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Document And Entity Information - shares	3 Months Ended
Document And Entity Information - shares	Mar. 31, 2019	Apr. 30, 2019
Document And Entity Information [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Mar. 31, 2019
Document Fiscal Period Focus	Q1
Document Fiscal Year Focus	2019
Entity Registrant Name	Addus HomeCare Corp
Entity Central Index Key	0001468328
Trading Symbol	adus
Current Fiscal Year End Date	--12-31
Entity Filer Category	Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Common Stock, Shares Outstanding		13,182,598

Consolidated Balance Sheets - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Current assets
Cash	$ 66,170	$ 70,406
Accounts receivable, net of allowances	120,143	108,000
Prepaid expenses and other current assets	7,146	7,098
Total current assets	193,459	185,504
Property and equipment, net of accumulated depreciation and amortization	10,843	10,658
Other assets
Goodwill	135,399	135,442
Intangibles, net of accumulated amortization	22,531	23,784
Operating lease assets, net	16,691
Total other assets	174,621	159,226
Total assets	378,923	355,388
Current liabilities
Accounts payable	11,506	12,238
Accrued payroll	24,139	22,449
Accrued expenses	17,202	11,648
Accrued workers' compensation insurance	14,537	15,169
Total current liabilities	67,384	61,504
Long-term liabilities
Long-term debt, less current portion, net of debt issuance costs	17,375	17,222
Long-term operating lease liabilities	11,679
Deferred tax liabilities, net	615	494
Other long-term liabilities	242	635
Total long-term liabilities	29,911	18,351
Total liabilities	97,295	79,855
Stockholders’ equity
Common stock—$.001 par value; 40,000 authorized and 13,178 and 13,126 shares issued and outstanding as of March 31, 2019 and December 31, 2018, respectively	13	13
Additional paid-in capital	178,916	177,683
Retained earnings	102,699	97,837
Total stockholders’ equity	281,628	275,533
Total liabilities and stockholders’ equity	$ 378,923	$ 355,388

Consolidated Balance Sheets (Parenthetical) - $ / shares	Mar. 31, 2019	Dec. 31, 2018
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	13,178,000	13,126,000
Common stock, shares outstanding	13,178,000	13,126,000

Condensed Consolidated Statements of Income - USD ($) shares in Thousands, $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Income Statement [Abstract]
Net service revenues	$ 139,254	$ 109,476
Cost of service revenues	101,680	81,543
Gross profit	37,574	27,933
General and administrative expenses	29,257	21,537
Depreciation and amortization	2,074	1,807
Total operating expenses	31,331	23,344
Operating income	6,243	4,589
Interest income	(215)	(2,322)
Interest expense	618	910
Total interest expense (income), net	403	(1,412)
Income before income taxes	5,840	6,001
Income tax expense	978	1,115
Net income	$ 4,862	$ 4,886
Net income per common share
Basic income per share	$ 0.37	$ 0.42
Diluted income per share	$ 0.36	$ 0.42
Weighted average number of common shares and potential common shares outstanding:
Basic	12,995	11,502
Diluted	13,381	11,696

Condensed Consolidated Statement 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, 2017	$ 176,309	$ 12	$ 95,963	$ 80,334
Balance, shares at Dec. 31, 2017		11,632
Issuance of shares of common stock under restricted stock award agreements, Shares		60
Forfeiture of shares of common stock under restricted stock award agreements, shares		(2)
Stock-based compensation	859		859
Shares issued for exercise of stock options	24		24
Shares issued for exercise of stock options, shares		1
Net income	4,886			4,886
Balance at Mar. 31, 2018	182,078	$ 12	96,846	85,220
Balance, shares at Mar. 31, 2018		11,691
Balance at Dec. 31, 2018	275,533	$ 13	177,683	97,837
Balance, shares at Dec. 31, 2018		13,126
Issuance of shares of common stock under restricted stock award agreements, Shares		52
Stock-based compensation	1,233		1,233
Net income	4,862			4,862
Balance at Mar. 31, 2019	$ 281,628	$ 13	$ 178,916	$ 102,699
Balance, shares at Mar. 31, 2019		13,178

- Definition

The portion of profit or loss for the period, net of income taxes, which is attributable to the parent.

+ References + Details

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Cash flows from operating activities:
Net income	$ 4,862	$ 4,886
Adjustments to reconcile net income to net cash provided by operating activities, net of acquisitions:
Depreciation and amortization	2,074	1,807
Deferred income taxes	121	129
Stock-based compensation	1,233	859
Amortization of debt issuance costs under the credit facility	161	147
Provision for doubtful accounts	57	78
Changes in operating assets and liabilities, net of acquisitions:
Accounts receivable	(12,989)	5,599
Prepaid expenses and other current assets	2,494	1,161
Accounts payable	(689)	2,092
Accrued expenses and other long-term liabilities	(521)	(2,482)
Net cash (used in) provided by operating activities	(3,197)	14,276
Cash flows from investing activities:
Acquisitions of businesses, net of cash acquired		(3,283)
Purchases of property and equipment	(1,006)	(416)
Net cash used in investing activities	(1,006)	(3,699)
Cash flows from financing activities:
Payments on term loan- credit facility		(563)
Payments for debt issuance costs under the credit facility		(18)
Payments on financing lease obligations	(33)	(368)
Cash received from exercise of stock options		24
Net cash used in financing activities	(33)	(925)
Net change in cash	(4,236)	9,652
Cash, at beginning of period	70,406	53,754
Cash, at end of period	66,170	63,406
Supplemental disclosures of cash flow information:
Cash paid for interest	723	766
Cash paid for income taxes	$ 1,082	1,187
Supplemental disclosures of non-cash investing and financing activities:
Contingent and deferred consideration accrued for acquisition		$ 847

Nature of Operations, Consolidation, and Presentation of Financial Statements

3 Months Ended

Mar. 31, 2019

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.

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. 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, 2018 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 and have not been audited by our independent auditors.

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.

Reclassification of Prior Period Balances

Certain reclassifications have been made to prior period amounts to conform to the current-year presentation. These reclassifications have no effect on the reported net income.

Recently Adopted Accounting Pronouncements

In February 2016, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2016-02, Leases (Topic 842). ASU 2016-02 requires lessees to recognize a lease liability and a right-of-use (“ROU”) asset for all leases, including operating leases, with a term greater than twelve months in their balance sheets. For income statement recognition purposes, leases will be classified as either a finance or an operating lease. In July 2018, the FASB issued ASU 2018-11, Leases (Topic 842) Targeted Improvements, which provided entities with additional and optional transition method. We elected to adopt the standard effective January 1, 2019 using the modified retrospective transition method. We elected the package of practical expedients available for expired or existing contracts, which allowed us to carryforward our historical assessments of (1) whether contracts are, or contain, leases, (2) lease classification and (3) initial direct costs. The Company secured new software to account for the change in accounting for leases. In addition, the Company is designing and implementing new processes and controls. The most significant changes relate to the recognition of right-of-use assets and significant lease liabilities on our consolidated balance sheet as a result of our operating lease obligations, as well as the impact of new disclosure requirements. Adoption of the new standard did not have a significant impact to our results of operations or liquidity.

Recently Issued Accounting Pronouncements

In June 2016, the FASB issued ASU 2016-13, Financial Instruments—Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments. ASU 2016-13 changes the impairment model for most financial assets and certain other instruments. Under the new standard, entities holding financial assets and net investment in leases that are not accounted for at fair value through net income are to be presented at the net amount expected to be collected. An allowance for credit losses will be a valuation account that will be deducted from the amortized cost basis of the financial asset to present the net carrying value at the amount expected to be collected on the financial asset. ASU 2016-13 is effective as of January 1, 2020. Early adoption is permitted. The Company is currently evaluating the impact of adopting this standard.

In January 2017, the FASB issued ASU 2017-04, Intangibles—Goodwill and Other (Topic 350): Simplifying the Test for Goodwill Impairment. The new guidance eliminates the requirement to calculate the implied fair value of goodwill (i.e., Step 2 of the current goodwill impairment test) to measure a goodwill impairment charge. Instead, entities will record an impairment charge based on the excess of a reporting unit’s carrying amount over its fair value (i.e., measure the charge based on the current Step 1). ASU 2017-04 is effective for annual and any interim impairment tests for periods beginning after December 15, 2019. Adoption of the new standard is not expected to have an impact to our results of operations or liquidity.

In August 2018, the FASB issued ASU 2018-15, Intangibles—Goodwill and Other—Internal-Use Software (Subtopic 350-40): Customer’s Accounting for Implementation Costs Incurred in a Cloud Computing Arrangement That is a Service Contract. ASU 2018-15 requires customers in a hosting arrangement that is a service contract to follow the internal-use software guidance in Accounting Standards Codification (“ASC”) 350-40 to determine which implementation costs to capitalize as assets or expense as incurred. The ASU is effective for annual periods, including interim periods within those annual periods, beginning after December 15, 2019. Early adoption is permitted. The Company is currently assessing the impact of adopting this standard.

Summary of Significant Accounting Policies

3 Months Ended

Mar. 31, 2019

Accounting Policies [Abstract]

Summary of Significant Accounting Policies

2. Summary of Significant Accounting Policies

Revenue Recognition

Personal Care Revenue

The majority of the Company’s net service revenues are generated from providing personal care services directly to consumers under contracts with state, local and other governmental agencies, managed care organizations, commercial insurers and private consumers. Generally, these contracts, which are negotiated based on current contracting practices as appropriate for the payor, establish the terms of a customer relationship and set the broad range of terms for services to be performed at a stated rate. However, the contracts do not give rise to rights and obligations until an order is placed with the Company. When an order is placed, it creates the performance obligation to provide a defined quantity of service hours, or authorized hours, per consumer. The Company satisfies its performance obligations over time, given that consumers simultaneously receive and consume the benefits provided by the Company as the services are performed. As the Company has a right to consideration from customers commensurate with the value provided to customers from the performance completed over a given invoice period, the Company has elected to use the practical expedient for measuring progress toward satisfaction of performance obligations and recognizes patient service revenue in the amount to which the Company has a right to invoice.

Hospice Revenue

The Company generates net service revenues from providing hospice services to terminally ill consumers and their families. Net service revenues are recognized as services are provided and costs for delivery of such services are incurred. The estimated payment rates are daily rates for each of the levels of care the Company delivers. Hospice companies are subject to two specific payment limit caps under the Medicare program each federal fiscal year, the inpatient cap and the aggregate cap. The inpatient cap limits the number of inpatient care days provided to no more than 20% of the total days of hospice care provided to Medicare patients for the year. The aggregate cap limits the amount of Medicare reimbursement a hospice may receive, based on the number of Medicare patients served. For the three months ended March 31, 2019, the Company was below the payment limits and did not record a cap liability.

Home Health Revenue

The Company also generates net service revenues from providing home healthcare services directly to consumers mainly under contracts with Medicare and managed care organizations. Generally, these contracts, which are negotiated based on current contracting practices as appropriate for the payor, establish the terms of a relationship and set the broad range of terms for services to be performed on an episodic basis at a stated rate. Home health Medicare services are paid under the Medicare Home Health Prospective Payment System (“HHPPS”), which is based on a 60-day episode of care. The HHPPS permits multiple, continuous episodes per patient. Medicare payment rates for episodes under HHPPS vary based on the severity of the patient’s condition as determined by assessment of a patient’s Home Health Resource Group score. The Company elects to use the same 60-day length of episode that Medicare recognizes as standard but accelerates revenue upon discharge to align with a patient’s episode length if less than the expected 60 days, which depicts the transfer of services and related benefits received by the patient over the term of the contract necessary to satisfy the obligations. The Company recognizes revenue based on the number of days elapsed during an episode of care within the reporting period. The Company satisfies its performance obligations as consumers receive and consume the benefits provided by the Company as the services are performed. As the Company has a right to reimbursement from Medicare commensurate with the services provided to customers from the performance completed over a given episodic period, the Company has elected to use the practical expedient for measuring progress toward satisfaction of performance obligations. Under this method recognizing revenue ratably over the episode based on beginning and ending dates is a reasonable proxy for the transfer of benefit of the service.

Implicit Price Concessions

We record estimated implicit price concessions (based primarily on historical collection experience) related to uninsured accounts to record self-pay revenues at the estimated amounts we expect to collect. The estimates for implicit price concessions are based upon management’s assessment of historical write offs and expected net collections, business and economic conditions, trends in federal, state and private employer health care coverage and other collection indicators. The Company recorded $2.2 million and $2.0 million for the three months ended March 31, 2019 and 2018, respectively, as a reduction to revenue.

Allowance for Doubtful Accounts

We are paid for our services primarily by federal, state and local agencies under Medicaid and Medicare programs, managed care organizations, commercial insurance companies and private consumers. While our accounts receivable are uncollateralized, our credit risk is somewhat limited due to the significance of governmental payors to our financial results of operations. Laws and regulations governing the governmental programs in which we participate are complex and subject to interpretation and change. Subsequent adjustments that are determined to be the result of an adverse change in the payor’s ability to pay are recognized as allowance for doubtful accounts. As of March 31, 2019 and December 31, 2018, the allowance for doubtful accounts balance was $0.8 million and $0.7 million, which is included in the account receivable, net of allowances on the Company’s Unaudited Condensed Consolidated Balance Sheets.

Property and Equipment

Property and equipment are recorded at cost and depreciated over the estimated useful lives of the related assets by use of the straight-line method. Maintenance and repairs are charged to expense as incurred. The estimated useful lives of the property and equipment are as follows:



Computer equipment			3 – 5 years
Furniture and equipment			5 – 7 years
Transportation equipment			5 years
Computer software			3 –10 years
Leasehold improvements			Lesser of useful life or lease term

Goodwill

The Company’s carrying value of goodwill is the excess of the purchase price over the fair value of the net assets acquired from various acquisitions. In accordance with ASC Topic 350, Goodwill and Other Intangible Assets, goodwill and intangible assets with indefinite useful lives are not amortized. The Company tests goodwill for impairment at the reporting unit level on an annual basis, as of October 1, or whenever potential impairment triggers occur, such as a significant change in business climate or regulatory changes that would indicate that an impairment may have occurred. The Company may use a qualitative test, known as “Step 0,” or a two-step quantitative method to determine whether impairment has occurred. In Step 0, the Company can elect to perform an optional qualitative analysis and based on the results can skip the two-step analysis. Additionally, it is the Company’s policy to update the fair value calculation of our reporting units and perform the quantitative goodwill impairment test on a periodic basis. In 2018, the Company performed the quantitative analysis to evaluate whether an impairment occurred. The Company concluded that there were no impairments for the year ended December 31, 2018. No impairment charges were recorded for the three months ended March 31, 2019 or 2018. As of March 31, 2019 and December 31, 2018, goodwill was $135.4 million, included in the Company’s Unaudited Condensed Consolidated Balance Sheets.

Intangible Assets

The Company’s identifiable intangible assets consist of customer and referral relationships, trade names, trademarks, state licenses and non-compete agreements. The Company uses various valuation techniques to determine initial fair value of its intangible assets, including relief-from-royalty, income approach methods, and discounted cash flow analysis, which use significant unobservable inputs, or Level 3 inputs, as defined by the fair value hierarchy in ASC 820, Fair Value Measurement. Under these valuation approaches, we are required to make estimates and assumptions about future market growth and trends, forecasted revenue and costs, expected periods over which the assets will be utilized, appropriate discount rates and other variables. The Company bases its fair value estimates on assumptions the Company believes to be reasonable but which are unpredictable and inherently uncertain. Actual future results may differ from those estimates.

Amortization is computed using straight-line and accelerated methods based upon the estimated useful lives of the respective assets, which range from three to twenty-five years and assessed for impairment whenever events or changes in circumstances indicate that the carrying amount may not be recoverable. The Company would recognize an impairment loss when the estimated future non-discounted cash flows associated with the intangible asset are less than the carrying value. An impairment charge would then be recorded for the excess of the carrying value over the fair value. The Company estimates the fair value of these intangible assets using the income approach. In accordance with ASC Topic 350, Goodwill and Other Intangible Assets, intangible assets with indefinite useful lives are not amortized. We test intangible assets with indefinite useful lives for impairment at the reporting unit level on an annual basis, as of October 1, or whenever potential impairment triggers occur, such as a significant change in business climate or regulatory changes that would indicate that an impairment may have occurred. No impairment charge was recorded for the three months ended March 31, 2019 and 2018. As of March 31, 2019 and December 31, 2018, intangibles, net of accumulated depreciation and amortization was $22.5 million and $23.8 million, respectively, included in the Company’s Unaudited Condensed Consolidated Balance Sheets.

Debt Issuance Costs

The Company amortizes debt issuance costs on a straight-line method over the term of the related debt. This method approximates the effective interest method. Debt issuance costs are classified as a current portion of long-term debt or long-term debt, less current portion as of March 31, 2019 and December 31, 2018.

Workers’ Compensation Program

The Company’s workers’ compensation insurance program has a $0.4 million deductible component. The Company recognizes its obligations associated with this program in the period the claim is incurred. The cost of both the claims reported and claims incurred but not reported, up to the deductible, have been accrued based on historical claims experience, industry statistics and an actuarial analysis performed by an independent third party. The Company monitors its claims quarterly and adjusts its reserves accordingly. These costs are recorded primarily as the cost of services on the Company’s Unaudited Condensed Consolidated Statements of Income. As of March 31, 2019 and December 31, 2018, the Company recorded $14.5 million and $15.2 million, respectively, in workers’ compensation insurance. As of March 31, 2019 and December 31, 2018, the Company recorded $1.6 million and $1.7 million, respectively, in workers’ compensation insurance recovery receivables. The workers’ compensation insurance recovery receivable is included in prepaid expenses and other current assets on the Company’s Unaudited Condensed Consolidated Balance Sheets.

Interest Income

Illinois law entitles designated service program providers to receive a prompt payment interest penalty based on qualifying services approved for payment that remain unpaid after a designated period of time. As the amount and timing of the receipt of these payments are not certain, the interest income is recognized when received. For the three months ended March 31, 2019, the Company received $0.1 million in prompt payment interest. For the three months ended March 31, 2018, the Company received $2.3 million in prompt payment interest.

Interest Expense

The Company’s interest expense consists of interest and unused credit line fees on its credit facilities, its Terminated Senior Credit Facility (as defined herein), and interest on its financing lease obligations, which is reported in the statement of income when incurred.

Income Tax Expense

The Company accounts for income taxes under the provisions of ASC Topic 740, Income Taxes. The objective of accounting for income taxes is to recognize the amount of taxes payable or refundable for the current year and deferred tax liabilities and assets for the future tax consequences of events that have been recognized in its financial statements or tax returns. Deferred taxes, resulting from differences between the financial and tax basis of the Company’s assets and liabilities, are also adjusted for changes in tax rates and tax laws when changes are enacted. ASC Topic 740 also requires that deferred tax assets be reduced by a valuation allowance if it is more likely than not that some portion or all of the deferred tax asset will not be realized. ASC Topic 740 also prescribes a recognition threshold and measurement process for recording in the financial statements uncertain tax positions taken or expected to be taken in a tax return. In addition, ASC Topic 740 provides guidance on derecognition, classification, accounting in interim periods and disclosure requirements for uncertain tax positions.

Stock-based Compensation

The Company currently has one stock incentive plan, the 2017 Omnibus Incentive Plan (the “2017 Plan”), under which new grants of stock-based employee compensation may be made. In addition, the Company has outstanding awards under its 2009 Stock Incentive Plan, as amended and restated. The Company accounts for stock-based compensation in accordance with ASC Topic 718, Stock Compensation. Under the 2017 Plan, compensation expense is recognized on a straight-line basis over the vesting period of the equity awards based on the grant date fair value of the options and restricted stock awards. The Company uses the Black-Scholes Option Pricing Model to value the Company’s options. The determination of the fair value of stock-based payments utilizing the Black-Scholes Model is affected by the Company’s stock price and a number of assumptions, including expected volatility, risk-free interest rate, expected term, and expected dividends yield. Stock-based compensation expense was $1.2 million and $0.9 million for the three months ended March 31, 2019 and 2018, respectively.

Diluted Net Income Per Common Share

Diluted net income per common share, calculated on the treasury stock method, is based on the weighted average number of shares outstanding during the period. The Company’s outstanding securities that may potentially dilute the common stock are stock options and restricted stock awards.

Included in the Company’s calculation of diluted earnings per share for the three months ended March 31, 2019 were approximately 685,000 stock options outstanding, of which approximately 303,000 were dilutive. In addition, there were approximately 153,000 restricted stock awards outstanding, 83,000 of which were dilutive for the three months ended March 31, 2019.

Included in the Company’s calculation of diluted earnings per share for the three months ended March 31, 2018 were approximately 746,000 stock options outstanding, of which approximately 129,000 were dilutive. In addition, there were approximately 166,000 restricted stock awards outstanding, 65,000 of which were dilutive for the three months ended March 31, 2018.

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: implicit price concessions, the allowance for doubtful accounts, reserve for self-insurance claims, accounting for stock-based compensation, accounting for lease incremental borrowing rates, accounting for income taxes, business combinations and when required, the quantitative assessment of goodwill. Actual results could differ from those estimates.

Fair Value Measurements

The Company’s financial instruments consist of cash, accounts receivable, payables and debt. The carrying amounts reported on the Company’s Unaudited Condensed Consolidated Balance Sheets for cash, accounts receivable, accounts payable and accrued expenses approximate fair value because of the short-term nature of these instruments. The carrying value of the Company’s long-term debt with variable interest rates approximates fair value based on instruments with similar terms using level 2 inputs as defined under ASC Topic 820, Fair Value Measurement.

Going Concern

In connection with the preparation of the financial statements for the three months ended March 31, 2019 and 2018, the Company conducted an evaluation as to whether there were conditions and events, considered in the aggregate, which raised substantial doubt as to the entity’s ability to continue as a going concern within one year after the date of the issuance, or the date of availability, of the financial statements to be issued. The evaluation concluded that there did not appear to be evidence of substantial doubt of the entity’s ability to continue as a going concern.

Leases

3 Months Ended

Mar. 31, 2019

Leases [Abstract]

Leases

3. Leases

During the quarter ended March 31, 2019, we adopted ASU 2016-02, Leases (Topic 842), which requires leases with durations greater than twelve months to be recognized on the balance sheet. We adopted the standard using the modified retrospective approach with an effective date as of the beginning of our fiscal year, January 1, 2019. Prior year financial statements were not recast under the new standard and, therefore, those amounts are not presented below. We elected the package of practical expedients available for expired or existing contracts, which allowed us to carryforward our historical assessments of (1) whether contracts are or contain leases, (2) lease classification and (3) initial direct costs. We also elected the practical expedients available for the consistent treatment of short-term leases for month-to-month leases and leases with a remaining term of less than one year and for all classes of assets we elected the practical expedient to aggregate lease and non-lease components.

We have historically had operating leases for local branches, our corporate headquarters and certain equipment, with lease expiration dates through 2029. Certain of our arrangements have free rent periods or escalating rent payment provisions. We recognize rent expense on a straight-line basis over the lease term. Our leases generally contain renewal options for periods ranging from one to five years. Because we are not reasonably certain to exercise these renewal options, the options generally are not considered in determining the lease term, and payments associated with the option years are excluded from lease payments.

When available, we use the rate implicit in the lease to discount lease payments to present value; however, most of our leases do not provide a readily determinable implicit rate. Therefore, we must estimate our incremental borrowing rate to discount the lease payments based on information available at lease commencement.

Amounts reported in the Company’s Unaudited Condensed Consolidated Balance Sheets as of March 31, 2019 for our operating leases were as follows:

	The Three Months Ended March 31, (Amounts in Thousands)
	2019
Operating lease right of use assets, net	$	16,691
Short-term operating lease liabilities (in Accrued expenses)		5,154
Long-term operating lease liabilities		11,679
Total operating lease liabilities	$	16,833

Leases Costs

Components of lease cost were reported in general and administrative expenses in the Company’s Unaudited Condensed Consolidated Statements of Income as follows:

	For the Three Months Ended March 31, (Amounts in Thousands)
	2019
Operating lease costs	$	1,646
Short-term lease costs		64
Total lease cost	$	1,710

Lease Term and Discount Rate

Weighted average remaining lease terms and discount rates were as follows:

	For the Three Months Ended March 31,
	2019
Operating leases:
Weighted average remaining lease term		4.02
Weighted average discount rate		5.75	%

Maturity of Lease Liabilities

A summary of our remaining operating lease payments as of March 31, 2019 were as follows:

	Operating Leases
	(Amounts in Thousands)
Due in 12 month period ended March 31,
2020	$	5,747
2021		4,544
2022		3,495
2023		2,248
2024		1,726
Thereafter		1,200
Total future minimum rental commitments		18,960
Less: Imputed interest		(2,127	)
Total lease liabilities	$	16,833

Supplemental cash flow information

	For the Three Months Ended March 31, (Amounts in Thousands)
	2019
Supplemental Cash Flows Information
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	1,639

Right-of-use assets obtained in exchange for lease obligations:
Operating leases		17,660

Financing Leases

Some of our financing leases include provisions to purchase the asset at the conclusion of the lease. The treatment of these leases remains consistent and the transition does not have an impact on the accounting for these leases.

As of March 31, 2019 and December 31, 2018 the Company has various financing leases (the underlying assets are included in “Property and equipment net of accumulated depreciation and amortization” in the accompanying the Company’s Unaudited Condensed Consolidated Balance Sheets). The financing lease obligations totaled $48,000 and $0.1 million at March 31, 2019 and December 31, 2018, respectively, the current portion is recorded in accrued expense and the long-term portion is recorded in long-term debt, less current portion, net of debt issuance cost in the Company’s Unaudited Condensed Consolidated Balance Sheets. These require monthly payments through August 2020 and have implicit interest rates that range from 3.64% to 7.72%. At the end of the term, the Company has the option to purchase the assets for $1 per lease agreement.

Acquisitions

3 Months Ended

Mar. 31, 2019

Business Combinations [Abstract]

Acquisitions

4. Acquisitions

On May 1, 2018, the Company completed its acquisition of all the outstanding securities of Ambercare Corporation (“Ambercare”). The purchase price was approximately $39.6 million plus the amount of excess cash held by Ambercare at closing (approximately $12.0 million). The purchase of Ambercare was funded by a delayed draw term loan under the Company’s credit facility. With the purchase of Ambercare, the Company expanded its New Mexico personal care operations and acquired its hospice and home health segments in the state of New Mexico. The related integration costs of $0.1 million for the three months ended March 31, 2019, were included in general and administrative expenses on the Company’s Unaudited Condensed Consolidated Statements of Income, and were expensed as incurred. The results of Ambercare are included on the Company’s Unaudited Condensed Consolidated Statements of Income from the date of the acquisition.

The Company’s acquisition of Ambercare has been accounted for in accordance with ASC Topic 805, Business Combinations, and the resulting goodwill and other intangible assets was accounted for under ASC Topic 350, Goodwill and Other Intangible Assets. The acquisition was recorded at its fair value as of May 1, 2018. Under business combination accounting, the Ambercare purchase price was $51.6 million and was allocated to Ambercare’s net tangible and identifiable intangible assets based on their estimated fair values. Based upon management’s valuation, which is preliminary and subject to completion of working capital adjustments, the total purchase price has been allocated as follows:

	Total (Amounts in Thousands)
Goodwill	$	28,831
Cash		12,028
Identifiable intangible assets		9,944
Accounts receivable		6,512
Other assets		442
Property and equipment		154
Accrued liabilities		(4,073	)
Deferred tax liability		(2,138	)
Financing lease		(75	)
Accounts payable		(3	)
Total purchase price allocation	$	51,622

Management’s assessment of qualitative factors affecting goodwill for Ambercare 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 market.

The Company acquired all of the outstanding stock of Ambercare. Identifiable intangible assets acquired consist of trade names and customer relationships, with estimated useful lives ranging from three to fifteen years, as well as indefinite lived state licenses. The preliminary estimated fair value of identifiable intangible assets was determined, using Level 3 inputs as defined under ASC Topic 820, with the assistance of a valuation specialist. The goodwill and intangible assets acquired are non-deductible for tax purposes.

The Ambercare acquisition accounted for $14.8 million of net service revenues and $3.4 million of net income prior to corporate allocation for the three months ended March 31, 2019.

On April 1, 2018, the Company acquired certain assets of Arcadia Home Care & Staffing (“Arcadia”), expanding its personal care services. The total consideration for the transaction was $18.9 million and was funded by a delayed draw term loan under the Company’s credit facility. The related integration costs of $0.1 million for the three months ended March 31, 2019, were included in general and administrative expenses on the Company’s Unaudited Condensed Consolidated Statements of Income, and were expensed as incurred. The results of operations from this acquired entity are included in the Company’s Unaudited Condensed Consolidated Statements of Income from the date of the acquisition.

The Company’s acquisition of Arcadia has been accounted for in accordance with ASC Topic 805 and the resulting goodwill and other intangible assets was accounted for under ASC Topic 350. The acquisition was recorded at its fair value as of April 1, 2018. Under business combination accounting, the Arcadia purchase price was $18.9 million and was allocated to Arcadia’s net tangible and identifiable intangible assets based on their estimated fair values. Based upon management’s valuation, the total purchase price has been allocated as follows:

	Total (Amounts in Thousands)
Goodwill	$	13,072
Accounts receivable		5,317
Identifiable intangible assets		2,264
Property and equipment		155
Other assets		92
Accrued liabilities		(1,540	)
Accounts payable		(508	)
Total purchase price allocation	$	18,852

Management’s assessment of qualitative factors affecting goodwill for Arcadia 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 market.

Identifiable intangible assets acquired consist of trade name, customer relationships and state licenses, with estimated useful lives ranging from seven to fifteen years. The preliminary estimated fair value of identifiable intangible assets was determined, using Level 3 inputs as defined under ASC Topic 820, with the assistance of a valuation specialist. The goodwill and intangible assets acquired are deductible for tax purposes.

The Arcadia acquisition accounted for $10.3 million of net service revenues and $1.3 million of net income prior to corporate allocation for the three months ended March 31, 2019.

During the fourth quarter of 2018, the Company acquired certain assets of affiliate branches of Arcadia for $0.6 million using cash on hand, the Company recorded goodwill of $0.6 million on the Company’s Unaudited Condensed Consolidated Balance Sheets. Goodwill generated from the acquisition is primarily attributable to expected synergies with existing Company operations and the goodwill acquired is deductible for tax purposes. Pro forma results of the operations related to the acquisition are not included in the pro forma presentation as they are not material to the Company’s Unaudited Condensed Consolidated Statements of Income.

Effective January 1, 2018, the Company acquired certain assets of LifeStyle Options, Inc. (“LifeStyle”) in order to expand private pay services in Illinois. The total consideration for the transaction was $4.1 million, comprised of $3.3 million in cash and $0.8 million, representing the preliminary estimated fair value of contingent consideration, subject to the achievement of certain performance targets set forth in an earn-out agreement. As of December 31, 2018, the performance targets were not met and the Company remeasured the earn-out to fair value. The related acquisition costs of $48,000 for the three months ended March 31, 2018 were included in general and administrative expenses on the Company’s Unaudited Condensed Consolidated Statements of Income, and were expensed as incurred. The results of operations from this acquired entity are included in the Company’s Unaudited Condensed Consolidated Statements of Income from the date of the acquisition.

The Company’s acquisition of LifeStyle has been accounted for in accordance with ASC Topic 805 and the resulting goodwill and other intangible assets was accounted for under ASC Topic 350. The acquisition was recorded at its fair value as of January 1, 2018. Under business combination accounting, the LifeStyle purchase price was $4.1 million and was allocated to LifeStyle’s net tangible and identifiable intangible assets based on their estimated fair values. Based upon management’s valuation, the total purchase price is final and has been allocated as follows:

	Total (Amounts in Thousands)
Goodwill	$	2,751
Identifiable intangible assets		1,152
Accounts receivable		573
Other assets		32
Property and equipment		18
Accrued liabilities		(291	)
Accounts payable		(105	)
Total purchase price allocation	$	4,130

Management’s assessment of qualitative factors affecting goodwill for LifeStyle 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 market.

Identifiable intangible assets acquired consist of trade name and customer relationships, with estimated useful lives ranging from ten to fifteen years. The estimated fair value of identifiable intangible assets was determined, using Level 3 inputs as defined under ASC Topic 820, with the assistance of a valuation specialist. The goodwill and intangible assets acquired are deductible for tax purposes.

The LifeStyle acquisition accounted for $1.2 million of net service revenues and $0.0 million of net income prior to corporate allocation for the three months ended March 31, 2019.

The following table contains unaudited pro forma condensed consolidated income statement information of the Company had the acquisitions of Ambercare and Arcadia closed on January 1, 2018.

	For the Three Months Ended March 31, (Amounts in Thousands)
	2019		2018
Net service revenues	$	139,254	$	138,218
Operating income		6,486		11,583
Net income		5,105		7,852
Net income per common share
Basic income per share	$	0.39	$	0.68
Diluted income per share	$	0.38	$	0.67

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 Ambercare and Arcadia had been acquired effective January 1, 2018. 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

3 Months Ended

Mar. 31, 2019

Goodwill And Intangible Assets Disclosure [Abstract]

Goodwill and Intangible Assets

5. Goodwill and Intangible Assets

A summary of the goodwill activity for the three months ended March 31, 2019 is provided below:

	Goodwill
	Personal Care			Hospice		Home Health		Total
	(Amounts in Thousands)
Goodwill as of December 31, 2018	$	112,377		$	22,200	$	865	$	135,442
Adjustments to previously recorded goodwill		(43	)		—		—		(43	)
Goodwill as of March 31, 2019	$	112,334		$	22,200	$	865	$	135,399

The Company’s identifiable intangible assets consist of customer and referral relationships, trade names, trademarks and non-competition agreements. Amortization is computed using straight-line and accelerated methods based upon the estimated useful lives of the respective assets, which range from three to twenty-five years. Goodwill and certain state licenses are not amortized pursuant to ASC Topic 350.

The carrying amount and accumulated amortization of each identifiable intangible asset category consisted of the following as of March 31, 2019:

	Customer and referral relationships			Trade names and trademarks			Non- competition agreements			State Licenses			Total
	(Amounts in Thousands)
Intangible assets with indefinite lives:		—			—			—			2,871			2,871
Intangible assets subject to amortization:
Gross carrying amount		42,356			21,551			2,155			241			66,303
Accumulated amortization		(33,436	)		(11,175	)		(2,009	)		(23	)		(46,643	)
Net book value, intangible assets subject to amortization		8,920			10,376			146			218			19,660
Total intangible assets at March 31, 2019	$	8,920		$	10,376		$	146		$	3,089		$	22,531

Amortization expense related to the identifiable intangible assets amounted to $1.3 million for the three months ended March 31, 2019 and 2018.

The weighted average remaining lives of identifiable intangible assets as of March 31, 2019 is 8.7 years.

The estimated future intangible amortization expense is as follows:

For the Three Months Ended March 31, 2019	Total (Amounts in Thousands)
Remainder of 2019		3,760
2020		3,400
2021		2,758
2022		1,724
2023		1,406
Thereafter		6,612
Total intangible assets subject to amortization	$	19,660

Details of Certain Balance Sheet Accounts

3 Months Ended

Mar. 31, 2019

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:

	March 31, 2019		December 31, 2018
	(Amounts in Thousands)
Workers’ compensation insurance receivable	$	1,564	$	1,692
Prepaid workers’ compensation and liability insurance		1,152		1,840
Health insurance receivable		676		564
Other		3,754		3,002
	$	7,146	$	7,098

Accrued expenses consisted of the following:

	March 31, 2019		December 31, 2018
	(Amounts in Thousands)
Current portion of operating lease liabilities	$	5,154	$	—
Accrued health insurance (1)		3,681		3,926
Accrued professional fees		2,096		2,260
Accrued payroll taxes		1,585		769
Other		4,686		4,693
	$	17,202	$	11,648

(1)

The Company provides health insurance coverage to qualified union employees providing personal care services in Illinois through a Taft-Hartley multi-employer health and welfare plan under Section 302(c)(5) of the Labor Management Relations Act of 1947. The Company’s insurance contributions equal the amount reimbursed by the state of Illinois. Contributions are due within five business days from the date the funds are received from the state. Amounts due of $0.7 million and $0.6 million for health insurance reimbursements and contributions were reflected in prepaid insurance and accrued insurance as of March 31, 2019 and December 31, 2018, respectively.

Long-Term Debt

3 Months Ended

Mar. 31, 2019

Long Term Debt [Abstract]

Long-Term Debt

7. Long-Term Debt

Long-term debt consisted of the following:

	March 31, 2019			December 31, 2018
	(Amounts in Thousands)
Revolving loan under the credit facility	$	20,000		$	20,000
Financing leases		48			81
Less unamortized issuance costs		(2,636	)		(2,797	)
Total	$	17,412		$	17,284
Less current maturities		(37	)		(62	)
Long-term debt	$	17,375		$	17,222

Amended and Restated Senior Secured Credit Facility

On October 31, 2018, the Company amended and restated its Existing Credit Agreement, as hereinafter defined (the “Credit Agreement,” and together with the Existing Credit Agreement, our “amended and restated credit facility” or “credit facility”) with certain lenders and Capital One, National Association as a lender and swing line lender and as agent for all lenders. This amended and restated credit facility totals $269.6 million, inclusive of a $250.0 million revolving loan and a $19.6 million delayed draw term loan, and is evidenced by the Credit Agreement. This amended and restated credit facility amended and restated the Company’s existing senior secured credit facility totaling $250.0 million. The maturity of this amended and restated credit facility is May 8, 2023, with borrowing under the delayed draw term loan available until June 30, 2019, as extended pursuant to the consent letter, dated January 30, 2019, executed by the Required Lenders (as defined in the Credit Agreement). Interest on the Company’s amended and restated 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 the adjusted LIBOR that would be applicable to a loan with an interest period of one month advanced on the applicable day (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 offered rate per annum for similar dollar deposits for the applicable interest period that appears on Reuters Screen LIBOR01 Page (not to be less than zero). Swing loans may not be LIBOR loans. The availability of additional draws under this amended and restated 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. In connection with this amended and restated credit facility, the Company incurred approximately $0.9 million of debt issuance costs.

Addus HealthCare, Inc. (“Addus HealthCare”) is the borrower, and its parent, Holdings, and substantially all of Holdings’ subsidiaries are guarantors under this amended and restated credit facility, and it is secured 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 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 portion of the amended and restated 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, as well as 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 our credit facility subject to compliance with the Total Net Leverage Ratio (as defined in the Credit Agreement), restrictions on mergers, dispositions of assets, and affiliate transactions, and restrictions on fundamental changes and lines of business. As of March 31, 2019, the Company was in compliance with all its Credit Agreement covenants.

During the three months ended March 31, 2019, the Company had no draws under its credit facility.

As of March 31, 2019, the Company had a total of $20.0 million of revolving loans outstanding with an interest rate of 4.49% on our credit facility and the total availability under the revolving credit loan facility was $141.2 million.

As of December 31, 2018, the Company had a total of $20.0 million of revolving loans outstanding with an interest rate of 4.35% on our credit facility and the total availability under the revolving credit loan facility was $142.9 million.

Senior Secured Credit Facility

Prior to October 31, 2018, we were a party to a credit agreement (the “Existing Credit Agreement”) with certain lenders and Capital One, National Association, as a lender and swing lender and as agent for all lenders. This credit facility totaled $250.0 million, replaced our previous senior secured credit facility totaling $125.0 million (“Terminated Senior Secured Credit Facility”), and terminated the Second Amended and Restated Credit and Guaranty Agreement, dated as of November 10, 2015, as modified by the May 24, 2016 amendment (as amended, the “Terminated Senior Secured Credit Agreement”), between us, certain lenders and Fifth Third Bank, as agent, which evidenced the Terminated Senior Secured Credit Facility. The credit facility included a $125.0 million revolving loan, a $45.0 million term loan and an $80.0 million delayed draw term loan.

Income Taxes

3 Months Ended

Mar. 31, 2019

Income Tax Disclosure [Abstract]

Income Taxes

8. Income Taxes

A reconciliation of the statutory federal tax rate of 21.0% for the three months ended March 31, 2019 and 2018 is summarized as follows:

	Three Months Ended March 31,
	2019				2018
Federal income tax at statutory rate		21.0		%		21.0		%
State and local taxes, net of federal benefit		6.1				6.9
Jobs tax credits, net		(6.0	)			(10.9	)
162(m) disallowance for executive compensation		2.8				2.2
Nondeductible permanent items		0.4				1.0
Excess tax benefit		(7.6	)			(1.5	)
Effective income tax rate		16.7		%		18.7		%

On December 22, 2017, the President of the United States signed into law the Tax Cuts and Jobs Act (“Tax Reform Act”). The legislation significantly changed U.S. tax law by, among other things, lowering corporate income tax rates. The Tax Reform Act permanently reduced the U.S. corporate income tax rate from a maximum of 35.0% to a flat 21.0% rate, effective January 1, 2018. The effective income tax rate was 16.7% and 18.7% for the three months ended March 31, 2019 and 2018, respectively. The difference between our federal statutory and effective income tax rates are principally due to the inclusion of state taxes and the use of federal employment tax credits.

Commitments and Contingencies

3 Months Ended

Mar. 31, 2019

Commitments And Contingencies Disclosure [Abstract]

Commitments and Contingencies

9. Commitments and Contingencies

Legal Proceedings

From time to time, the Company is subject to legal and/or administrative proceedings incidental to its business. 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.

On January 20, 2016, the Company was served with a lawsuit filed in the United States District Court for the Northern District of Illinois against the Company and Cigna Corporation by Stop Illinois Marketing Fraud, LLC, a qui tam relator formed for the purpose of bringing this action. In the action, the plaintiff alleges, inter alia, violations of the federal False Claims Act relating primarily to allegations of violations of the federal Anti-Kickback Statute and allegedly improper referrals of patients from the Company’s home care division to the Company’s home health business, substantially all of which was sold in 2013. The plaintiff seeks to recover damages, fees and costs under the federal False Claims Act including treble damages, civil penalties and its attorneys’ fees. The U.S. government has declined to intervene at this time. Plaintiff amended its complaint on April 4, 2016 to include additional allegations in support of its False Claims Act claims, including alleged violations of the federal Anti-Kickback Statute. The Company and Cigna Corporation filed a motion to dismiss the amended complaint on June 6, 2016. On February 3, 2017, the Court granted Cigna Corporation’s motion to dismiss in full, and granted the Company’s motion to dismiss in part allowing Plaintiff another chance to amend its complaint. Plaintiff timely filed a second amended complaint on March 10, 2017, withdrawing its conspiracy claim under the Federal False Claims Act and adding an explicit claim under the Illinois False Claims Act for the same underlying kickback allegations. On April 7, 2017, the Company filed a partial motion to dismiss the Second Amended Complaint. On May 24, 2017, the State of Illinois filed notice that it was declining to intervene in the plaintiff’s claim under the Illinois False Claims Act. On March 21, 2018, the Court granted the Company’s motion to dismiss the Second Amended Complaint in part and narrowed the lawsuit to whether the federal False Claims Act was violated with respect to home health services provided at three senior living facilities in Illinois. The Company intends to defend the litigation vigorously and believes the case will not have a material adverse effect on its business, financial condition or results of operations.

Employment Agreements

During 2017, the Company entered into employment agreements with certain members of senior management. The terms of these agreements are up to four years with the potential to auto-renew and include non-compete, non-solicitation and nondisclosure provisions, as well as provide for defined severance payments in the event of termination. On November 5, 2018 we amended and restated the employment agreements of each of our named executive officers in order to: (i) increase the amount of severance that would be payable on certain terminations of employment in connection with a change in control (as defined in the employment agreements), from two times annual compensation to three times annual compensation (as defined in the employment agreements) in the case of our chief executive officer, and from one times annual compensation to two times annual compensation (as defined in the employment agreements) in the case of our other named executive officers; (ii) provide that the enhanced severance for terminations of employment in connection with a change in control would be payable if the named executive officers self-terminated for good reason (as defined in the employment agreements); (iii) stipulate that severance for terminations of employment in connection with a change in control would include any unpaid bonus for a performance period completed prior to termination (the chief executive officer already had this right); and (iv) adjust the duration of non-competition and non-solicitation periods to match the number of years of annual compensation that the named executive officer would receive in severance.

A substantial percentage of the Company’s workforce is represented by the Service Employees International Union (“SEIU”) through local collective bargaining agreements. These agreements are re-negotiated at various intervals. These negotiations are often initiated when the Company receives increases in hourly reimbursement rates from various state agencies. Upon expiration of these collective bargaining agreements, the Company may not be able to negotiate labor agreements on satisfactory terms with these labor unions.

Severance and Restructuring

3 Months Ended

Mar. 31, 2019

Restructuring And Related Activities [Abstract]

Severance and Restructuring

10. Severance and Restructuring

In 2016, the Company initiated steps to streamline its operations. The Company incurred total expenses related to these initiatives of approximately $0.4 million and $0.5 million for the three months ended March 31, 2019 and 2018, respectively. These costs are included in general and administrative expenses on the Company’s Unaudited Condensed Consolidated Statements of Income. The expenses recorded for the three months ended March 31, 2019 and 2018 included costs related to terminated employees and other professional fees. The Company expects some additional restructuring and other costs to occur, however, the amount and timing cannot be determined at this time.

The following provides the components of and changes in our severance and restructuring accruals:

	Employee Termination Costs			Restructuring and Other
	(Amounts in Thousands)
Balance at December 31, 2018	$	80		$	585
Provision		65			288
Utilization		(110	)		(311	)
Balance at March 31, 2019	$	35		$	562

Employee termination costs represent accrued severance payable to terminated employees with employment and/or separation agreements with the Company. Restructuring and other costs consist of the accrual related to lease commitments and write-offs of leasehold improvements and unused office space and property and equipment resulting from the closure of three adult day services centers in Illinois. These costs are included in accrued expenses on the Unaudited Condensed Consolidated Balance Sheets at March 31, 2019 and December 31, 2018.

Segment Information

3 Months Ended

Mar. 31, 2019

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 our 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. As a result of the acquisition of Ambercare on May 1, 2018, we began reporting the hospice and home health segments.

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 and 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 our reportable segments for the three months ended March 31, 2019 and 2018 along with the items necessary to reconcile the segment information to the totals reported in the accompanying consolidated financial statements. Segment assets are not reviewed by the company’s chief decision makers and therefore are not disclosed below.

Segment operating income consists of the net service revenues 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 March 31, 2019
	(Amounts in Thousands)
	Personal Care		Hospice		Home Health		Total
Net service revenues	$	128,641	$	7,917	$	2,696	$	139,254
Cost of services revenues		95,995		3,770		1,915		101,680
Gross profit		32,646		4,147		781		37,574
General and administrative expenses		12,539		1,590		686		14,815
Segment operating income	$	20,107	$	2,557	$	95	$	22,759

	For the Three Months Ended March 31, 2018
	(Amounts in Thousands)
	Personal Care		Hospice		Home Health		Total
Net service revenues	$	109,476	$	—	$	—	$	109,476
Cost of services revenues		81,543		—		—		81,543
Gross profit		27,933		—		—		27,933
General and administrative expenses		9,637		—		—		9,637
Segment operating income	$	18,296	$	—	$	—	$	18,296

	For the Three Months Ended March 31,
	2019			2018
	(Amounts in Thousands)
Segment Reconciliation:
Total segment operating income	$	22,759		$	18,296

Items not allocated at segment level:
Other general and administrative expenses		14,442			11,900
Depreciation and amortization		2,074			1,807
Interest income		(215	)		(2,322	)
Interest expense		618			910
Income before income taxes	$	5,840		$	6,001

Significant Payors

3 Months Ended

Mar. 31, 2019

Significant Payors [Abstract]

Significant Payors

12. Significant Payors

For the three months ended March 31, 2019 and 2018, the Company’s revenue by payor type was as follows:

	Personal Care
	For the Three Months Ended March 31,
	2019					2018
	Amount (in Thousands)		% of Segment Net Service Revenues			Amount (in Thousands)		% of Segment Net Service Revenues
State, local and other governmental programs	$	72,059		56.0	%	$	67,328		61.5	%
Managed care organizations		48,005		37.3			37,830		34.6
Private pay		5,019		3.9			3,755		3.4
Commercial insurance		1,867		1.5			563		0.5
Other		1,691		1.3			—		—
Total personal care segment net service revenues	$	128,641		100.0	%	$	109,476		100.0	%

	Hospice

	For the Three Months Ended March 31,
	2019
	Amount (in Thousands)		% of Segment Net Service Revenues
Medicare	$	7,390		93.3	%
Managed care organizations		361		4.6
Other		166		2.1
Total hospice segment net service revenues	$	7,917		100.0	%

	Home Health

	For the Three Months Ended March 31,
	2019
	Amount (in Thousands)		% of Segment Net Service Revenues
Medicare	$	2,199		81.6	%
Managed care organizations		414		15.4
Other		83		3.0
Total home health segment net service revenues	$	2,696		100.0	%

The percentages of segment revenue for each of the Company’s significant states for the three months ended March 31, 2019 and 2018 were as follows:

	Personal Care
	For the Three Months Ended March 31,
	2019					2018
	Amount (in Thousands)		% of Segment Net Service Revenues			Amount (in Thousands)		% of Segment Net Service Revenues
Illinois	$	57,596		44.8	%	$	57,386		52.4	%
New York		17,813		13.8			15,363		14.0
New Mexico		17,208		13.4			11,770		10.8
All other states		36,024		28.0			24,957		22.8
Total personal care segment net service revenues	$	128,641		100.0	%	$	109,476		100.0	%

	Hospice
	For the Three Months Ended March 31,
	2019
	Amount (in Thousands)		% of Segment Net Service Revenues
New Mexico	$	7,917		100.0	%
Total hospice segment net service revenues	$	7,917		100.0	%

	Home Health
	For the Three Months Ended March 31,
	2019
	Amount (in Thousands)		% of Segment Net Service Revenues
New Mexico	$	2,696		100.0	%
Total home health segment net service revenues	$	2,696		100.0	%

A substantial portion of the Company’s net service revenues and accounts receivable are derived from services performed for state and local governmental agencies. The Illinois Department on Aging, the largest payor program for our Illinois personal care operations, accounted for 28.9% and 36.6% of the Company’s net service revenues for the three months ended March 31, 2019 and 2018, respectively.

The related receivables due from the Illinois Department on Aging represented 24.5% and 22.5% of the Company’s net accounts receivable at March 31, 2019 and December 31, 2018, respectively.

Concentration of Cash

3 Months Ended

Mar. 31, 2019

Risks And Uncertainties [Abstract]

Concentration of Cash

13. Concentration of Cash

The Company owns financial instruments, including cash, that potentially subject the Company to significant concentrations of credit risk. The Company maintains cash with financial institutions which, at times, may exceed federally insured limits. The Company believes it is not exposed to any significant credit risk on cash.

Summary of Significant Accounting Policies (Policies)

3 Months Ended

Mar. 31, 2019

Accounting Policies [Abstract]

Principles of Consolidation

Reclassification of Prior Period Balances

Certain reclassifications have been made to prior period amounts to conform to the current-year presentation. These reclassifications have no effect on the reported net income.

Recently Issued and Adopted Accounting Pronouncements

Recently Adopted Accounting Pronouncements

Recently Issued Accounting Pronouncements

Revenue Recognition

Personal Care Revenue

Hospice Revenue

Home Health Revenue

Implicit Price Concessions

Allowance for Doubtful Accounts

Property and Equipment



Computer equipment			3 – 5 years
Furniture and equipment			5 – 7 years
Transportation equipment			5 years
Computer software			3 –10 years
Leasehold improvements			Lesser of useful life or lease term

Goodwill

Intangible Assets

Debt Issuance Costs

Workers' Compensation Program

Workers’ Compensation Program

Interest Income

Interest Expense

Income Tax Expense

Stock-Based Compensation

Stock-based Compensation

Diluted Net Income Per Common Share

Estimates

Fair Value Measurements

Going Concern

Summary of Significant Accounting Policies (Tables)

3 Months Ended

Mar. 31, 2019

Accounting Policies [Abstract]

Estimated Useful Lives of Property and Equipment

The estimated useful lives of the property and equipment are as follows:



Computer equipment			3 – 5 years
Furniture and equipment			5 – 7 years
Transportation equipment			5 years
Computer software			3 –10 years
Leasehold improvements			Lesser of useful life or lease term

Leases (Tables)

3 Months Ended

Mar. 31, 2019

Leases [Abstract]

Amounts Reported in Unaudited Condensed Consolidated Balance Sheets for Operating Leases

Amounts reported in the Company’s Unaudited Condensed Consolidated Balance Sheets as of March 31, 2019 for our operating leases were as follows:

	The Three Months Ended March 31, (Amounts in Thousands)
	2019
Operating lease right of use assets, net	$	16,691
Short-term operating lease liabilities (in Accrued expenses)		5,154
Long-term operating lease liabilities		11,679
Total operating lease liabilities	$	16,833

Components of Lease Cost Reported in General and Administrative Expenses in Unaudited Condensed Consolidated Statements of Income

Components of lease cost were reported in general and administrative expenses in the Company’s Unaudited Condensed Consolidated Statements of Income as follows:

	For the Three Months Ended March 31, (Amounts in Thousands)
	2019
Operating lease costs	$	1,646
Short-term lease costs		64
Total lease cost	$	1,710

Schedule of Weighted Average Remaining Lease Terms and Discount Rates

Weighted average remaining lease terms and discount rates were as follows:

	For the Three Months Ended March 31,
	2019
Operating leases:
Weighted average remaining lease term		4.02
Weighted average discount rate		5.75	%

Summary of Remaining Operating Lease Payments

A summary of our remaining operating lease payments as of March 31, 2019 were as follows:

	Operating Leases
	(Amounts in Thousands)
Due in 12 month period ended March 31,
2020	$	5,747
2021		4,544
2022		3,495
2023		2,248
2024		1,726
Thereafter		1,200
Total future minimum rental commitments		18,960
Less: Imputed interest		(2,127	)
Total lease liabilities	$	16,833

Supplemental Cash Flows Information

	For the Three Months Ended March 31, (Amounts in Thousands)
	2019
Supplemental Cash Flows Information
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	1,639

Right-of-use assets obtained in exchange for lease obligations:
Operating leases		17,660

Acquisitions (Tables)

3 Months Ended

Mar. 31, 2019

Ambercare Corporation [Member]

Business Acquisition [Line Items]

Schedule of Purchase Price Allocation

	Total (Amounts in Thousands)
Goodwill	$	28,831
Cash		12,028
Identifiable intangible assets		9,944
Accounts receivable		6,512
Other assets		442
Property and equipment		154
Accrued liabilities		(4,073	)
Deferred tax liability		(2,138	)
Financing lease		(75	)
Accounts payable		(3	)
Total purchase price allocation	$	51,622

Arcadia Home Care And Staffing [Member]

Business Acquisition [Line Items]

Schedule of Purchase Price Allocation

	Total (Amounts in Thousands)
Goodwill	$	13,072
Accounts receivable		5,317
Identifiable intangible assets		2,264
Property and equipment		155
Other assets		92
Accrued liabilities		(1,540	)
Accounts payable		(508	)
Total purchase price allocation	$	18,852

Lifestyle Options, Inc. [Member]

Business Acquisition [Line Items]

Schedule of Purchase Price Allocation

	Total (Amounts in Thousands)
Goodwill	$	2,751
Identifiable intangible assets		1,152
Accounts receivable		573
Other assets		32
Property and equipment		18
Accrued liabilities		(291	)
Accounts payable		(105	)
Total purchase price allocation	$	4,130

Ambercare and Arcadia [Member]

Business Acquisition [Line Items]

Unaudited Pro Forma Condensed Consolidated Income Statement Information

The following table contains unaudited pro forma condensed consolidated income statement information of the Company had the acquisitions of Ambercare and Arcadia closed on January 1, 2018.

	For the Three Months Ended March 31, (Amounts in Thousands)
	2019		2018
Net service revenues	$	139,254	$	138,218
Operating income		6,486		11,583
Net income		5,105		7,852
Net income per common share
Basic income per share	$	0.39	$	0.68
Diluted income per share	$	0.38	$	0.67

Goodwill and Intangible Assets (Tables)

3 Months Ended

Mar. 31, 2019

Goodwill And Intangible Assets Disclosure [Abstract]

Summary of Goodwill and Related Adjustments

A summary of the goodwill activity for the three months ended March 31, 2019 is provided below:

	Goodwill
	Personal Care			Hospice		Home Health		Total
	(Amounts in Thousands)
Goodwill as of December 31, 2018	$	112,377		$	22,200	$	865	$	135,442
Adjustments to previously recorded goodwill		(43	)		—		—		(43	)
Goodwill as of March 31, 2019	$	112,334		$	22,200	$	865	$	135,399

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 March 31, 2019:

	Customer and referral relationships			Trade names and trademarks			Non- competition agreements			State Licenses			Total
	(Amounts in Thousands)
Intangible assets with indefinite lives:		—			—			—			2,871			2,871
Intangible assets subject to amortization:
Gross carrying amount		42,356			21,551			2,155			241			66,303
Accumulated amortization		(33,436	)		(11,175	)		(2,009	)		(23	)		(46,643	)
Net book value, intangible assets subject to amortization		8,920			10,376			146			218			19,660
Total intangible assets at March 31, 2019	$	8,920		$	10,376		$	146		$	3,089		$	22,531

Schedule of Future Amortization of Intangible Assets

The estimated future intangible amortization expense is as follows:

For the Three Months Ended March 31, 2019	Total (Amounts in Thousands)
Remainder of 2019		3,760
2020		3,400
2021		2,758
2022		1,724
2023		1,406
Thereafter		6,612
Total intangible assets subject to amortization	$	19,660

Details of Certain Balance Sheet Accounts (Tables)

3 Months Ended

Mar. 31, 2019

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:

	March 31, 2019		December 31, 2018
	(Amounts in Thousands)
Workers’ compensation insurance receivable	$	1,564	$	1,692
Prepaid workers’ compensation and liability insurance		1,152		1,840
Health insurance receivable		676		564
Other		3,754		3,002
	$	7,146	$	7,098

Schedule of Accrued Expenses

Accrued expenses consisted of the following:

	March 31, 2019		December 31, 2018
	(Amounts in Thousands)
Current portion of operating lease liabilities	$	5,154	$	—
Accrued health insurance (1)		3,681		3,926
Accrued professional fees		2,096		2,260
Accrued payroll taxes		1,585		769
Other		4,686		4,693
	$	17,202	$	11,648

(1)

Long-Term Debt (Tables)

3 Months Ended

Mar. 31, 2019

Long Term Debt [Abstract]

Schedule of Long-Term Debt

Long-term debt consisted of the following:

	March 31, 2019			December 31, 2018
	(Amounts in Thousands)
Revolving loan under the credit facility	$	20,000		$	20,000
Financing leases		48			81
Less unamortized issuance costs		(2,636	)		(2,797	)
Total	$	17,412		$	17,284
Less current maturities		(37	)		(62	)
Long-term debt	$	17,375		$	17,222

- Definition

Tabular disclosure of long-debt instruments or arrangements, including identification, terms, features, collateral requirements and other information necessary to a fair presentation. These are debt arrangements that originally required repayment more than twelve months after issuance or greater than the normal operating cycle of the entity, if longer.

+ References

Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 210
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SX 210.5-02.22)
-URI http://asc.fasb.org/extlink&oid=6877327&loc=d3e13212-122682

Reference 2: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 835
-SubTopic 30
-Section 45
-Paragraph 1A
-URI http://asc.fasb.org/extlink&oid=114775744&loc=d3e28541-108399

Reference 3: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 505
-SubTopic 10
-Section 50
-Paragraph 6
-URI http://asc.fasb.org/extlink&oid=109259400&loc=d3e21506-112644

Reference 4: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 235
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08.(e),(f))
-URI http://asc.fasb.org/extlink&oid=26873400&loc=d3e23780-122690

Reference 5: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 835
-SubTopic 30
-Section 45
-Paragraph 2
-URI http://asc.fasb.org/extlink&oid=114775744&loc=d3e28551-108399

Reference 6: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 505
-SubTopic 10
-Section 50
-Paragraph 7
-URI http://asc.fasb.org/extlink&oid=109259400&loc=d3e21521-112644

Reference 7: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 505
-SubTopic 10
-Section 50
-Paragraph 8
-URI http://asc.fasb.org/extlink&oid=109259400&loc=d3e21538-112644

Reference 8: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 942
-SubTopic 470
-Section 50
-Paragraph 3
-URI http://asc.fasb.org/extlink&oid=75038535&loc=d3e64711-112823

Reference 9: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 835
-SubTopic 30
-Section 55
-Paragraph 8
-URI http://asc.fasb.org/extlink&oid=114775985&loc=d3e28878-108400

Reference 10: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 505
-SubTopic 10
-Section 50
-Paragraph 3
-URI http://asc.fasb.org/extlink&oid=109259400&loc=d3e21475-112644

+ Details

Income Taxes (Tables)

3 Months Ended

Mar. 31, 2019

Income Tax Disclosure [Abstract]

Reconciliation of Statutory Federal Tax Rate

A reconciliation of the statutory federal tax rate of 21.0% for the three months ended March 31, 2019 and 2018 is summarized as follows:

	Three Months Ended March 31,
	2019				2018
Federal income tax at statutory rate		21.0		%		21.0		%
State and local taxes, net of federal benefit		6.1				6.9
Jobs tax credits, net		(6.0	)			(10.9	)
162(m) disallowance for executive compensation		2.8				2.2
Nondeductible permanent items		0.4				1.0
Excess tax benefit		(7.6	)			(1.5	)
Effective income tax rate		16.7		%		18.7		%

Severance and Restructuring (Tables)

3 Months Ended

Mar. 31, 2019

Restructuring And Related Activities [Abstract]

Components of and Changes in Severance and Restructuring Accruals

The following provides the components of and changes in our severance and restructuring accruals:

	Employee Termination Costs			Restructuring and Other
	(Amounts in Thousands)
Balance at December 31, 2018	$	80		$	585
Provision		65			288
Utilization		(110	)		(311	)
Balance at March 31, 2019	$	35		$	562

Segment Information (Tables)

3 Months Ended

Mar. 31, 2019

Segment Reporting [Abstract]

Summary Of Segment Information

	For the Three Months Ended March 31, 2019
	(Amounts in Thousands)
	Personal Care		Hospice		Home Health		Total
Net service revenues	$	128,641	$	7,917	$	2,696	$	139,254
Cost of services revenues		95,995		3,770		1,915		101,680
Gross profit		32,646		4,147		781		37,574
General and administrative expenses		12,539		1,590		686		14,815
Segment operating income	$	20,107	$	2,557	$	95	$	22,759

	For the Three Months Ended March 31, 2018
	(Amounts in Thousands)
	Personal Care		Hospice		Home Health		Total
Net service revenues	$	109,476	$	—	$	—	$	109,476
Cost of services revenues		81,543		—		—		81,543
Gross profit		27,933		—		—		27,933
General and administrative expenses		9,637		—		—		9,637
Segment operating income	$	18,296	$	—	$	—	$	18,296

	For the Three Months Ended March 31,
	2019			2018
	(Amounts in Thousands)
Segment Reconciliation:
Total segment operating income	$	22,759		$	18,296

Items not allocated at segment level:
Other general and administrative expenses		14,442			11,900
Depreciation and amortization		2,074			1,807
Interest income		(215	)		(2,322	)
Interest expense		618			910
Income before income taxes	$	5,840		$	6,001

Significant Payors (Tables)

3 Months Ended

Mar. 31, 2019

Significant Payors [Abstract]

Schedule of Revenue by Payor Type

For the three months ended March 31, 2019 and 2018, the Company’s revenue by payor type was as follows:

	Personal Care
	For the Three Months Ended March 31,
	2019					2018
	Amount (in Thousands)		% of Segment Net Service Revenues			Amount (in Thousands)		% of Segment Net Service Revenues
State, local and other governmental programs	$	72,059		56.0	%	$	67,328		61.5	%
Managed care organizations		48,005		37.3			37,830		34.6
Private pay		5,019		3.9			3,755		3.4
Commercial insurance		1,867		1.5			563		0.5
Other		1,691		1.3			—		—
Total personal care segment net service revenues	$	128,641		100.0	%	$	109,476		100.0	%

	Hospice

	For the Three Months Ended March 31,
	2019
	Amount (in Thousands)		% of Segment Net Service Revenues
Medicare	$	7,390		93.3	%
Managed care organizations		361		4.6
Other		166		2.1
Total hospice segment net service revenues	$	7,917		100.0	%

	Home Health

	For the Three Months Ended March 31,
	2019
	Amount (in Thousands)		% of Segment Net Service Revenues
Medicare	$	2,199		81.6	%
Managed care organizations		414		15.4
Other		83		3.0
Total home health segment net service revenues	$	2,696		100.0	%

Schedule of Revenue by Geographic Location

The percentages of segment revenue for each of the Company’s significant states for the three months ended March 31, 2019 and 2018 were as follows:

	Personal Care
	For the Three Months Ended March 31,
	2019					2018
	Amount (in Thousands)		% of Segment Net Service Revenues			Amount (in Thousands)		% of Segment Net Service Revenues
Illinois	$	57,596		44.8	%	$	57,386		52.4	%
New York		17,813		13.8			15,363		14.0
New Mexico		17,208		13.4			11,770		10.8
All other states		36,024		28.0			24,957		22.8
Total personal care segment net service revenues	$	128,641		100.0	%	$	109,476		100.0	%

	Hospice
	For the Three Months Ended March 31,
	2019
	Amount (in Thousands)		% of Segment Net Service Revenues
New Mexico	$	7,917		100.0	%
Total hospice segment net service revenues	$	7,917		100.0	%

	Home Health
	For the Three Months Ended March 31,
	2019
	Amount (in Thousands)		% of Segment Net Service Revenues
New Mexico	$	2,696		100.0	%
Total home health segment net service revenues	$	2,696		100.0	%

Nature of Operations, Consolidation, and Presentation of Financial Statements (Narrative) (Details)	3 Months Ended
	Mar. 31, 2019 segment
Organization Consolidation And Presentation Of Financial Statements [Abstract]
Number of operating segments	3

Summary of Significant Accounting Policies (Narrative) (Details)	3 Months Ended		12 Months Ended
	Mar. 31, 2019 USD ($) item shares	Mar. 31, 2018 USD ($) shares	Dec. 31, 2018 USD ($)
Summary Of Significant Accounting Policies [Line Items]
Revenues	$ 139,254,000	$ 109,476,000
Accounts receivable, allowance for doubtful accounts	800,000		$ 700,000
Goodwill impairment charge	0	0	0
Goodwill	135,399,000		135,442,000
Impairment of finite-lived intangible assets	0	0
Intangibles, net of accumulated depreciation and amortization	22,531,000		23,784,000
Deductible component of workers' compensation	400,000
Accrued workers' compensation insurance	14,537,000		15,169,000
Workers' compensation insurance recovery receivables	1,564,000		$ 1,692,000
Interest income received	$ 100,000	2,300,000
Number of stock incentive plans \| item	1
Stock-based compensation expense	$ 1,200,000	$ 900,000
Shares of restricted stock awards included in calculation \| shares	153,000	166,000
Stock Options [Member]
Summary Of Significant Accounting Policies [Line Items]
Number of stock options included in calculation \| shares	685,000	746,000
Number of dilutive shares outstanding \| shares	303,000	129,000
Restricted Stock [Member]
Summary Of Significant Accounting Policies [Line Items]
Number of dilutive shares outstanding \| shares	83,000	65,000
Minimum [Member]
Summary Of Significant Accounting Policies [Line Items]
Intangible assets, estimated useful lives	3 years
Maximum [Member]
Summary Of Significant Accounting Policies [Line Items]
Intangible assets, estimated useful lives	25 years
Accounting Standards Update 2014-09 [Member]
Summary Of Significant Accounting Policies [Line Items]
Revenues	$ 2,200,000	$ 2,000,000

Summary of Significant Accounting Policies (Estimated Useful Lives of Property and Equipment) (Details)	3 Months Ended
	Mar. 31, 2019
Transportation Equipment [Member]
Property, Plant and Equipment [Line Items]
Property and equipment useful life	5 years
Leasehold Improvements [Member]
Property, Plant and Equipment [Line Items]
Property and equipment useful life	Lesser of useful life or lease term
Minimum [Member] \| Computer Equipment [Member]
Property, Plant and Equipment [Line Items]
Property and equipment useful life	3 years
Minimum [Member] \| Furniture and Equipment [Member]
Property, Plant and Equipment [Line Items]
Property and equipment useful life	5 years
Minimum [Member] \| Computer Software [Member]
Property, Plant and Equipment [Line Items]
Property and equipment useful life	3 years
Maximum [Member] \| Computer Equipment [Member]
Property, Plant and Equipment [Line Items]
Property and equipment useful life	5 years
Maximum [Member] \| Furniture and Equipment [Member]
Property, Plant and Equipment [Line Items]
Property and equipment useful life	7 years
Maximum [Member] \| Computer Software [Member]
Property, Plant and Equipment [Line Items]
Property and equipment useful life	10 years

Leases (Narrative) (Details)	3 Months Ended
Leases (Narrative) (Details)	Mar. 31, 2019 USD ($) $ / agreement	Dec. 31, 2018 USD ($)
Lessee Lease [Line Items]
Lease, practical expedients package	true
Operating lease expiration dates	expiration dates through 2029
Financing lease obligations \| $	$ 48,000	$ 81,000
Financing leases payment term	monthly payments through August 2020
Option to purchase assets per lease agreement \| $ / agreement	1
Minimum [Member]
Lessee Lease [Line Items]
Leases renewal option	1 year
Implicit interest rates	3.64%
Maximum [Member]
Lessee Lease [Line Items]
Leases renewal option	5 years
Implicit interest rates	7.72%

Leases (Amounts Reported in Unaudited Condensed Consolidated Balance Sheets for Operating Leases) (Details) $ in Thousands	Mar. 31, 2019 USD ($)
Leases [Abstract]
Operating lease assets, net	$ 16,691
Short-term operating lease liabilities (in Accrued expenses)	$ 5,154
Operating Lease, Liability, Current, Statement of Financial Position [Extensible List]	us-gaap:AccruedLiabilitiesCurrent
Long-term operating lease liabilities	$ 11,679
Total operating lease liabilities	$ 16,833

Leases (Components of Lease Cost Reported in General and Administrative Expenses in Unaudited Condensed Consolidated Statements of Income) (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2019 USD ($)
Leases [Abstract]
Operating lease costs	$ 1,646
Short-term lease costs	64
Total lease cost	$ 1,710

Leases (Schedule of Weighted Average Remaining Lease Terms and Discount Rates) (Details)	Mar. 31, 2019
Leases [Abstract]
Weighted average remaining lease term	4 years 7 days
Weighted average discount rate	5.75%

Leases (Summary of Remaining Operating Lease Payments) (Details) $ in Thousands	Mar. 31, 2019 USD ($)
Leases [Abstract]
2020	$ 5,747
2021	4,544
2022	3,495
2023	2,248
2024	1,726
Thereafter	1,200
Total future minimum rental commitments	18,960
Less: Imputed interest	(2,127)
Total lease liabilities	$ 16,833

Leases (Supplemental Cash Flows Information) (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2019 USD ($)
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$ 1,639
Right-of-use assets obtained in exchange for lease obligations:
Operating leases	$ 17,660

Acquisitions (Narrative) (Details) - USD ($) $ in Thousands				3 Months Ended
Acquisitions (Narrative) (Details) - USD ($) $ in Thousands	May 01, 2018	Apr. 01, 2018	Jan. 01, 2018	Mar. 31, 2019	Dec. 31, 2018	Mar. 31, 2018
Business Acquisition [Line Items]
Total purchase price for business acquisition						$ 3,283
Net service revenues				$ 139,254		109,476
Net income from continuing operations				5,840		6,001
Goodwill				$ 135,399	$ 135,442
Minimum [Member]
Business Acquisition [Line Items]
Intangible assets, estimated useful lives				3 years
Maximum [Member]
Business Acquisition [Line Items]
Intangible assets, estimated useful lives				25 years
Ambercare Corporation [Member]
Business Acquisition [Line Items]
Cash paid for acquisition	$ 12,028
Total purchase price allocation	51,622
Goodwill	28,831
Ambercare Corporation [Member] \| Minimum [Member] \| Trade Name and Customer Relationships [Member]
Business Acquisition [Line Items]
Intangible assets, estimated useful lives				3 years
Ambercare Corporation [Member] \| Maximum [Member] \| Trade Name and Customer Relationships [Member]
Business Acquisition [Line Items]
Intangible assets, estimated useful lives				15 years
Ambercare Corporation [Member] \| New Mexico [Member]
Business Acquisition [Line Items]
Total purchase price for business acquisition	39,600
Cash paid for acquisition	$ 12,000
Integration costs				$ 100
Net service revenues				14,800
Net income from continuing operations				3,400
Arcadia Home Care And Staffing [Member]
Business Acquisition [Line Items]
Integration costs				100
Total purchase price allocation		$ 18,852
Net service revenues				10,300
Net income from continuing operations				$ 1,300
Total purchase price for business acquisition		18,900
Goodwill		$ 13,072
Arcadia Home Care And Staffing [Member] \| Minimum [Member] \| Trade Names, Customer Relationships and State Licenses [Member]
Business Acquisition [Line Items]
Intangible assets, estimated useful lives				7 years
Arcadia Home Care And Staffing [Member] \| Maximum [Member] \| Trade Names, Customer Relationships and State Licenses [Member]
Business Acquisition [Line Items]
Intangible assets, estimated useful lives				15 years
Affiliate Branches of Arcadia [Member]
Business Acquisition [Line Items]
Acquisitions of business cash consideration					600
Goodwill					$ 600
Lifestyle Options, Inc. [Member]
Business Acquisition [Line Items]
Total purchase price allocation			$ 4,130
Goodwill			2,751
Lifestyle Options, Inc. [Member] \| Minimum [Member] \| Trade Name and Customer Relationships [Member]
Business Acquisition [Line Items]
Intangible assets, estimated useful lives				10 years
Lifestyle Options, Inc. [Member] \| Maximum [Member] \| Trade Name and Customer Relationships [Member]
Business Acquisition [Line Items]
Intangible assets, estimated useful lives				15 years
Lifestyle Options, Inc. [Member] \| Illinois [Member]
Business Acquisition [Line Items]
Net service revenues				$ 1,200
Net income from continuing operations				$ 0
Total purchase price for business acquisition			4,100
Acquisitions of business cash consideration			3,300
Business acquisition, contingent earn-out obligation			$ 800
Acquisition related costs						$ 48,000

Acquisitions (Schedule of Purchase Price Allocation) (Details) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018	May 01, 2018	Apr. 01, 2018	Jan. 01, 2018
Business Acquisition [Line Items]
Goodwill	$ 135,399	$ 135,442
Ambercare Corporation [Member]
Business Acquisition [Line Items]
Goodwill			$ 28,831
Cash			12,028
Identifiable intangible assets			9,944
Accounts receivable			6,512
Other assets			442
Property and equipment			154
Accrued liabilities			(4,073)
Deferred tax liability			(2,138)
Financing lease			(75)
Accounts payable			(3)
Total purchase price allocation			$ 51,622
Arcadia Home Care And Staffing [Member]
Business Acquisition [Line Items]
Goodwill				$ 13,072
Identifiable intangible assets				2,264
Accounts receivable				5,317
Other assets				92
Property and equipment				155
Accrued liabilities				(1,540)
Accounts payable				(508)
Total purchase price allocation				$ 18,852
Lifestyle Options, Inc. [Member]
Business Acquisition [Line Items]
Goodwill					$ 2,751
Identifiable intangible assets					1,152
Accounts receivable					573
Other assets					32
Property and equipment					18
Accrued liabilities					(291)
Accounts payable					(105)
Total purchase price allocation					$ 4,130

Acquisitions (Unaudited Pro Forma Condensed Consolidated Income Statement Information) (Details) - Ambercare and Arcadia [Member] - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Business Acquisition [Line Items]
Net service revenues	$ 139,254	$ 138,218
Operating income	6,486	11,583
Net income	$ 5,105	$ 7,852
Basic income per share	$ 0.39	$ 0.68
Diluted income per share	$ 0.38	$ 0.67

Goodwill and Intangible Assets (Summary of Goodwill and Related Adjustments) (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2019 USD ($)
Goodwill [Line Items]
Goodwill, at Beginning of Period	$ 135,442
Adjustments to previously recorded goodwill	(43)
Goodwill, at End of Period	135,399
Personal Care [Member]
Goodwill [Line Items]
Goodwill, at Beginning of Period	112,377
Adjustments to previously recorded goodwill	(43)
Goodwill, at End of Period	112,334
Hospice [Member]
Goodwill [Line Items]
Goodwill, at Beginning of Period	22,200
Goodwill, at End of Period	22,200
Home Health [Member]
Goodwill [Line Items]
Goodwill, at Beginning of Period	865
Goodwill, at End of Period	$ 865

Goodwill and Intangible Assets (Narrative) (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Goodwill [Line Items]
Amortization expense	$ 1.3	$ 1.3
Weighted average remaining lives of identifiable intangible assets	8 years 8 months 12 days
Minimum [Member]
Goodwill [Line Items]
Intangible assets, estimated useful lives	3 years
Maximum [Member]
Goodwill [Line Items]
Intangible assets, estimated useful lives	25 years

Goodwill and Intangible Assets (Schedule of Carrying Amount and Accumulated Amortization of Intangible Asset) (Details) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Finite Lived Intangible Assets [Line Items]
Intangible assets with indefinite lives:	$ 2,871
Intangible assets subject to amortization:
Gross carrying amount	66,303
Accumulated amortization	(46,643)
Net book value, intangible assets subject to amortization	19,660
Total intangible assets at March 31, 2019	22,531	$ 23,784
Customer And Referral Relationships [Member]
Intangible assets subject to amortization:
Gross carrying amount	42,356
Accumulated amortization	(33,436)
Net book value, intangible assets subject to amortization	8,920
Total intangible assets at March 31, 2019	8,920
Trade Names And Trademarks [Member]
Intangible assets subject to amortization:
Gross carrying amount	21,551
Accumulated amortization	(11,175)
Net book value, intangible assets subject to amortization	10,376
Total intangible assets at March 31, 2019	10,376
Non-competition Agreements [Member]
Intangible assets subject to amortization:
Gross carrying amount	2,155
Accumulated amortization	(2,009)
Net book value, intangible assets subject to amortization	146
Total intangible assets at March 31, 2019	146
State Licenses [Member]
Finite Lived Intangible Assets [Line Items]
Intangible assets with indefinite lives:	2,871
Intangible assets subject to amortization:
Gross carrying amount	241
Accumulated amortization	(23)
Net book value, intangible assets subject to amortization	218
Total intangible assets at March 31, 2019	$ 3,089

Goodwill And Intangible Assets (Schedule of Future Amortization of Intangible Assets) (Details) $ in Thousands	Mar. 31, 2019 USD ($)
Finite-Lived Intangible Assets, Net, Amortization Expense, Fiscal Year Maturity [Abstract]
Remainder of 2019	$ 3,760
2020	3,400
2021	2,758
2022	1,724
2023	1,406
Thereafter	6,612
Net book value, intangible assets subject to amortization	$ 19,660

Details of Certain Balance Sheet Accounts (Schedule of Prepaid Expenses and Other Current Assets) (Details) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Details Of Certain Balance Sheet Accounts [Abstract]
Workers' compensation insurance recovery receivables	$ 1,564	$ 1,692
Prepaid workers’ compensation and liability insurance	1,152	1,840
Health insurance receivable	676	564
Other	3,754	3,002
Prepaid expense and other current assets	$ 7,146	$ 7,098

Details of Certain Balance Sheet Accounts (Schedule of Accrued Expenses) (Details) - USD ($)
$ in Thousands

3 Months Ended

Mar. 31, 2019

Dec. 31, 2018

Current portion of operating lease liabilities

$ 5,154

Accrued health insurance

^[1]

3,681

$ 3,926

Accrued professional fees

2,096

2,260

Accrued payroll taxes

1,585

769

Other

4,686

4,693

Accrued Liabilities, Current

17,202

11,648

Health insurance reimbursement and contribution due

$ 700

$ 600

Illinois [Member]

Contributions due after fund received, period

5 days

[1]

Long-Term Debt (Schedule of Long-Term Debt) (Details) - USD ($)	Mar. 31, 2019	Dec. 31, 2018
Debt Instrument [Line Items]
Financing lease obligations	$ 48,000	$ 81,000
Less unamortized issuance costs	(2,636,000)	(2,797,000)
Total	17,412,000	17,284,000
Less current maturities	(37,000)	(62,000)
Long-term debt	17,375,000	17,222,000
Revolving Credit Loan [Member] \| Senior Secured Credit Facility [Member]
Debt Instrument [Line Items]
Long-term debt gross	$ 20,000,000	$ 20,000,000

Long-Term Debt (Narrative) (Details) - Capital One, National Association [Member] - USD ($)	1 Months Ended		3 Months Ended
	Oct. 31, 2018	Oct. 30, 2018	Mar. 31, 2019	Dec. 31, 2018	May 08, 2017
Credit Agreement [Member]
Debt Instrument [Line Items]
Maximum aggregate loan amount available	$ 269,600,000
Debt instrument, maturity date			May 08, 2023
Debt instrument total net leverage ratio		4.25%
Debt issuance costs	900,000
Credit Agreement [Member] \| Revolving Credit Loan [Member]
Debt Instrument [Line Items]
Maximum aggregate loan amount available	250,000,000		$ 141,200,000	$ 142,900,000
Proceeds from line of credit			0
Line of credit outstanding amount			$ 20,000,000	$ 20,000,000
Debt instrument stated interest rate			4.49%	4.35%
Credit Agreement [Member] \| Delayed Draw Term Loan [Member]
Debt Instrument [Line Items]
Maximum aggregate loan amount available	$ 19,600,000
Credit Agreement [Member] \| Minimum [Member] \| Revolving Credit Loan [Member]
Debt Instrument [Line Items]
Fee charged on unused portion of revolving credit facility			0.20%
Credit Agreement [Member] \| Maximum [Member]
Debt Instrument [Line Items]
Debt instrument total net leverage ratio	3.75%
Credit Agreement [Member] \| Maximum [Member] \| Revolving Credit Loan [Member]
Debt Instrument [Line Items]
Fee charged on unused portion of revolving credit facility			0.35%
Credit Agreement [Member] \| Federal Funds Rate [Member]
Debt Instrument [Line Items]
Debt instrument variable interest rate margin	0.50%
Credit Agreement [Member] \| London Interbank Offered Rate (LIBOR)
Debt Instrument [Line Items]
Debt instrument variable interest rate margin	1.00%
Credit Agreement [Member] \| London Interbank Offered Rate (LIBOR) \| Minimum [Member]
Debt Instrument [Line Items]
Debt instrument variable interest rate margin	0.00%
Existing Credit Agreement [Member]
Debt Instrument [Line Items]
Maximum aggregate loan amount available					$ 250,000,000
Existing Credit Agreement [Member] \| Revolving Credit Loan [Member]
Debt Instrument [Line Items]
Maximum aggregate loan amount available					125,000,000
Existing Credit Agreement [Member] \| Delayed Draw Term Loan [Member]
Debt Instrument [Line Items]
Maximum aggregate loan amount available					80,000,000
Existing Credit Agreement [Member] \| Term Loan [Member]
Debt Instrument [Line Items]
Maximum aggregate loan amount available					45,000,000
Terminated Senior Secured Credit Facility [Member]
Debt Instrument [Line Items]
Maximum aggregate loan amount available					$ 125,000,000
Based On Applicable Senior Leverage Ratio \| Credit Agreement [Member] \| Minimum [Member]
Debt Instrument [Line Items]
Debt instrument variable interest rate margin	0.75%
Based On Applicable Senior Leverage Ratio \| Credit Agreement [Member] \| Maximum [Member]
Debt Instrument [Line Items]
Debt instrument variable interest rate margin	1.50%
Based On Applicable Leverage Ratio [Member] \| Credit Agreement [Member] \| Minimum [Member]
Debt Instrument [Line Items]
Debt instrument variable interest rate margin	1.75%
Based On Applicable Leverage Ratio [Member] \| Credit Agreement [Member] \| Maximum [Member]
Debt Instrument [Line Items]
Debt instrument variable interest rate margin	2.50%
Restriction on Dividends [Member] \| Credit Agreement [Member] \| Maximum [Member]
Debt Instrument [Line Items]
Aggregate amount of dividends and distributions			$ 7,500,000

Income Taxes (Narrative) (Details)	3 Months Ended		12 Months Ended
Income Taxes (Narrative) (Details)	Mar. 31, 2019	Mar. 31, 2018	Dec. 31, 2017
Income Tax Disclosure [Abstract]
Statutory federal tax rate	21.00%	21.00%	35.00%
Effective income tax rate	16.70%	18.70%

Income Taxes (Reconciliation of Statutory Federal Tax Rate) (Details)	3 Months Ended		12 Months Ended
	Mar. 31, 2019	Mar. 31, 2018	Dec. 31, 2017
Components Of Income Tax Expense Benefit Continuing Operations [Abstract]
Federal income tax at statutory rate	21.00%	21.00%	35.00%
State and local taxes, net of federal benefit	6.10%	6.90%
Jobs tax credits, net	(6.00%)	(10.90%)
162(m) disallowance for executive compensation	2.80%	2.20%
Nondeductible permanent items	0.40%	1.00%
Excess tax benefit	(7.60%)	(1.50%)
Effective income tax rate	16.70%	18.70%

Commitments and Contingencies (Narrative) (Details)	3 Months Ended
Commitments and Contingencies (Narrative) (Details)	Mar. 31, 2019 Facility
Senior Management [Member] \| Maximum [Member]
Commitments and Contingencies [Line Items]
Employment agreement term	4 years
Illinois [Member]
Commitments and Contingencies [Line Items]
Number of senior living facilities	3

Severance and Restructuring (Narrative) (Details) $ in Millions	3 Months Ended
	Mar. 31, 2019 USD ($) item	Mar. 31, 2018 USD ($)
Total expenses related to streamlining initiatives \| $	$ 0.4	$ 0.5
Illinois [Member]
Number of adult day centers closed \| item	3

Severance and Restructuring (Components of and Changes in Severance and Restructuring Accruals) (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2019 USD ($)
Employee Termination Costs [Member]
Restructuring Cost and Reserve [Line Items]
Balance	$ 80
Provision	65
Utilization	(110)
Balance	35
Restructuring and Other [Member]
Restructuring Cost and Reserve [Line Items]
Balance	585
Provision	288
Utilization	(311)
Balance	$ 562

Segment Information (Narrative) (Details)	3 Months Ended
Segment Information (Narrative) (Details)	Mar. 31, 2019 segment
Segment Reporting [Abstract]
Number of business segments	3

Segment Information (Summary Of Segment Information) (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Segment Reporting Information [Line Items]
Net service revenues	$ 139,254	$ 109,476
Cost of services revenues	101,680	81,543
Gross profit	37,574	27,933
General and administrative expenses	29,257	21,537
Operating income	6,243	4,589
Operating Segments [Member]
Segment Reporting Information [Line Items]
General and administrative expenses	14,815	9,637
Operating income	22,759	18,296
Personal Care [Member]
Segment Reporting Information [Line Items]
Net service revenues	128,641	109,476
Cost of services revenues	95,995	81,543
Gross profit	32,646	27,933
Personal Care [Member] \| Operating Segments [Member]
Segment Reporting Information [Line Items]
General and administrative expenses	12,539	9,637
Operating income	20,107	$ 18,296
Hospice [Member]
Segment Reporting Information [Line Items]
Net service revenues	7,917
Cost of services revenues	3,770
Gross profit	4,147
Hospice [Member] \| Operating Segments [Member]
Segment Reporting Information [Line Items]
General and administrative expenses	1,590
Operating income	2,557
Home Health [Member]
Segment Reporting Information [Line Items]
Net service revenues	2,696
Cost of services revenues	1,915
Gross profit	781
Home Health [Member] \| Operating Segments [Member]
Segment Reporting Information [Line Items]
General and administrative expenses	686
Operating income	$ 95

Segment Information (Segment Reconciliation to Totals reported in the accompanying Consolidated Financial Statements) (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Segment Reporting Information [Line Items]
Operating income	$ 6,243	$ 4,589
Other general and administrative expenses	14,442	11,900
Depreciation and amortization	2,074	1,807
Interest income	(215)	(2,322)
Interest expense	618	910
Income before income taxes	5,840	6,001
Operating Segments [Member]
Segment Reporting Information [Line Items]
Operating income	$ 22,759	$ 18,296

Significant Payors (Revenue by Payor Type) (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Net service revenues	$ 139,254	$ 109,476
Personal Care [Member]
Net service revenues	128,641	109,476
Personal Care [Member] \| Revenues [Member] \| Customer Concentration Risk [Member]
Net service revenues	$ 128,641	$ 109,476
Concentration risk, percentage	100.00%	100.00%
Personal Care [Member] \| Revenues [Member] \| Customer Concentration Risk [Member] \| State, Local And Other Governmental Programs [Member]
Net service revenues	$ 72,059	$ 67,328
Concentration risk, percentage	56.00%	61.50%
Personal Care [Member] \| Revenues [Member] \| Customer Concentration Risk [Member] \| Managed Care Organizations [Member]
Net service revenues	$ 48,005	$ 37,830
Concentration risk, percentage	37.30%	34.60%
Personal Care [Member] \| Revenues [Member] \| Customer Concentration Risk [Member] \| Private Pay [Member]
Net service revenues	$ 5,019	$ 3,755
Concentration risk, percentage	3.90%	3.40%
Personal Care [Member] \| Revenues [Member] \| Customer Concentration Risk [Member] \| Commercial Insurance [Member]
Net service revenues	$ 1,867	$ 563
Concentration risk, percentage	1.50%	0.50%
Personal Care [Member] \| Revenues [Member] \| Customer Concentration Risk [Member] \| Other [Member]
Net service revenues	$ 1,691
Concentration risk, percentage	1.30%
Hospice [Member]
Net service revenues	$ 7,917
Hospice [Member] \| Revenues [Member] \| Customer Concentration Risk [Member]
Net service revenues	$ 7,917
Concentration risk, percentage	100.00%
Hospice [Member] \| Revenues [Member] \| Customer Concentration Risk [Member] \| Managed Care Organizations [Member]
Net service revenues	$ 361
Concentration risk, percentage	4.60%
Hospice [Member] \| Revenues [Member] \| Customer Concentration Risk [Member] \| Other [Member]
Net service revenues	$ 166
Concentration risk, percentage	2.10%
Hospice [Member] \| Revenues [Member] \| Customer Concentration Risk [Member] \| Medicare [Member]
Net service revenues	$ 7,390
Concentration risk, percentage	93.30%
Home Health [Member]
Net service revenues	$ 2,696
Home Health [Member] \| Revenues [Member] \| Customer Concentration Risk [Member]
Net service revenues	$ 2,696
Concentration risk, percentage	100.00%
Home Health [Member] \| Revenues [Member] \| Customer Concentration Risk [Member] \| Managed Care Organizations [Member]
Net service revenues	$ 414
Concentration risk, percentage	15.40%
Home Health [Member] \| Revenues [Member] \| Customer Concentration Risk [Member] \| Other [Member]
Net service revenues	$ 83
Concentration risk, percentage	3.00%
Home Health [Member] \| Revenues [Member] \| Customer Concentration Risk [Member] \| Medicare [Member]
Net service revenues	$ 2,199
Concentration risk, percentage	81.60%

Significant Payors (Revenue by Geographic Location) (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Net service revenues	$ 139,254	$ 109,476
Personal Care [Member]
Net service revenues	128,641	109,476
Personal Care [Member] \| Revenues [Member] \| Geographic Concentration Risk [Member]
Net service revenues	$ 128,641	$ 109,476
Concentration risk, percentage	100.00%	100.00%
Personal Care [Member] \| Revenues [Member] \| Geographic Concentration Risk [Member] \| Illinois [Member]
Net service revenues	$ 57,596	$ 57,386
Concentration risk, percentage	44.80%	52.40%
Personal Care [Member] \| Revenues [Member] \| Geographic Concentration Risk [Member] \| New York [Member]
Net service revenues	$ 17,813	$ 15,363
Concentration risk, percentage	13.80%	14.00%
Personal Care [Member] \| Revenues [Member] \| Geographic Concentration Risk [Member] \| New Mexico [Member]
Net service revenues	$ 17,208	$ 11,770
Concentration risk, percentage	13.40%	10.80%
Personal Care [Member] \| Revenues [Member] \| Geographic Concentration Risk [Member] \| All Other States [Member]
Net service revenues	$ 36,024	$ 24,957
Concentration risk, percentage	28.00%	22.80%
Hospice [Member]
Net service revenues	$ 7,917
Hospice [Member] \| Revenues [Member] \| Geographic Concentration Risk [Member]
Net service revenues	$ 7,917
Concentration risk, percentage	100.00%
Hospice [Member] \| Revenues [Member] \| Geographic Concentration Risk [Member] \| New Mexico [Member]
Net service revenues	$ 7,917
Concentration risk, percentage	100.00%
Home Health [Member]
Net service revenues	$ 2,696
Home Health [Member] \| Revenues [Member] \| Geographic Concentration Risk [Member]
Net service revenues	$ 2,696
Concentration risk, percentage	100.00%
Home Health [Member] \| Revenues [Member] \| Geographic Concentration Risk [Member] \| New Mexico [Member]
Net service revenues	$ 2,696
Concentration risk, percentage	100.00%

Significant Payors (Narrative) (Details) - Illinois Department On Aging [Member]	3 Months Ended		12 Months Ended
	Mar. 31, 2019	Mar. 31, 2018	Dec. 31, 2018
Revenues [Member]
Concentration Risk [Line Items]
Concentration risk, percentage	28.90%	36.60%
Accounts Receivable [Member]
Concentration Risk [Line Items]
Concentration risk, percentage	24.50%		22.50%