock-based compensation	7,945		7,945
Shares issued for exercise of stock options	1,285		1,285
Shares issued for exercise of stock options, shares		25
Net income	31,263			31,263
Balance at Sep. 30, 2022	614,837	$ 16	389,267	225,554
Balance, shares at Sep. 30, 2022		16,090
Balance at Jun. 30, 2022	599,777	$ 16	385,750	214,011
Balance, shares at Jun. 30, 2022		16,081
Forfeiture of shares of common stock under restricted stock award agreements, shares		(1)
Stock-based compensation	2,780		2,780
Shares issued for exercise of stock options	737		737
Shares issued for exercise of stock options, shares		10
Net income	11,543			11,543
Balance at Sep. 30, 2022	614,837	$ 16	389,267	225,554
Balance, shares at Sep. 30, 2022		16,090
Balance at Dec. 31, 2022	633,540	$ 16	393,208	240,316
Balance, shares at Dec. 31, 2022		16,128
Issuance of shares of common stock under restricted stock award agreements, shares		86
Stock-based compensation	7,831		7,831
Shares issued for exercise of stock options	25		25
Net income	42,938			42,938
Balance at Sep. 30, 2023	684,334	$ 16	401,064	283,254
Balance, shares at Sep. 30, 2023		16,214
Balance at Jun. 30, 2023	666,351	$ 16	398,492	267,843
Balance, shares at Jun. 30, 2023		16,214
Stock-based compensation	2,572		2,572
Net income	15,411			15,411
Balance at Sep. 30, 2023	$ 684,334	$ 16	$ 401,064	$ 283,254
Balance, shares at Sep. 30, 2023		16,214

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
Cash flows from operating activities:
Net income	$ 42,938	$ 31,263
Adjustments to reconcile net income to net cash provided by operating activities, net of acquisitions:
Depreciation and amortization	10,449	10,571
Deferred income taxes	246	413
Stock-based compensation	7,831	7,945
Amortization of debt issuance costs under the credit facility	645	645
Provision for credit losses	508	481
Impairment of operating lease assets	8	1,174
Changes in operating assets and liabilities, net of acquisitions:
Accounts receivable	9,929	18,232
Prepaid expenses and other current assets	6,277	10,568
Government stimulus advances	(5,528)	16,985
Accounts payable	(2,118)	(693)
Accrued payroll	4,464	(10,421)
Accrued expenses and other long-term liabilities	6,549	(6,345)
Net cash provided by (used in) operating activities	82,198	80,818
Cash flows from investing activities:
Acquisitions of businesses, net of cash acquired	(109,800)	(84,490)
Purchases of property and equipment	(4,134)	(2,864)
Net cash used in investing activities	(113,934)	(87,354)
Cash flows from financing activities:
Payments on revolver loan — credit facility	(78,500)	(105,000)
Proceeds from borrowings on revolver — credit facility	110,000	47,000
Cash received from exercise of stock options	25	1,285
Net cash provided by (used in) financing activities	31,525	(56,715)
Net change in cash	(211)	(63,251)
Cash, at beginning of period	79,961	168,895
Cash, at end of period	79,750	105,644
Supplemental disclosures of cash flow information:
Cash paid for interest	7,364	5,589
Cash paid for income taxes	$ 10,565	$ 629

Pay vs Performance Disclosure

Pay vs Performance Disclosure - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Pay vs Performance Disclosure
Net Income (Loss)	$ 15,411	$ 11,543	$ 42,938	$ 31,263

Insider Trading Arrangements

Insider Trading Arrangements	9 Months Ended
	Sep. 30, 2023
Trading Arrangements, by Individual
Rule 10b5-1 Arrangement Adopted	false
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false

Nature of Operations, Consolida

Nature of Operations, Consolidation, and Presentation of Financial Statements	9 Months Ended
	Sep. 30, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Nature of Operations, Consolidation, and Presentation of Financial Statements	1. Nature of Operations, Consolidation, and Presentation of Financial Statements Addus HomeCare Corporation (“Holdings”) and its subsidiaries (together with Holdings, the “Company”, “we”, “us” or “our”) operate as a multi-state provider of three distinct but related business segments providing in-home services. In its personal care services segment, the Company provides non-medical assistance with activities of daily living, primarily to persons who are at increased risk of hospitalization or institutionalization, such as the elderly, chronically ill or disabled. In its hospice segment, the Company provides physical, emotional and spiritual care for people who are terminally ill as well as related services for their families. In its home health segment, the Company provides services that are primarily medical in nature to individuals who may require assistance during an illness or after hospitalization and include skilled nursing and physical, occupational and speech therapy. The Company’s payors include federal, state and local governmental agencies, managed care organizations, commercial insurers and private individuals. Basis of Presentation The accompanying Unaudited Condensed Consolidated Financial Statements and related notes have been prepared in accordance with the rules and regulations of the U.S. Securities and Exchange Commission (“SEC”) for Quarterly Reports on Form 10-Q. The accompanying balance sheet as of December 31, 2022 has been derived from the Company’s audited financial statements for the year ended December 31, 2022 previously filed with the SEC. Accordingly, these financial statements do not include all of the information and note disclosures required by accounting principles generally accepted in the United States of America (“GAAP”) for annual financial statements and should be read in conjunction with our consolidated financial statements and notes thereto for the year ended December 31, 2022 included in our Annual Report on Form 10-K, which includes information and disclosures not included herein. In the opinion of management, these financial statements reflect all adjustments of a normal, recurring nature necessary for the fair statement of our financial position, results of operations, and cash flows for the interim periods presented in conformity with GAAP. Our results for any interim period are not necessarily indicative of results for a full year or any other interim period. Principles of Consolidation These Unaudited Condensed Consolidated Financial Statements include the accounts of Addus HomeCare Corporation, and its subsidiaries. All intercompany balances and transactions have been eliminated in consolidation.

Summary of Significant Accounti

Summary of Significant Accounting Policies	9 Months Ended
	Sep. 30, 2023
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	2. Summary of Significant Accounting Policies Estimates The financial statements are prepared by management in conformity with GAAP and include estimated amounts and certain disclosures based on assumptions about future events. The Company’s critical accounting estimates include the following areas: revenue recognition, goodwill and intangibles in business combinations and when required, the quantitative assessment of goodwill. Actual results could differ from those estimates. Computation of Weighted Average Shares The following table sets forth the computation of basic and diluted common shares: For the Three Months Ended September 30, For the Nine Months Ended September 30, (Amounts in thousands) (Amounts in thousands) 2023 2022 2023 2022 Weighted average number of shares outstanding for basic per share 16,012 15,872 15,988 15,846 Effect of dilutive potential shares: Stock options 227 255 239 244 Restricted stock awards 47 57 80 56 Adjusted weighted average shares outstanding for diluted per share 16,286 16,184 16,307 16,146 Anti-dilutive shares: Stock options 111 111 61 111 Restricted stock awards 1 36 1 3 Recently Adopted Accounting Pronouncements In October 2021, the Financial Accounting Standards Board (“FASB”) issued ASU No. 2021-08, Accounting for Contract Assets and Contract Liabilities from Contracts with Customers (Topic 805). This ASU requires an acquirer in a business combination to recognize and measure contract assets and contract liabilities (deferred revenue) from acquired contracts using the revenue recognition guidance in Topic 606. At the acquisition date, the acquirer applies the revenue model as if it had originated the acquired contracts. The ASU was adopted prospectively on January 1, 2023 . The additional disclosures required did no t have a material impact on our consolidated financial statements. In March 2020, the FASB issued ASU 2020-04, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting. ASU 2020-04 provides optional expedients and exceptions for applying GAAP to contract modifications and hedging relationships, and other transactions subject to meeting certain criteria, that reference the London Inter-Bank Offered Rate (“LIBOR”) or another reference rate expected to be discontinued. The ASU provides companies with optional guidance to ease the potential accounting burden associated with transitioning away from reference rates that are expected to be discontinued. Therefore, it was in effect for a limited time through December 31, 2022. The ASU could be adopted no later than December 1, 2022 with early adoption permitted. As discussed further in Note 8 and pursuant to the Third Amendment to Amended and Restated Credit Agreement dated as of April 26, 2023, the Company amended its credit facility to replace LIBOR with the secured overnight financing rate as administered by the Federal Reserve Bank of New York (“SOFR”) as the benchmark reference rate for loans under its credit facility. The transition to SOFR did not and is not expected to have a material impact on the Company’s results of operations or liquidity.

Leases

Leases	9 Months Ended
	Sep. 30, 2023
Leases [Abstract]
Leases	3. Leases Amounts reported on the Company’s Unaudited Condensed Consolidated Balance Sheets for operating leases were as follows: September 30, 2023 December 31, 2022 (Amounts in Thousands) Operating lease assets, net $ 47,183 $ 38,980 Short-term operating lease liabilities 11,434 10,801 Long-term operating lease liabilities 41,632 35,479 Total operating lease liabilities $ 53,066 $ 46,280 Lease Costs Components of lease costs were reported in general and administrative expenses in the Company’s Unaudited Condensed Consolidated Statements of Income as follows: For the Three Months Ended September 30, For the Nine Months Ended September 30, 2023 2022 2023 2022 Operating lease costs $ 3,344 $ 3,251 $ 9,678 $ 8,888 Short-term lease costs 249 589 949 2,251 Total lease costs 3,593 3,840 10,627 11,139 Less: sublease income ( 704 ) ( 176 ) ( 2,104 ) ( 529 ) Total lease costs, net $ 2,889 $ 3,664 $ 8,523 $ 10,610 Lease Term and Discount Rate Weighted average remaining lease terms and discount rates were as follows: September 30, 2023 December 31, 2022 Operating leases: Weighted average remaining lease term (years) 6.39 5.82 Weighted average discount rate 5.36 % 3.98 % Maturity of Lease Liabilities Remaining operating lease payments as of September 30, 2023 were as follows: Operating Leases (Amounts in Thousands) Due in the 12-month period ended September 30, 2024 $ 3,678 2025 13,434 2026 10,242 2027 7,943 2028 6,057 Thereafter 22,354 Total future minimum rental commitments 63,708 Less: Imputed interest ( 10,642 ) Total lease liabilities $ 53,066 Supplemental cash flows information For the Nine Months Ended September 30, (Amounts in Thousands) 2023 2022 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows from operating leases $ 10,702 $ 9,752 Right-of-use assets obtained in exchange for lease obligations: Operating leases $ 15,903 $ 13,130

Acquisitions

Acquisitions	3 Months Ended
	Sep. 30, 2023
Business Combinations [Abstract]
Acquisitions	4. Acquisitions The Company’s acquisitions have been accounted for in accordance with ASC Topic 805, Business Combinations , and the resulting goodwill and other intangible assets were accounted for under ASC Topic 350, Goodwill and Other Intangible Assets . Under business combination accounting, the assets and liabilities are generally recognized at their fair values, with the difference between the consideration transferred, excluding transaction costs, and the fair values of the assets acquired and liabilities assumed recognized as goodwill. The results of each business acquisition are included on the Unaudited Condensed Consolidated Statements of Income from the date of the acquisition. Management’s assessment of qualitative factors affecting goodwill for each acquisition includes estimates of market share at the date of purchase, ability to grow in the market, synergy with existing Company operations and the payor profile in the markets. Tennessee Quality Care On August 1, 2023, we completed the acquisition of American Home Care, LLC, a Tennessee limited liability company (“AHC”), and its subsidiaries, Homecare, LLC, a Tennessee limited liability company (“Homecare”), Tennessee Valley Home Care, LLC (d/b/a Tennessee Quality Care – Home Health), a Tennessee limited liability company (“TQC – Home Health”), and Tri-County Home Health and Hospice, LLC (d/b/a Tennessee Quality Care - Hospice), a Tennessee limited liability company (“TQC – Hospice”, and collectively with AHC, Homecare, and TQC – Home Health “Tennessee Quality Care”). The purchase price was approximately $ 111.2 million, including the amount of acquired excess cash held by Tennessee Quality Care at the closing of the acquisition (approximately $ 2.4 million), and is subject to the completion of working capital and related adjustments. The Tennessee Quality Care acquisition was funded with a combination of a $ 110.0 million draw on the Company ’ s revolving credit facility and available cash. With the purchase of Tennessee Quality Care, the Company expanded its services within its hospice and home health segments in Tennessee. The related acquisition and integration costs were $ 0.5 million and $ 2.1 million for the three and nine months ended September 30, 2023, respectively. These costs were included in general and administrative expenses on the Unaudited Condensed Consolidated Statements of Income and were expen sed as incurred. Based upon management’s valuations, which are preliminary and subject to the completion of working capital and related adjustments, the fair values of the assets and liabilities acquired are as follows: Total Goodwill $ 79,318 Identifiable intangible assets 26,740 Cash 2,368 Accounts receivable 5,593 Property and equipment 307 Operating lease assets, net 194 Other assets 200 Accrued expenses ( 1,115 ) Accrued payroll ( 2,303 ) Long-term operating lease liabilities ( 73 ) Total purchase price $ 111,229 Identifiable intangible assets acquired included $ 7.5 million in a trade name and $ 19.2 million of indefinite-lived state licenses. The preliminary estimated fair value of identifiable intangible assets was determined with the assistance of a valuation specialist, using Level 3 inputs as defined under ASC Topic 820. The fair value analysis and related valuations reflect the conclusions of management. All estimates, key assumptions, and forecasts were either provided by or reviewed by the Company. The goodwill and intangible assets acquired are deductible for tax purposes. The Tennessee Quality Care acquisition accounted for $ 6.9 million of net service revenues and $ 1.5 million of operating income for each of the three and nine months ended September 30, 2023, respectively. The following table contains unaudited pro forma condensed consolidated income statement information of the Company for the three and nine months ended September 30, 2023 as if the Tennessee Quality Care acquisition closed on January 1, 2022. For the Three Months Ended September 30, For the Nine Months Ended September 30, 2023 2022 2023 2022 Net service revenues $ 274,559 $ 249,262 $ 808,408 $ 730,227 Operating income 25,310 18,871 68,951 53,049 Net income 17,512 11,755 46,031 32,695 Net income per common share Basic income per share $ 1.09 $ 0.74 $ 2.88 $ 2.06 Diluted income per share $ 1.08 $ 0.73 $ 2.82 $ 2.03 The pro forma disclosures in the table above include adjustments for amortization of intangible assets, tax expense and acquisition costs to reflect results that are more representative of the combined results of the transactions as if the operations of Tennessee Quality Care had been acquired effective January 1, 2022. This pro forma information is presented for illustrative purposes only and may not be indicative of the results of operations that would have actually occurred. In addition, future results may vary significantly from the results reflected in the pro forma information. The unaudited pro forma financial information does not reflect the impact of future events that may occur after the acquisition, such as anticipated cost savings from operating synergies.

Goodwill and Intangible Assets

Goodwill and Intangible Assets	9 Months Ended
	Sep. 30, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill and Intangible Assets	5. Goodwill and Intangible Assets A summary of the goodwill and related adjustments is provided below: Hospice Personal Care Home Health Total (Amounts in Thousands) Goodwill as of December 31, 2022 $ 397,728 $ 152,688 $ 32,421 $ 582,837 Additions for acquisitions 23,114 601 56,204 79,919 Adjustments to previously recorded goodwill 225 225 Goodwill as of September 30, 2023 $ 420,842 $ 153,289 $ 88,850 $ 662,981 In connection with the acquisition of Coastal Nursecare of Florida, Inc. (“CareStaff”) , the Company recognized goodwill in its personal care segment of $ 0.6 million during the nine months ended September 30, 2023. In connection with the Tennessee Quality Care acquisition, the Company recognized goodwill in its hospice and home health segments of $ 23.1 million and $ 56.2 million during the nine months ended September 30, 2023, respectively. The Company’s identifiable intangible assets consist of customer and referral relationships, trade names and trademarks, non-competition agreements and state licenses. Amortization is computed using straight-line and accelerated methods based upon the estimated useful lives of the respective assets, which range from five to twenty-five years . Customer and referral relationships are amortized systematically over the periods of expected economic benefit, which range from five to ten years . The carrying amount and accumulated amortization of each identifiable intangible asset category consisted of the following as of September 30, 2023: Customer Trade Non- State Total (Amounts in Thousands) Intangible assets with indefinite lives $ — $ — $ — $ 46,328 $ 46,328 Intangible assets subject to amortization: Gross carrying amount 44,672 59,567 6,785 12,670 123,694 Accumulated amortization ( 39,203 ) ( 23,104 ) ( 5,397 ) ( 8,519 ) ( 76,223 ) Intangible assets subject to amortization, net 5,469 36,463 1,388 4,151 47,471 Total intangible assets at September 30, 2023 $ 5,469 $ 36,463 $ 1,388 $ 50,479 $ 93,799 In connection with the Tennessee Quality Care acquisition, the Company recognized a trade name of $ 2.1 million and indefinite-lived state licenses of $ 7.6 million in its hospice segment during the nine months ended September 30, 2023. The Company recognized a trade name of $ 5.4 million and indefinite-lived state licenses of $ 11.6 million in its home health segment during the nine months ended September 30, 2023. See Note 4 for additional information regarding the acquisition. Amortization expense related to the intangible assets was $ 1.8 million and $ 5.3 milli on for the three and nine months ended September 30, 2023 , respectively, and $ 1.8 million and $ 5.4 million for the three and nine months ended September 30, 2022, respectively. The weighted average remaining useful lives of identifiable intangible assets as of September 30, 2023 was 10.3 years.

Details of Certain Balance Shee

Details of Certain Balance Sheet Accounts	9 Months Ended
	Sep. 30, 2023
Details Of Certain Balance Sheet Accounts [Abstract]
Details of Certain Balance Sheet Accounts	6. Details of Certain Balance Sheet Accounts Prepaid expenses and other current assets consisted of the following: September 30, 2023 December 31, 2022 (Amounts in Thousands) Prepaid payroll $ — $ 7,566 Prepaid workers' compensation and liability insurance 2,549 3,399 Prepaid licensing fees 4,392 3,722 Workers' compensation insurance receivable 587 666 Other 2,859 1,992 Total prepaid expenses and other current assets $ 10,387 $ 17,345 Accrued expenses consisted of the following: September 30, 2023 December 31, 2022 (Amounts in Thousands) Accrued health benefits $ 8,630 $ 5,152 Payor advances (1) 1,770 4,473 Accrued professional fees 6,015 3,576 Accrued payroll and other taxes 9,169 6,175 Other 9,368 8,131 Total accrued expenses $ 34,952 $ 27,507 (1) Represents the deferred portion of payments received from payors for COVID-19 reimbursements which will be recognized as we incur specific COVID-19 related expenses (including expenses related to securing and maintaining adequate personnel) or will be returned to the extent such related expenses are not incurred.

Government Actions to Mitigate

Government Actions to Mitigate COVID-19's Impact	9 Months Ended
	Sep. 30, 2023
Risks and Uncertainties [Abstract]
Government Actions to Mitigate COVID-19's Impact	7. Government Actions to Mitigate COVID-19’s Impact The acute phase of the coronavirus (“COVID-19”) global pandemic has faded, but the future course of COVID-19 remains uncertain. We will continue to closely monitor the impact of COVID-19 on all aspects of our business, including the impacts to our employees, patients and suppliers. In recognition of the significant threat to the liquidity of financial markets posed by the COVID-19 pandemic, the Federal Reserve and Congress took dramatic actions to provide liquidity to businesses and the banking system in the United States, including relief for healthcare providers in the Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”), which was expanded by the Paycheck Protection Program and Health Care Enhancement (“PPPHCE”) Act, and the Consolidated Appropriations Act (“CAA”), as well as the American Rescue Plan Act of 2021 (“ARPA”). ARPA Spending Plans The ARPA provides for $ 350 billion in relief funding for eligible state, local, territorial, and Tribal governments to mitigate the fiscal effects of the COVID-19 public health emergency. Additionally, the law provides for a 10 -percentage point increase in federal matching funds for Medicaid home and community-based services (“HCBS”) from April 1, 2021, through March 31, 2022, provided the state satisfied certain conditions. States are permitted to use the state funds equivalent to the additional federal funds through March 31, 2025. States must use the monies attributable to this matching fund increase to supplement, not supplant, their level of state spending for the implementation of activities enhanced under the Medicaid HCBS in effect as of April 1, 2021. HCBS spending plans for the additional matching funds vary by state, but common initiatives in which the Company is participating include those aimed at strengthening the provider workforce (e.g., efforts to recruit, retain, and train direct service providers). The Company is required to properly and fully document the use of such funds in rep orts to the state in which the funds originated. Funds may be subject to recoupment if not expended or if they are expended on non-approved uses. During the nine months ended September 30, 2023, the Company received additional state funding provided by the ARPA in an aggregate amount of $ 2.0 million. The Company recorded revenue of $ 0.2 million for certain states that met the revenue recognition criteria. The Company deferred the remaining $ 1.8 million, which was received from states with specific spending plans and reporting requirements. Of the total state funding received by the Company pursuant to the ARPA through September 30, 2023, the Company utilized $ 2.1 million and $ 6.9 million during the three and nine months ended September 30, 2023, respectively, primarily for caregivers and adding support to recruiting and retention efforts, and included as a reduction of cost of service revenues in the Company’s Unaudited Condensed Consolidated Statements of Income. As of September 30, 2023, the deferred portion of ARPA funding of $ 7.8 million is included within Government stimulus advances on the Company’s Unaudited Condensed Consolidated Balance Sheets. Medicare sequester The CARES Act and related laws temporarily lifted the Medicare sequester which would have otherwise reduced payments to Medicare providers by 2 %, as required by the Budget Control Act of 2011, from May 1, 2020, through March 31, 2022. The sequestration payment adjustment was phased back in with a 1 % reduction beginning April 1, 2022, and returned to 2 % on July 1, 2022. These sequestration cuts have been extended through the first six months of 2032. The ARPA increases the federal budget deficit in a manner that triggers an additional statutorily mandated sequestration under the Pay-As-You-Go Act of 2010 (“PAYGO Act”). As a result, an additional Medicare payment reduction of up to 4 % was required to take effect in January 2022. However, Congress delayed implementation of this payment reduction until 2025. In the hospice segment, Medicare sequester relief resulted in an increase in net service revenues of $ 1.4 million for the nine months ended September 30, 2022. In the home health segment, Medicare sequester relief resulted in an increase in net service revenues of $ 0.3 million for the nine months ended September 30, 2022.

Long-Term Debt

Long-Term Debt	9 Months Ended
	Sep. 30, 2023
Long-Term Debt, Unclassified [Abstract]
Long-Term Debt	8. Long-Term Debt Long-term debt consisted of the following: September 30, 2023 December 31, 2022 (Amounts in Thousands) Revolving loan under the credit facility $ 166,353 $ 134,853 Less unamortized issuance costs ( 2,436 ) ( 3,081 ) Long-term debt $ 163,917 $ 131,772 Amended and Restated Senior Secured Credit Facility On October 31, 2018, the Company entered into the Amended and Restated Credit Agreement, with certain lenders and Capital One, National Association, as a lender and as agent for all lenders, as amended by the First Amendment to Amended and Restated Credit Agreement, dated as of September 12, 2019, as further amended by the Second Amendment to Amended and Restated Credit Agreement, dated as of July 30, 2021, and as further amended by the Third Amendment to Amended and Restated Credit Agreement, dated as of April 26, 2023 (as described below, the “Third Amendment”) (as amended, the “Credit Agreement,” as used throughout this Quarterly Report on Form 10-Q, “credit facility” shall mean the credit facility evidenced by the Credit Agreement). The credit facility consists of a $ 600.0 million revolving credit facility and a $ 125.0 million incremental loan facility, which incremental loan facility may be for term loans or an increase to the revolving loan commitments. The maturity of this credit facility is July 30, 2026 . On April 26, 2023, the Company entered into the Third Amendment to replace LIBOR with SOFR as the benchmark reference rate for loans under its credit facility. The Third Amendment did not amend any other terms of the Credit Agreement. Interest on the credit facility may be payable at (x) the sum of (i) an applicable margin ranging from 0.75 % to 1.50 % based on the applicable senior net leverage ratio plus (ii) a base rate equal to the greatest of (a) the rate of interest last quoted by The Wall Street Journal as the “prime rate,” (b) the sum of the federal funds rate plus a margin of 0.50 % and (c) the sum of Term SOFR (as published by the CME Group Benchmark Administrative Limited) for an interest period of one month for such applicable day plus 0.10 % (not to be less than 0.00 %), plus a margin of 1.00 % or (y) the sum of (i) an applicable margin ranging from 1.75 % to 2.50 % based on the applicable senior net leverage ratio plus (ii) the rate per annum equal to the sum of Term SOFR (as published by the CME Group Benchmark Administrative Limited) for the applicable interest period plus 0.10 % (not to be less than zero ). Swing loans may not be SOFR loans. The transition to SOFR did not and is not expected to have a material impact on the Company’s results of operations or liquidity. Addus HealthCare, Inc. (“Addus HealthCare”) is the borrower, and its parent, Holdings, and substantially all of Holdings’ subsidiaries are guarantors under this credit facility, and it is collateralized by a first priority security interest in all of the Company’s and the other credit parties’ current and future tangible and intangible assets, including the shares of stock of the borrower and subsidiaries. The Credit Agreement contains affirmative and negative covenants customary for credit facilities of this type, including limitations on the Company with respect to liens, indebtedness, guaranties, investments, distributions, mergers and acquisitions and dispositions of assets. The availability of additional draws under this credit facility is conditioned, among other things, upon (after giving effect to such draws) the Total Net Leverage Ratio (as defined in the Credit Agreement) not exceeding 3.75 :1.00. In certain circumstances, in connection with a Material Acquisition (as defined in the Credit Agreement), the Company can elect to increase its Total Net Leverage Ratio compliance covenant to 4.25 :1.00 for the then current fiscal quarter and the three succeeding fiscal quarters. The Company pays a fee ranging from 0.20 % to 0.35 % based on the applicable senior net leverage ratio times the unused portion of the revolving loan portion of the credit facility. The Credit Agreement contains customary affirmative covenants regarding, among other things, the maintenance of records, compliance with laws, maintenance of permits, maintenance of insurance and property and payment of taxes. The Credit Agreement also contains certain customary financial covenants and negative covenants that, among other things, include a requirement to maintain a minimum Interest Coverage Ratio (as defined in the Credit Agreement), a requirement to stay below a maximum Total Net Leverage Ratio (as defined in the Credit Agreement) and a requirement to stay below a maximum permitted amount of capital expenditures. The Credit Agreement also contains restrictions on guarantees, indebtedness, liens, investments and loans, subject to customary carve outs, a restriction on dividends (provided that Addus HealthCare may make distributions to the Company in an amount that does not exceed $ 7.5 million in any year absent of an event of default, plus limited exceptions for tax and administrative distributions), a restriction on the ability to consummate acquisitions (without the consent of the lenders) under its credit facility subject to compliance with the Total Net Leverage Ratio (as defined in the Credit Agreement) thresholds, restrictions on mergers, dispositions of assets, and affiliate transactions, and restrictions on fundamental changes and lines of business. During the nine months ended September 30, 2023 , the Company (i) drew $ 110.0 million under its credit facility to fund, in part, the Tennessee Quality Care acquisition and (ii) repaid $ 78.5 million under the revolving credit facility. During the nine months ended September 30, 2022, the Company drew $ 47.0 million under its credit facility to fund, in part, the acquisition of the operations of JourneyCare Inc. (“JourneyCare”) and the acquisition of Apple Home HealthCare, LTD (“Apple Home”). At September 30, 2023, the Company had a total of $ 166.4 million of revolving loans, with an interest rate of 7.17 %, outstanding on its credit facility. After giving effect to the amount drawn on its credit facility, approximately $ 8.1 million of outstanding letters of credit and borrowing limits based on an advance multiple of adjusted EBITDA (as defined in the Credit Agreement), the Company had $ 450.0 million of capacity and $ 275.6 million available for borrowing under its credit facility. As of December 31, 2022, the Company had a total of $ 134.9 million of revolving loans, with an interest rate of 6.13 %, outstanding on its credit facility. As of September 30, 2023, the Company was in compliance with all financial covenants under the Credit Agreement.

Income Taxes

Income Taxes	9 Months Ended
	Sep. 30, 2023
Income Tax Disclosure [Abstract]
Income Taxes	9. Income Taxes The effective income tax rates were 23.8 % and 23.7 % for the three months ended September 30, 2023 and 2022 , respectively. The effective income tax rates were 23.3 % and 25.4 % for the nine months ended September 30, 2023 and 2022 , respectively. The difference between our federal statutory rate of 21 % and our effective income tax rates is principally due to the inclusion of state taxes and non-deductible compensation, partially offset by the use of federal employment tax credits.

Commitments and Contingencies

Commitments and Contingencies	9 Months Ended
	Sep. 30, 2023
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	10. Commitments and Contingencies Legal Proceedings From time to time, the Company is subject to legal and/or administrative proceedings incidental to its business. On June 2, 2021, the Company received a $ 6.5 million Request for Repayment from Palmetto, GBA, LLC (“Palmetto”), a Medicare administrative contractor, regarding Ambercare Hospice Inc. (“Ambercare”), our subsidiary that provides hospice services in New Mexico. In 2018, the Office of Audit Services (“OAS”), under the HHS Office of Inspector General, initiated a clinical review of certain hospice claims billed during a timeframe from January 1, 2016 to December 31, 2017. The OAS review concluded that certain payments to Ambercare for hospice services during the review period were made in error. The Company acquired Ambercare in May 2018 and has a contractual right to full indemnification from any potential losses from the OAS review and has been fully reimbursed for the amount of the Request for Repayment through the terms of the Ambercare purchase agreement. The Company disputes the results of the OAS review and related asserted billing errors and is in the process of filing administrative appeals. At this stage, the Company cannot predict the ultimate outcome of the appeal process. It is the opinion of management that the outcome of pending legal and/or administrative proceedings will not have a material effect on the Company’s Unaudited Condensed Consolidated Balance Sheets and Unaudited Condensed Consolidated Statements of Income.

Segment Information

Segment Information	9 Months Ended
	Sep. 30, 2023
Segment Reporting [Abstract]
Segment Information	11. Segment Information Operating segments are defined as components of a company that engage in business activities from which it may earn revenues and incur expenses, and for which separate financial information is available and is regularly reviewed by the Company’s chief operating decision makers, to assess the performance of the individual segments and make decisions about resources to be allocated to the segments. The Company operates as a multi-state provider of three distinct but related business segments providing in-home services. In its personal care segment, the Company provides non-medical assistance with activities of daily living, primarily to persons who are at increased risk of hospitalization or institutionalization, such as the elderly, chronically ill or disabled. In its hospice segment, the Company provides physical, emotional and spiritual care for people who are terminally ill as well as related services for their families. In its home health segment, the Company provides services that are primarily medical in nature to individuals who may require assistance during an illness or after hospitalization and include skilled nursing and physical, occupational and speech therapy. The tables below set forth information about the Company’s reportable segments, along with the items necessary to reconcile the segment information to the totals reported in the accompanying Unaudited Condensed Consolidated Financial Statements. Segment assets are not reviewed by the Company’s chief operating decision maker function and therefore are not disclosed below. Segment operating income consists of revenue generated by a segment, less the direct costs of service revenues and general and administrative expenses that are incurred directly by the segment. Unallocated general and administrative costs are those costs for functions performed in a centralized manner and therefore not attributable to a particular segment. These costs include accounting, finance, human resources, legal, information technology, corporate office support and facility costs and overall corporate management. For the Three Months Ended September 30, 2023 (Amounts in Thousands) Personal Care Hospice Home Health Total Net service revenues $ 201,882 $ 53,121 $ 15,718 $ 270,721 Cost of services revenues 145,808 28,155 10,028 183,991 Gross profit 56,074 24,966 5,690 86,730 General and administrative expenses 16,096 13,246 4,131 33,473 Segment operating income $ 39,978 $ 11,720 $ 1,559 $ 53,257 For the Three Months Ended September 30, 2022 (Amounts in Thousands) Personal Care Hospice Home Health Total Net service revenues $ 179,180 $ 51,359 $ 9,956 $ 240,495 Cost of services revenues 131,968 25,695 7,647 165,310 Gross profit 47,212 25,664 2,309 75,185 General and administrative expenses 15,238 12,550 2,410 30,198 Segment operating income $ 31,974 $ 13,114 $ ( 101 ) $ 44,987 For the Three Months Ended September 30, 2023 2022 (Amounts in Thousands) Segment reconciliation: Total segment operating income $ 53,257 $ 44,987 Items not allocated at segment level: Other general and administrative expenses 26,798 24,030 Depreciation and amortization 3,620 3,441 Interest income ( 580 ) ( 83 ) Interest expense 3,199 2,472 Income before income taxes $ 20,220 $ 15,127 For the Nine Months Ended September 30, 2023 (Amounts in Thousands) Personal Care Hospice Home Health Total Net service revenues $ 590,227 $ 152,414 $ 39,659 $ 782,300 Cost of services revenues 428,163 82,028 24,646 534,837 Gross profit 162,064 70,386 15,013 247,463 General and administrative expenses 48,299 39,028 9,653 96,980 Segment operating income $ 113,765 $ 31,358 $ 5,360 $ 150,483 For the Nine Months Ended September 30, 2022 (Amounts in Thousands) Personal Care Hospice Home Health Total Net service revenues $ 523,142 $ 151,160 $ 29,768 $ 704,070 Cost of services revenues 386,940 74,659 21,501 483,100 Gross profit 136,202 76,501 8,267 220,970 General and administrative expenses 45,688 37,298 7,270 90,256 Segment operating income $ 90,514 $ 39,203 $ 997 $ 130,714 For the Nine Months Ended September 30, 2023 2022 (Amounts in Thousands) Segment reconciliation: Total segment operating income $ 150,483 $ 130,714 Items not allocated at segment level: Other general and administrative expenses 77,048 72,220 Depreciation and amortization 10,449 10,571 Interest income ( 977 ) ( 249 ) Interest expense 7,991 6,278 Income before income taxes $ 55,972 $ 41,894

Significant Payors

Significant Payors	9 Months Ended
	Sep. 30, 2023
Significant Payors [Abstract]
Significant Payors	12. Significant Payors The Company’s revenue by payor type was as follows: Personal Care Segment For the Three Months Ended September 30, For the Nine Months Ended September 30, 2023 2022 2023 2022 Amount % of Amount % of Amount % of Amount % of State, local and other governmental programs $ 101,821 50.4 % $ 88,448 49.4 % $ 297,541 50.4 % $ 257,817 49.4 % Managed care organizations 93,583 46.4 83,199 46.4 272,758 46.2 241,164 46.1 Private pay 3,990 2.0 4,521 2.6 12,354 2.1 13,758 2.6 Commercial insurance 1,631 0.8 1,870 1.0 4,937 0.8 5,988 1.1 Other 856 0.4 1,142 0.6 2,637 0.5 4,415 0.8 Total personal care segment net service revenues $ 201,882 100.0 % $ 179,180 100.0 % $ 590,227 100.0 % $ 523,142 100.0 % Hospice Segment For the Three Months Ended September 30, For the Nine Months Ended September 30, 2023 2022 2023 2022 Amount % of Amount % of Amount % of Amount % of Medicare $ 47,313 89.1 % $ 46,537 90.6 % $ 137,432 90.2 % $ 137,174 90.8 % Commercial insurance 3,640 6.8 2,772 5.4 8,916 5.8 7,742 5.1 Managed care organizations 1,808 3.4 1,815 3.5 5,022 3.3 5,498 3.6 Other 360 0.7 235 0.5 1,044 0.7 746 0.5 Total hospice segment net service revenues $ 53,121 100.0 % $ 51,359 100.0 % $ 152,414 100.0 % $ 151,160 100.0 % Home Health Segment For the Three Months Ended September 30, For the Nine Months Ended September 30, 2023 2022 2023 2022 Amount % of Amount % of Amount % of Amount % of Medicare $ 11,325 72.1 % $ 7,320 73.5 % $ 29,306 73.9 % $ 21,727 73.0 % Managed care organizations 3,445 21.9 1,998 20.1 8,239 20.8 6,160 20.7 Other 948 6.0 638 6.4 2,114 5.3 1,881 6.3 Total home health segment net service revenues $ 15,718 100.0 % $ 9,956 100.0 % $ 39,659 100.0 % $ 29,768 100.0 % The Company derives a significant amount of its revenue from its operations in Illinois, New Mexico and New York. The percentages of segment revenue for each of these significant states were as follows: Personal Care Segment For the Three Months Ended September 30, For the Nine Months Ended September 30, 2023 2022 2023 2022 Amount % of Amount % of Amount % of Amount % of Illinois $ 105,206 52.1 % $ 92,804 51.8 % $ 306,711 52.0 % $ 266,284 50.9 % New Mexico 28,347 14.0 26,912 15.0 84,969 14.3 78,825 15.1 New York (1) 22,989 11.4 20,997 11.7 68,910 11.7 63,510 12.1 All other states 45,340 22.5 38,467 21.5 129,637 22.0 114,523 21.9 Total personal care segment net service revenues $ 201,882 100.0 % $ 179,180 100.0 % $ 590,227 100.0 % $ 523,142 100.0 % (1) In 2019, New York initiated a new Request For Offer (“RFO”) process to competitively procure CDPAP fiscal intermediaries. The Company was not selected in the initial RFO process. We submitted a formal protest in response to the selection process, which was filed and accepted in March 2021. The New York fiscal year 2023 state budget, passed in April 2022, amended the Fiscal Intermediary RFO process to authorize all fiscal intermediaries that submitted an RFO application and served at least 200 clients in New York City or 50 clients in other counties between January 1, 2020 and March 31, 2020 to contract with the New York State Department of Health and continue to operate in all counties contained in their application, if the fiscal intermediary submitted an attestation and supporting information to the New York State Department of Health no later than November 29, 2022. The Company submitted an attestation on November 22, 2022, which allowed the Company to continue its CDPAP fiscal intermediary operations. However, the Company decided at that time to suspend materially all of its new fee-for-service patient admissions in the CDPAP program through County Social Service Departments. On June 6, 2023, the New York State Department of Health notified the Company that it had received a contract award. Under this contract, the Company is providing services to all current payors and has resumed new fee-for-service patient admissions through County Social Service Departments in the CDPAP program. Hospice Segment For the Three Months Ended September 30, For the Nine Months Ended September 30, 2023 2022 2023 2022 Amount % of Amount % of Amount % of Amount % of Ohio $ 18,916 35.6 % $ 18,139 35.3 % $ 55,363 36.3 % $ 51,714 34.2 % Illinois 12,477 23.5 12,188 23.7 34,750 22.8 35,290 23.3 New Mexico 7,619 14.3 7,789 15.2 23,688 15.5 23,867 15.8 All other states 14,109 26.6 13,243 25.8 38,612 25.4 40,289 26.7 Total hospice segment net service revenues $ 53,121 100.0 % $ 51,359 100.0 % $ 152,414 100.0 % $ 151,160 100.0 % Home Health Segment For the Three Months Ended September 30, For the Nine Months Ended September 30, 2023 2022 2023 2022 Amount % of Amount % of Amount % of Amount % of New Mexico $ 8,040 51.2 % $ 8,375 84.1 % $ 25,277 63.7 % $ 24,954 83.8 % Illinois 2,909 18.5 1,581 15.9 9,539 24.1 4,814 16.2 Tennessee 4,769 30.3 — — 4,843 12.2 — — Total home health segment net service revenues $ 15,718 100.0 % $ 9,956 100.0 % $ 39,659 100.0 % $ 29,768 100.0 % A substantial portion of the Company’s revenue and accounts receivable are derived from services performed for federal, state and local governmental agencies. We derive a significant amount of our net service revenues in Illinois, which represented 44.5 % and 44.3 % of our net service revenues for the three months ended September 30, 2023, and 2022, respectively, and accounted for 44.9 % and 43.5 % of our net service revenues for the nine months ended September 30, 2023 and 2022, respectively. The Illinois Department on Aging, the largest payor program for the Company’s Illinois personal care operations, accounted for 20.5 % and 21.0 % of the Company’s net service revenues for the three months ended September 30, 2023 and 2022, respectively, and accounted for 21.2 % and 20.8 % of the Company’s net service revenues for the nine months ended September 30, 2023 and 2022, respectively. The related receivables due from the Illinois Department on Aging represented 20.5 % and 18.0 % of the Company’s net accounts receivable at September 30, 2023 and December 31, 2022 , respectively.

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	9 Months Ended
	Sep. 30, 2023
Accounting Policies [Abstract]
Basis of Presentation	Basis of Presentation The accompanying Unaudited Condensed Consolidated Financial Statements and related notes have been prepared in accordance with the rules and regulations of the U.S. Securities and Exchange Commission (“SEC”) for Quarterly Reports on Form 10-Q. The accompanying balance sheet as of December 31, 2022 has been derived from the Company’s audited financial statements for the year ended December 31, 2022 previously filed with the SEC. Accordingly, these financial statements do not include all of the information and note disclosures required by accounting principles generally accepted in the United States of America (“GAAP”) for annual financial statements and should be read in conjunction with our consolidated financial statements and notes thereto for the year ended December 31, 2022 included in our Annual Report on Form 10-K, which includes information and disclosures not included herein. In the opinion of management, these financial statements reflect all adjustments of a normal, recurring nature necessary for the fair statement of our financial position, results of operations, and cash flows for the interim periods presented in conformity with GAAP. Our results for any interim period are not necessarily indicative of results for a full year or any other interim period.
Principles of Consolidation	Principles of Consolidation These Unaudited Condensed Consolidated Financial Statements include the accounts of Addus HomeCare Corporation, and its subsidiaries. All intercompany balances and transactions have been eliminated in consolidation.
Estimates	Estimates The financial statements are prepared by management in conformity with GAAP and include estimated amounts and certain disclosures based on assumptions about future events. The Company’s critical accounting estimates include the following areas: revenue recognition, goodwill and intangibles in business combinations and when required, the quantitative assessment of goodwill. Actual results could differ from those estimates.
Computation of Weighted Average Shares	Computation of Weighted Average Shares The following table sets forth the computation of basic and diluted common shares: For the Three Months Ended September 30, For the Nine Months Ended September 30, (Amounts in thousands) (Amounts in thousands) 2023 2022 2023 2022 Weighted average number of shares outstanding for basic per share 16,012 15,872 15,988 15,846 Effect of dilutive potential shares: Stock options 227 255 239 244 Restricted stock awards 47 57 80 56 Adjusted weighted average shares outstanding for diluted per share 16,286 16,184 16,307 16,146 Anti-dilutive shares: Stock options 111 111 61 111 Restricted stock awards 1 36 1 3
Recently Adopted Accounting Pronouncements	Recently Adopted Accounting Pronouncements In October 2021, the Financial Accounting Standards Board (“FASB”) issued ASU No. 2021-08, Accounting for Contract Assets and Contract Liabilities from Contracts with Customers (Topic 805). This ASU requires an acquirer in a business combination to recognize and measure contract assets and contract liabilities (deferred revenue) from acquired contracts using the revenue recognition guidance in Topic 606. At the acquisition date, the acquirer applies the revenue model as if it had originated the acquired contracts. The ASU was adopted prospectively on January 1, 2023 . The additional disclosures required did no t have a material impact on our consolidated financial statements. In March 2020, the FASB issued ASU 2020-04, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting. ASU 2020-04 provides optional expedients and exceptions for applying GAAP to contract modifications and hedging relationships, and other transactions subject to meeting certain criteria, that reference the London Inter-Bank Offered Rate (“LIBOR”) or another reference rate expected to be discontinued. The ASU provides companies with optional guidance to ease the potential accounting burden associated with transitioning away from reference rates that are expected to be discontinued. Therefore, it was in effect for a limited time through December 31, 2022. The ASU could be adopted no later than December 1, 2022 with early adoption permitted. As discussed further in Note 8 and pursuant to the Third Amendment to Amended and Restated Credit Agreement dated as of April 26, 2023, the Company amended its credit facility to replace LIBOR with the secured overnight financing rate as administered by the Federal Reserve Bank of New York (“SOFR”) as the benchmark reference rate for loans under its credit facility. The transition to SOFR did not and is not expected to have a material impact on the Company’s results of operations or liquidity.

Summary of Significant Accoun_3

Summary of Significant Accounting Policies (Tables)	9 Months Ended
	Sep. 30, 2023
Accounting Policies [Abstract]
Computation of Basic and Diluted Common Shares	The following table sets forth the computation of basic and diluted common shares: For the Three Months Ended September 30, For the Nine Months Ended September 30, (Amounts in thousands) (Amounts in thousands) 2023 2022 2023 2022 Weighted average number of shares outstanding for basic per share 16,012 15,872 15,988 15,846 Effect of dilutive potential shares: Stock options 227 255 239 244 Restricted stock awards 47 57 80 56 Adjusted weighted average shares outstanding for diluted per share 16,286 16,184 16,307 16,146 Anti-dilutive shares: Stock options 111 111 61 111 Restricted stock awards 1 36 1 3

Leases (Tables)

Leases (Tables)	9 Months Ended
	Sep. 30, 2023
Leases [Abstract]
Amounts Reported in Unaudited and Audited Condensed Consolidated Balance Sheets for Operating Leases	Amounts reported on the Company’s Unaudited Condensed Consolidated Balance Sheets for operating leases were as follows: September 30, 2023 December 31, 2022 (Amounts in Thousands) Operating lease assets, net $ 47,183 $ 38,980 Short-term operating lease liabilities 11,434 10,801 Long-term operating lease liabilities 41,632 35,479 Total operating lease liabilities $ 53,066 $ 46,280
Components of Lease Costs Reported in General and Administrative Expenses in Unaudited Condensed Consolidated Statements of Income	Components of lease costs were reported in general and administrative expenses in the Company’s Unaudited Condensed Consolidated Statements of Income as follows: For the Three Months Ended September 30, For the Nine Months Ended September 30, 2023 2022 2023 2022 Operating lease costs $ 3,344 $ 3,251 $ 9,678 $ 8,888 Short-term lease costs 249 589 949 2,251 Total lease costs 3,593 3,840 10,627 11,139 Less: sublease income ( 704 ) ( 176 ) ( 2,104 ) ( 529 ) Total lease costs, net $ 2,889 $ 3,664 $ 8,523 $ 10,610
Schedule of Weighted Average Remaining Lease Terms and Discount Rates	Weighted average remaining lease terms and discount rates were as follows: September 30, 2023 December 31, 2022 Operating leases: Weighted average remaining lease term (years) 6.39 5.82 Weighted average discount rate 5.36 % 3.98 %
Summary of Remaining Operating Lease Payments	Remaining operating lease payments as of September 30, 2023 were as follows: Operating Leases (Amounts in Thousands) Due in the 12-month period ended September 30, 2024 $ 3,678 2025 13,434 2026 10,242 2027 7,943 2028 6,057 Thereafter 22,354 Total future minimum rental commitments 63,708 Less: Imputed interest ( 10,642 ) Total lease liabilities $ 53,066
Supplemental Cash Flows Information	For the Nine Months Ended September 30, (Amounts in Thousands) 2023 2022 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows from operating leases $ 10,702 $ 9,752 Right-of-use assets obtained in exchange for lease obligations: Operating leases $ 15,903 $ 13,130

Acquisitions (Tables)

Acquisitions (Tables)	9 Months Ended
	Sep. 30, 2023
Business Combinations [Abstract]
Schedule of Fair Values of Assets and Liabilities	Based upon management’s valuations, which are preliminary and subject to the completion of working capital and related adjustments, the fair values of the assets and liabilities acquired are as follows: Total Goodwill $ 79,318 Identifiable intangible assets 26,740 Cash 2,368 Accounts receivable 5,593 Property and equipment 307 Operating lease assets, net 194 Other assets 200 Accrued expenses ( 1,115 ) Accrued payroll ( 2,303 ) Long-term operating lease liabilities ( 73 ) Total purchase price $ 111,229
Unaudited Pro Forma Condensed Consolidated Income Statement Information	The following table contains unaudited pro forma condensed consolidated income statement information of the Company for the three and nine months ended September 30, 2023 as if the Tennessee Quality Care acquisition closed on January 1, 2022. For the Three Months Ended September 30, For the Nine Months Ended September 30, 2023 2022 2023 2022 Net service revenues $ 274,559 $ 249,262 $ 808,408 $ 730,227 Operating income 25,310 18,871 68,951 53,049 Net income 17,512 11,755 46,031 32,695 Net income per common share Basic income per share $ 1.09 $ 0.74 $ 2.88 $ 2.06 Diluted income per share $ 1.08 $ 0.73 $ 2.82 $ 2.03

Goodwill and Intangible Assets

Goodwill and Intangible Assets (Tables)	9 Months Ended
	Sep. 30, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Summary of Goodwill and Related Adjustments	A summary of the goodwill and related adjustments is provided below: Hospice Personal Care Home Health Total (Amounts in Thousands) Goodwill as of December 31, 2022 $ 397,728 $ 152,688 $ 32,421 $ 582,837 Additions for acquisitions 23,114 601 56,204 79,919 Adjustments to previously recorded goodwill 225 225 Goodwill as of September 30, 2023 $ 420,842 $ 153,289 $ 88,850 $ 662,981
Schedule of Carrying Amount and Accumulated Amortization of Intangible Asset	The carrying amount and accumulated amortization of each identifiable intangible asset category consisted of the following as of September 30, 2023: Customer Trade Non- State Total (Amounts in Thousands) Intangible assets with indefinite lives $ — $ — $ — $ 46,328 $ 46,328 Intangible assets subject to amortization: Gross carrying amount 44,672 59,567 6,785 12,670 123,694 Accumulated amortization ( 39,203 ) ( 23,104 ) ( 5,397 ) ( 8,519 ) ( 76,223 ) Intangible assets subject to amortization, net 5,469 36,463 1,388 4,151 47,471 Total intangible assets at September 30, 2023 $ 5,469 $ 36,463 $ 1,388 $ 50,479 $ 93,799

Details of Certain Balance Sh_2

Details of Certain Balance Sheet Accounts (Tables)	9 Months Ended
	Sep. 30, 2023
Details Of Certain Balance Sheet Accounts [Abstract]
Schedule of Prepaid Expenses and Other Current Assets	Prepaid expenses and other current assets consisted of the following: September 30, 2023 December 31, 2022 (Amounts in Thousands) Prepaid payroll $ — $ 7,566 Prepaid workers' compensation and liability insurance 2,549 3,399 Prepaid licensing fees 4,392 3,722 Workers' compensation insurance receivable 587 666 Other 2,859 1,992 Total prepaid expenses and other current assets $ 10,387 $ 17,345
Schedule of Accrued Expenses	Accrued expenses consisted of the following: September 30, 2023 December 31, 2022 (Amounts in Thousands) Accrued health benefits $ 8,630 $ 5,152 Payor advances (1) 1,770 4,473 Accrued professional fees 6,015 3,576 Accrued payroll and other taxes 9,169 6,175 Other 9,368 8,131 Total accrued expenses $ 34,952 $ 27,507 (1) Represents the deferred portion of payments received from payors for COVID-19 reimbursements which will be recognized as we incur specific COVID-19 related expenses (including expenses related to securing and maintaining adequate personnel) or will be returned to the extent such related expenses are not incurred.

Long-Term Debt (Tables)

Long-Term Debt (Tables)	9 Months Ended
	Sep. 30, 2023
Long-Term Debt, Unclassified [Abstract]
Schedule of Long-Term Debt	Long-term debt consisted of the following: September 30, 2023 December 31, 2022 (Amounts in Thousands) Revolving loan under the credit facility $ 166,353 $ 134,853 Less unamortized issuance costs ( 2,436 ) ( 3,081 ) Long-term debt $ 163,917 $ 131,772

Segment Information (Tables)

Segment Information (Tables)	9 Months Ended
	Sep. 30, 2023
Segment Reporting [Abstract]
Summary of Segment Information	For the Three Months Ended September 30, 2023 (Amounts in Thousands) Personal Care Hospice Home Health Total Net service revenues $ 201,882 $ 53,121 $ 15,718 $ 270,721 Cost of services revenues 145,808 28,155 10,028 183,991 Gross profit 56,074 24,966 5,690 86,730 General and administrative expenses 16,096 13,246 4,131 33,473 Segment operating income $ 39,978 $ 11,720 $ 1,559 $ 53,257 For the Three Months Ended September 30, 2022 (Amounts in Thousands) Personal Care Hospice Home Health Total Net service revenues $ 179,180 $ 51,359 $ 9,956 $ 240,495 Cost of services revenues 131,968 25,695 7,647 165,310 Gross profit 47,212 25,664 2,309 75,185 General and administrative expenses 15,238 12,550 2,410 30,198 Segment operating income $ 31,974 $ 13,114 $ ( 101 ) $ 44,987 For the Three Months Ended September 30, 2023 2022 (Amounts in Thousands) Segment reconciliation: Total segment operating income $ 53,257 $ 44,987 Items not allocated at segment level: Other general and administrative expenses 26,798 24,030 Depreciation and amortization 3,620 3,441 Interest income ( 580 ) ( 83 ) Interest expense 3,199 2,472 Income before income taxes $ 20,220 $ 15,127 For the Nine Months Ended September 30, 2023 (Amounts in Thousands) Personal Care Hospice Home Health Total Net service revenues $ 590,227 $ 152,414 $ 39,659 $ 782,300 Cost of services revenues 428,163 82,028 24,646 534,837 Gross profit 162,064 70,386 15,013 247,463 General and administrative expenses 48,299 39,028 9,653 96,980 Segment operating income $ 113,765 $ 31,358 $ 5,360 $ 150,483 For the Nine Months Ended September 30, 2022 (Amounts in Thousands) Personal Care Hospice Home Health Total Net service revenues $ 523,142 $ 151,160 $ 29,768 $ 704,070 Cost of services revenues 386,940 74,659 21,501 483,100 Gross profit 136,202 76,501 8,267 220,970 General and administrative expenses 45,688 37,298 7,270 90,256 Segment operating income $ 90,514 $ 39,203 $ 997 $ 130,714 For the Nine Months Ended September 30, 2023 2022 (Amounts in Thousands) Segment reconciliation: Total segment operating income $ 150,483 $ 130,714 Items not allocated at segment level: Other general and administrative expenses 77,048 72,220 Depreciation and amortization 10,449 10,571 Interest income ( 977 ) ( 249 ) Interest expense 7,991 6,278 Income before income taxes $ 55,972 $ 41,894

Significant Payors (Tables)

Significant Payors (Tables)	9 Months Ended
	Sep. 30, 2023
Significant Payors [Abstract]
Schedule of Revenue by Payor Type	The Company’s revenue by payor type was as follows: Personal Care Segment For the Three Months Ended September 30, For the Nine Months Ended September 30, 2023 2022 2023 2022 Amount % of Amount % of Amount % of Amount % of State, local and other governmental programs $ 101,821 50.4 % $ 88,448 49.4 % $ 297,541 50.4 % $ 257,817 49.4 % Managed care organizations 93,583 46.4 83,199 46.4 272,758 46.2 241,164 46.1 Private pay 3,990 2.0 4,521 2.6 12,354 2.1 13,758 2.6 Commercial insurance 1,631 0.8 1,870 1.0 4,937 0.8 5,988 1.1 Other 856 0.4 1,142 0.6 2,637 0.5 4,415 0.8 Total personal care segment net service revenues $ 201,882 100.0 % $ 179,180 100.0 % $ 590,227 100.0 % $ 523,142 100.0 % Hospice Segment For the Three Months Ended September 30, For the Nine Months Ended September 30, 2023 2022 2023 2022 Amount % of Amount % of Amount % of Amount % of Medicare $ 47,313 89.1 % $ 46,537 90.6 % $ 137,432 90.2 % $ 137,174 90.8 % Commercial insurance 3,640 6.8 2,772 5.4 8,916 5.8 7,742 5.1 Managed care organizations 1,808 3.4 1,815 3.5 5,022 3.3 5,498 3.6 Other 360 0.7 235 0.5 1,044 0.7 746 0.5 Total hospice segment net service revenues $ 53,121 100.0 % $ 51,359 100.0 % $ 152,414 100.0 % $ 151,160 100.0 % Home Health Segment For the Three Months Ended September 30, For the Nine Months Ended September 30, 2023 2022 2023 2022 Amount % of Amount % of Amount % of Amount % of Medicare $ 11,325 72.1 % $ 7,320 73.5 % $ 29,306 73.9 % $ 21,727 73.0 % Managed care organizations 3,445 21.9 1,998 20.1 8,239 20.8 6,160 20.7 Other 948 6.0 638 6.4 2,114 5.3 1,881 6.3 Total home health segment net service revenues $ 15,718 100.0 % $ 9,956 100.0 % $ 39,659 100.0 % $ 29,768 100.0 %
Schedule of Revenue by Geographic Location	The percentages of segment revenue for each of these significant states were as follows: Personal Care Segment For the Three Months Ended September 30, For the Nine Months Ended September 30, 2023 2022 2023 2022 Amount % of Amount % of Amount % of Amount % of Illinois $ 105,206 52.1 % $ 92,804 51.8 % $ 306,711 52.0 % $ 266,284 50.9 % New Mexico 28,347 14.0 26,912 15.0 84,969 14.3 78,825 15.1 New York (1) 22,989 11.4 20,997 11.7 68,910 11.7 63,510 12.1 All other states 45,340 22.5 38,467 21.5 129,637 22.0 114,523 21.9 Total personal care segment net service revenues $ 201,882 100.0 % $ 179,180 100.0 % $ 590,227 100.0 % $ 523,142 100.0 % (1) In 2019, New York initiated a new Request For Offer (“RFO”) process to competitively procure CDPAP fiscal intermediaries. The Company was not selected in the initial RFO process. We submitted a formal protest in response to the selection process, which was filed and accepted in March 2021. The New York fiscal year 2023 state budget, passed in April 2022, amended the Fiscal Intermediary RFO process to authorize all fiscal intermediaries that submitted an RFO application and served at least 200 clients in New York City or 50 clients in other counties between January 1, 2020 and March 31, 2020 to contract with the New York State Department of Health and continue to operate in all counties contained in their application, if the fiscal intermediary submitted an attestation and supporting information to the New York State Department of Health no later than November 29, 2022. The Company submitted an attestation on November 22, 2022, which allowed the Company to continue its CDPAP fiscal intermediary operations. However, the Company decided at that time to suspend materially all of its new fee-for-service patient admissions in the CDPAP program through County Social Service Departments. On June 6, 2023, the New York State Department of Health notified the Company that it had received a contract award. Under this contract, the Company is providing services to all current payors and has resumed new fee-for-service patient admissions through County Social Service Departments in the CDPAP program. Hospice Segment For the Three Months Ended September 30, For the Nine Months Ended September 30, 2023 2022 2023 2022 Amount % of Amount % of Amount % of Amount % of Ohio $ 18,916 35.6 % $ 18,139 35.3 % $ 55,363 36.3 % $ 51,714 34.2 % Illinois 12,477 23.5 12,188 23.7 34,750 22.8 35,290 23.3 New Mexico 7,619 14.3 7,789 15.2 23,688 15.5 23,867 15.8 All other states 14,109 26.6 13,243 25.8 38,612 25.4 40,289 26.7 Total hospice segment net service revenues $ 53,121 100.0 % $ 51,359 100.0 % $ 152,414 100.0 % $ 151,160 100.0 % Home Health Segment For the Three Months Ended September 30, For the Nine Months Ended September 30, 2023 2022 2023 2022 Amount % of Amount % of Amount % of Amount % of New Mexico $ 8,040 51.2 % $ 8,375 84.1 % $ 25,277 63.7 % $ 24,954 83.8 % Illinois 2,909 18.5 1,581 15.9 9,539 24.1 4,814 16.2 Tennessee 4,769 30.3 — — 4,843 12.2 — — Total home health segment net service revenues $ 15,718 100.0 % $ 9,956 100.0 % $ 39,659 100.0 % $ 29,768 100.0 %

Nature of Operations, Consoli_2

Nature of Operations, Consolidation, and Presentation of Financial Statements (Narrative) (Details)	9 Months Ended
	Sep. 30, 2023 Segment
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Number of operating segments	3

Summary of Significant Accoun_4

Summary of Significant Accounting Policies (Computation of Basic and Diluted Common Shares) (Details) - shares shares in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Summary Of Significant Accounting Policies [Line Items]
Weighted average number of shares outstanding for basic per share calculation	16,012	15,872	15,988	15,846
Effect of dilutive potential shares:
Adjusted weighted average shares outstanding for diluted per share calculation	16,286	16,184	16,307	16,146
Employee Stock Option
Effect of dilutive potential shares:
Effect of dilutive potential shares	227	255	239	244
Anti-dilutive shares:
Anti-dilutive shares	111	111	61	111
Restricted Stock Awards [Member]
Effect of dilutive potential shares:
Effect of dilutive potential shares	47	57	80	56
Anti-dilutive shares:
Anti-dilutive shares	1	36	1	3

Summary of Significant Accoun_5

Summary of Significant Accounting Policies (Narrative) (Details) - ASU 2021-08 [Member]	Sep. 30, 2023
Summary Of Significant Accounting Policies [Line Items]
Change in accounting principle, accounting standards update, adopted	true
Change in accounting principle, accounting standards update, immaterial effect	true
Change in accounting principle, accounting standards update, adoption date	Jan. 01, 2023

Leases (Amounts Reported in Una

Leases (Amounts Reported in Unaudited and Audited Condensed Consolidated Balance Sheets for Operating Leases) (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Leases [Abstract]
Operating lease assets, net	$ 47,183	$ 38,980
Short-term operating lease liabilities	11,434	10,801
Long-term operating lease liabilities	41,632	35,479
Total operating lease liabilities	$ 53,066	$ 46,280

Leases (Components of Lease Cos

Leases (Components of Lease Costs Reported in General and Administrative Expenses in Unaudited Condensed Consolidated Statements of Income) (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Leases [Abstract]
Operating lease costs	$ 3,344	$ 3,251	$ 9,678	$ 8,888
Short-term lease costs	249	589	949	2,251
Total lease costs	3,593	3,840	10,627	11,139
Less: sublease income	(704)	(176)	(2,104)	(529)
Total lease costs, net	$ 2,889	$ 3,664	$ 8,523	$ 10,610

Leases (Schedule of Weighted Av

Leases (Schedule of Weighted Average Remaining Lease Terms and Discount Rates) (Details)	Sep. 30, 2023	Dec. 31, 2022
Leases [Abstract]
Weighted average remaining lease term (years)	6 years 4 months 20 days	5 years 9 months 25 days
Weighted average discount rate	5.36%	3.98%

Leases (Summary of Remaining Op

Leases (Summary of Remaining Operating Lease Payments) (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Leases [Abstract]
2024	$ 3,678
2025	13,434
2026	10,242
2027	7,943
2028	6,057
Thereafter	22,354
Total future minimum rental commitments	63,708
Less: Imputed interest	(10,642)
Total lease liabilities	$ 53,066	$ 46,280

Leases (Supplemental Cash Flows

Leases (Supplemental Cash Flows Information) (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$ 10,702	$ 9,752
Right-of-use assets obtained in exchange for lease obligations:
Operating leases	$ 15,903	$ 13,130

Acquisitions (Narrative) (Detai

Acquisitions (Narrative) (Details) - USD ($) $ in Thousands		3 Months Ended		9 Months Ended
	Aug. 01, 2023	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Business Acquisition [Line Items]
Total purchase price for business acquisition				$ 109,800	$ 84,490
Net service revenues		$ 270,721	$ 240,495	782,300	704,070
Operating income		22,839	$ 17,516	62,986	$ 47,923
Tennessee Quality Care [Member]
Business Acquisition [Line Items]
Net service revenues		6,900		6,900
Operating income		1,500		1,500
Tennessee Quality Care [Member] | Trade Names [Member]
Business Acquisition [Line Items]
Identifiable intangible assets acquired	$ 7,500
Tennessee Quality Care [Member] | State Licenses [Member]
Business Acquisition [Line Items]
Indefinite lived intangible assets acquired	19,200
Tennessee Quality Care [Member] | Tennessee [Member]
Business Acquisition [Line Items]
Total purchase price for business acquisition	111,200
Acquisition related costs		500		500
Integration costs		$ 2,100		$ 2,100
Excess cash held by acquired business	2,400
Tennessee Quality Care [Member] | Tennessee [Member] | Revolving Credit Facility [Member]
Business Acquisition [Line Items]
Line of credit outstanding amount	$ 110,000

Acquisitions (Schedule of Fair

Acquisitions (Schedule of Fair Values of Assets and Liabilities) (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Aug. 01, 2023	Dec. 31, 2022
Business Acquisition [Line Items]
Goodwill	$ 662,981		$ 582,837
Tennessee Quality Care [Member]
Business Acquisition [Line Items]
Goodwill		$ 79,318
Identifiable intangible assets		26,740
Cash		2,368
Accounts receivable		5,593
Property and equipment		307
Operating lease assets, net		194
Other assets		200
Accrued expenses		(1,115)
Accrued payroll		(2,303)
Long-term operating lease liabilities		(73)
Total purchase price		$ 111,229

Acquisitions (Unaudited Pro For

Acquisitions (Unaudited Pro Forma Condensed Consolidated Income Statement Information) (Details) - Tennessee Quality Care [Member] - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Business Acquisition [Line Items]
Net service revenues	$ 274,559	$ 249,262	$ 808,408	$ 730,227
Operating income	25,310	18,871	68,951	53,049
Net income	$ 17,512	$ 11,755	$ 46,031	$ 32,695
Basic income per share	$ 1.09	$ 0.74	$ 2.88	$ 2.06
Diluted income per share	$ 1.08	$ 0.73	$ 2.82	$ 2.03

Goodwill and Intangible Asset_2

Goodwill and Intangible Assets (Summary of Goodwill and Related Adjustments) (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2023 USD ($)
Goodwill [Line Items]
Goodwill, at Beginning of Period	$ 582,837
Additions for acquisitions	79,919
Adjustments to previously recorded goodwill	225
Goodwill, at End of Period	662,981
Hospice [Member]
Goodwill [Line Items]
Goodwill, at Beginning of Period	397,728
Additions for acquisitions	23,114
Goodwill, at End of Period	420,842
Personal Care [Member]
Goodwill [Line Items]
Goodwill, at Beginning of Period	152,688
Additions for acquisitions	601
Goodwill, at End of Period	153,289
Home Health [Member]
Goodwill [Line Items]
Goodwill, at Beginning of Period	32,421
Additions for acquisitions	56,204
Adjustments to previously recorded goodwill	225
Goodwill, at End of Period	$ 88,850

Goodwill and Intangible Asset_3

Goodwill and Intangible Assets (Narrative) (Details) - USD ($) $ in Thousands		3 Months Ended		9 Months Ended
	Aug. 01, 2023	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Goodwill [Line Items]
Additions for acquisitions				$ 79,919
Amortization expense		$ 1,800	$ 1,800	$ 5,300	$ 5,400
Weighted average remaining useful lives of identifiable intangible assets		10 years 3 months 18 days		10 years 3 months 18 days
Minimum [Member]
Goodwill [Line Items]
Intangible assets, estimated useful lives		5 years		5 years
Minimum [Member] | Customer and Referral Relationships [Member]
Goodwill [Line Items]
Intangible assets, estimated useful lives		5 years		5 years
Maximum [Member]
Goodwill [Line Items]
Intangible assets, estimated useful lives		25 years		25 years
Maximum [Member] | Customer and Referral Relationships [Member]
Goodwill [Line Items]
Intangible assets, estimated useful lives		10 years		10 years
Hospice [Member]
Goodwill [Line Items]
Additions for acquisitions				$ 23,114
Home Health [Member]
Goodwill [Line Items]
Additions for acquisitions				56,204
Personal Care [Member]
Goodwill [Line Items]
Additions for acquisitions				601
Coastal Nursecare of Florida Inc [Member] | Personal Care [Member]
Goodwill [Line Items]
Additions for acquisitions				600
Tennessee Quality Care [Member] | Trade Names [Member]
Goodwill [Line Items]
Identifiable intangible assets acquired	$ 7,500
Tennessee Quality Care [Member] | State Licenses [Member]
Goodwill [Line Items]
Indefinite lived intangible assets acquired	$ 19,200
Tennessee Quality Care [Member] | Hospice [Member]
Goodwill [Line Items]
Additions for acquisitions				23,100
Tennessee Quality Care [Member] | Hospice [Member] | Trade Names [Member]
Goodwill [Line Items]
Identifiable intangible assets acquired				2,100
Tennessee Quality Care [Member] | Hospice [Member] | State Licenses [Member]
Goodwill [Line Items]
Indefinite lived intangible assets acquired				7,600
Tennessee Quality Care [Member] | Home Health [Member]
Goodwill [Line Items]
Additions for acquisitions				56,200
Tennessee Quality Care [Member] | Home Health [Member] | Trade Names [Member]
Goodwill [Line Items]
Identifiable intangible assets acquired				5,400
Tennessee Quality Care [Member] | Home Health [Member] | State Licenses [Member]
Goodwill [Line Items]
Indefinite lived intangible assets acquired				$ 11,600

Goodwill and Intangible Asset_4

Goodwill and Intangible Assets (Schedule of Carrying Amount and Accumulated Amortization of Intangible Asset) (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Finite Lived Intangible Assets [Line Items]
Intangible assets with indefinite lives	$ 46,328
Intangible assets subject to amortization:
Gross carrying amount	123,694
Accumulated amortization	(76,223)
Intangible assets subject to amortization, net	47,471
Total intangible assets at September 30, 2023	93,799	$ 72,188
Customer And Referral Relationships [Member]
Intangible assets subject to amortization:
Gross carrying amount	44,672
Accumulated amortization	(39,203)
Intangible assets subject to amortization, net	5,469
Total intangible assets at September 30, 2023	5,469
Trade Names and Trademarks [Member]
Intangible assets subject to amortization:
Gross carrying amount	59,567
Accumulated amortization	(23,104)
Intangible assets subject to amortization, net	36,463
Total intangible assets at September 30, 2023	36,463
Noncompete Agreements
Intangible assets subject to amortization:
Gross carrying amount	6,785
Accumulated amortization	(5,397)
Intangible assets subject to amortization, net	1,388
Total intangible assets at September 30, 2023	1,388
State Licenses [Member]
Finite Lived Intangible Assets [Line Items]
Intangible assets with indefinite lives	46,328
Intangible assets subject to amortization:
Gross carrying amount	12,670
Accumulated amortization	(8,519)
Intangible assets subject to amortization, net	4,151
Total intangible assets at September 30, 2023	$ 50,479

Details of Certain Balance Sh_3

Details of Certain Balance Sheet Accounts (Schedule of Prepaid Expenses and Other Current Assets) (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Details Of Certain Balance Sheet Accounts [Abstract]
Prepaid payroll		$ 7,566
Prepaid workers' compensation and liability insurance	$ 2,549	3,399
Prepaid licensing fees	4,392	3,722
Workers' compensation insurance receivable	587	666
Other	2,859	1,992
Total prepaid expenses and other current assets	$ 10,387	$ 17,345

Details of Certain Balance Sh_4

Details of Certain Balance Sheet Accounts (Schedule of Accrued Expenses) (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Details Of Certain Balance Sheet Accounts [Abstract]
Accrued health benefits	$ 8,630	$ 5,152
Payor advances	1,770	4,473
Accrued professional fees	6,015	3,576
Accrued payroll and other taxes	9,169	6,175
Other	9,368	8,131
Total accrued expenses	$ 34,952	$ 27,507

Government Actions to Mitigat_2

Government Actions to Mitigate COVID-19's Impact (Narrative) (Details) - USD ($)			1 Months Ended	3 Months Ended			9 Months Ended		12 Months Ended	23 Months Ended
	Jul. 01, 2022	Mar. 11, 2021	Jan. 31, 2022	Sep. 30, 2023	Sep. 30, 2022	Jun. 30, 2022	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2022	Mar. 31, 2022
Unusual Risk Or Uncertainty [Line Items]
Net service revenues				$ 270,721,000	$ 240,495,000		$ 782,300,000	$ 704,070,000
Hospice [Member]
Unusual Risk Or Uncertainty [Line Items]
Net service revenues				53,121,000	51,359,000		152,414,000	151,160,000
Home Health [Member]
Unusual Risk Or Uncertainty [Line Items]
Net service revenues				15,718,000	9,956,000		39,659,000	29,768,000
Personal Care [Member]
Unusual Risk Or Uncertainty [Line Items]
Net service revenues				201,882,000	$ 179,180,000		590,227,000	523,142,000
CARES Act [Member]
Unusual Risk Or Uncertainty [Line Items]
Percentage of reduced payments to Medicare providers	2%									2%
Reduction percentage on sequestration adjustment						1%
CARES Act [Member] | Hospice [Member]
Unusual Risk Or Uncertainty [Line Items]
Net service revenues								1,400,000
CARES Act [Member] | Home Health [Member]
Unusual Risk Or Uncertainty [Line Items]
Net service revenues								$ 300,000
ARPA [Member]
Unusual Risk Or Uncertainty [Line Items]
Relief funding to mitigate fiscal effects of COVID-19		$ 350,000,000,000
percentage point increase in federal matching funds									10%
Deferred portion of spending plans				7,800,000			7,800,000
Aggregate principal amount of grants received				1,800,000			1,800,000
Fund distributed to primarily for caregivers and retention efforts				$ 2,100			6,900
Cost of revenue							200,000
Aggregate funding amount							$ 2,000,000
PAYGO Act [Member]
Unusual Risk Or Uncertainty [Line Items]
Percentage of additional payment reduction			4%

Long-Term Debt (Schedule of Lon

Long-Term Debt (Schedule of Long-Term Debt) (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Debt Instrument [Line Items]
Less unamortized issuance costs	$ (2,436)	$ (3,081)
Long-term debt	163,917	131,772
Revolving Credit Loan [Member] | Senior Secured Credit Facility [Member]
Debt Instrument [Line Items]
Long-term debt gross	$ 166,353	$ 134,853

Long-Term Debt (Narrative) (Det

Long-Term Debt (Narrative) (Details) - Credit Agreement [Member] - USD ($)		9 Months Ended
	Apr. 26, 2023	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2022
Debt Instrument [Line Items]
Line of credit outstanding amount		$ 450,000,000
Capital One, National Association [Member]
Debt Instrument [Line Items]
Maximum aggregate loan amount available			$ 275,600,000
Debt instrument, maturity date	Jul. 30, 2026
Debt instrument variable interest rate margin	1%
Debt instrument total net leverage ratio	4.25%
Line of credit outstanding amount		8,100,000
Capital One, National Association [Member] | Term Loan [Member]
Debt Instrument [Line Items]
Line of credit outstanding amount		166,400,000
Capital One, National Association [Member] | Maximum [Member]
Debt Instrument [Line Items]
Debt instrument total net leverage ratio	3.75%
Capital One, National Association [Member] | Federal Funds Rate [Member]
Debt Instrument [Line Items]
Debt instrument variable interest rate margin	0.50%
Capital One, National Association [Member] | One-Month Secured Overnight Financing Rate (SOFR) [Member]
Debt Instrument [Line Items]
Debt instrument variable interest rate margin	0.10%
Capital One, National Association [Member] | One-Month Secured Overnight Financing Rate (SOFR) [Member] | Minimum [Member]
Debt Instrument [Line Items]
Debt instrument variable interest rate margin	0%
Capital One, National Association [Member] | One-Month SOFR [Member] | Minimum [Member]
Debt Instrument [Line Items]
Debt instrument variable interest rate margin	0%
Capital One, National Association [Member] | Based On Applicable Senior Leverage Ratio [Member] | Minimum [Member]
Debt Instrument [Line Items]
Debt instrument variable interest rate margin	0.75%
Capital One, National Association [Member] | Based On Applicable Senior Leverage Ratio [Member] | Maximum [Member]
Debt Instrument [Line Items]
Debt instrument variable interest rate margin	1.50%
Capital One, National Association [Member] | Based On Applicable Leverage Ratio [Member] | Minimum [Member]
Debt Instrument [Line Items]
Debt instrument variable interest rate margin	1.75%
Capital One, National Association [Member] | Based On Applicable Leverage Ratio [Member] | Maximum [Member]
Debt Instrument [Line Items]
Debt instrument variable interest rate margin	2.50%
Capital One, National Association [Member] | Restriction on Dividends [Member] | Maximum [Member]
Debt Instrument [Line Items]
Aggregate amount of dividends and distributions		7,500,000
Revolving Credit Loan [Member] | Capital One, National Association [Member]
Debt Instrument [Line Items]
Maximum aggregate loan amount available		$ 600,000,000
Line of credit outstanding amount				$ 134,900,000
Debt instrument stated interest rate		7.17%		6.13%
Revolving Credit Loan [Member] | Capital One, National Association [Member] | JourneyCare and Apple Home [Member]
Debt Instrument [Line Items]
Proceeds from line of credit			$ 47,000,000
Revolving Credit Loan [Member] | Capital One, National Association [Member] | Tennessee Quality Care [Member]
Debt Instrument [Line Items]
Proceeds from line of credit		$ 110,000,000
Repayments of line of credit		$ 78,500,000
Revolving Credit Loan [Member] | Capital One, National Association [Member] | Minimum [Member]
Debt Instrument [Line Items]
Fee charged on unused portion of revolving credit facility		0.20%
Revolving Credit Loan [Member] | Capital One, National Association [Member] | Maximum [Member]
Debt Instrument [Line Items]
Fee charged on unused portion of revolving credit facility		0.35%
Incremental Loan Facility [Member]
Debt Instrument [Line Items]
Maximum aggregate loan amount available		$ 125,000,000

Income Taxes (Narrative) (Detai

Income Taxes (Narrative) (Details)	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Income Tax Disclosure [Abstract]
Effective income tax rate	23.80%	23.70%	23.30%	25.40%
Effective income tax, federal statutory rate			21%

Commitments and Contingencies (

Commitments and Contingencies (Narrative) (Details) $ in Millions	Jun. 02, 2021 USD ($)
Palmetto [Member]
Commitments And Contingencies [Line Items]
Proceeds from legal settlements	$ 6.5

Segment Information (Narrative)

Segment Information (Narrative) (Details)	9 Months Ended
	Sep. 30, 2023 Segment
Segment Reporting [Abstract]
Number of business segments	3

Segment Information (Summary of

Segment Information (Summary of Segment Information) (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Segment Reporting Information [Line Items]
Net service revenues	$ 270,721	$ 240,495	$ 782,300	$ 704,070
Cost of services revenues	183,991	165,310	534,837	483,100
Gross profit	86,730	75,185	247,463	220,970
General and administrative expenses	60,271	54,228	174,028	162,476
Operating income	22,839	17,516	62,986	47,923
Operating Segments [Member]
Segment Reporting Information [Line Items]
General and administrative expenses	33,473	30,198	96,980	90,256
Operating income	53,257	44,987	150,483	130,714
Personal Care [Member]
Segment Reporting Information [Line Items]
Net service revenues	201,882	179,180	590,227	523,142
Cost of services revenues	145,808	131,968	428,163	386,940
Gross profit	56,074	47,212	162,064	136,202
Personal Care [Member] | Operating Segments [Member]
Segment Reporting Information [Line Items]
General and administrative expenses	16,096	15,238	48,299	45,688
Operating income	39,978	31,974	113,765	90,514
Hospice [Member]
Segment Reporting Information [Line Items]
Net service revenues	53,121	51,359	152,414	151,160
Cost of services revenues	28,155	25,695	82,028	74,659
Gross profit	24,966	25,664	70,386	76,501
Hospice [Member] | Operating Segments [Member]
Segment Reporting Information [Line Items]
General and administrative expenses	13,246	12,550	39,028	37,298
Operating income	11,720	13,114	31,358	39,203
Home Health [Member]
Segment Reporting Information [Line Items]
Net service revenues	15,718	9,956	39,659	29,768
Cost of services revenues	10,028	7,647	24,646	21,501
Gross profit	5,690	2,309	15,013	8,267
Home Health [Member] | Operating Segments [Member]
Segment Reporting Information [Line Items]
General and administrative expenses	4,131	2,410	9,653	7,270
Operating income	$ 1,559	$ (101)	$ 5,360	$ 997

Segment Information (Segment Re

Segment Information (Segment Reconciliation to Totals reported in the accompanying Consolidated Financial Statements) (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Segment Reporting Information [Line Items]
Operating income	$ 22,839	$ 17,516	$ 62,986	$ 47,923
Other general and administrative expenses	26,798	24,030	77,048	72,220
Depreciation and amortization	3,620	3,441	10,449	10,571
Interest income	(580)	(83)	(977)	(249)
Interest expense	3,199	2,472	7,991	6,278
Income before income taxes	20,220	15,127	55,972	41,894
Operating Segments [Member]
Segment Reporting Information [Line Items]
Operating income	$ 53,257	$ 44,987	$ 150,483	$ 130,714

Significant Payors (Revenue by

Significant Payors (Revenue by Payor Type) (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Net service revenues	$ 270,721	$ 240,495	$ 782,300	$ 704,070
Personal Care [Member]
Net service revenues	201,882	179,180	590,227	523,142
Personal Care [Member] | Revenues [Member] | Customer Concentration Risk [Member]
Net service revenues	$ 201,882	$ 179,180	$ 590,227	$ 523,142
Concentration risk, percentage	100%	100%	100%	100%
Personal Care [Member] | Revenues [Member] | Customer Concentration Risk [Member] | State, Local And Other Governmental Programs [Member]
Net service revenues	$ 101,821	$ 88,448	$ 297,541	$ 257,817
Concentration risk, percentage	50.40%	49.40%	50.40%	49.40%
Personal Care [Member] | Revenues [Member] | Customer Concentration Risk [Member] | Managed Care Organizations [Member]
Net service revenues	$ 93,583	$ 83,199	$ 272,758	$ 241,164
Concentration risk, percentage	46.40%	46.40%	46.20%	46.10%
Personal Care [Member] | Revenues [Member] | Customer Concentration Risk [Member] | Private Pay [Member]
Net service revenues	$ 3,990	$ 4,521	$ 12,354	$ 13,758
Concentration risk, percentage	2%	2.60%	2.10%	2.60%
Personal Care [Member] | Revenues [Member] | Customer Concentration Risk [Member] | Commercial Insurance [Member]
Net service revenues	$ 1,631	$ 1,870	$ 4,937	$ 5,988
Concentration risk, percentage	0.80%	1%	0.80%	1.10%
Personal Care [Member] | Revenues [Member] | Customer Concentration Risk [Member] | Other [Member]
Net service revenues	$ 856	$ 1,142	$ 2,637	$ 4,415
Concentration risk, percentage	0.40%	0.60%	0.50%	0.80%
Hospice [Member]
Net service revenues	$ 53,121	$ 51,359	$ 152,414	$ 151,160
Hospice [Member] | Revenues [Member] | Customer Concentration Risk [Member]
Net service revenues	$ 53,121	$ 51,359	$ 152,414
Concentration risk, percentage	100%	100%	100%	100%
Hospice [Member] | Revenues [Member] | Customer Concentration Risk [Member] | Medicare [Member]
Net service revenues	$ 47,313	$ 46,537	$ 137,432	$ 137,174
Concentration risk, percentage	89.10%	90.60%	90.20%	90.80%
Hospice [Member] | Revenues [Member] | Customer Concentration Risk [Member] | Managed Care Organizations [Member]
Net service revenues	$ 1,808	$ 1,815	$ 5,022	$ 5,498
Concentration risk, percentage	3.40%	3.50%	3.30%	3.60%
Hospice [Member] | Revenues [Member] | Customer Concentration Risk [Member] | Commercial Insurance [Member]
Net service revenues	$ 3,640	$ 2,772	$ 8,916	$ 7,742
Concentration risk, percentage	6.80%	5.40%	5.80%	5.10%
Hospice [Member] | Revenues [Member] | Customer Concentration Risk [Member] | Other [Member]
Net service revenues	$ 360	$ 235	$ 1,044	$ 746
Concentration risk, percentage	0.70%	0.50%	0.70%	0.50%
Home Health [Member]
Net service revenues	$ 15,718	$ 9,956	$ 39,659	$ 29,768
Home Health [Member] | Revenues [Member] | Customer Concentration Risk [Member]
Net service revenues	$ 15,718	$ 9,956	$ 39,659	$ 29,768
Concentration risk, percentage	100%	100%	100%	100%
Home Health [Member] | Revenues [Member] | Customer Concentration Risk [Member] | Medicare [Member]
Net service revenues	$ 11,325	$ 7,320	$ 29,306	$ 21,727
Concentration risk, percentage	72.10%	73.50%	73.90%	73%
Home Health [Member] | Revenues [Member] | Customer Concentration Risk [Member] | Managed Care Organizations [Member]
Net service revenues	$ 3,445	$ 1,998	$ 8,239	$ 6,160
Concentration risk, percentage	21.90%	20.10%	20.80%	20.70%
Home Health [Member] | Revenues [Member] | Customer Concentration Risk [Member] | Other [Member]
Net service revenues	$ 948	$ 638	$ 2,114	$ 1,881
Concentration risk, percentage	6%	6.40%	5.30%	6.30%

Significant Payors (Revenue b_2

Significant Payors (Revenue by Geographic Location) (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Net service revenues	$ 270,721	$ 240,495	$ 782,300	$ 704,070
Revenues [Member] | Geographic Concentration Risk [Member] | Illinois [Member]
Concentration risk, percentage	44.50%	44.30%	44.90%	43.50%
Personal Care [Member]
Net service revenues	$ 201,882	$ 179,180	$ 590,227	$ 523,142
Personal Care [Member] | Revenues [Member] | Geographic Concentration Risk [Member]
Net service revenues	$ 201,882	$ 179,180	$ 590,227	$ 523,142
Concentration risk, percentage	100%	100%	100%	100%
Personal Care [Member] | Revenues [Member] | Geographic Concentration Risk [Member] | Illinois [Member]
Net service revenues	$ 105,206	$ 92,804	$ 306,711	$ 266,284
Concentration risk, percentage	52.10%	51.80%	52%	50.90%
Personal Care [Member] | Revenues [Member] | Geographic Concentration Risk [Member] | New Mexico [Member]
Net service revenues	$ 28,347	$ 26,912	$ 84,969	$ 78,825
Concentration risk, percentage	14%	15%	14.30%	15.10%
Personal Care [Member] | Revenues [Member] | Geographic Concentration Risk [Member] | New York [Member]
Net service revenues	$ 22,989	$ 20,997	$ 68,910	$ 63,510
Concentration risk, percentage	11.40%	11.70%	11.70%	12.10%
Personal Care [Member] | Revenues [Member] | Geographic Concentration Risk [Member] | All Other States [Member]
Net service revenues	$ 45,340	$ 38,467	$ 129,637	$ 114,523
Concentration risk, percentage	22.50%	21.50%	22%	21.90%
Hospice [Member]
Net service revenues	$ 53,121	$ 51,359	$ 152,414	$ 151,160
Hospice [Member] | Revenues [Member] | Geographic Concentration Risk [Member]
Net service revenues	$ 53,121	$ 51,359	$ 152,414	$ 151,160
Concentration risk, percentage	100%	100%	100%	100%
Hospice [Member] | Revenues [Member] | Geographic Concentration Risk [Member] | Ohio [Member]
Net service revenues	$ 18,916	$ 18,139	$ 55,363	$ 51,714
Concentration risk, percentage	35.60%	35.30%	36.30%	34.20%
Hospice [Member] | Revenues [Member] | Geographic Concentration Risk [Member] | Illinois [Member]
Net service revenues	$ 12,477	$ 12,188	$ 34,750	$ 35,290
Concentration risk, percentage	23.50%	23.70%	22.80%	23.30%
Hospice [Member] | Revenues [Member] | Geographic Concentration Risk [Member] | New Mexico [Member]
Net service revenues	$ 7,619	$ 7,789	$ 23,688	$ 23,867
Concentration risk, percentage	14.30%	15.20%	15.50%	15.80%
Hospice [Member] | Revenues [Member] | Geographic Concentration Risk [Member] | All Other States [Member]
Net service revenues	$ 14,109	$ 13,243	$ 38,612	$ 40,289
Concentration risk, percentage	26.60%	25.80%	25.40%	26.70%
Home Health [Member]
Net service revenues	$ 15,718	$ 9,956	$ 39,659	$ 29,768
Home Health [Member] | Revenues [Member] | Geographic Concentration Risk [Member]
Net service revenues	$ 15,718	$ 9,956	$ 39,659	$ 29,768
Concentration risk, percentage	100%	100%	100%	100%
Home Health [Member] | Revenues [Member] | Geographic Concentration Risk [Member] | Illinois [Member]
Net service revenues	$ 2,909	$ 1,581	$ 9,539	$ 4,814
Concentration risk, percentage	18.50%	15.90%	24.10%	16.20%
Home Health [Member] | Revenues [Member] | Geographic Concentration Risk [Member] | New Mexico [Member]
Net service revenues	$ 8,040	$ 8,375	$ 25,277	$ 24,954
Concentration risk, percentage	51.20%	84.10%	63.70%	83.80%
Home Health [Member] | Revenues [Member] | Geographic Concentration Risk [Member] | Tennessee [Member]
Net service revenues	$ 4,769		$ 4,843
Concentration risk, percentage	30.30%		12.20%

Significant Payors (Narrative)

Significant Payors (Narrative) (Details) - Illinois [Member]	3 Months Ended		9 Months Ended		12 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2022
Revenues [Member] | Illinois Department On Aging [Member]
Concentration Risk [Line Items]
Concentration risk, percentage	20.50%	21%	21.20%	20.80%
Revenues [Member] | Geographic Concentration Risk [Member]
Concentration Risk [Line Items]
Concentration risk, percentage	44.50%	44.30%	44.90%	43.50%
Accounts Receivable [Member] | Illinois Department On Aging [Member]
Concentration Risk [Line Items]
Concentration risk, percentage			20.50%		18%