0001564590-21-009604 | 10-K | XBRL Viewer

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Document And Entity Information - USD ($)	12 Months Ended
Document And Entity Information - USD ($)	Dec. 31, 2020	Feb. 19, 2021	Jun. 30, 2020
Cover [Abstract]
Document Type	10-K
Amendment Flag	false
Document Period End Date	Dec. 31, 2020
Document Fiscal Period Focus	FY
Document Fiscal Year Focus	2020
Entity Registrant Name	ADDUS HOMECARE CORPORATION
Entity Central Index Key	0001468328
Trading Symbol	ADUS
Current Fiscal Year End Date	--12-31
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		15,826,284
Entity Public Float			$ 1,335,406,000
Entity Well-known Seasoned Issuer	No
Entity Current Reporting Status	No
Entity Voluntary Filers	No
Entity Interactive Data Current	No
Title of 12(b) Security	Common Stock, $0.001 par value
Security Exchange Name	NASDAQ
Entity File Number	001-34504
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	20-5340172
Entity Address, Address Line One	6303 Cowboys Way
Entity Address, Address Line Two	Suite 600
Entity Address, City or Town	Frisco
Entity Address, State or Province	TX
Entity Address, Postal Zip Code	75034
City Area Code	469
Local Phone Number	535-8200
Document Annual Report	true
Document Transition Report	false
ICFR Auditor Attestation Flag	true
Documents Incorporated by Reference	Certain portions of the registrant’s Definitive Proxy Statement for its 2021 Annual Meeting of Stockholders (which is expected to be filed with the Commission within 120 days after the end of the registrant’s 2020 fiscal year) are incorporated by reference into Part III of this Annual Report on Form 10-K.

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Current assets
Cash	$ 145,078	$ 111,714
Accounts receivable, net of allowances	132,650	149,680
Prepaid expenses and other current assets	9,969	7,993
Total current assets	287,697	269,387
Property and equipment, net of accumulated depreciation and amortization	19,749	12,156
Other assets
Goodwill	469,072	275,368
Intangibles, net of accumulated amortization	71,549	57,079
Deferred tax assets, net	6,524	1,647
Operating lease assets, net	37,991	21,111
Total other assets	585,136	355,205
Total assets	892,582	636,748
Current liabilities
Accounts payable	23,705	19,641
Accrued payroll	35,815	30,587
Accrued expenses	37,564	22,429
Government stimulus advances	32,087
Accrued workers’ compensation insurance	13,759	14,143
Current portion of long-term debt	971	728
Total current liabilities	143,901	87,528
Long-term liabilities
Long-term debt, less current portion, net of debt issuance costs	193,901	59,164
Long-term operating lease liabilities	35,516	14,301
Other long-term liabilities	588	163
Total long-term liabilities	230,005	73,628
Total liabilities	373,906	161,156
Stockholders’ equity
Common stock—$.001 par value; 40,000 authorized and 15,826 and 15,617 shares issued and outstanding as of December 31, 2020 and 2019, respectively	16	15
Additional paid-in capital	369,495	359,545
Retained earnings	149,165	116,032
Total stockholders’ equity	518,676	475,592
Total liabilities and stockholders’ equity	$ 892,582	$ 636,748

Consolidated Balance Sheets (Parenthetical) - $ / shares	Dec. 31, 2020	Dec. 31, 2019
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	15,826,000	15,826,000
Common stock, shares outstanding	15,617,000	15,617,000

Consolidated Statements of Income - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Income Statement [Abstract]
Net service revenues	$ 764,775	$ 648,791	$ 516,647
Cost of service revenues	538,538	469,553	379,843
Gross profit	226,237	179,238	136,804
General and administrative expenses	169,679	133,912	105,335
Depreciation and amortization	12,051	10,574	8,642
Total operating expenses	181,730	144,486	113,977
Operating income from continuing operations	44,507	34,752	22,827
Interest income	(624)	(1,523)	(2,592)
Interest expense	3,189	3,105	5,016
Total interest expense, net	2,565	1,582	2,424
Income from continuing operations before income taxes	41,942	33,170	20,403
Income tax expense	8,809	7,359	4,096
Net income from continuing operations	33,133	25,811	16,307
(Loss) earnings from discontinued operations		(574)	126
Net income	$ 33,133	$ 25,237	$ 16,433
Basic income per share
Continuing operations	$ 2.12	$ 1.87	$ 1.35
Discontinued operations		(0.04)	0.01
Basic income per share	2.12	1.83	1.36
Diluted income per share
Continuing operations	2.08	1.81	1.32
Discontinued operations		(0.04)	0.01
Diluted income per share	$ 2.08	$ 1.77	$ 1.33
Weighted average number of common shares and potential common shares outstanding:
Basic	15,596	13,816	12,049
Diluted	15,956	14,248	12,383

Consolidated Statements of Stockholders' Equity - USD ($) shares in Thousands, $ in Thousands	Total	Common Stock [Member]	Additional Paid-in Capital [Member]	Retained Earnings [Member]
Balance at Dec. 31, 2017	$ 170,337	$ 12	$ 95,963	$ 74,362
Balance, shares at Dec. 31, 2017		11,632
Issuance of shares of common stock under restricted stock award agreements, shares		78
Forfeiture of shares of common stock under restricted stock award agreements, shares		(16)
Stock-based compensation	4,109		4,109
Shares issued for exercise of stock options	994		994
Shares issued for exercise of stock options, shares		42
Shares issued in secondary and public offering, net of offering costs	76,618	$ 1	76,617
Shares issued in secondary and public offering, net of offering costs, shares		1,390
Net income	16,433			16,433
Balance at Dec. 31, 2018	268,491	$ 13	177,683	90,795
Balance, shares at Dec. 31, 2018		13,126
Issuance of shares of common stock under restricted stock award agreements, shares		70
Forfeiture of shares of common stock under restricted stock award agreements, shares		(4)
Stock-based compensation	5,766		5,766
Shares issued for exercise of stock options	3,153		3,153
Shares issued for exercise of stock options, shares		125
Shares issued in secondary and public offering, net of offering costs	172,945	$ 2	172,943
Shares issued in secondary and public offering, net of offering costs, shares		2,300
Net income	25,237			25,237
Balance at Dec. 31, 2019	475,592	$ 15	359,545	116,032
Balance, shares at Dec. 31, 2019		15,617
Issuance of shares of common stock under restricted stock award agreements, shares		88
Forfeiture of shares of common stock under restricted stock award agreements, shares		(6)
Stock-based compensation	6,005		6,005
Shares issued for exercise of stock options	3,946	$ 1	3,945
Shares issued for exercise of stock options, shares		127
Net income	33,133			33,133
Balance at Dec. 31, 2020	$ 518,676	$ 16	$ 369,495	$ 149,165
Balance, shares at Dec. 31, 2020		15,826

Consolidated Statements of Cash Flows - USD ($)
$ in Thousands

12 Months Ended

Dec. 31, 2020

Dec. 31, 2019

Dec. 31, 2018

Cash flows from operating activities:

Net income

$ 33,133

$ 25,237

$ 16,433

Adjustments to reconcile net income to net cash provided by operating activities, net of acquisitions:

Depreciation and amortization

12,051

10,574

8,642

Deferred income taxes

(4,652)

(1,063)

(375)

Stock-based compensation

6,005

5,766

4,109

Amortization of debt issuance costs under the credit facility

737

716

606

Provision for doubtful accounts

918

343

272

^[1]

Contingent consideration

(847)

Loss (gain) on sale and/or impairment of assets

1,256

Changes in operating assets and liabilities, net of acquisitions:

Accounts receivable

23,860

(37,478)

(697)

Prepaid expenses and other current assets

(1,973)

(792)

1,652

Government stimulus advances

19,393

Accounts payable

2,159

4,638

4,235

Accrued expenses and other liabilities

16,524

4,078

(865)

Net cash provided by operating activities

109,411

12,019

33,203

Cash flows from investing activities:

Acquisitions of businesses, net of cash acquired

(207,660)

(184,076)

(62,440)

Proceeds on disposal of businesses

255

Purchases of property and equipment

(6,831)

(4,621)

(5,349)

Net cash used in investing activities

(214,236)

(188,697)

(67,789)

Cash flows from financing activities:

Proceeds from issuance of common stock, net of issuance costs

172,945

76,618

Borrowings on revolver — credit facility

135,000

23,458

20,000

Borrowings on term loan — credit facility

19,600

60,420

Payments on term loan — credit facility

(735)

(104,858)

Payments on financing lease obligations

(22)

(63)

(1,013)

Payments for debt issuance costs under the credit facility

(372)

(923)

Cash received from exercise of stock options

3,946

3,153

994

Net cash provided by financing activities

138,189

217,986

51,238

Net change in cash

33,364

41,308

16,652

Cash, at beginning of period

111,714

70,406

53,754

Cash, at end of period

145,078

111,714

70,406

Supplemental disclosures of cash flow information:

Cash paid for interest

2,365

2,320

4,339

Cash paid for income taxes

10,590

7,303

4,097

Supplemental disclosures of non-cash investing and financing activities

Leasehold improvements acquired through tenant allowances

5,161

682

$ 225

$ 117

[1]

With the adoption of ASU 2014-09, Revenue from Contracts with Customers, in 2018 and subsequent periods, subsequent adjustments that are determined to be the result of an adverse change in the payor’s ability to pay are recognized as provision for doubtful accounts. We recorded $18.0 million for the year ended December 31, 2018 as a reduction to revenue that would have been recorded as provision for doubtful accounts under the prior revenue recognition guidance.

Significant Accounting Policies

12 Months Ended

Dec. 31, 2020

Accounting Policies [Abstract]

Significant Accounting Policies

1. Significant Accounting Policies

Basis of Presentation and Description of Business

The Consolidated Financial Statements include the accounts of Addus HomeCare Corporation (“Holdings”) and its subsidiaries (together with Holdings, the “Company,” “we,” “us,” or “our”). The Company operates as a multi-state provider of three distinct but related business segments providing in-home services. In its personal care services segment, the Company provides non-medical assistance with activities of daily living, primarily to persons who are at increased risk of hospitalization or institutionalization, such as the elderly, chronically ill or disabled. In its hospice segment, the Company provides physical, emotional and spiritual care for people who are terminally ill as well as related services for their families. In its home health segment, the Company provides services that are primarily medical in nature to individuals who may require assistance during an illness or after hospitalization and include skilled nursing and physical, occupational and speech therapy. The Company’s payor clients include federal, state and local governmental agencies, managed care organizations, commercial insurers and private individuals.

Principles of Consolidation

All intercompany balances and transactions have been eliminated in consolidation.

Discontinued Operations

In 2013, the Company sold substantially all of the assets used in its then home health business (the “2013 Home Health Business”) in Arkansas, Nevada and South Carolina, and 90% of the 2013 Home Health Business in California and Illinois. Effective October 1, 2017, the Company sold its remaining 10% ownership interest in the 2013 Home Health Business in California and Illinois. The results of the 2013 Home Health Business are reflected as discontinued operations for all periods presented herein. For the year ended December 31, 2019, in connection with a 2013 Home Health Business litigation settlement, the Company recognized an expense of $0.6 million. The lawsuit was dismissed in full on October 15, 2019. For the years ended December 31, 2018, discontinued operations consisted of the reduction of the indemnification reserve, net of tax, for the Company’s 2013 Home Health Business.

Revenue Recognition

Net service revenue is recognized at the amount that reflects the consideration the Company expects to receive in exchange for providing services directly to consumers. Receipts are from federal, state and local governmental agencies, managed care organizations, commercial insurers and private consumers for services rendered. The Company assesses the consumers' ability to pay at the time of their admission based on the Company's verification of the customer's insurance coverage under the Medicare, Medicaid, and other commercial or managed care insurance programs. Laws and regulations governing the governmental programs in which the Company participates are complex and subject to interpretation. Net service revenues related to uninsured accounts, or self-pay, is recorded net of implicit price concessions estimated based on historical collection experience to reduce revenue to the estimated amount the Company expects to collect. Amounts collected from all sources may be less than amounts billed due to implicit price concessions, resulting from client eligibility issues, insufficient or incomplete documentation, services at levels other than authorized, pricing differences and other reasons unrelated to credit risk. The Company monitors our net service revenues and collections from these sources and records any necessary adjustment to net service revenues 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 initial estimate of net service revenues is determined by reducing the standard charge by any contractual adjustments, discounts, and implicit price concessions. Subsequent changes to the estimate of net service revenues are generally recorded in the period of the change. Changes in estimates of implicit price concessions, discounts, and contractual adjustments for performance obligations satisfied in prior years resulted in additional net service revenue of $3.0 million and $1.3 million, for the years ended December 31, 2019 and 2018, respectively. Subsequent changes that are determined to be the result of an adverse change in the patient's ability to pay are recorded as bad debt expense.

Personal Care

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 consumers who are terminally ill as well as related services for 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 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 year ended December 31, 2020 and 2019, the Company recorded a liability of $1.8 million and $0.4 million related to the Medicare aggregate cap limit.

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 were paid under the Medicare Home Health Prospective Payment System (“HHPPS”), for the year ended December 31, 2020, which is based on 30-day periods of care as a unit of service. The HHPPS permits multiple, continuous periods per patient. Medicare payment rates for periods 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 30-day periods that Medicare recognizes as standard but accelerates revenue upon discharge to align with a patient’s episode length if less than the expected 30 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 a period 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 consideration 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.

Accounts Receivable and Allowances

Accounts receivable is reduced to the amount expected to be collected in future periods for services rendered to customers prior to the balance sheet date. Management estimates the value of accounts receivable, net of allowances for implicit price concessions, based upon historical experience and other factors, including an aging of accounts receivable, evaluation of expected adjustments, past adjustments and collection experience in relation to amounts billed, current contract and reimbursement terms, shifts in payors and other relevant information. Collection of net service revenues the Company expects to receive is normally a function of providing complete and correct billing information to the payors within the various filing deadlines. The evaluation of these historical and other factors involves complex, subjective judgments impacting the determination of the implicit price concession assumption. In addition, the Company compares its cash collections to recorded net service revenues and evaluates its historical allowance, including implicit price concessions, based upon the ultimate resolution of the accounts receivable balance.

Prior to 2018, the Company established an allowance for doubtful accounts to the extent it was probable that a portion or all of a particular account will not be collected. The Company established its provision for doubtful accounts primarily by reviewing the creditworthiness of significant customers and through evaluations over the collectability of the receivables. An allowance for doubtful accounts was maintained at a level that the Company’s management believed was sufficient to cover potential losses.

With the modified retrospective adoption of ASU 2014-09, Revenue from Contracts with Customers, in 2018, subsequent adjustments that are determined to be the result of an adverse change in the payor’s ability to pay are recognized as provision for doubtful accounts. The majority of what historically was classified as provision for doubtful accounts under operating expenses is now treated as an implicit price concession factored into the determination of net service revenues discussed above. Our collection procedures include review of account aging and direct contact with our payors. We have historically not used collection agencies. An

uncollectible amount is written off to the allowance account after reasonable collection efforts have been exhausted. As of December 31, 2020 and 2019, the allowance for doubtful accounts balance was $1.0 million and $1.0 million, respectively, which is included in accounts receivable, net of allowances on the Company’s Consolidated Balance Sheets.

Activity in the allowance for doubtful accounts is as follows (in thousands):

Allowance for doubtful accounts	Balance at beginning of period		Additions/ charges		Deductions ⁽¹⁾		Balance at end of period
Year ended December 31, 2020
Allowance for doubtful accounts	$	962		918		907	$	973
Year ended December 31, 2019
Allowance for doubtful accounts	$	945		343		326	$	962
Year ended December 31, 2018 ⁽²⁾
Allowance for doubtful accounts	$	18,749		272		18,076	$	945

⁽¹⁾Write-offs, net of recoveries

⁽²⁾

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

Leases

In February 2016, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2016-02, Leases (ASC 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 sheet. We elected to adopt the standard effective January 1, 2019 using the modified retrospective transition method.

We have historically entered into operating leases for local branches, our corporate headquarters and certain equipment. The Company’s current leases have expiration dates through 2031. Certain of our arrangements have free rent periods and/or escalating rent payment provisions. We recognize rent expense on a straight-line basis over the lease term. Certain of the Company’s leases include termination options and renewal options for periods ranging from one to five years. Renewal options generally are not considered in determining the lease term, and payments associated with the option years are excluded from lease payments unless we are reasonably certain to exercise the renewal option.

The operating lease liabilities are calculated using the present value of lease payments. If 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.

Operating lease assets are valued based on the initial operating lease liabilities plus any prepaid rent, reduced by tenant improvement allowances. Operating lease assets are tested for impairment in the same manner as our long-lived assets. For the year ended December 31, 2020, we impaired approximately $1.0 million in operating lease assets, as a result of expanding the Frisco corporate headquarters, included within general and administrative expenses. See Note 2 for additional information related to leases.

Goodwill and Intangible Assets

Under business combination accounting, assets and liabilities are generally recognized at their fair values and the difference between the consideration transferred, excluding transaction costs, and the fair values of the assets and liabilities is recognized as goodwill. The Company’s significant identifiable intangible assets consist of customer and referral relationships, trade names and trademarks and state licenses. The Company uses various valuation techniques to determine initial fair value of its intangible assets, including relief-from-royalty, income approach, discounted cash flow analysis, and multi-period excess earnings, which use significant unobservable inputs, or Level 3 inputs, as defined by the fair value hierarchy. 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 estimates the fair values of the trade names using the relief-from-royalty method, which requires assumptions such as the long-term growth rates of future revenues, the relief from royalty rate for such revenue, the tax rate and the discount rate. The Company estimates the fair value of existing indefinite-lived state licenses based on a blended approach of the replacement cost method and cost savings method, which involves estimating the total process costs and opportunity costs to obtain a license, by estimating future earnings before interest and taxes and applying an estimated discount rate, tax rate and time to obtain the license. The Company estimates the fair value of existing finite-lived state licenses based on a method of analyzing the definite revenue streams with the license and without the license, which involves estimating revenues and expenses, estimated time to build up to a current revenue base, which is market specific, and the non-licensed revenue allocation, revenue growth rates, discount rate and tax amortization benefits. The Company estimates the fair value of customer and referral relationships based on a multi-period excess earnings method, which involves identifying revenue streams associated with the assets, estimating the attrition rates based upon historical financial data, expenses and cash flows associated with the assets, contributory asset charges, rates of return for specific assets, growth rates, discount rate and tax amortization benefits. The Company estimates the fair value of non-competition agreements based on a method of analyzing the factors to compete and factors not to compete, which involves estimating historical financial data, forecasted financial statements, growth rates, tax amortization benefit, discount rate, review of factors to compete and factors not to compete as well as an assessment of the probability of successful competition for each non-competition agreement.

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.

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 Accounting Standards Codification (“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 to determine whether impairment has occurred. 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. The goodwill impairment test involves comparing the fair value of a reporting unit with its carrying value, including goodwill. If the fair value of a reporting unit exceeds its carrying value, then goodwill is not impaired. If the fair value of a reporting unit is less than its carrying value, then goodwill is impaired to the extent of the difference. For the years ended December 31, 2020, 2019 and 2018, the Company performed the quantitative analysis to evaluate whether an impairment occurred. Based on the totality of the information available, the Company concluded that it was more likely than not that the estimated fair values were greater than the carrying values of the reporting units. For the fiscal year 2020 impairment test, the fair value of the reporting units exceeded their respective carrying values by at least 90% (commonly referred to as “headroom”). The Company concluded that there were no impairments for the years ended December 31, 2020, 2019 or 2018. As of December 31, 2020 and 2019, goodwill was $469.1 million and $275.4 million, respectively, included in the Company’s Consolidated Balance Sheets.

The Company’s identifiable intangible assets consist of customer and referral relationships, trade names, trademarks, state licenses and non-competition agreements. Definite-lived intangible assets are amortized using straight-line and accelerated methods based upon the estimated useful lives of the respective assets, which range from one to twenty-five years, and assessed for impairment whenever events or changes in circumstances indicate that the carrying amount may not be recoverable. Customer and referral relationships are amortized systematically over the periods of expected economic benefit, which range from five to ten years. 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 years ended December 31, 2020, 2019 or 2018. As of December 31, 2020 and 2019, intangibles, net of accumulated amortization, was $71.5 million and $57.1 million, respectively, included in the Company’s Consolidated Balance Sheets. Amortization of intangible assets is reported in the statement of income caption, “Depreciation and amortization” and not included in the income statement caption cost of service revenues.

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. In accordance with ASU 2015-03, Simplifying the Presentation of Debt Issuance Costs, the Company has classified the debt issuance costs as a direct deduction from the carrying amount of the related liability.

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. The future claims payments related to the workers’ compensation program are secured by letters of credit. These letters of credit totaled $9.0 million and $10.0 million at December 31, 2020 and 2019, respectively. The Company monitors its claims quarterly and adjusts its reserves accordingly. These costs are recorded primarily as the cost of services on the Consolidated Statements of Income. As of December 31, 2020 and 2019, the Company recorded $13.8 million and $14.1 million, respectively, in accrued workers’ compensation insurance on the Company’s Consolidated Balance Sheets. As of December 31, 2020 and 2019, the Company recorded $1.9 million and $2.0 million, respectively, in workers’ compensation insurance receivables. The workers’ compensation insurance receivable is included in prepaid expenses and other current assets on the Company’s 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 and reported in the statement of income caption, “Interest income.” For the years ended December 31, 2019 and 2018, the Company received $0.7 million and $2.3 million, respectively, in prompt payment interest. For the year ended December 31, 2020, prompt payment interest received was immaterial. While the Company may be owed additional prompt payment interest in the future, the amount, timing and intent to provide receipt of such payments remains uncertain, and the Company will continue to recognize prompt payment interest income upon satisfaction of these constraints.

Interest Expense

Interest expense is reported in the Consolidated Statements of Income when incurred and consists of (i) interest and unused credit line fees on the credit facility, evidenced by the Credit Agreement (as defined in Note 8), (ii) interest on our financing lease obligations and (iii) amortization and write-off of debt issuance costs.

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 assets and liabilities 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 assets 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. The Company recognizes interest and penalties accrued related to uncertain tax positions in interest expense and penalties within operating expenses on the Consolidated Statements of Income. Uncertain tax positions are immaterial for all periods presented.

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 are made. The Company accounts for stock-based compensation in accordance with ASC Topic 718, Stock Compensation. Compensation expense is recognized on a straight-line basis under the 2017 Plan over the vesting period of the equity awards based on the grant date fair value of the options and restricted stock awards. The Company utilizes the Black-Scholes Option Pricing Model to value the Company’s options. Forfeitures are recognized when they occur. Stock-based compensation expense was $6.0 million, $5.8 million and $4.1 million for the years ended December 31, 2020, 2019 and 2018, respectively, within general and administrative expenses on the Consolidated Statements of Income.

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 year ended December 31, 2020 were approximately 506,000 stock options outstanding, of which approximately 304,000 were dilutive. In addition, there were approximately 154,000 restricted stock awards outstanding, of which approximately 57,000 were dilutive for the year ended December 31, 2020.

Included in the Company’s calculation of diluted earnings per share for the year ended December 31, 2019 were approximately 648,000 stock options outstanding, of which approximately 346,000 were dilutive. In addition, there were approximately 149,000 restricted stock awards outstanding, of which approximately 86,000 were dilutive for the year ended December 31, 2019.

Included in the Company’s calculation of diluted earnings per share for the year ended December 31, 2018 were approximately 683,000 stock options outstanding, of which approximately 247,000 were dilutive. In addition, there were approximately 149,000 restricted stock awards outstanding, of which approximately 88,000 were dilutive for the year ended December 31, 2018.

Estimates

The financial statements are prepared by management in conformity with U.S. Generally Accepted Accounting Principles (“GAAP”) and include estimated amounts and certain disclosures based on assumptions about future events. The Company’s critical accounting estimates include the following areas: revenue recognition, allowance for doubtful accounts, goodwill and intangibles and 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 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.

The Company applies fair value techniques on a non-recurring basis associated with valuing potential impairment losses related to goodwill, if required, and indefinite-lived intangible assets and also when determining the fair value of contingent consideration, if applicable. To determine the fair value in these situations, the Company uses Level 3 inputs, under ASC Topic 820 and defined as unobservable inputs in which little or no market data exists; therefore requiring an entity to develop its own assumptions, such as discounted cash flows, or if available, what a market participant would pay on the measurement date.

The Company uses various valuation techniques to determine fair value of its intangible assets, including relief-from-royalty, income approach, discounted cash flow analysis, and multi-period excess earnings, which use significant unobservable inputs, or Level 3 inputs, as defined by the fair value hierarchy. 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.

Going Concern

In connection with the preparation of the financial statements for the years ended December 31, 2020 and 2019, 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 cash flows are sufficient for the next year and there did not appear to be evidence of substantial doubt of the entity’s ability to continue as a going concern.

Recently Adopted 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. We have reviewed our provision for doubtful accounts process as required by ASU 2016-13. Management estimates allowances on accounts receivable based upon historical experience and other factors, including an aging of accounts receivable, evaluation of expected adjustments, past adjustments and collection experience in relation to amounts billed, current contract and reimbursement terms, shifts in payors and other current relevant information. Adoption of the new standard did not have a significant impact on our results of operations or liquidity.

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). Adoption of the new standard did not have a significant impact on 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 ASC 350-40 to determine which implementation costs to capitalize as assets or expense as incurred. Adoption of the new standard did not have a significant impact on our results of operations or liquidity.

Recently Issued Accounting Pronouncements

In December 2019, the FASB issued ASU 2019-12, Income Taxes (Topic 740): Simplifying the Accounting for Income Taxes. ASU 2019-12 intends to simplify various aspects related to accounting for income taxes and removes certain exceptions to the general guidance in ASC 740. In addition, the ASU clarifies and amends existing guidance to improve consistent application of its requirements. The ASU is effective for fiscal years, including interim periods within those fiscal years, beginning after December 15, 2020. Early adoption is permitted. Adoption of the new standard is not expected to have an impact on our results of operations or liquidity.

In March 2020, the FASB issued ASU 2020-04, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting. ASU 2020-04 provides optional expedients and exceptions for applying GAAP to contract modifications and hedging relationships, and other transactions subject to meeting certain criteria, that reference LIBOR or another reference rate expected to be discontinued. The ASU provides companies with optional guidance to ease the potential accounting burden associated with transitioning away from reference rates that are expected to be discontinued. Therefore, it will be in effect for a limited time through December 31, 2022. The ASU can be adopted no later than December 1, 2022 with early adoption permitted. The Company is evaluating the effect of adopting this new accounting guidance.

Leases

12 Months Ended

Dec. 31, 2020

Leases [Abstract]

Leases

2. Leases

Amounts reported in the Consolidated Balance Sheets as of December 31, 2020 and 2019 for our operating leases were as follows:

	December 31,
	2020		2019
	(Amounts in Thousands)
Operating lease assets, net	$	37,991	$	21,111

Short-term operating lease liabilities (in accrued expenses)		9,283		7,234
Long-term operating lease liabilities		35,516		14,301
Total operating lease liabilities	$	44,799	$	21,535

The Company signed an eleven-year lease agreement to expand its Frisco corporate headquarters by approximately 75,000 square feet which resulted in an increase in the operating lease asset, net, and operating lease liability by approximately $17.0 million and $22.6 million, respectively, as of December 31, 2020. Approximately 21,000 square feet and 12,000 square feet of our office space in Downers Grove and Frisco, respectively, are sublet to a third party.

Lease Costs

Components of lease cost were reported in general and administrative expenses in the Consolidated Statements of Income as follows:

	For the Years Ended December 31,
	(Amounts in Thousands)
	2020			2019
Operating lease costs	$	9,197		$	7,219
Short-term lease costs		761			585
Less: sublease income		(323	)		(312	)
Total lease cost, net	$	9,635		$	7,492

Lease Term and Discount Rate

Weighted average remaining lease terms and discount rates for the years ended December 31, 2020 and 2019 were as follows:

	2020			2019
Operating leases:
Weighted average remaining lease term		6.97			3.42
Weighted average discount rate		4.18	%		5.14	%

Maturity of Lease Liabilities

A summary of our remaining operating lease payments as of December 31, 2020 were as follows:

	Operating Leases
	(Amounts in Thousands)
Due in 12-month period ended December 31,
2021	$	10,681
2022		9,007
2023		6,977
2024		5,231
2025		3,521
Thereafter		16,514
Total future minimum rental commitments		51,931
Less: Imputed interest		(7,132	)
Total lease liabilities	$	44,799

Supplemental cash flows information

	For the Years Ended December 31,
	(Amounts in Thousands)
		2020		2019
Supplemental Cash Flows Information
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	8,769	$	7,574

Right-of-use assets obtained in exchange for lease obligations:
Operating leases	$	25,807	$	10,299

Comparative Disclosure Prior to the Adoption of the New Lease Accounting Standard (ASU 2016-02)

Aggregate rental expense for all operating leases amounted to $6.0 million for the year ended December 31, 2018. During the year ended December 31, 2018, we recognized sublease income of $0.3 million related to our leased space in Downers Grove.

Financing Leases

Some of our financing leases include provisions to purchase the asset at the conclusion of the lease. The adoption of ASC 842 did not impact the accounting for these leases. Financing leases were not material as of December 31, 2020 and 2019.

Public Offering

12 Months Ended

Dec. 31, 2020

Equity [Abstract]

Public Offering

3. Public Offering

On September 9, 2019, the Company completed a public offering of an aggregate 2,300,000 shares of common stock, par value $0.001 per share, including 300,000 shares of common stock sold pursuant to the exercise in full by the underwriters of their option to purchase additional shares at a public offering price of $79.50 per share (the “Public Offering”). The Company received net proceeds of approximately $172.9 million, after deducting underwriting discounts and estimated offering expenses of approximately $9.9 million. The Company used approximately $130.0 million from the net proceeds of the Public Offering to fund the purchase price for the Company’s acquisition of Hospice Partners of America, LLC (“Hospice Partners”), on October 1, 2019 and used the remaining net proceeds of the Public Offering for general corporate purposes, and to fund, in part, 2020 acquisitions. The Public Offering resulted in an increase to additional paid in capital of approximately $172.9 million on the Company’s Consolidated Balance Sheets at December 31, 2019.

On August 20, 2018, the Company together with Eos Capital Partners III, L.P. (the “Selling Stockholder”) completed a secondary public offering of an aggregate 2,100,000 shares of common stock, par value $0.001 per share at a purchase price per share to the public of $59.00 (the “2018 Public Offering Price”). Pursuant to the terms and conditions of the Underwriting Agreement, 1,075,267 shares of Common Stock were issued and sold by the Company (the “Primary Shares”) and 1,024,733 shares of Common Stock were sold by the Selling Stockholder (the “Secondary Shares”). The Company received net proceeds of approximately $59.1 million from the sale of 1,075,267 Primary Shares. On August 22, 2018, the underwriters exercised their full over-allotment option in connection with the offering and, as a result, the Company issued and sold an additional 315,000 shares of common stock to the underwriters at the 2018 Public Offering Price, less the underwriting discount. The over-allotment resulted in additional net proceeds to the Company of approximately $17.5 million. The Company used the net proceeds from the offering for general corporate purposes, and to pay down the $102.6 million of our delayed term loan in connection with the amendment and restatement of our credit facility. The Company did not receive any of the proceeds from the sale of the Secondary Shares. The secondary offering resulted in an increase to additional paid in capital of approximately $76.6 million, net of issuance costs of $5.4 million, on the Company’s Consolidated Balance Sheets at December 31, 2018.

Acquisitions

12 Months Ended

Dec. 31, 2020

Business Combinations [Abstract]

Acquisitions

4. Acquisitions

The Company’s acquisitions have been accounted for in accordance with ASC Topic 805, Business Combinations, and the resulting goodwill and other intangible assets were accounted for under ASC Topic 350, Goodwill and Other Intangible Assets. Under business combination accounting, the assets and liabilities are generally recognized at their fair values and the difference between the consideration transferred, excluding transaction costs, and the fair values of the assets and liabilities is recognized as goodwill. The results of each business acquisition are included on the Consolidated Statements of Income from the date of the acquisition.

Management’s assessment of qualitative factors affecting goodwill for each acquisition includes estimates of market share at the date of purchase, ability to grow in the market, synergy with existing Company operations and the payor profile in the markets.

Queen City Hospice

On December 4, 2020, we completed the acquisition of Queen City Hospice, LLC and its affiliate Miracle City Hospice, LLC (together “Queen City Hospice”). The purchase price was approximately $194.8 million, including the amount of acquired excess cash held by Queen City Hospice at the closing of the acquisition (approximately $15.4 million). The purchase of Queen City Hospice was funded with the Company’s revolving credit facility and available cash. With the purchase of Queen City Hospice, the Company expanded its hospice services in the state of Ohio. The related acquisition costs were $1.8 million and integration costs were $0.1 million for the year ended December 31, 2020. These costs were included in general and administrative expenses on the Consolidated Statements of Income and were expensed as incurred.

Based upon management’s valuations, which are preliminary and subject to completion of working capital adjustments, the fair values of the assets and liabilities are as follows:

	Total (Amounts in Thousands)
Goodwill	$	169,207
Identifiable intangible assets		20,015
Cash		15,444
Property and equipment		759
Accounts receivable		5,835
Operating lease assets, net		3,028
Other assets		121
Accounts payable		(2,092	)
Accrued expenses		(503	)
Accrued payroll		(1,598	)
Long-term operating lease liabilities		(2,765	)
Government stimulus advances		(12,694	)
Total purchase price	$	194,757

Identifiable intangible assets acquired included $11.0 million in trade names, $1.5 million of non-competition agreements with estimated useful lives of fifteen years and five years, respectively, and $7.5 million of indefinite lived state licenses. The preliminary estimated fair value of identifiable intangible assets was determined with the assistance of a valuation specialist, using Level 3 inputs as defined under ASC Topic 820. The fair value analysis and related valuations reflect the conclusions of management. All estimates, key assumptions, and forecasts were either provided by or reviewed by the Company. The goodwill and intangible assets acquired are deductible for tax purposes.

The Queen City Hospice acquisition accounted for $4.9 million of net service revenues and $0.6 million of operating income for the year ended December 31, 2020.

County Homemakers

On November 1, 2020, we completed the acquisition of County Homemakers. The purchase price was approximately $15.8 million, including the amount of acquired excess cash held by County Homemakers at the closing of the acquisition (approximately $1.1 million). The purchase of County Homemakers was funded with the Company’s available cash. With the purchase of County Homemakers, the Company expanded its personal care services in the state of Pennsylvania. The related acquisition costs were $0.3 million and integration costs were $0.2 million for the year ended December 31, 2020. These costs were included in general and administrative expenses on the Consolidated Statements of Income and were expensed as incurred.

Based upon management’s valuations, which are preliminary and subject to completion of working capital adjustments, the fair values of the assets and liabilities are as follows:

	Total (Amounts in Thousands)
Goodwill	$	13,363
Identifiable intangible assets		474
Cash		1,104
Property and equipment		52
Accounts receivable		1,387
Operating lease assets, net		485
Other assets		40
Accounts payable		(19	)
Accrued expenses		(37	)
Accrued payroll		(543	)
Long-term operating lease liabilities		(485	)
Total purchase price	$	15,821

Identifiable intangible assets acquired included approximately $0.3 million in state licenses and $0.1 million in trade names with estimated useful lives of eight years and one year, respectively. The preliminary estimated fair value of identifiable intangible assets was determined with the assistance of a valuation specialist, using Level 3 inputs as defined under ASC Topic 820. The fair value analysis and related valuations reflect the conclusions of management. All estimates, key assumptions, and forecasts were either provided by or reviewed by the Company. The goodwill and intangible assets acquired are deductible for tax purposes.

The County Homemakers acquisition accounted for $2.3 million of net service revenues and $0.2 million of operating income for the year ended December 31, 2020.

A Plus Health Care

On July 1, 2020, we completed the acquisition of A Plus Health Care, Inc. (“A Plus”). The purchase price was approximately $14.5 million, including the amount of acquired excess cash held by A Plus at the closing of the acquisition (approximately $2.8 million). The purchase of A Plus was funded with the Company’s available cash. With the purchase of A Plus, the Company expanded its personal care services in the state of Montana. The related acquisition costs were $0.4 million and integration costs were $0.3 million for the year ended December 31, 2020. These costs were included in general and administrative expenses on the Consolidated Statements of Income and were expensed as incurred.

Based upon management’s valuations, which are preliminary and subject to completion of working capital adjustments, the fair values of the assets and liabilities are as follows:

	Total (Amounts in Thousands)
Goodwill	$	9,698
Identifiable intangible assets		1,523
Cash		2,819
Accounts receivable		1,075
Operating lease assets, net		180
Other assets		26
Accounts payable		(21	)
Accrued expenses		(362	)
Accrued payroll		(311	)
Long-term operating lease liabilities		(100	)
Total purchase price	$	14,527

Identifiable intangible assets acquired included $1.4 million in trade names with an estimated useful life of fifteen years. The preliminary estimated fair value of identifiable intangible assets was determined with the assistance of a valuation specialist, using Level 3 inputs as defined under ASC Topic 820. The fair value analysis and related valuations reflect the conclusions of management. All estimates, key assumptions, and forecasts were either provided by or reviewed by the Company. The goodwill and intangible assets acquired are deductible for tax purposes.

The A Plus acquisition accounted for $4.9 million of net service revenues and $1.0 million of operating income for the year ended December 31, 2020.

SunLife Hospice

On December 1, 2020, we completed the acquisition of SunLife Home Care (“SunLife”) for approximately $1.7 million and recorded goodwill of $1.6 million. With the purchase of SunLife Home Care, we expanded our personal care services in the state of Arizona. Goodwill generated from the acquisition is primarily attributable to expected synergies with existing Company operations and the goodwill acquired is deductible for tax purposes.

Hospice Partners

On October 1, 2019, the Company completed the acquisition of the assets of Hospice Partners of America, LLC (“Hospice Partners”). The purchase price was approximately $135.6 million, including the amount of acquired excess cash held by Hospice Partners at the closing of the acquisition (approximately $5.5 million). The purchase of Hospice Partners was funded through a portion of the net proceeds of our public offering of an aggregate 2,300,000 shares of common stock, par value $0.001 per share, including 300,000 shares of common stock sold pursuant to the exercise in full by the underwriters of their option to purchase additional shares at a public offering price of $79.50 per share, which the Company completed on September 9, 2019 (the “Public Offering”). With the purchase of Hospice Partners, we expanded our hospice operations through 21 locations in Idaho, Kansas, Missouri, Oregon, Texas and Virginia. The related acquisition costs were $1.6 million for the year ended December 31, 2019 and integration costs were $1.6

million and $0.6 million for the years ended December 31, 2020 and 2019, respectively. These costs were included in general and administrative expenses on the Consolidated Statements of Income and were expensed as incurred.

Based upon management’s final valuations, the fair values of the assets and liabilities are as follows:

	Total (Amounts in Thousands)
Goodwill	$	111,806
Identifiable intangible assets		18,090
Cash		5,489
Property and equipment		164
Accounts receivable		6,411
Operating lease assets, net		2,425
Other assets		702
Accounts payable		(1,737	)
Accrued expenses		(3,635	)
Accrued payroll		(1,110	)
Deferred tax liability		(1,422	)
Long-term operating lease liabilities		(1,615	)
Total purchase price	$	135,568

Identifiable intangible assets acquired consist of $9.5 million in trade names with estimated useful lives of fifteen years, $2.5 million in non-competition agreements with estimated useful lives of three to five years and $6.1 million of indefinite lived state licenses. The estimated fair value of identifiable intangible assets was determined with the assistance of a valuation specialist, using Level 3 inputs as defined under ASC Topic 820. The fair value analysis and related valuations reflect the conclusions of management. All estimates, key assumptions, and forecasts were either provided by or reviewed by the Company. The goodwill and intangible assets acquired are deductible for tax purposes.

The Hospice Partners acquisition accounted for $14.8 million of net service revenues and $2.3 million of operating income for the year ended December 31, 2019.

Alliance Home Health Care

On August 1, 2019, the Company completed the acquisition of all of the assets of Alliance Home Health Care (“Alliance”). The purchase price was approximately $23.5 million. The purchase of Alliance was funded through the Company’s revolving credit facility and available cash. With the purchase of Alliance, the Company expanded its personal care, home health and hospice operations in the state of New Mexico. The related acquisition costs were $0.4 million for the year ended December 31, 2019 and integration costs were $0.2 million and $0.4 million for the years ended December 31, 2020 and 2019, respectively. These costs were included in general and administrative expenses on the Consolidated Statements of Income and were expensed as incurred.

Based upon management’s final valuations, the fair values of the assets and liabilities are as follows:

	Total (Amounts in Thousands)
Goodwill	$	17,062
Identifiable intangible assets		5,422
Cash		177
Accounts receivable		1,754
Accounts payable		(316	)
Other liabilities		(641	)
Total purchase price	$	23,458

Identifiable intangible assets acquired consist of $1.1 million in state licenses, subject to amortization, with an estimated useful life of ten years and $4.3 million of indefinite lived state licenses. The estimated fair value of identifiable intangible assets was determined with the assistance of a valuation specialist, using Level 3 inputs as defined under ASC Topic 820. The fair value analysis and related valuations reflect the conclusions of management. All estimates, key assumptions, and forecasts were either provided by or reviewed by the Company. The goodwill and intangible assets acquired are deductible for tax purposes.

The Alliance acquisition accounted for $8.8 million of net service revenues and $2.1 million of operating income for the year ended December 31, 2019.

VIP Health Care Services

On June 1, 2019, the Company completed the acquisition of all of the assets of VIP Health Care Services (“VIP”). The purchase price was approximately $29.9 million. The purchase of VIP was funded through a combination of the Company’s delayed draw term loan portion of its credit facility and available cash. With the purchase of VIP, the Company expanded its personal care operations in the state of New York and into the New York City metropolitan area. The related acquisition costs were $0.3 million for the year ended December 31, 2019 and integration costs were $0.2 million and $0.5 million for the years ended December 31, 2020 and 2019, respectively. These costs were included in general and administrative expenses on the Consolidated Statements of Income and were expensed as incurred.

Based upon management’s final valuations, the fair values of the assets and liabilities are as follows:

	Total (Amounts in Thousands)
Goodwill	$	11,936
Identifiable intangible assets		15,370
Cash		130
Accounts receivable		4,730
Operating lease assets, net		2,278
Other assets		30
Property and equipment		27
Accounts payable		(540	)
Accrued expenses		(770	)
Accrued payroll		(1,742	)
Long-term operating lease liabilities		(1,531	)
Total purchase price	$	29,918

Identifiable intangible assets acquired consist of $10.7 million in state licenses, subject to amortization, and $4.7 million in customer relationships, with estimated useful lives of six and eight years, respectively. The estimated fair value of identifiable intangible assets was determined with the assistance of a valuation specialist, using Level 3 inputs as defined under ASC Topic 820. The fair value analysis and related valuations reflect the conclusions of management. All estimates, key assumptions, and forecasts were either provided by or reviewed by the Company. The goodwill and intangible assets acquired are deductible for tax purposes.

The VIP acquisition accounted for $30.0 million of net service revenues and $0.2 million of operating loss for the year ended December 31, 2019.

Ambercare Corporation

On May 1, 2018, the Company completed the acquisition of all the issued and outstanding securities of Ambercare Corporation (“Ambercare”). The purchase price was approximately $39.6 million, plus the amount of excess cash held by Ambercare at the closing of the acquisition (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 entered into its hospice and home health segments in the state of New Mexico. The related acquisition costs were $0.8 million for the year ended December 31, 2018, and integration costs were $0.2 million and $1.6 million for the years ended December 31, 2019 and 2018, respectively. These costs were included in general and administrative expenses on the Company’s Consolidated Statements of Income, and were expensed as incurred. The results of Ambercare are included on the Company’s Consolidated Statements of Income from the date of the acquisition.

Based upon management’s final valuations, the fair values of the assets and liabilities are 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 expenses		(4,073	)
Deferred tax liability		(2,138	)
Financing lease		(75	)
Accounts payable		(3	)
Total purchase price	$	51,622

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 estimated fair value of identifiable intangible assets was determined with the assistance of a valuation specialist, using Level 3 inputs as defined under ASC Topic 820. The fair value analysis and related valuations reflect the conclusions of management. All estimates, key assumptions, and forecasts were either provided by or reviewed by the Company. The goodwill and intangible assets acquired are non-deductible for tax purposes.

The Ambercare acquisition accounted for $36.7 million of net service revenues and $7.1 million of operating income for the year ended December 31, 2018.

Arcadia Home Care & Staffing

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 acquisition costs were $0.8 million for the year ended December 31, 2018, and integration costs were $0.2 million and $1.1 million for the years ended December 31, 2019 and 2018, respectively. These costs were included in general and administrative expenses on the Company’s Consolidated Statements of Income, and were expensed as incurred.

Based upon management’s final valuations, the fair values of the assets and liabilities are 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 expenses		(1,540	)
Accounts payable		(508	)
Total purchase price	$	18,852

Identifiable intangible assets acquired consist of trade name, customer relationships and state licenses, with estimated useful lives ranging from seven to fifteen years. The estimated fair value of identifiable intangible assets was determined with the assistance of a valuation specialist, using Level 3 inputs as defined under ASC Topic 820. The fair value analysis and related valuations reflect the conclusions of management. All estimates, key assumptions, and forecasts were either provided by or reviewed by the Company. The goodwill and intangible assets acquired are deductible for tax purposes.

The Arcadia acquisition accounted for $32.7 million of net service revenues and $4.7 million of operating income for the year ended December 31, 2018.

In September 2018, the Company acquired certain assets of affiliate branches of Arcadia for $0.6 million using available cash, the Company recorded goodwill of $0.6 million on the Company’s 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.

LifeStyle Options, Inc.

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 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 contingent consideration was remeasured to zero.

Based upon management’s final valuations, the fair values of the assets and liabilities are 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 expenses		(291	)
Accounts payable		(105	)
Total purchase price	$	4,130

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 with the assistance of a valuation specialist, using Level 3 inputs as defined under ASC Topic 820. The fair value analysis and related valuations reflect the conclusions of management. All estimates, key assumptions, and forecasts were either provided by or reviewed by the Company. The goodwill and intangible assets acquired are deductible for tax purposes.

The LifeStyle acquisition accounted for $5.8 million of net service revenues and $0.5 million of operating income for the year ended December 31, 2018.

For the year ended December 31, 2020, the following table contains unaudited pro forma Consolidated Income Statement information of the Company as if each of the acquisitions of Queen City Hospice, A Plus and County Homemakers closed on January 1, 2019. For the year ended December 31, 2019, the following table contains unaudited pro forma Consolidated Income Statement information of the Company as if each of the acquisitions of Hospice Partners, Alliance and VIP closed on January 1, 2018. For the year ended December 31, 2018, the following table contains unaudited pro forma Consolidated Income Statement information of the Company as if each of the acquisitions of Ambercare, Arcadia and LifeStyle closed on January 1, 2017.

	For the Years Ended December 31, (Amounts in Thousands, Unaudited)
	2020		2019		2018
Net service revenues	$	831,290	$	726,727	$	550,326
Operating income from continuing operations		45,555		46,571		36,985
Net income from continuing operations		34,564		35,748		24,346
Net income per common share from continuing operations
Basic income per share	$	2.22	$	2.59	$	2.02
Diluted income per share	$	2.17	$	2.51	$	1.97

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. 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.

Property and Equipment

12 Months Ended

Dec. 31, 2020

Property Plant And Equipment [Abstract]

Property and Equipment

5. Property and Equipment

Property and equipment consisted of the following:

	December 31,
	2020			2019
	(Amounts in Thousands)
Computer equipment	$	8,135		$	5,304
Furniture and equipment		5,097			3,410
Transportation equipment		199			157
Leasehold improvements		9,402			3,749
Computer software		11,881			9,563
		34,714			22,183
Less: accumulated depreciation and amortization		(14,965	)		(10,027	)
	$	19,749		$	12,156

Computer software includes $1.7 million and $1.6 million of internally developed software for the years ended December 31, 2020 and 2019, respectively. Depreciation and amortization expense totaled $5.0 million, $4.0 million and $2.5 million for the years ended December 31, 2020, 2019 and 2018, respectively.

Goodwill and Intangible Assets

12 Months Ended

Dec. 31, 2020

Goodwill And Intangible Assets Disclosure [Abstract]

Goodwill and Intangible Assets

6. Goodwill and Intangible Assets

The goodwill for the Company was $469.1 million and $275.4 million as of December 31, 2020 and 2019, respectively.

A summary of goodwill and related adjustments is provided below:

	Goodwill
		Hospice			Personal Care			Home Health			Total
	(Amounts In Thousands)
Goodwill at December 31, 2018		$	22,200		$	112,377		$	865		$	135,442
Additions for acquisitions			124,750			14,368			941			140,059
Adjustments to previously recorded goodwill			33			(168	)		2			(133	)
Goodwill at December 31, 2019			146,983			126,577			1,808			275,368
Additions for acquisitions			169,207			24,660			—			193,867
Divestiture			(1,167	)		—			—			(1,167	)
Adjustments to previously recorded goodwill			(190	)		1,211			(17	)		1,004
Goodwill at December 31, 2020		$	314,833		$	152,448		$	1,791		$	469,072

The Company recognized goodwill in the hospice segment of $169.2 million related to the acquisition of Queen City Hospice on December 4, 2020. In connection with the acquisitions of County Homemakers, A Plus and SunLife for the year ended December 31, 2020, the Company recognized goodwill of approximately $24.7 million in the personal care segment. Additionally, the Company made adjustments to previously recorded goodwill due to adjustments to accounts receivable and accrued expenses based on the final valuations for the acquisitions of Hospice Partners, Alliance and VIP. See Note 4 to the Notes to Consolidated Financial Statements for additional information regarding the acquisitions made by the Company for the years ended December 31, 2020 and 2019.

In 2020, the Company divested certain branches and their related net assets including $1.2 million of related goodwill. The Company recognized a $0.3 million loss on the disposition, reflected in general and administrative expense for the year ended December 31, 2020.

Goodwill and certain state licenses are not amortized pursuant to ASC Topic 350. 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. The Company estimates the fair value of the reporting unit using both a discounted cash flow model as well as a market multiple model. The cash flow forecasts are adjusted by an appropriate discount rate based on the Company’s estimate of a market participant’s weighted-average cost of capital. These models are both based on the Company’s best estimate of future revenues and operating costs and are reconciled to the Company’s consolidated market capitalization, with consideration of the amount a potential acquirer would be required to pay, in the form of a control premium. The determination of fair value in the Company’s goodwill impairment analysis is based on an estimate of fair value for each reporting unit utilizing known and estimated inputs at the evaluation date. Some of those inputs include, but are not limited to, the most recent price of the Company’s common stock and fair value of long

term debt, estimates of future revenue and expense growth, estimated market multiples, expected capital expenditures, income tax rates and cost of invested capital. Significant assumptions used in the analysis included an 8.5% discount rate and long-term revenue growth rates that ranged from 5.0% to 5.5%. For the fiscal year 2020 impairment test, the fair value of the reporting units exceeded their respective carrying values by at least 90% (commonly referred to as “headroom”). The Company did not record any impairment charges for the years ended December 31, 2020, 2019 or 2018.

The Company’s identifiable intangible assets consist of customer and referral relationships, trade names and trademarks, non-competition agreements and state licenses. Amortization is computed using straight-line and accelerated methods based upon the estimated useful lives of the respective assets, which range from one to twenty-five years. Customer and referral relationships are amortized systematically over the periods of expected economic benefit, which range from five to ten years.

The carrying amount and accumulated amortization of each identifiable intangible asset category consisted of the following at December 31, 2020 and 2019:

	Customer and referral relationships			Trade names and trademarks			Non- competition agreements			State Licenses			Total
	(Amounts in Thousands)
Intangible assets with indefinite lives	$	—		$	—		$	—		$	20,791		$	20,791
Intangible assets subject to amortization:
Gross carrying amount		44,672			42,926			6,225			12,507			106,330
Accumulated amortization		(34,439	)		(15,191	)		(2,887	)		(3,055	)		(55,572	)
Intangible assets subject to amortization, net		10,233			27,735			3,338			9,452			50,758
Net balance at December 31, 2020	$	10,233		$	27,735		$	3,338		$	30,243		$	71,549

Intangible assets with indefinite lives	$	—		$	—		$	—		$	13,306		$	13,306
Intangible assets subject to amortization:
Gross carrying amount		48,028			31,036			4,655			12,020			95,739
Accumulated amortization		(35,665	)		(12,941	)		(2,234	)		(1,126	)		(51,966	)
Intangible assets subject to amortization, net		12,363			18,095			2,421			10,894			43,773
Net balance at December 31, 2019	$	12,363		$	18,095		$	2,421		$	24,200		$	57,079

During the year ended December 31, 2020, the Company acquired (i) indefinite lived state licenses, trade names and non-competition agreements of $7.5 million, $11.0 million and $1.5 million, respectively, related to the acquisition of Queen City Hospice, (ii) state licenses, subject to amortization of $0.3 million and $0.1 million in trade names related to the acquisition of County Homemakers, and (iii) a trade name of $1.4 million related to the acquisition of A Plus.

Amortization expense related to the identifiable intangible assets amounted to $7.1 million, $6.6 million and $6.2 million for the years ended December 31, 2020, 2019 and 2018, respectively.

The weighted average remaining useful lives of identifiable intangible assets as of December 31, 2020 is 9.8 years.

The estimated future intangible amortization expense is as follows:

For the year ended December 31,	Total (Amount in Thousands)
2021	$	7,711
2022		6,582
2023		6,098
2024		5,855
2025		4,232
Thereafter		20,280
Total, intangible assets subject to amortization	$	50,758

Details of Certain Balance Sheet Accounts

12 Months Ended

Dec. 31, 2020

Details Of Certain Balance Sheet Accounts [Abstract]

Details of Certain Balance Sheet Accounts

7. Details of Certain Balance Sheet Accounts

Prepaid expenses and other current assets consist of the following:

	December 31,
	2020		2019
	(Amounts in Thousands)
Prepaid workers’ compensation and liability insurance	$	2,838	$	2,040
Workers’ compensation insurance receivable		1,860		1,989
Health insurance receivable		528		1,567
Other		4,743		2,397
Total prepaid expenses and other current assets	$	9,969	$	7,993

Accrued expenses consisted of the following:

	December 31,
	2020		2019
	(Amounts in Thousands)
Current portion of operating lease liabilities	$	9,283	$	7,234
Accrued health insurance		5,607		4,140
Accrued professional fees		4,220		2,517
Payor advances ⁽¹⁾		4,206		—
Accrued payroll taxes		4,543		1,843
Other		9,705		6,695
Total accrued expenses	$	37,564	$	22,429

(1)

The Company deferred the recognition of $4.2 million of payments received from payors for COVID-19 reimbursements which will be recognized if we incur specific expenses such as additional personal protective equipment or will be returned as stipulated if COVID-19 expenses are not incurred.

Government stimulus advances consisted of the following:

	December 31,
	2020		2019
	(Amounts in Thousands)
Provider Relief Fund		12,252	$	—
CMS advanced payment program - Queen City Hospice		10,801		—
Payroll tax deferral		7,141		—
Provider Relief Fund - Queen City Hospice		1,893		—
Total government stimulus advances	$	32,087	$	—

Provider Relief Funds

In April 2020, the Company received grants in an aggregate principal amount of $6.9 million, for which it did not apply, from the Provider Relief Fund as part of the automatic general distributions by HHS. The Company returned these funds in June 2020. In November 2020, the Company received grants in an aggregate principal amount of $13.7 million from the Provider Relief Fund, for which we applied. The Company utilized $1.4 million of these funds for healthcare related expenses attributable to COVID-19 that were unreimbursed by other sources in the period ended December 31, 2020 and, in accordance with the current guidance issued by HHS, expects to utilize additional funds through June 30, 2021, at which point any unused funds will be returned. We are required to properly and fully document the use of such funds in reports to HHS. The Company’s ability to utilize and retain some or all of such funds will depend on the magnitude, timing and nature of the impact of the COVID-19 pandemic, as well as the terms and conditions of the funds received. In April 2020, Queen City Hospice received grants in an aggregate principal amount of approximately $2.5 million, for which it did not apply, from the Provider Relief Fund as part of the automatic general distributions by HHS. Queen City Hospice utilized approximately $0.6 million for healthcare related expenses attributable to COVID-19 that were unreimbursed by other sources. Queen City Hospice intends to repay $1.9 million, which represents the remainder of the grants received but not utilized, in 2021. Commercial organizations that receive annual total awards of $750,000 or more in federal funding, including

payments received through the Provider Relief Fund, are subject to federal audit requirements.

Medicare Accelerated and Advance Payment Program – Queen City Hospice

In addition, the CARES Act expands the Medicare Accelerated and Advance Payment Program to increase cash flow to providers impacted by the COVID-19 pandemic. Hospice and home health providers were able to request an advance or accelerated payment of up to 100% of the Medicare payment amount for a three-month period (not including Medicare Advantage payments). The Medicare Accelerated and Advance Payment Program payments are a loan that providers must pay back. Recoupment of these payments was due to begin in August, but CMS has delayed the recoupment process for these payments, based on amended repayment terms imposed by the CAA, enacted October 1, 2020, until one year after payment was issued. In April 2020, Queen City Hospice received an amount equal to $10.8 million pursuant to the Medicare Accelerated and Advance Payment Program. Queen City Hospice did not repay the funds prior to the completion of our acquisition of Queen City Hospice, however, Queen City Hospice intends to repay such funds in March 2021, prior to any CMS recoupment and before any interest accrues.

Payroll tax deferral

The CARES Act also provides for certain federal income and other tax changes, including the deferral of the employer portion of Social Security payroll taxes. The Company received a cash benefit of approximately $7.1 million related to the deferral of employer payroll taxes for 2020 under the CARES Act, for the period April 2, 2020 through June 30, 2020. Effective July 1, 2020, the Company began paying its deferred portion of employer Social Security payroll taxes and expects to repay the $7.1 million in 2021.

Long-Term Debt

12 Months Ended

Dec. 31, 2020

Long Term Debt [Abstract]

Long-Term Debt

8. Long-Term Debt

Long-term debt consisted of the following:

	December 31,
	2020			2019
	(Amounts in Thousands)
Revolving loan under the credit facility	$	178,458		$	43,458
Term loan under the credit facility		18,130			18,865
Financing leases		—			21
Less unamortized issuance costs		(1,716	)		(2,452	)
Total		194,872			59,892
Less current maturities		(971	)		(728	)
Long-term debt	$	193,901		$	59,164

Amended and Restated Senior Secured Credit Facility

On October 31, 2018, the Company entered into the Amended and Restated Credit Agreement, dated as of October 31, 2018, with certain lenders and Capital One, National Association, as a lender and as agent for all lenders (as amended by the Amendment (as hereinafter defined), the “Credit Agreement”). This credit facility totaled $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 credit facility amended and restated the Company’s existing senior secured credit facility totaling $250.0 million. As used throughout this Annual Report on Form 10-K, “credit facility” shall mean the credit facility evidenced by the Credit Agreement. The maturity of this credit facility is May 8, 2023. Interest on the Company’s 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 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 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 credit facility, and it is collateralized by a first priority security interest in all of the Company’s and the other credit parties’ current and future tangible and intangible assets, including the shares of stock of the borrower and subsidiaries. The Credit Agreement contains affirmative and negative covenants customary for credit facilities of this type, including

limitations on the Company with respect to liens, indebtedness, guaranties, investments, distributions, mergers and acquisitions and dispositions of assets.

The Company pays a fee ranging from 0.20% to 0.35% based on the applicable senior net leverage ratio times the unused portion of the revolving loan portion of the credit facility.

The Credit Agreement contains customary affirmative covenants regarding, among other things, the maintenance of records, compliance with laws, maintenance of permits, maintenance of insurance and property and payment of taxes. The Credit Agreement also contains certain customary financial covenants and negative covenants that, among other things, include a requirement to maintain a minimum Interest Coverage Ratio (as defined in the Credit Agreement), a requirement to stay below a maximum Total Net Leverage Ratio (as defined in the Credit Agreement) and a requirement to stay below a maximum permitted amount of capital expenditures, 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 its credit facility subject to compliance with the Total Net Leverage Ratio (as defined in the Credit Agreement thresholds), restrictions on mergers, dispositions of assets, and affiliate transactions, and restrictions on fundamental changes and lines of business. As of December 31, 2020, the Company was in compliance with all financial covenants under the Credit Agreement.

On September 12, 2019, the Company entered into a First Amendment (the “Amendment”) to its Credit Agreement. The Amendment increased the Company’s credit facility by $50.0 million in incremental revolving loans, for an aggregate $300.0 million in revolving loans. The Amendment provides that future incremental loans may be for term loans or an increase to the revolving loan commitments. The Amendment further provides that the proceeds of the incremental revolving loan commitments may be used for, among other things, general corporate purposes. In connection with the modification of this Amendment, the Company incurred approximately $0.4 million of debt issuance costs.

The Company drew approximately $135.0 million on the revolver portion of its credit facility to fund, in part, the acquisition of Queen City Hospice on December 4, 2020.

At December 31, 2020, the Company had a total of $178.5 million of revolving loans, with an interest rate of 1.90%, and $18.1 million of term loans, with an interest rate of 1.90%, outstanding on its credit facility. After giving effect to the amount drawn on its credit facility, approximately $9.0 million of outstanding letters of credit and borrowing limits based on an advance multiple of adjusted EBITDA (as defined in the Credit Agreement), the Company had $112.6 million available for borrowing under its credit facility.

During the year ended December 31, 2019, the Company drew approximately $23.5 million on the revolver portion of its credit facility to fund, in part, the purchase price for the Alliance acquisition on August 1, 2019. Additionally, the Company drew $19.6 million under the delayed draw term loan portion of its credit facility to fund, in part, the acquisition of VIP on June 1, 2019.

At December 31, 2019, the Company had a total of $43.4 million of revolving loans, with an interest rate of 3.44% and $18.9 million of term loans, with an interest rate of 3.45%, outstanding on its credit facility. After giving effect to the amount drawn on its credit facility, approximately $10.0 million of outstanding letters of credit and borrowing limits based on an advance multiple of adjusted EBITDA (as defined in the Credit Agreement), the Company had $191.4 million available for borrowing under its credit facility.

Income Taxes

12 Months Ended

Dec. 31, 2020

Income Tax Disclosure [Abstract]

Income Taxes

9. Income Taxes

The current and deferred federal and state income tax provision from continuing operations, are comprised of the following:

	December 31,
	2020			2019			2018
	(Amounts in Thousands)
Current
Federal	$	10,230		$	5,876		$	2,883
State		3,312			2,442			1,562
Deferred
Federal		(3,690	)		(734	)		(265	)
State		(1,043	)		(225	)		(84	)
Provision for income taxes	$	8,809		$	7,359		$	4,096

The tax effects of certain temporary differences between the Company’s book and tax bases of assets and liabilities give rise to significant portions of the deferred income tax assets (liabilities) at December 31, 2020 and 2019. The deferred tax assets (liabilities) consisted of the following:

	December 31,
	2020			2019
	(Amounts in Thousands)
Deferred tax assets
Long-term
Accounts receivable allowances	$	14,023		$	9,256
Accrued compensation		3,580			2,765
Accrued workers’ compensation		3,220			3,327
Transaction costs		1,677			1,311
Restructuring costs		108			135
Stock-based compensation		833			793
Government stimulus advances		1,933			—
Operating lease liabilities		12,123			5,896
Other		1,269			584
Total long-term deferred tax assets		38,766			24,067
Deferred tax liabilities
Long-term
Goodwill and intangible assets		(18,891	)		(15,079	)
Property and equipment		(3,217	)		(1,037	)
Prepaid insurance		—			(534	)
Operating lease assets, net		(10,052	)		(5,606	)
Other		(82	)		(164	)
Total long-term deferred tax liabilities		(32,242	)		(22,420	)
Valuation allowance		—			—
Total net deferred tax assets	$	6,524		$	1,647

Management considers whether it is more likely than not that some portion or all of the deferred tax assets will not be realized. The ultimate realization of deferred tax assets is dependent upon the generation of future taxable income during the periods in which those temporary differences become deductible. Management considers all available evidence in making this assessment.

A reconciliation for continuing operations of the statutory federal tax rate of 21.0% to the effective income tax rate, for the years ended December 31, 2020, 2019 and 2018, is summarized as follows:

	December 31,
	2020				2019				2018
Federal income tax at statutory rate		21.0		%		21.0		%		21.0		%
State and local taxes, net of federal benefit		6.0				6.4				6.3
Jobs tax credits, net		(5.1	)			(8.3	)			(10.7	)
162(m) disallowance for executive compensation		6.0				7.5				4.5
Nondeductible permanent items		0.4				0.7				2.2
Nondeductible penalties		—				1.3				—
Excess tax benefit		(5.6	)			(6.7	)			(2.7	)
Federal/state return to provision		(1.6	)			0.6				0.2
Other		(0.1	)			(0.3	)			(0.7	)
Effective income tax rate		21.0		%		22.2		%		20.1		%

The effective income tax rate was 21.0%, 22.2% and 20.1% for the years ended December 31, 2020, 2019 and 2018, respectively. The difference between our federal statutory and effective income tax rates is principally due to the inclusion of state taxes and non-deductible compensation, offset by an excess tax benefit and the use of federal employment tax credits.

The Company is subject to taxation in the jurisdictions in which it operates. The Company continues to remain subject to examination by U.S. federal authorities for the years 2017 through 2019 and for various state authorities for the years 2015 through 2019.

- Definition

The entire disclosure for income taxes. Disclosures may include net deferred tax liability or asset recognized in an enterprise's statement of financial position, net change during the year in the total valuation allowance, approximate tax effect of each type of temporary difference and carryforward that gives rise to a significant portion of deferred tax liabilities and deferred tax assets, utilization of a tax carryback, and tax uncertainties information.

+ References + Details

Stock Options And Restricted Stock Awards

12 Months Ended

Dec. 31, 2020

Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]

Stock Options And Restricted Stock Awards

10. Stock Options and Restricted Stock Awards

The Board approved the 2017 Omnibus Incentive Plan (“the 2017 Plan”) as of April 27, 2017, which was approved by our shareholders on June 14, 2017. The 2017 Plan was intended to replace our existing incentive compensation plan, the 2009 Stock Incentive Plan (“the 2009 Plan”). All awards are now granted from the 2017 Plan. Outstanding awards under the 2009 Plan will continue to be governed by the 2009 Plan and the agreements under which they were granted.

The 2017 Plan allows us to grant performance-based incentive awards and equity-based awards (each an “Award”) to eligible employees, directors and consultants in the form of Stock Options, Stock Appreciation Rights, Restricted Stock, Deferred Stock Units/Restricted Stock Units, Other Stock Units or Performance Awards. The Company’s Board believes that the 2017 Plan is necessary to continue the Company’s effectiveness in attracting, motivating and retaining employees, directors and consultants with appropriate experience and to increase the grantees’ alignment of interest with the Company’s shareholders.

Under the 2017 Plan, Awards may be made in shares of our common stock. Subject to adjustment as provided by the terms of the 2017 Plan, the maximum aggregate number of shares of common stock with respect to which awards may be granted under the 2017 Plan will be 1,182,270, less the number of shares subject to awards that are granted pursuant to the 2009 Plan after March 31, 2017. The aggregate awards granted during any calendar year to any single Participant cannot exceed (i) 500,000 shares subject to stock options or stock appreciation rights (“SARs”) or (ii) 300,000 shares subject to Awards denominated in shares of common stock (whether or not settled in common stock). These individual annual limitations are cumulative in that any shares of common stock or cash for which Awards are permitted to be granted to a Participant during a fiscal year are not covered by an Award in that fiscal year, the number of shares of common stock will automatically increase in the subsequent fiscal years during the term of the 2017 Plan until the earlier of the time the increase has been granted to the Participant, or the end of the third fiscal year following the year to which such increase relates. At December 31, 2020, there were 614,888 shares of common stock available for future grant under the 2017 Plan.

Any shares of common stock subject to an Award under the 2017 Plan that are forfeited, canceled, settled in cash or otherwise terminated without a distribution of shares to a Participant, or that are delivered by attestation or withheld by the Company in connection with an option exercise or the payment of any required income tax withholding upon an option exercise or the vesting of restricted stock, will be deemed available for Awards under the 2017 Plan. Additionally, any shares of common stock subject to an Award under the 2009 Plan that are forfeited, canceled, settled in cash or otherwise terminated without a distribution of shares to a participant, or that are delivered by attestation or withheld by the Company in connection with an option exercise or the payment of any required income tax withholding upon an option exercise or the vesting of restricted stock, will be deemed available for Awards under the 2017 Plan.

Stock options are awarded with a strike price equal to the fair market value based on the closing price of our common stock on the date of grant. Options granted typically vest over a service period ranging from three to four years and expire ten years from the date of grant. Restricted shares typically vest over a service period ranging from one to four years and expire ten years from date of grant.

The exercise prices of stock options outstanding on December 31, 2020 range from $8.91 to $87.80. Restricted stock awards are full-value awards.

Stock Options

A summary of stock option activity and weighted average exercise price is as follows:

	For The Year Ended December 31,
	2020
	Options (Amounts in Thousands)			Weighted Average Exercise Price
Outstanding, beginning of period		648		$	37.43
Granted		—			—
Exercised		(127	)		31.07
Forfeited/Cancelled		(15	)		37.25
Outstanding, end of period		506		$	39.03

The weighted-average estimated fair value of employee stock options granted as calculated using the Black-Scholes Option Pricing Model in 2019 and 2018. The Company did not grant any stock options in 2020. The related assumptions follow:

	For the Years Ended December 31,
	2020		2019		2018
	Grants		Grants		Grants
Weighted average fair value	$	—	$	29.78	$	14.72
Risk-free discount rate		—	1.72% - 2.29%		2.32% - 2.84%
Expected life		—	4.2 - 4.4 years		4.1 - 4.2 years
Dividend yield		—		—		—
Volatility		—	43%		45%

Stock option compensation expense totaled $2.0 million, $2.5 million and $2.0 million for the years ended December 31, 2020, 2019 and 2018, respectively. As of December 31, 2020, there was $2.6 million of total unrecognized compensation cost that is expected to be recognized over a weighted average period of 1.5 years.

The intrinsic value of vested and outstanding stock options was $27.0 million and $12.5 million, respectively, as of December 31, 2020.

As of December 31, 2020, there were 312,499 and 193,221 shares of stock options vested and unvested, respectively.

The intrinsic value of stock options exercised during the years ended December 31, 2020, 2019 and 2018 was $7.5 million, $7.3 million and $1.8 million, respectively.

Restricted Stock Awards

The following table summarizes the status of unvested restricted stock awards outstanding at December 31, 2020:

	For The Year Ended December 31,
	2020
	Restricted Stock Awards (Amounts in Thousands)			Weighted Average Grant Date Fair Value
Unvested restricted stock awards, beginning of period		149		$	51.10
Awarded		88			101.96
Vested		(77	)		45.67
Forfeited		(6	)		45.65
Unvested restricted stock awards, end of period		154		$	83.30

The fair market value of restricted stock awards that vested during the year ended December 31, 2020 was $6.0 million.

Restricted stock award compensation expense totaled $4.0 million, $3.3 million and $2.1 million for the years ended December 31, 2020, 2019 and 2018, respectively. As of December 31, 2020, there was $9.8 million of total unrecognized compensation cost that is expected to be recognized over a weighted average period of 1.7 years.

Employee Benefit Plans

12 Months Ended

Dec. 31, 2020

Compensation And Retirement Disclosure [Abstract]

Employee Benefit Plans

11. Employee Benefit Plans

The 401(k) retirement plan is a defined contribution plan that provides for matching contributions by the Company to all non-union employees. Matching contributions are discretionary and subject to change by management. Under the provisions of the 401(k) plan, employees can contribute up to the maximum percentage and limits allowable under the U.S. Revenue Code. The Company provided contributions totaling $0.3 million, $0.2 million and $0.3 million for the years ended December 31, 2020, 2019 and 2018, respectively.

- Definition

The entire disclosure for retirement benefits.

+ References

Reference 1: http://www.xbrl.org/2003/role/exampleRef
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+ Details

Commitments and Contingencies

12 Months Ended

Dec. 31, 2020

Commitments And Contingencies Disclosure [Abstract]

Commitments and Contingencies

12. Commitments and Contingencies

Government Actions to Mitigate COVID-19’s Impact

On January 31, 2020, the Secretary of the U.S. Department of Health and Human Services (“HHS”) declared a national public health emergency due to a novel coronavirus. In March 2020, the World Health Organization declared the outbreak of COVID-19, a disease caused by this novel coronavirus, a pandemic. This disease continues to spread throughout the United States and other parts of the world.

In recognition of the significant threat to the liquidity of financial markets posed by the COVID-19 pandemic, the Federal Reserve and Congress have taken dramatic actions to provide liquidity to businesses and the banking system in the United States. For example, on March 27, 2020, President Trump signed into law the CARES Act, a sweeping stimulus bill intended to bolster the U.S. economy. The PPPHCE Act and the CAA both expansions of the CARES Act, were signed into law on April 24, 2020 and December 27, 2020, respectively. In total, the CARES Act, the PPPHCE Act and CAA authorize $178 billion in funding to be distributed to health care providers through the Provider Relief Fund. This funding is intended to support healthcare providers by reimbursing them for healthcare-related expenses or lost revenues attributable to COVID-19.

In addition to the Provider Relief Fund, the CARES Act includes temporary changes to Medicare and Medicaid payment rules and relief from certain accounting provisions, for example temporarily lifting the Medicare sequester, which would have otherwise reduced payments to Medicare providers by 2%, from May 1, 2020, through March 31, 2021 (but also extending sequestration through 2030). The Medicare sequester relief resulted in an increase of $0.2 million to home health net service revenues and $1.3 million to hospice net service revenues for the year ended December 31, 2020.

It is impossible to predict the effect and ultimate impact of the COVID-19 pandemic on the Company as the situation continues to rapidly evolve. See Note 7 for additional information regarding government stimulus advances the Company has received.

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 Consolidated Balance Sheets and Consolidated Statements of Income.

Segment Information

12 Months Ended

Dec. 31, 2020

Segment Reporting [Abstract]

Segment Information

13. Segment Information

Operating segments are defined as components of a company that engage in business activities from which it may earn revenues and incur expenses, and for which separate financial information is available and is regularly reviewed by the Company’s chief operating decision makers, to assess the performance of the individual segments and make decisions about resources to be allocated to the segments. The Company operates as a multi-state provider of three distinct but related business segments providing in-home services.

In its personal care segment, the Company provides non-medical assistance with activities of daily living, primarily to persons who are at increased risk of hospitalization or institutionalization, such as the elderly, chronically ill or disabled. In its hospice segment, the Company provides physical, emotional and spiritual care for people who are terminally ill as well as related services for their families. In its home health segment, the Company provides services that are primarily medical in nature to individuals who may require assistance during an illness or after hospitalization and include skilled nursing and physical, occupational and speech therapy.

The tables below set forth information about the Company’s reportable segments for the years ended December 31, 2020, 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 operating decision maker function and therefore are not disclosed below.

Segment operating income consists of revenue generated by a segment, less the direct costs of service revenues and general and administrative expenses that are incurred directly by the segment. Unallocated general and administrative costs are those costs for functions performed in a centralized manner and therefore not attributable to a particular segment. These costs include accounting, finance, human resources, legal, information technology, corporate office support and facility costs and overall corporate management.

	For the Year Ended December 31, 2020
	(Amounts in Thousands)
	Personal Care		Hospice		Home Health		Total
Net service revenues	$	647,233	$	101,297	$	16,245	$	764,775
Cost of services revenues		480,191		47,197		11,150		538,538
Gross profit		167,042		54,100		5,095		226,237
General and administrative expenses		60,468		25,394		3,773		89,635
Segment operating income	$	106,574	$	28,706	$	1,322	$	136,602

	For the Year Ended December 31, 2019
	(Amounts in Thousands)
	Personal Care		Hospice		Home Health		Total
Net service revenues	$	580,728	$	53,601	$	14,462	$	648,791
Cost of services revenues		432,413		27,203		9,937		469,553
Gross profit		148,315		26,398		4,525		179,238
General and administrative expenses		56,887		12,399		3,205		72,491
Segment operating income	$	91,428	$	13,999	$	1,320	$	106,747

	For the Year Ended December 31, 2018
	(Amounts in Thousands)
	Personal Care		Hospice		Home Health		Total
Net service revenues	$	490,941	$	18,850	$	6,856	$	516,647
Cost of services revenues		365,264		10,010		4,569		379,843
Gross profit		125,677		8,840		2,287		136,804
General and administrative expenses		44,728		3,742		1,545		50,015
Segment operating income	$	80,949	$	5,098	$	742	$	86,789

	For the Years Ended December 31,
	(Amounts in Thousands)
	2020			2019			2018
Segment reconciliation:
Total segment operating income	$	136,602		$	106,747		$	86,789

Items not allocated at segment level:
Other general and administrative expenses		80,044			61,421			55,320
Depreciation and amortization		12,051			10,574			8,642
Interest income		(624	)		(1,523	)		(2,592	)
Interest expense		3,189			3,105			5,016
Income before income taxes	$	41,942		$	33,170		$	20,403

- Definition

The entire disclosure for reporting segments including data and tables. Reportable segments include those that meet any of the following quantitative thresholds a) it's reported revenue, including sales to external customers and intersegment sales or transfers is 10 percent or more of the combined revenue, internal and external, of all operating segments b) the absolute amount of its reported profit or loss is 10 percent or more of the greater, in absolute amount of 1) the combined reported profit of all operating segments that did not report a loss or 2) the combined reported loss of all operating segments that did report a loss c) its assets are 10 percent or more of the combined assets of all operating segments.

+ References

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+ Details

Significant Payors

12 Months Ended

Dec. 31, 2020

Significant Payors [Abstract]

Significant Payors

14. Significant Payors

For 2020, 2019 and 2018, our revenue by payor type was as follows:

	Personal Care
	2020					2019					2018
	Amount (in Thousands)		% of Segment Net Service Revenues			Amount (in Thousands)		% of Segment Net Service Revenues			Amount (in Thousands)		% of Segment Net Service Revenues
State, local and other governmental programs	$	324,670		50.2	%	$	303,479		52.2	%	$	285,973		58.2	%
Managed care organizations		287,032		44.3			239,559		41.3			173,391		35.3
Private pay		20,398		3.2			21,765		3.7			20,003		4.1
Commercial insurance		9,991		1.5			9,204		1.6			6,173		1.3
Other		5,142		0.8			6,721		1.2			5,401		1.1
Total personal care segment net service revenues	$	647,233		100.0	%	$	580,728		100.0	%	$	490,941		100.0	%

	Hospice
	2020					2019					2018
	Amount (in Thousands)		% of Segment Net Service Revenues			Amount (in Thousands)		% of Segment Net Service Revenues			Amount (in Thousands)		% of Segment Net Service Revenues
Medicare	$	94,068		92.9	%	$	49,649		92.6	%	$	17,652		93.6	%
Managed care organizations		4,931		4.9			2,768		5.2			1,047		5.6
Other		2,298		2.2			1,184		2.2			151		0.8
Total hospice segment net service revenues	$	101,297		100.0	%	$	53,601		100.0	%	$	18,850		100.0	%

	Home Health
	2020					2019					2018
	Amount (in Thousands)		% of Segment Net Service Revenues			Amount (in Thousands)		% of Segment Net Service Revenues			Amount (in Thousands)		% of Segment Net Service Revenues
Medicare	$	12,765		78.6	%	$	11,218		77.6	%	$	6,034		88.0	%
Managed care organizations		3,188		19.6			2,942		20.3			752		11.0
Other		292		1.8			302		2.1			70		1.0
Total home health segment net service revenues	$	16,245		100.0	%	$	14,462		100.0	%	$	6,856		100.0	%

The Company derives a significant amount of its revenue from its operations in Illinois, New York and New Mexico. The percentages of segment revenue for each of these significant states for 2020, 2019 and 2018 were as follows:

	Personal Care
	2020					2019					2018
	Amount (in Thousands)		% of Segment Net Service Revenues			Amount (in Thousands)		% of Segment Net Service Revenues			Amount (in Thousands)		% of Segment Net Service Revenues
Illinois	$	288,326		44.6	%	$	247,524		42.6	%	$	232,518		47.3	%
New York		115,510		17.8			108,403		18.7			65,117		13.3
New Mexico		86,618		13.4			75,666		13.0			58,914		12.0
All other states		156,779		24.2			149,135		25.7			134,392		27.4
Total personal care segment net service revenues	$	647,233		100.0	%	$	580,728		100.0	%	$	490,941		100.0	%

	Hospice
	2020					2019					2018
	Amount (in Thousands)		% of Segment Net Service Revenues			Amount (in Thousands)		% of Segment Net Service Revenues			Amount (in Thousands)		% of Segment Net Service Revenues
New Mexico	$	42,648		42.1	%	$	38,790		72.4	%	$	18,850		100.0	%
All other states		58,649		57.9			14,811		27.6			—		—
Total hospice segment net service revenues	$	101,297		100.0	%	$	53,601		100.0	%	$	18,850		100.0	%

	Home Health
	2020					2019					2018
	Amount (in Thousands)		% of Segment Net Service Revenues			Amount (in Thousands)		% of Segment Net Service Revenues			Amount (in Thousands)		% of Segment Net Service Revenues
New Mexico	$	16,245		100.0	%	$	14,462		100.0	%	$	6,856		100.0	%
Total home health segment net service revenues	$	16,245		100.0	%	$	14,462		100.0	%	$	6,856		100.0	%

A substantial portion of the Company’s revenue and accounts receivable are derived from services performed for state and local governmental agencies. We derive a significant amount of our net service revenues in Illinois, which represented 37.7%, 38.2% and 45.0% of our net service revenues for the years ended December 31, 2020, 2019 and 2018, respectively. The Illinois Department on Aging, the largest payor program for the Company’s Illinois personal care operations, accounted for 23.0%, 25.3% and 31.7% of the Company’s net service revenues for 2020, 2019 and 2018, respectively.

The related receivables due from the Illinois Department on Aging represented 15.9% and 25.1% of the Company’s net accounts receivable at December 31, 2020 and 2019, respectively.

Concentration of Cash

12 Months Ended

Dec. 31, 2020

Risks And Uncertainties Abstract

Concentration of Cash

15. Concentration of Cash

The Company owns financial instruments that potentially subject the Company to significant concentrations of credit risk include cash. 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.

Unaudited Summarized Quarterly Financial Information

12 Months Ended

Dec. 31, 2020

Quarterly Financial Information Disclosure [Abstract]

Unaudited Summarized Quarterly Financial Information

16. Unaudited Summarized Quarterly Financial Information

The following is a summary of the Company’s unaudited quarterly results of operations:

	Year Ended December 31, 2020								Year Ended December 31, 2019
	Dec. 31		Sept. 30		Jun. 30		Mar. 31		Dec. 31		Sept. 30			Jun. 30		Mar. 31
	(Amounts and Shares in Thousands, Except Per Share Data)
Net service revenues	$	195,996	$	193,987	$	184,576	$	190,216	$	192,376	$	168,993		$	148,915	$	138,507
Gross profit		59,104		56,301		54,997		55,835		57,542		45,176			39,693		36,827
Operating income from continuing operations		11,716		12,523		9,607		10,661		14,530		7,335			7,391		5,496
Net income from continuing operations		8,449		9,119		6,907		8,658		10,737		5,486			5,292		4,296
Loss from discontinued operations		—		—		—		—		—		(574	)		—		—
Net income	$	8,449	$	9,119	$	6,907	$	8,658	$	10,737	$	4,912		$	5,292	$	4,296
Average shares outstanding:
Basic		15,664		15,618		15,582		15,519		15,435		13,766			13,044		12,995
Diluted		16,013		15,957		15,916		15,907		15,881		14,203			13,433		13,381
Income per common share:
Basic
Continuing operations	$	0.54	$	0.58	$	0.44	$	0.56	$	0.70	$	0.40		$	0.41	$	0.33
Discontinued operations		—		—		—		—		—		(0.04	)		—		—
Basic net income per share	$	0.54	$	0.58	$	0.44	$	0.56	$	0.70	$	0.36		$	0.41	$	0.33
Diluted net income per share
Continuing operations	$	0.53	$	0.57	$	0.43	$	0.54	$	0.68	$	0.39		$	0.39	$	0.32
Discontinued operations		—		—		—		—		—		(0.04	)		—		—
Diluted net income per share	$	0.53	$	0.57	$	0.43	$	0.54	$	0.68	$	0.35		$	0.39	$	0.32

Subsequent Events

12 Months Ended

Dec. 31, 2020

Subsequent Events [Abstract]

Subsequent Events

17. Subsequent Events

On February 11, 2021, the state of New York announced its initial selection of parties to enter into contracts as a Lead Fiscal Intermediary under its previously announced Request for Offer (“RFO”) process related to its Consumer Directed Personal Assistance Program (“CDPAP”), in which the Company currently participates as a provider. The Company was not one of the selected entities in the initial RFO process. The announcement followed an extended RFO process first begun in 2019, with responses originally due in February 2020. It is unclear at this time whether the selected parties have the ability to fully meet the CDPAP Program needs or the timing and outcome of next steps in the process. Management believes changes are unlikely to occur during an estimated 6 to 12 month transition period and any financial impact to the Company in 2021 is expected to be immaterial. Based on its current run rate, the Company estimates that it receives approximately $52 million in annualized revenue from the program. The Company will continue to explore its options, including appeals, other arrangements under which the Company may continue to provide these services, and expense reductions to minimize any potential final impact of the RFO process.

Significant Accounting Policies (Policies)

12 Months Ended

Dec. 31, 2020

Accounting Policies [Abstract]

Principles of Consolidation

All intercompany balances and transactions have been eliminated in consolidation.

Discontinued Operations

Revenue Recognition

Personal Care

Hospice Revenue

Home Health Revenue

Accounts Receivable and Allowances

Activity in the allowance for doubtful accounts is as follows (in thousands):

Allowance for doubtful accounts	Balance at beginning of period		Additions/ charges		Deductions ⁽¹⁾		Balance at end of period
Year ended December 31, 2020
Allowance for doubtful accounts	$	962		918		907	$	973
Year ended December 31, 2019
Allowance for doubtful accounts	$	945		343		326	$	962
Year ended December 31, 2018 ⁽²⁾
Allowance for doubtful accounts	$	18,749		272		18,076	$	945

⁽¹⁾Write-offs, net of recoveries

⁽²⁾

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

Leases

Goodwill and 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

Recently Issued and Adopted Accounting Pronouncements

Recently Adopted Accounting Pronouncements

Recently Issued Accounting Pronouncements

Significant Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2020

Accounting Policies [Abstract]

Activity in Allowance for Doubtful Accounts

Activity in the allowance for doubtful accounts is as follows (in thousands):

Allowance for doubtful accounts	Balance at beginning of period		Additions/ charges		Deductions ⁽¹⁾		Balance at end of period
Year ended December 31, 2020
Allowance for doubtful accounts	$	962		918		907	$	973
Year ended December 31, 2019
Allowance for doubtful accounts	$	945		343		326	$	962
Year ended December 31, 2018 ⁽²⁾
Allowance for doubtful accounts	$	18,749		272		18,076	$	945

⁽¹⁾Write-offs, net of recoveries

⁽²⁾

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)

12 Months Ended

Dec. 31, 2020

Leases [Abstract]

Amounts Reported in Condensed Consolidated Balance Sheets for Operating Leases

Amounts reported in the Consolidated Balance Sheets as of December 31, 2020 and 2019 for our operating leases were as follows:

	December 31,
	2020		2019
	(Amounts in Thousands)
Operating lease assets, net	$	37,991	$	21,111

Short-term operating lease liabilities (in accrued expenses)		9,283		7,234
Long-term operating lease liabilities		35,516		14,301
Total operating lease liabilities	$	44,799	$	21,535

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

Components of lease cost were reported in general and administrative expenses in the Consolidated Statements of Income as follows:

	For the Years Ended December 31,
	(Amounts in Thousands)
	2020			2019
Operating lease costs	$	9,197		$	7,219
Short-term lease costs		761			585
Less: sublease income		(323	)		(312	)
Total lease cost, net	$	9,635		$	7,492

Schedule of Weighted Average Remaining Lease Terms and Discount Rates

Weighted average remaining lease terms and discount rates for the years ended December 31, 2020 and 2019 were as follows:

	2020			2019
Operating leases:
Weighted average remaining lease term		6.97			3.42
Weighted average discount rate		4.18	%		5.14	%

Supplemental Cash Flows Information

	For the Years Ended December 31,
	(Amounts in Thousands)
		2020		2019
Supplemental Cash Flows Information
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	8,769	$	7,574

Right-of-use assets obtained in exchange for lease obligations:
Operating leases	$	25,807	$	10,299

Acquisitions (Tables)

12 Months Ended

Dec. 31, 2020

Business Acquisition [Line Items]

Unaudited Pro Forma Condensed Consolidated Income Statement Information

	For the Years Ended December 31, (Amounts in Thousands, Unaudited)
	2020		2019		2018
Net service revenues	$	831,290	$	726,727	$	550,326
Operating income from continuing operations		45,555		46,571		36,985
Net income from continuing operations		34,564		35,748		24,346
Net income per common share from continuing operations
Basic income per share	$	2.22	$	2.59	$	2.02
Diluted income per share	$	2.17	$	2.51	$	1.97

Queen City Hospice [Member]

Business Acquisition [Line Items]

Schedule of Fair Values of Assets and Liabilities

Based upon management’s valuations, which are preliminary and subject to completion of working capital adjustments, the fair values of the assets and liabilities are as follows:

	Total (Amounts in Thousands)
Goodwill	$	169,207
Identifiable intangible assets		20,015
Cash		15,444
Property and equipment		759
Accounts receivable		5,835
Operating lease assets, net		3,028
Other assets		121
Accounts payable		(2,092	)
Accrued expenses		(503	)
Accrued payroll		(1,598	)
Long-term operating lease liabilities		(2,765	)
Government stimulus advances		(12,694	)
Total purchase price	$	194,757

County Homemakers [Member]

Business Acquisition [Line Items]

Schedule of Fair Values of Assets and Liabilities

Based upon management’s valuations, which are preliminary and subject to completion of working capital adjustments, the fair values of the assets and liabilities are as follows:

	Total (Amounts in Thousands)
Goodwill	$	13,363
Identifiable intangible assets		474
Cash		1,104
Property and equipment		52
Accounts receivable		1,387
Operating lease assets, net		485
Other assets		40
Accounts payable		(19	)
Accrued expenses		(37	)
Accrued payroll		(543	)
Long-term operating lease liabilities		(485	)
Total purchase price	$	15,821

A Plus Health Care, Inc [Member]

Business Acquisition [Line Items]

Schedule of Fair Values of Assets and Liabilities

Based upon management’s valuations, which are preliminary and subject to completion of working capital adjustments, the fair values of the assets and liabilities are as follows:

	Total (Amounts in Thousands)
Goodwill	$	9,698
Identifiable intangible assets		1,523
Cash		2,819
Accounts receivable		1,075
Operating lease assets, net		180
Other assets		26
Accounts payable		(21	)
Accrued expenses		(362	)
Accrued payroll		(311	)
Long-term operating lease liabilities		(100	)
Total purchase price	$	14,527

Hospice Partners [Member]

Business Acquisition [Line Items]

Schedule of Fair Values of Assets and Liabilities

Based upon management’s final valuations, the fair values of the assets and liabilities are as follows:

	Total (Amounts in Thousands)
Goodwill	$	111,806
Identifiable intangible assets		18,090
Cash		5,489
Property and equipment		164
Accounts receivable		6,411
Operating lease assets, net		2,425
Other assets		702
Accounts payable		(1,737	)
Accrued expenses		(3,635	)
Accrued payroll		(1,110	)
Deferred tax liability		(1,422	)
Long-term operating lease liabilities		(1,615	)
Total purchase price	$	135,568

Alliance Home Health Care [Member]

Business Acquisition [Line Items]

Schedule of Fair Values of Assets and Liabilities

Based upon management’s final valuations, the fair values of the assets and liabilities are as follows:

	Total (Amounts in Thousands)
Goodwill	$	17,062
Identifiable intangible assets		5,422
Cash		177
Accounts receivable		1,754
Accounts payable		(316	)
Other liabilities		(641	)
Total purchase price	$	23,458

VIP Health Care Services [Member]

Business Acquisition [Line Items]

Schedule of Fair Values of Assets and Liabilities

Based upon management’s final valuations, the fair values of the assets and liabilities are as follows:

	Total (Amounts in Thousands)
Goodwill	$	11,936
Identifiable intangible assets		15,370
Cash		130
Accounts receivable		4,730
Operating lease assets, net		2,278
Other assets		30
Property and equipment		27
Accounts payable		(540	)
Accrued expenses		(770	)
Accrued payroll		(1,742	)
Long-term operating lease liabilities		(1,531	)
Total purchase price	$	29,918

Ambercare Corporation [Member]

Business Acquisition [Line Items]

Schedule of Fair Values of Assets and Liabilities

Based upon management’s final valuations, the fair values of the assets and liabilities are 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 expenses		(4,073	)
Deferred tax liability		(2,138	)
Financing lease		(75	)
Accounts payable		(3	)
Total purchase price	$	51,622

Arcadia Home Care And Staffing [Member]

Business Acquisition [Line Items]

Schedule of Fair Values of Assets and Liabilities

Based upon management’s final valuations, the fair values of the assets and liabilities are 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 expenses		(1,540	)
Accounts payable		(508	)
Total purchase price	$	18,852

Lifestyle Options, Inc. [Member]

Business Acquisition [Line Items]

Schedule of Fair Values of Assets and Liabilities

Based upon management’s final valuations, the fair values of the assets and liabilities are 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 expenses		(291	)
Accounts payable		(105	)
Total purchase price	$	4,130

Property and Equipment (Tables)

12 Months Ended

Dec. 31, 2020

Property Plant And Equipment [Abstract]

Schedule of Property and Equipment

Property and equipment consisted of the following:

	December 31,
	2020			2019
	(Amounts in Thousands)
Computer equipment	$	8,135		$	5,304
Furniture and equipment		5,097			3,410
Transportation equipment		199			157
Leasehold improvements		9,402			3,749
Computer software		11,881			9,563
		34,714			22,183
Less: accumulated depreciation and amortization		(14,965	)		(10,027	)
	$	19,749		$	12,156

Goodwill and Intangible Assets (Tables)

12 Months Ended

Dec. 31, 2020

Goodwill And Intangible Assets Disclosure [Abstract]

Summary of Goodwill and Related Adjustments

A summary of goodwill and related adjustments is provided below:

	Goodwill
		Hospice			Personal Care			Home Health			Total
	(Amounts In Thousands)
Goodwill at December 31, 2018		$	22,200		$	112,377		$	865		$	135,442
Additions for acquisitions			124,750			14,368			941			140,059
Adjustments to previously recorded goodwill			33			(168	)		2			(133	)
Goodwill at December 31, 2019			146,983			126,577			1,808			275,368
Additions for acquisitions			169,207			24,660			—			193,867
Divestiture			(1,167	)		—			—			(1,167	)
Adjustments to previously recorded goodwill			(190	)		1,211			(17	)		1,004
Goodwill at December 31, 2020		$	314,833		$	152,448		$	1,791		$	469,072

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 at December 31, 2020 and 2019:

	Customer and referral relationships			Trade names and trademarks			Non- competition agreements			State Licenses			Total
	(Amounts in Thousands)
Intangible assets with indefinite lives	$	—		$	—		$	—		$	20,791		$	20,791
Intangible assets subject to amortization:
Gross carrying amount		44,672			42,926			6,225			12,507			106,330
Accumulated amortization		(34,439	)		(15,191	)		(2,887	)		(3,055	)		(55,572	)
Intangible assets subject to amortization, net		10,233			27,735			3,338			9,452			50,758
Net balance at December 31, 2020	$	10,233		$	27,735		$	3,338		$	30,243		$	71,549

Intangible assets with indefinite lives	$	—		$	—		$	—		$	13,306		$	13,306
Intangible assets subject to amortization:
Gross carrying amount		48,028			31,036			4,655			12,020			95,739
Accumulated amortization		(35,665	)		(12,941	)		(2,234	)		(1,126	)		(51,966	)
Intangible assets subject to amortization, net		12,363			18,095			2,421			10,894			43,773
Net balance at December 31, 2019	$	12,363		$	18,095		$	2,421		$	24,200		$	57,079

Schedule of Future Amortization of Intangible Assets

The estimated future intangible amortization expense is as follows:

For the year ended December 31,	Total (Amount in Thousands)
2021	$	7,711
2022		6,582
2023		6,098
2024		5,855
2025		4,232
Thereafter		20,280
Total, intangible assets subject to amortization	$	50,758

Details of Certain Balance Sheet Accounts (Tables)

12 Months Ended

Dec. 31, 2020

Details Of Certain Balance Sheet Accounts [Abstract]

Schedule of Prepaid Expenses and Other Current Assets

Prepaid expenses and other current assets consist of the following:

	December 31,
	2020		2019
	(Amounts in Thousands)
Prepaid workers’ compensation and liability insurance	$	2,838	$	2,040
Workers’ compensation insurance receivable		1,860		1,989
Health insurance receivable		528		1,567
Other		4,743		2,397
Total prepaid expenses and other current assets	$	9,969	$	7,993

Schedule of Accrued Expenses

Accrued expenses consisted of the following:

	December 31,
	2020		2019
	(Amounts in Thousands)
Current portion of operating lease liabilities	$	9,283	$	7,234
Accrued health insurance		5,607		4,140
Accrued professional fees		4,220		2,517
Payor advances ⁽¹⁾		4,206		—
Accrued payroll taxes		4,543		1,843
Other		9,705		6,695
Total accrued expenses	$	37,564	$	22,429

(1)

Schedule of Government Stimulus Advances

Government stimulus advances consisted of the following:

	December 31,
	2020		2019
	(Amounts in Thousands)
Provider Relief Fund		12,252	$	—
CMS advanced payment program - Queen City Hospice		10,801		—
Payroll tax deferral		7,141		—
Provider Relief Fund - Queen City Hospice		1,893		—
Total government stimulus advances	$	32,087	$	—

Long-Term Debt (Tables)

12 Months Ended

Dec. 31, 2020

Long Term Debt [Abstract]

Schedule of Long-Term Debt

Long-term debt consisted of the following:

	December 31,
	2020			2019
	(Amounts in Thousands)
Revolving loan under the credit facility	$	178,458		$	43,458
Term loan under the credit facility		18,130			18,865
Financing leases		—			21
Less unamortized issuance costs		(1,716	)		(2,452	)
Total		194,872			59,892
Less current maturities		(971	)		(728	)
Long-term debt	$	193,901		$	59,164

- 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

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Reference 4: http://fasb.org/us-gaap/role/ref/legacyRef
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Reference 9: http://fasb.org/us-gaap/role/ref/legacyRef
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Reference 10: http://fasb.org/us-gaap/role/ref/legacyRef
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-URI http://asc.fasb.org/extlink&oid=109259400&loc=d3e21475-112644

+ Details

Income Taxes (Tables)

12 Months Ended

Dec. 31, 2020

Income Tax Disclosure [Abstract]

Current and Deferred Federal and State Income Tax Provision from Continuing Operations

The current and deferred federal and state income tax provision from continuing operations, are comprised of the following:

	December 31,
	2020			2019			2018
	(Amounts in Thousands)
Current
Federal	$	10,230		$	5,876		$	2,883
State		3,312			2,442			1,562
Deferred
Federal		(3,690	)		(734	)		(265	)
State		(1,043	)		(225	)		(84	)
Provision for income taxes	$	8,809		$	7,359		$	4,096

Deferred Tax Assets And Liabilities

	December 31,
	2020			2019
	(Amounts in Thousands)
Deferred tax assets
Long-term
Accounts receivable allowances	$	14,023		$	9,256
Accrued compensation		3,580			2,765
Accrued workers’ compensation		3,220			3,327
Transaction costs		1,677			1,311
Restructuring costs		108			135
Stock-based compensation		833			793
Government stimulus advances		1,933			—
Operating lease liabilities		12,123			5,896
Other		1,269			584
Total long-term deferred tax assets		38,766			24,067
Deferred tax liabilities
Long-term
Goodwill and intangible assets		(18,891	)		(15,079	)
Property and equipment		(3,217	)		(1,037	)
Prepaid insurance		—			(534	)
Operating lease assets, net		(10,052	)		(5,606	)
Other		(82	)		(164	)
Total long-term deferred tax liabilities		(32,242	)		(22,420	)
Valuation allowance		—			—
Total net deferred tax assets	$	6,524		$	1,647

Reconciliation of Statutory Federal Tax Rate

A reconciliation for continuing operations of the statutory federal tax rate of 21.0% to the effective income tax rate, for the years ended December 31, 2020, 2019 and 2018, is summarized as follows:

	December 31,
	2020				2019				2018
Federal income tax at statutory rate		21.0		%		21.0		%		21.0		%
State and local taxes, net of federal benefit		6.0				6.4				6.3
Jobs tax credits, net		(5.1	)			(8.3	)			(10.7	)
162(m) disallowance for executive compensation		6.0				7.5				4.5
Nondeductible permanent items		0.4				0.7				2.2
Nondeductible penalties		—				1.3				—
Excess tax benefit		(5.6	)			(6.7	)			(2.7	)
Federal/state return to provision		(1.6	)			0.6				0.2
Other		(0.1	)			(0.3	)			(0.7	)
Effective income tax rate		21.0		%		22.2		%		20.1		%

Stock Options And Restricted Stock Awards (Tables)

12 Months Ended

Dec. 31, 2020

Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]

Summary of Stock Option Activity and Weighted Average Exercise Price

	For The Year Ended December 31,
	2020
	Options (Amounts in Thousands)			Weighted Average Exercise Price
Outstanding, beginning of period		648		$	37.43
Granted		—			—
Exercised		(127	)		31.07
Forfeited/Cancelled		(15	)		37.25
Outstanding, end of period		506		$	39.03

Weighted-Average Estimated Fair Value of Employee Stock Options Granted

	For the Years Ended December 31,
	2020		2019		2018
	Grants		Grants		Grants
Weighted average fair value	$	—	$	29.78	$	14.72
Risk-free discount rate		—	1.72% - 2.29%		2.32% - 2.84%
Expected life		—	4.2 - 4.4 years		4.1 - 4.2 years
Dividend yield		—		—		—
Volatility		—	43%		45%

Summary of Status of Unvested Restricted Stock Awards Outstanding

	For The Year Ended December 31,
	2020
	Restricted Stock Awards (Amounts in Thousands)			Weighted Average Grant Date Fair Value
Unvested restricted stock awards, beginning of period		149		$	51.10
Awarded		88			101.96
Vested		(77	)		45.67
Forfeited		(6	)		45.65
Unvested restricted stock awards, end of period		154		$	83.30

Segment Information (Tables)

12 Months Ended

Dec. 31, 2020

Segment Reporting [Abstract]

Summary of Segment Information

	For the Year Ended December 31, 2020
	(Amounts in Thousands)
	Personal Care		Hospice		Home Health		Total
Net service revenues	$	647,233	$	101,297	$	16,245	$	764,775
Cost of services revenues		480,191		47,197		11,150		538,538
Gross profit		167,042		54,100		5,095		226,237
General and administrative expenses		60,468		25,394		3,773		89,635
Segment operating income	$	106,574	$	28,706	$	1,322	$	136,602

	For the Year Ended December 31, 2019
	(Amounts in Thousands)
	Personal Care		Hospice		Home Health		Total
Net service revenues	$	580,728	$	53,601	$	14,462	$	648,791
Cost of services revenues		432,413		27,203		9,937		469,553
Gross profit		148,315		26,398		4,525		179,238
General and administrative expenses		56,887		12,399		3,205		72,491
Segment operating income	$	91,428	$	13,999	$	1,320	$	106,747

	For the Year Ended December 31, 2018
	(Amounts in Thousands)
	Personal Care		Hospice		Home Health		Total
Net service revenues	$	490,941	$	18,850	$	6,856	$	516,647
Cost of services revenues		365,264		10,010		4,569		379,843
Gross profit		125,677		8,840		2,287		136,804
General and administrative expenses		44,728		3,742		1,545		50,015
Segment operating income	$	80,949	$	5,098	$	742	$	86,789

	For the Years Ended December 31,
	(Amounts in Thousands)
	2020			2019			2018
Segment reconciliation:
Total segment operating income	$	136,602		$	106,747		$	86,789

Items not allocated at segment level:
Other general and administrative expenses		80,044			61,421			55,320
Depreciation and amortization		12,051			10,574			8,642
Interest income		(624	)		(1,523	)		(2,592	)
Interest expense		3,189			3,105			5,016
Income before income taxes	$	41,942		$	33,170		$	20,403

Significant Payors (Tables)

12 Months Ended

Dec. 31, 2020

Significant Payors [Abstract]

Schedule of Revenue by Payor Type

For 2020, 2019 and 2018, our revenue by payor type was as follows:

	Personal Care
	2020					2019					2018
	Amount (in Thousands)		% of Segment Net Service Revenues			Amount (in Thousands)		% of Segment Net Service Revenues			Amount (in Thousands)		% of Segment Net Service Revenues
State, local and other governmental programs	$	324,670		50.2	%	$	303,479		52.2	%	$	285,973		58.2	%
Managed care organizations		287,032		44.3			239,559		41.3			173,391		35.3
Private pay		20,398		3.2			21,765		3.7			20,003		4.1
Commercial insurance		9,991		1.5			9,204		1.6			6,173		1.3
Other		5,142		0.8			6,721		1.2			5,401		1.1
Total personal care segment net service revenues	$	647,233		100.0	%	$	580,728		100.0	%	$	490,941		100.0	%

	Hospice
	2020					2019					2018
	Amount (in Thousands)		% of Segment Net Service Revenues			Amount (in Thousands)		% of Segment Net Service Revenues			Amount (in Thousands)		% of Segment Net Service Revenues
Medicare	$	94,068		92.9	%	$	49,649		92.6	%	$	17,652		93.6	%
Managed care organizations		4,931		4.9			2,768		5.2			1,047		5.6
Other		2,298		2.2			1,184		2.2			151		0.8
Total hospice segment net service revenues	$	101,297		100.0	%	$	53,601		100.0	%	$	18,850		100.0	%

	Home Health
	2020					2019					2018
	Amount (in Thousands)		% of Segment Net Service Revenues			Amount (in Thousands)		% of Segment Net Service Revenues			Amount (in Thousands)		% of Segment Net Service Revenues
Medicare	$	12,765		78.6	%	$	11,218		77.6	%	$	6,034		88.0	%
Managed care organizations		3,188		19.6			2,942		20.3			752		11.0
Other		292		1.8			302		2.1			70		1.0
Total home health segment net service revenues	$	16,245		100.0	%	$	14,462		100.0	%	$	6,856		100.0	%

Schedule of Revenue by Geographic Location

	Personal Care
	2020					2019					2018
	Amount (in Thousands)		% of Segment Net Service Revenues			Amount (in Thousands)		% of Segment Net Service Revenues			Amount (in Thousands)		% of Segment Net Service Revenues
Illinois	$	288,326		44.6	%	$	247,524		42.6	%	$	232,518		47.3	%
New York		115,510		17.8			108,403		18.7			65,117		13.3
New Mexico		86,618		13.4			75,666		13.0			58,914		12.0
All other states		156,779		24.2			149,135		25.7			134,392		27.4
Total personal care segment net service revenues	$	647,233		100.0	%	$	580,728		100.0	%	$	490,941		100.0	%

	Hospice
	2020					2019					2018
	Amount (in Thousands)		% of Segment Net Service Revenues			Amount (in Thousands)		% of Segment Net Service Revenues			Amount (in Thousands)		% of Segment Net Service Revenues
New Mexico	$	42,648		42.1	%	$	38,790		72.4	%	$	18,850		100.0	%
All other states		58,649		57.9			14,811		27.6			—		—
Total hospice segment net service revenues	$	101,297		100.0	%	$	53,601		100.0	%	$	18,850		100.0	%

	Home Health
	2020					2019					2018
	Amount (in Thousands)		% of Segment Net Service Revenues			Amount (in Thousands)		% of Segment Net Service Revenues			Amount (in Thousands)		% of Segment Net Service Revenues
New Mexico	$	16,245		100.0	%	$	14,462		100.0	%	$	6,856		100.0	%
Total home health segment net service revenues	$	16,245		100.0	%	$	14,462		100.0	%	$	6,856		100.0	%

Unaudited Summarized Quarterly Financial Information (Tables)

12 Months Ended

Dec. 31, 2020

Quarterly Financial Information Disclosure [Abstract]

Schedule of Quarterly Results of Operations

The following is a summary of the Company’s unaudited quarterly results of operations:

	Year Ended December 31, 2020								Year Ended December 31, 2019
	Dec. 31		Sept. 30		Jun. 30		Mar. 31		Dec. 31		Sept. 30			Jun. 30		Mar. 31
	(Amounts and Shares in Thousands, Except Per Share Data)
Net service revenues	$	195,996	$	193,987	$	184,576	$	190,216	$	192,376	$	168,993		$	148,915	$	138,507
Gross profit		59,104		56,301		54,997		55,835		57,542		45,176			39,693		36,827
Operating income from continuing operations		11,716		12,523		9,607		10,661		14,530		7,335			7,391		5,496
Net income from continuing operations		8,449		9,119		6,907		8,658		10,737		5,486			5,292		4,296
Loss from discontinued operations		—		—		—		—		—		(574	)		—		—
Net income	$	8,449	$	9,119	$	6,907	$	8,658	$	10,737	$	4,912		$	5,292	$	4,296
Average shares outstanding:
Basic		15,664		15,618		15,582		15,519		15,435		13,766			13,044		12,995
Diluted		16,013		15,957		15,916		15,907		15,881		14,203			13,433		13,381
Income per common share:
Basic
Continuing operations	$	0.54	$	0.58	$	0.44	$	0.56	$	0.70	$	0.40		$	0.41	$	0.33
Discontinued operations		—		—		—		—		—		(0.04	)		—		—
Basic net income per share	$	0.54	$	0.58	$	0.44	$	0.56	$	0.70	$	0.36		$	0.41	$	0.33
Diluted net income per share
Continuing operations	$	0.53	$	0.57	$	0.43	$	0.54	$	0.68	$	0.39		$	0.39	$	0.32
Discontinued operations		—		—		—		—		—		(0.04	)		—		—
Diluted net income per share	$	0.53	$	0.57	$	0.43	$	0.54	$	0.68	$	0.35		$	0.39	$	0.32

Significant Accounting Policies (Narrative) (Details)			3 Months Ended								12 Months Ended
Significant Accounting Policies (Narrative) (Details)	Oct. 01, 2017	Mar. 01, 2013	Dec. 31, 2020 USD ($) shares	Sep. 30, 2020 USD ($)	Jun. 30, 2020 USD ($)	Mar. 31, 2020 USD ($)	Dec. 31, 2019 USD ($) shares	Sep. 30, 2019 USD ($)	Jun. 30, 2019 USD ($)	Mar. 31, 2019 USD ($)	Dec. 31, 2020 USD ($) segment item shares	Dec. 31, 2019 USD ($) shares	Dec. 31, 2018 USD ($) shares
Summary Of Significant Accounting Policies [Line Items]
Number of operating segments \| segment											3
Net service revenues			$ 195,996,000	$ 193,987,000	$ 184,576,000	$ 190,216,000	$ 192,376,000	$ 168,993,000	$ 148,915,000	$ 138,507,000	$ 764,775,000	$ 648,791,000	$ 516,647,000
Contract with customer liability			$ 1,800,000				400,000				$ 1,800,000	400,000
Percent of fair value of reporting unit excess of carrying value			90.00%								90.00%
Goodwill impairment charge											$ 0	0	0
Goodwill			$ 469,072,000				275,368,000				469,072,000	275,368,000	135,442,000
Impairment of finite-lived intangible assets											0	0	0
Intangibles, net of accumulated amortization			71,549,000				57,079,000				71,549,000	57,079,000
Deductible component of workers' compensation											400,000
Letters of credit secure compensation program			9,000,000.0				10,000,000.0				9,000,000.0	10,000,000.0
Accrued workers’ compensation insurance			13,759,000				14,143,000				13,759,000	14,143,000
Workers' compensation insurance recovery receivables			$ 1,860,000				$ 1,989,000				$ 1,860,000	1,989,000
Interest income received												700,000	2,300,000
Number of stock incentive plans \| item											1
Stock-based compensation expense											$ 6,000,000.0	5,800,000	4,100,000
Stock Options [Member]
Summary Of Significant Accounting Policies [Line Items]
Stock-based compensation expense											$ 2,000,000.0	$ 2,500,000	$ 2,000,000.0
Number of stock options included in calculation \| shares			506,000				648,000				506,000	648,000	683,000
Number of dilutive shares outstanding \| shares											304,000	346,000	247,000
Restricted Stock [Member]
Summary Of Significant Accounting Policies [Line Items]
Stock-based compensation expense											$ 4,000,000.0	$ 3,300,000	$ 2,100,000
Number of dilutive shares outstanding \| shares											57,000	86,000	88,000
Shares of restricted stock awards included in calculation \| shares											154,000	149,000	149,000
Minimum [Member]
Summary Of Significant Accounting Policies [Line Items]
Leases termination and renewal option											1 year
Intangible assets, estimated useful lives											1 year
Minimum [Member] \| Customer and Referral Relationships [Member]
Summary Of Significant Accounting Policies [Line Items]
Intangible assets, estimated useful lives											5 years
Maximum [Member]
Summary Of Significant Accounting Policies [Line Items]
Leases termination and renewal option											5 years
Intangible assets, estimated useful lives											25 years
Maximum [Member] \| Customer and Referral Relationships [Member]
Summary Of Significant Accounting Policies [Line Items]
Intangible assets, estimated useful lives											10 years
General and Administrative Expenses [Member] \| Frisco Corporate Headquarter [Member]
Summary Of Significant Accounting Policies [Line Items]
Operating lease asset, impairment											$ 1,000,000.0
Accounting Standards Update 2014-09 [Member]
Summary Of Significant Accounting Policies [Line Items]
Net service revenues													$ 18,000,000.0
Accounts receivable, allowance for doubtful accounts			$ 1,000,000.0				$ 1,000,000.0				$ 1,000,000.0	$ 1,000,000.0
Accounting Standards Update 2014-09 [Member] \| Subsequent Changes [Member]
Summary Of Significant Accounting Policies [Line Items]
Net service revenues												3,000,000.0	$ 1,300,000
Accounting Standards Update 2016-13 [Member]
Summary Of Significant Accounting Policies [Line Items]
Change in accounting principle, accounting standards update, adopted			true								true
Change in accounting principle, accounting standards update, immaterial effect			true								true
Accounting Standards Update 2017-04 [Member]
Summary Of Significant Accounting Policies [Line Items]
Change in accounting principle, accounting standards update, adopted			true								true
Change in accounting principle, accounting standards update, immaterial effect			true								true
Accounting Standards Update 2018-15 [Member]
Summary Of Significant Accounting Policies [Line Items]
Change in accounting principle, accounting standards update, adopted			true								true
Change in accounting principle, accounting standards update, immaterial effect			true								true
Accounting Standards Update 2019-12 [Member]
Summary Of Significant Accounting Policies [Line Items]
Change in accounting principle, accounting standards update, adopted			true								true
Change in accounting principle, accounting standards update, immaterial effect			false								false
Change in accounting principle, accounting standards update, adoption date			Dec. 15, 2020								Dec. 15, 2020
2013 Home Health Business [Member]
Summary Of Significant Accounting Policies [Line Items]
Equity ownership percentage sold in joint venture	10.00%	90.00%
Settlement expense in discontinued operation												$ 600,000

Significant Accounting Policies (Activity in Allowance for Doubtful Accounts) (Details) - USD ($)
$ in Thousands

12 Months Ended

Dec. 31, 2020

Dec. 31, 2019

Dec. 31, 2018

^[1]

Credit Loss [Abstract]

Balance at beginning of period

$ 962

$ 945

^[1]

$ 18,749

Provision for doubtful accounts

918

343

272

Deductions

^[2]

907

326

18,076

Balance at end of period

$ 973

$ 962

$ 945

[1]

[2]

Write-offs, net of recoveries

Significant Accounting Policies (Activity in Allowance for Doubtful Accounts) (Parenthetical) (Details) - USD ($) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2020	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Allowance For Doubtful Accounts Receivable [Line Items]
Net service revenues	$ 195,996	$ 193,987	$ 184,576	$ 190,216	$ 192,376	$ 168,993	$ 148,915	$ 138,507	$ 764,775	$ 648,791	$ 516,647
Accounting Standards Update 2014-09 [Member]
Allowance For Doubtful Accounts Receivable [Line Items]
Net service revenues											$ 18,000

- Definition

Amount, excluding tax collected from customer, of revenue from satisfaction of performance obligation by transferring promised good or service to customer. Tax collected from customer is tax assessed by governmental authority that is both imposed on and concurrent with specific revenue-producing transaction, including, but not limited to, sales, use, value added and excise.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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Reference 10: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130545-203045

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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+ Details

Significant Accounting Policies (Estimated Useful Lives of Property and Equipment) (Details)	12 Months Ended
	Dec. 31, 2020
Computer Equipment [Member] \| Minimum [Member]
Property, Plant and Equipment [Line Items]
Property and equipment useful life	3 years
Computer Equipment [Member] \| Maximum [Member]
Property, Plant and Equipment [Line Items]
Property and equipment useful life	5 years
Furniture and Equipment [Member] \| Minimum [Member]
Property, Plant and Equipment [Line Items]
Property and equipment useful life	5 years
Furniture and Equipment [Member] \| Maximum [Member]
Property, Plant and Equipment [Line Items]
Property and equipment useful life	7 years
Transportation Equipment [Member]
Property, Plant and Equipment [Line Items]
Property and equipment useful life	5 years
Computer Software [Member] \| Minimum [Member]
Property, Plant and Equipment [Line Items]
Property and equipment useful life	3 years
Computer Software [Member] \| Maximum [Member]
Property, Plant and Equipment [Line Items]
Property and equipment useful life	10 years
Leasehold Improvements [Member]
Property, Plant and Equipment [Line Items]
Leasehold improvements	Lesser of useful life or lease term

Leases (Amounts Reported in Condensed Consolidated Balance Sheets for Operating Leases) (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Leases [Abstract]
Operating lease assets, net	$ 37,991	$ 21,111
Short-term operating lease liabilities (in accrued expenses)	$ 9,283	$ 7,234
Operating lease, liability, current, statement of financial position [Extensible List]	us-gaap:AccruedLiabilitiesCurrent	us-gaap:AccruedLiabilitiesCurrent
Long-term operating lease liabilities	$ 35,516	$ 14,301
Total operating lease liabilities	$ 44,799	$ 21,535

Leases (Narrative) (Details) $ in Millions	12 Months Ended
Leases (Narrative) (Details) $ in Millions	Dec. 31, 2020 USD ($) ft²	Dec. 31, 2018 USD ($)
Lessee Lease [Line Items]
Rent expense		$ 6.0
Sublease income recognized		$ 0.3
Downers Grove [Member]
Lessee Lease [Line Items]
Area of office space sublet \| ft²	21,000
Frisco Corporate Headquarter [Member]
Lessee Lease [Line Items]
Lease agreement term	11 years
Area of space after expand \| ft²	75,000
Increase in the operating lease asset, net	$ 17.0
Increase in operating lease liability	$ 22.6
Frisco Corporate Headquarter [Member] \| Frisco [Member]
Lessee Lease [Line Items]
Area of office space sublet \| ft²	12,000

Leases (Components of Lease Cost Reported in General and Administrative Expenses in Condensed Consolidated Statements of Income) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Leases [Abstract]
Operating lease costs	$ 9,197	$ 7,219
Short-term lease costs	761	585
Less: sublease income	323	312
Total lease cost, net	$ 9,635	$ 7,492

Leases (Schedule of Weighted Average Remaining Lease Terms and Discount Rates) (Details)	Dec. 31, 2020	Dec. 31, 2019
Leases [Abstract]
Weighted average remaining lease term	6 years 11 months 19 days	3 years 5 months 1 day
Weighted average discount rate	4.18%	5.14%

Leases (Summary of Future Minimum Remaining Operating Lease Payments on Non-cancelable Leases) (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Leases [Abstract]
Year 1	$ 10,681
Year 2	9,007
Year 3	6,977
Year 4	5,231
Year 5	3,521
Thereafter	16,514
Total future minimum rental commitments	51,931
Less: Imputed interest	(7,132)
Total lease liabilities	$ 44,799	$ 21,535

Leases (Supplemental Cash Flows Information) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$ 8,769	$ 7,574
Right-of-use assets obtained in exchange for lease obligations:
Operating leases	$ 25,807	$ 10,299

Public Offering (Narrative) (Details) - USD ($) $ / shares in Units, $ in Thousands					12 Months Ended
	Oct. 01, 2019	Sep. 09, 2019	Aug. 22, 2018	Aug. 20, 2018	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Class Of Stock [Line Items]
Common stock, par value					$ 0.001	$ 0.001
Proceeds from issuance of common stock, net of issuance costs						$ 172,945	$ 76,618
Business acquisition purchase price					$ 207,660	184,076	62,440
Increase to additional paid in capital from public offering						$ 172,945	76,618
Issuance costs							$ 5,400
Term Loan [Member] \| Credit Facility [Member]
Class Of Stock [Line Items]
Repayment of credit facility			$ 102,600
Hospice Partners of America, LLC [Member]
Class Of Stock [Line Items]
Business acquisition purchase price	$ 130,000
Common Stock [Member]
Class Of Stock [Line Items]
Shares issued during period		2,300,000		2,100,000		2,300,000	1,390,000
Common stock, par value		$ 0.001		$ 0.001
Public offering price, per share		$ 79.50
Proceeds from issuance of common stock, net of issuance costs		$ 172,900
Underwriting discounts and estimated offering expenses		$ 9,900
Increase to additional paid in capital from public offering						$ 2	$ 1
Purchase price per share				$ 59.00
Additional Paid-in Capital [Member]
Class Of Stock [Line Items]
Increase to additional paid in capital from public offering						$ 172,943	$ 76,617
Over-Allotment Option [Member] \| Common Stock [Member]
Class Of Stock [Line Items]
Shares issued during period		300,000	315,000
Proceeds from issuance of common stock, net of issuance costs			$ 17,500
Primary Shares [Member] \| Common Stock [Member]
Class Of Stock [Line Items]
Shares issued during period				1,075,267
Proceeds from issuance of common stock, net of issuance costs				$ 59,100
Secondary Shares [Member] \| Common Stock [Member]
Class Of Stock [Line Items]
Shares issued during period				1,024,733

Acquisitions (Narrative) (Details)													1 Months Ended	3 Months Ended								12 Months Ended
Acquisitions (Narrative) (Details)	Dec. 04, 2020 USD ($)	Nov. 01, 2020 USD ($)	Jul. 01, 2020 USD ($)	Oct. 01, 2019 USD ($) location $ / shares shares	Sep. 09, 2019 $ / shares shares	Aug. 01, 2019 USD ($)	Jun. 01, 2019 USD ($)	Aug. 22, 2018 shares	Aug. 20, 2018 $ / shares shares	May 01, 2018 USD ($)	Apr. 01, 2018 USD ($)	Jan. 01, 2018 USD ($)	Sep. 30, 2018 USD ($)	Dec. 31, 2020 USD ($) $ / shares	Sep. 30, 2020 USD ($)	Jun. 30, 2020 USD ($)	Mar. 31, 2020 USD ($)	Dec. 31, 2019 USD ($) $ / shares	Sep. 30, 2019 USD ($)	Jun. 30, 2019 USD ($)	Mar. 31, 2019 USD ($)	Dec. 31, 2020 USD ($) $ / shares	Dec. 31, 2019 USD ($) $ / shares shares	Dec. 31, 2018 USD ($) shares
Business Acquisition [Line Items]
Total purchase price for business acquisition																						$ 207,660,000	$ 184,076,000	$ 62,440,000
Net service revenues														$ 195,996,000	$ 193,987,000	$ 184,576,000	$ 190,216,000	$ 192,376,000	$ 168,993,000	$ 148,915,000	$ 138,507,000	764,775,000	648,791,000	516,647,000
Operating income (loss) from continuing operations																						41,942,000	33,170,000	20,403,000
Goodwill														$ 469,072,000				$ 275,368,000				$ 469,072,000	$ 275,368,000	$ 135,442,000
Common stock, par value \| $ / shares														$ 0.001				$ 0.001				$ 0.001	$ 0.001
Minimum [Member]
Business Acquisition [Line Items]
Intangible assets, estimated useful lives																						1 year
Maximum [Member]
Business Acquisition [Line Items]
Intangible assets, estimated useful lives																						25 years
Common Stock [Member]
Business Acquisition [Line Items]
Shares issued during period \| shares					2,300,000				2,100,000														2,300,000	1,390,000
Common stock, par value \| $ / shares					$ 0.001				$ 0.001
Public offering price, per share \| $ / shares									$ 59.00
Over Allotment Option [Member] \| Common Stock [Member]
Business Acquisition [Line Items]
Shares issued during period \| shares					300,000			315,000
State Licenses [Member]
Business Acquisition [Line Items]
Identifiable intangible assets acquired							$ 10,700,000
Customer Relationships [Member]
Business Acquisition [Line Items]
Identifiable intangible assets acquired							4,700,000
Queen City Hospice [Member]
Business Acquisition [Line Items]
Goodwill	$ 169,207,000
Queen City Hospice [Member] \| Trade Names [Member]
Business Acquisition [Line Items]
Intangible assets, estimated useful lives																						15 years
Identifiable intangible assets acquired	$ 11,000,000.0																					$ 11,000,000.0
Queen City Hospice [Member] \| Non-competition Agreements [Member]
Business Acquisition [Line Items]
Intangible assets, estimated useful lives	5 years
Identifiable intangible assets acquired	$ 1,500,000																					1,500,000
Queen City Hospice [Member] \| State Licenses [Member]
Business Acquisition [Line Items]
Identifiable intangible assets acquired																						7,500,000
Indefinite lived intangible assets acquired	7,500,000
Queen City Hospice [Member] \| Ohio [Member]
Business Acquisition [Line Items]
Total purchase price for business acquisition	194,800,000
Acquisition related costs																						1,800,000
Integration costs																						100,000
Excess cash held by acquired business	$ 15,400,000
Net service revenues																						4,900,000
Operating income (loss) from continuing operations																						$ 600,000
County Homemakers [Member]
Business Acquisition [Line Items]
Goodwill		$ 13,363,000
County Homemakers [Member] \| Trade Names [Member]
Business Acquisition [Line Items]
Intangible assets, estimated useful lives																						1 year
Identifiable intangible assets acquired		$ 100,000																				$ 100,000
County Homemakers [Member] \| State Licenses [Member]
Business Acquisition [Line Items]
Intangible assets, estimated useful lives		8 years
Identifiable intangible assets acquired		$ 300,000																				300,000
County Homemakers [Member] \| Pennsylvania [Member]
Business Acquisition [Line Items]
Total purchase price for business acquisition		15,800,000
Acquisition related costs																						300,000
Integration costs																						200,000
Excess cash held by acquired business		$ 1,100,000
Net service revenues																						2,300,000
Operating income (loss) from continuing operations																						$ 200,000
A Plus Health Care, Inc [Member]
Business Acquisition [Line Items]
Goodwill			$ 9,698,000
A Plus Health Care, Inc [Member] \| Trade Names [Member]
Business Acquisition [Line Items]
Intangible assets, estimated useful lives																						15 years
Identifiable intangible assets acquired			1,400,000																			$ 1,400,000
A Plus Health Care, Inc [Member] \| Montana [Member]
Business Acquisition [Line Items]
Total purchase price for business acquisition			14,500,000
Acquisition related costs																						400,000
Integration costs																						300,000
Excess cash held by acquired business			$ 2,800,000
Net service revenues																						4,900,000
Operating income (loss) from continuing operations																						1,000,000.0
SunLife Hospice [Member]
Business Acquisition [Line Items]
Total purchase price for business acquisition																						1,700,000
Goodwill														$ 1,600,000								1,600,000
Hospice Partners [Member]
Business Acquisition [Line Items]
Total purchase price for business acquisition				$ 135,600,000
Acquisition related costs																							$ 1,600,000
Integration costs																							600,000
Excess cash held by acquired business				5,500,000
Net service revenues																							14,800,000
Operating income (loss) from continuing operations																							2,300,000
Goodwill				$ 111,806,000
Number of locations \| location				21
Hospice Partners [Member] \| Common Stock [Member]
Business Acquisition [Line Items]
Shares issued during period \| shares				2,300,000,000
Common stock, par value \| $ / shares				$ 0.001
Public offering price, per share \| $ / shares				$ 79.50
Hospice Partners [Member] \| Over Allotment Option [Member]
Business Acquisition [Line Items]
Integration costs																						$ 1,600,000
Hospice Partners [Member] \| Over Allotment Option [Member] \| Common Stock [Member]
Business Acquisition [Line Items]
Shares issued during period \| shares				300,000,000
Hospice Partners [Member] \| Trade Names [Member]
Business Acquisition [Line Items]
Intangible assets, estimated useful lives																						15 years
Identifiable intangible assets acquired				$ 9,500,000
Hospice Partners [Member] \| Non-competition Agreements [Member]
Business Acquisition [Line Items]
Identifiable intangible assets acquired				$ 2,500,000
Hospice Partners [Member] \| Non-competition Agreements [Member] \| Minimum [Member]
Business Acquisition [Line Items]
Intangible assets, estimated useful lives				3 years
Hospice Partners [Member] \| Non-competition Agreements [Member] \| Maximum [Member]
Business Acquisition [Line Items]
Intangible assets, estimated useful lives				5 years
Hospice Partners [Member] \| State Licenses [Member]
Business Acquisition [Line Items]
Indefinite lived intangible assets acquired				$ 6,100,000
Alliance Home Health Care [Member]
Business Acquisition [Line Items]
Total purchase price for business acquisition						$ 23,500,000
Acquisition related costs																							400,000
Integration costs																						$ 200,000	400,000
Goodwill						17,062,000
Alliance Home Health Care [Member] \| State Licenses [Member]
Business Acquisition [Line Items]
Intangible assets, estimated useful lives																						10 years
Identifiable intangible assets acquired						1,100,000
Indefinite lived intangible assets acquired						$ 4,300,000
Alliance Home Health Care [Member] \| New York [Member]
Business Acquisition [Line Items]
Net service revenues																							8,800,000
Operating income (loss) from continuing operations																							2,100,000
VIP Health Care Services [Member]
Business Acquisition [Line Items]
Total purchase price for business acquisition							29,900,000
Acquisition related costs																							300,000
Integration costs																						$ 200,000	500,000
Goodwill							$ 11,936,000
VIP Health Care Services [Member] \| State Licenses [Member]
Business Acquisition [Line Items]
Intangible assets, estimated useful lives																						6 years
VIP Health Care Services [Member] \| Customer Relationships [Member]
Business Acquisition [Line Items]
Intangible assets, estimated useful lives																						8 years
VIP Health Care Services [Member] \| New York [Member]
Business Acquisition [Line Items]
Net service revenues																							30,000,000.0
Operating income (loss) from continuing operations																							(200,000)
Ambercare Corporation [Member]
Business Acquisition [Line Items]
Goodwill										$ 28,831,000
Ambercare Corporation [Member] \| Trade Name and Customer Relationships [Member] \| Minimum [Member]
Business Acquisition [Line Items]
Intangible assets, estimated useful lives																						3 years
Ambercare Corporation [Member] \| Trade Name and Customer Relationships [Member] \| Maximum [Member]
Business Acquisition [Line Items]
Intangible assets, estimated useful lives																						15 years
Ambercare Corporation [Member] \| New Mexico [Member]
Business Acquisition [Line Items]
Acquisition related costs																								$ 800,000
Integration costs																							200,000	1,600,000
Excess cash held by acquired business										12,000,000.0
Net service revenues																								36,700,000
Operating income (loss) from continuing operations																								7,100,000
Total purchase price for business acquisition										$ 39,600,000
Arcadia Home Care And Staffing [Member]
Business Acquisition [Line Items]
Acquisition related costs																								800,000
Integration costs																							$ 200,000	1,100,000
Net service revenues																								32,700,000
Operating income (loss) from continuing operations																								4,700,000
Goodwill											$ 13,072,000
Total purchase price for business acquisition											$ 18,900,000
Arcadia Home Care And Staffing [Member] \| Trade Names, Customer Relationships and State Licenses [Member] \| Minimum [Member]
Business Acquisition [Line Items]
Intangible assets, estimated useful lives																						7 years
Arcadia Home Care And Staffing [Member] \| Trade Names, Customer Relationships and State Licenses [Member] \| Maximum [Member]
Business Acquisition [Line Items]
Intangible assets, estimated useful lives																						15 years
Affiliate Branches of Arcadia [Member]
Business Acquisition [Line Items]
Goodwill													$ 600,000
Acquisitions of business cash consideration													$ 600,000
Lifestyle Options, Inc. [Member]
Business Acquisition [Line Items]
Goodwill												$ 2,751,000
Lifestyle Options, Inc. [Member] \| Trade Name and Customer Relationships [Member] \| Minimum [Member]
Business Acquisition [Line Items]
Intangible assets, estimated useful lives																						10 years
Lifestyle Options, Inc. [Member] \| Trade Name and Customer Relationships [Member] \| Maximum [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																								5,800,000
Operating income (loss) from continuing operations																								500,000
Total purchase price for business acquisition												4,100,000
Acquisitions of business cash consideration												3,300,000
Business acquisition, contingent earn-out obligation												$ 800,000
Contingent consideration, remeasured																								$ 0

Acquisitions (Schedule of Fair Values of Assets and Liabilities) (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 04, 2020	Nov. 01, 2020	Jul. 01, 2020	Dec. 31, 2019	Oct. 01, 2019	Aug. 01, 2019	Jun. 01, 2019	Dec. 31, 2018	May 01, 2018	Apr. 01, 2018	Jan. 01, 2018
Business Acquisition [Line Items]
Goodwill	$ 469,072				$ 275,368				$ 135,442
Queen City Hospice [Member]
Business Acquisition [Line Items]
Goodwill		$ 169,207
Identifiable intangible assets		20,015
Cash		15,444
Property and equipment		759
Accounts receivable		5,835
Operating lease assets, net		3,028
Other assets		121
Accounts payable		(2,092)
Accrued expenses		(503)
Accrued payroll		(1,598)
Long-term operating lease liabilities		(2,765)
Government stimulus advances		(12,694)
Total purchase price		$ 194,757
County Homemakers [Member]
Business Acquisition [Line Items]
Goodwill			$ 13,363
Identifiable intangible assets			474
Cash			1,104
Property and equipment			52
Accounts receivable			1,387
Operating lease assets, net			485
Other assets			40
Accounts payable			(19)
Accrued expenses			(37)
Accrued payroll			(543)
Long-term operating lease liabilities			(485)
Total purchase price			$ 15,821
A Plus Health Care, Inc [Member]
Business Acquisition [Line Items]
Goodwill				$ 9,698
Identifiable intangible assets				1,523
Cash				2,819
Accounts receivable				1,075
Operating lease assets, net				180
Other assets				26
Accounts payable				(21)
Accrued expenses				(362)
Accrued payroll				(311)
Long-term operating lease liabilities				(100)
Total purchase price				$ 14,527
Hospice Partners [Member]
Business Acquisition [Line Items]
Goodwill						$ 111,806
Identifiable intangible assets						18,090
Cash						5,489
Property and equipment						164
Accounts receivable						6,411
Operating lease assets, net						2,425
Other assets						702
Accounts payable						(1,737)
Accrued expenses						(3,635)
Accrued payroll						(1,110)
Deferred tax liability						(1,422)
Long-term operating lease liabilities						(1,615)
Total purchase price						$ 135,568
Alliance Home Health Care [Member]
Business Acquisition [Line Items]
Goodwill							$ 17,062
Identifiable intangible assets							5,422
Cash							177
Accounts receivable							1,754
Accounts payable							(316)
Other liabilities							(641)
Total purchase price							$ 23,458
VIP Health Care Services [Member]
Business Acquisition [Line Items]
Goodwill								$ 11,936
Identifiable intangible assets								15,370
Cash								130
Property and equipment								27
Accounts receivable								4,730
Operating lease assets, net								2,278
Other assets								30
Accounts payable								(540)
Accrued expenses								(770)
Accrued payroll								(1,742)
Long-term operating lease liabilities								(1,531)
Total purchase price								$ 29,918
Ambercare Corporation [Member]
Business Acquisition [Line Items]
Goodwill										$ 28,831
Identifiable intangible assets										9,944
Cash										12,028
Property and equipment										154
Accounts receivable										6,512
Other assets										442
Financing lease										(75)
Accounts payable										(3)
Accrued expenses										(4,073)
Deferred tax liability										(2,138)
Total purchase price										$ 51,622
Arcadia Home Care And Staffing [Member]
Business Acquisition [Line Items]
Goodwill											$ 13,072
Identifiable intangible assets											2,264
Property and equipment											155
Accounts receivable											5,317
Other assets											92
Accounts payable											(508)
Accrued expenses											(1,540)
Total purchase price											$ 18,852
Lifestyle Options, Inc. [Member]
Business Acquisition [Line Items]
Goodwill												$ 2,751
Identifiable intangible assets												1,152
Property and equipment												18
Accounts receivable												573
Other assets												32
Accounts payable												(105)
Accrued expenses												(291)
Total purchase price												$ 4,130

Acquisitions (Unaudited Pro Forma Condensed Consolidated Income Statement Information) (Details) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Queen City Hospice, A Plus and County Homemakers [Member]
Business Acquisition [Line Items]
Net service revenues	$ 831,290
Operating income from continuing operations	45,555
Net income from continuing operations	$ 34,564
Basic income per share	$ 2.22
Diluted income per share	$ 2.17
Hospice Partners, Alliance and VIP [Member]
Business Acquisition [Line Items]
Net service revenues		$ 726,727
Operating income from continuing operations		46,571
Net income from continuing operations		$ 35,748
Basic income per share		$ 2.59
Diluted income per share		$ 2.51
Ambercare Arcadia and Life Style {Member]
Business Acquisition [Line Items]
Net service revenues			$ 550,326
Operating income from continuing operations			36,985
Net income from continuing operations			$ 24,346
Basic income per share			$ 2.02
Diluted income per share			$ 1.97

Property and Equipment (Schedule of Property and Equipment) (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 34,714	$ 22,183
Less: accumulated depreciation and amortization	(14,965)	(10,027)
Property and equipment, net	19,749	12,156
Computer Equipment [Member]
Property, Plant and Equipment [Line Items]
Property and equipment, gross	8,135	5,304
Furniture and Equipment [Member]
Property, Plant and Equipment [Line Items]
Property and equipment, gross	5,097	3,410
Transportation Equipment [Member]
Property, Plant and Equipment [Line Items]
Property and equipment, gross	199	157
Leasehold Improvements [Member]
Property, Plant and Equipment [Line Items]
Property and equipment, gross	9,402	3,749
Computer Software [Member]
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 11,881	$ 9,563

Property and Equipment (Narrative) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Property, Plant and Equipment [Line Items]
Property and equipment	$ 34,714	$ 22,183
Depreciation and amortization	12,051	10,574	$ 8,642
Internally Developed Software [Member]
Property, Plant and Equipment [Line Items]
Property and equipment	1,700	1,600
Depreciation and amortization	$ 5,000	$ 4,000	$ 2,500

Goodwill and Intangible Assets (Narrative) (Details) - USD ($)					12 Months Ended
	Dec. 04, 2020	Nov. 01, 2020	Jul. 01, 2020	Jun. 01, 2019	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Goodwill [Line Items]
Goodwill					$ 469,072,000	$ 275,368,000	$ 135,442,000
Adjustment of goodwill related to divestiture					$ 1,167,000
Discount rate used in goodwill impairment analysis					8.50%
Percent of fair value of reporting unit excess of carrying value					90.00%
Goodwill impairment charge					$ 0	0	0
Amortization expense					$ 7,100,000	6,600,000	6,200,000
Weighted average remaining useful lives of identifiable intangible assets					9 years 9 months 18 days
State Licenses [Member]
Goodwill [Line Items]
Finite-lived intangible assets related to acquisition				$ 10,700,000
Customer Relationships [Member]
Goodwill [Line Items]
Finite-lived intangible assets related to acquisition				$ 4,700,000
Minimum [Member]
Goodwill [Line Items]
Long-term revenue growth rate assumed in goodwill impairment analysis					5.00%
Intangible assets, estimated useful lives					1 year
Minimum [Member] \| Customer and Referral Relationships [Member]
Goodwill [Line Items]
Intangible assets, estimated useful lives					5 years
Maximum [Member]
Goodwill [Line Items]
Long-term revenue growth rate assumed in goodwill impairment analysis					5.50%
Intangible assets, estimated useful lives					25 years
Maximum [Member] \| Customer and Referral Relationships [Member]
Goodwill [Line Items]
Intangible assets, estimated useful lives					10 years
Hospice [Member]
Goodwill [Line Items]
Goodwill					$ 314,833,000	146,983,000	22,200,000
Adjustment of goodwill related to divestiture					1,167,000
Personal Care [Member]
Goodwill [Line Items]
Goodwill					152,448,000	$ 126,577,000	$ 112,377,000
Queen City Hospice [Member]
Goodwill [Line Items]
Goodwill	$ 169,207,000
Queen City Hospice [Member] \| State Licenses [Member]
Goodwill [Line Items]
Finite-lived intangible assets related to acquisition					$ 7,500,000
Queen City Hospice [Member] \| Trade Names [Member]
Goodwill [Line Items]
Intangible assets, estimated useful lives					15 years
Finite-lived intangible assets related to acquisition	$ 11,000,000.0				$ 11,000,000.0
Queen City Hospice [Member] \| Non-competition Agreements [Member]
Goodwill [Line Items]
Intangible assets, estimated useful lives	5 years
Finite-lived intangible assets related to acquisition	$ 1,500,000				1,500,000
Queen City Hospice [Member] \| Hospice [Member]
Goodwill [Line Items]
Goodwill	$ 169,200,000
County Homemakers, A Plus and SunLife [Member] \| Personal Care [Member]
Goodwill [Line Items]
Goodwill					24,700,000
County Homemakers [Member]
Goodwill [Line Items]
Goodwill		$ 13,363,000
County Homemakers [Member] \| State Licenses [Member]
Goodwill [Line Items]
Intangible assets, estimated useful lives		8 years
Finite-lived intangible assets related to acquisition		$ 300,000			$ 300,000
County Homemakers [Member] \| Trade Names [Member]
Goodwill [Line Items]
Intangible assets, estimated useful lives					1 year
Finite-lived intangible assets related to acquisition		$ 100,000			$ 100,000
A Plus Health Care, Inc [Member]
Goodwill [Line Items]
Goodwill			$ 9,698,000
A Plus Health Care, Inc [Member] \| Trade Names [Member]
Goodwill [Line Items]
Intangible assets, estimated useful lives					15 years
Finite-lived intangible assets related to acquisition			$ 1,400,000		$ 1,400,000
General and Administrative Expense [Member]
Goodwill [Line Items]
Loss of disposal of assets					$ 300,000

Goodwill and Intangible Assets (Summary of Goodwill and Related Adjustments) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Goodwill [Line Items]
Goodwill, at Beginning of Period	$ 275,368	$ 135,442
Additions for acquisitions	193,867	140,059
Divestiture	(1,167)
Adjustments to previously recorded goodwill	1,004	(133)
Goodwill, at End of Period	469,072	275,368
Hospice [Member]
Goodwill [Line Items]
Goodwill, at Beginning of Period	146,983	22,200
Additions for acquisitions	169,207	124,750
Divestiture	(1,167)
Adjustments to previously recorded goodwill	(190)	33
Goodwill, at End of Period	314,833	146,983
Personal Care [Member]
Goodwill [Line Items]
Goodwill, at Beginning of Period	126,577	112,377
Additions for acquisitions	24,660	14,368
Adjustments to previously recorded goodwill	1,211	(168)
Goodwill, at End of Period	152,448	126,577
Home Health [Member]
Goodwill [Line Items]
Goodwill, at Beginning of Period	1,808	865
Additions for acquisitions		941
Adjustments to previously recorded goodwill	(17)	2
Goodwill, at End of Period	$ 1,791	$ 1,808

Goodwill and Intangible Assets (Schedule of Carrying Amount and Accumulated Amortization of Intangible Asset) (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Finite Lived Intangible Assets [Line Items]
Intangible assets with indefinite lives	$ 20,791	$ 13,306
Intangible assets subject to amortization:
Gross carrying amount	106,330	95,739
Accumulated amortization	(55,572)	(51,966)
Intangible assets subject to amortization, net	50,758	43,773
Net balance at end of period	71,549	57,079
Customer and Referral Relationships [Member]
Intangible assets subject to amortization:
Gross carrying amount	44,672	48,028
Accumulated amortization	(34,439)	(35,665)
Intangible assets subject to amortization, net	10,233	12,363
Net balance at end of period	10,233	12,363
Trade Names and Trademarks [Member]
Intangible assets subject to amortization:
Gross carrying amount	42,926	31,036
Accumulated amortization	(15,191)	(12,941)
Intangible assets subject to amortization, net	27,735	18,095
Net balance at end of period	27,735	18,095
Non-competition Agreements [Member]
Intangible assets subject to amortization:
Gross carrying amount	6,225	4,655
Accumulated amortization	(2,887)	(2,234)
Intangible assets subject to amortization, net	3,338	2,421
Net balance at end of period	3,338	2,421
State Licenses [Member]
Finite Lived Intangible Assets [Line Items]
Intangible assets with indefinite lives	20,791	13,306
Intangible assets subject to amortization:
Gross carrying amount	12,507	12,020
Accumulated amortization	(3,055)	(1,126)
Intangible assets subject to amortization, net	9,452	10,894
Net balance at end of period	$ 30,243	$ 24,200

Goodwill And Intangible Assets (Schedule of Future Amortization of Intangible Assets) (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Finite-Lived Intangible Assets, Net, Amortization Expense, Fiscal Year Maturity [Abstract]
2021	$ 7,711
2022	6,582
2023	6,098
2024	5,855
2025	4,232
Thereafter	20,280
Intangible assets subject to amortization, net	$ 50,758	$ 43,773

Details of Certain Balance Sheet Accounts (Schedule of Prepaid Expenses and Other Current Assets) (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Details Of Certain Balance Sheet Accounts [Abstract]
Prepaid workers’ compensation and liability insurance	$ 2,838	$ 2,040
Workers’ compensation insurance receivable	1,860	1,989
Health insurance receivable	528	1,567
Other	4,743	2,397
Total prepaid expenses and other current assets	$ 9,969	$ 7,993

Details of Certain Balance Sheet Accounts (Schedule of Accrued Expenses) (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Details Of Certain Balance Sheet Accounts [Abstract]
Current portion of operating lease liabilities	$ 9,283	$ 7,234
Accrued health insurance	5,607	4,140
Accrued professional fees	4,220	2,517
Payor advances	4,206
Accrued payroll taxes	4,543	1,843
Other	9,705	6,695
Total accrued expenses	$ 37,564	$ 22,429

Details of Certain Balance Sheet Accounts (Schedule of Accrued Expenses) (Parenthetical) (Details) $ in Millions	Dec. 31, 2020 USD ($)
CARES Act [Member]
Schedule Of Accrued Expenses [Line Items]
Deferred payor advance	$ 4.2

Details of Certain Balance Sheet Accounts (Schedule of Government Stimulus Advances) (Details) $ in Thousands	Dec. 31, 2020 USD ($)
Details Of Certain Balance Sheet Accounts [Line Items]
Provider Relief Fund	$ 12,252
Payroll tax deferral	7,141
Total government stimulus advances	32,087
Queen City Hospice [Member]
Details Of Certain Balance Sheet Accounts [Line Items]
Provider Relief Fund	1,893
CMS advanced payment program - Queen City Hospice	$ 10,801

Details of Certain Balance Sheet Accounts (Narrative) (Details) - USD ($)	1 Months Ended			12 Months Ended
	Nov. 30, 2020	Jun. 30, 2020	Apr. 30, 2020	Dec. 31, 2020
Details Of Certain Balance Sheet Accounts [Line Items]
Payroll tax deferral				$ 7,141,000
Queen City Hospice [Member]
Details Of Certain Balance Sheet Accounts [Line Items]
CMS advanced payment program - Queen City Hospice				10,801,000
CARES Act [Member]
Details Of Certain Balance Sheet Accounts [Line Items]
Payroll tax deferral			$ 7,100,000
Repayment of deferred payroll taxes in 2021			7,000,000
CARES Act [Member] \| Provider Relief Fund [Member]
Details Of Certain Balance Sheet Accounts [Line Items]
Aggregate principal amount of grants received	$ 13,700,000		6,900,000
Repayment of grants		$ 6,900,000
Fund distributed to health care related expenses				$ 1,400,000
CARES Act [Member] \| Provider Relief Fund [Member] \| Queen City Hospice [Member]
Details Of Certain Balance Sheet Accounts [Line Items]
Aggregate principal amount of grants received			2,500,000
Repayment of grants			1,900,000
Fund distributed to health care related expenses			600,000
CARES Act [Member] \| Provider Relief Fund [Member] \| Minimum [Member]
Details Of Certain Balance Sheet Accounts [Line Items]
Annual awards for commercial organizations			750,000
CARES Act [Member] \| Medicare Accelerated And Advance Payment Program [Member] \| Queen City Hospice [Member]
Details Of Certain Balance Sheet Accounts [Line Items]
Repayment of grants			0
CMS advanced payment program - Queen City Hospice			$ 10,800,000
Repayment of funds period			2021-03
CARES Act [Member] \| Medicare Accelerated And Advance Payment Program [Member] \| Hospice and Home Health [Member]
Details Of Certain Balance Sheet Accounts [Line Items]
Medicare payment period			3 months
CARES Act [Member] \| Medicare Accelerated And Advance Payment Program [Member] \| Maximum [Member] \| Hospice and Home Health [Member]
Details Of Certain Balance Sheet Accounts [Line Items]
Request percentage of advance or accelerated payment			100.00%

Long-Term Debt (Schedule of Long-Term Debt) (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Debt Instrument [Line Items]
Financing leases		$ 21
Less unamortized issuance costs	$ (1,716)	(2,452)
Total	194,872	59,892
Less current maturities	(971)	(728)
Long-term debt	193,901	59,164
Revolving Credit Loan [Member] \| Senior Secured Credit Facility [Member]
Debt Instrument [Line Items]
Long-term debt gross	178,458	43,458
Term Loan [Member] \| Senior Secured Credit Facility [Member]
Debt Instrument [Line Items]
Long-term debt gross	$ 18,130	$ 18,865

Long-Term Debt (Narrative) (Details) - USD ($)				1 Months Ended	12 Months Ended
Long-Term Debt (Narrative) (Details) - USD ($)	Sep. 12, 2019	Aug. 01, 2019	Jun. 01, 2019	Oct. 31, 2018	Dec. 31, 2020	Dec. 31, 2019
Debt Instrument [Line Items]
Debt issuance costs					$ 1,716,000	$ 2,452,000
Credit Agreement [Member] \| Capital One, National Association [Member]
Debt Instrument [Line Items]
Maximum aggregate loan amount available				$ 269,600,000	112,600,000	191,400,000
Debt instrument, maturity date				May 08, 2023
Debt instrument total net leverage ratio				4.25%
Debt issuance costs				$ 900,000
Line of credit outstanding amount					9,000,000.0	10,000,000.0
Credit Agreement [Member] \| Capital One, National Association [Member] \| Delayed Draw Term Loan [Member]
Debt Instrument [Line Items]
Maximum aggregate loan amount available				$ 19,600,000
Credit Agreement [Member] \| Capital One, National Association [Member] \| Delayed Draw Term Loan [Member] \| Alliance Home Health Care [Member]
Debt Instrument [Line Items]
Proceeds from line of credit		$ 23,500,000
Credit Agreement [Member] \| Capital One, National Association [Member] \| Term Loan [Member]
Debt Instrument [Line Items]
Line of credit outstanding amount					$ 18,100,000	$ 18,900,000
Debt instrument stated interest rate					1.90%	3.45%
Credit Agreement [Member] \| Capital One, National Association [Member] \| Revolving Credit Loan [Member] \| VIP Health Care Services [Member]
Debt Instrument [Line Items]
Proceeds from line of credit			$ 19,600,000
Credit Agreement [Member] \| Capital One, National Association [Member] \| Maximum [Member]
Debt Instrument [Line Items]
Debt instrument total net leverage ratio				3.75%
Credit Agreement [Member] \| Capital One, National Association [Member] \| Federal Funds Rate [Member]
Debt Instrument [Line Items]
Debt instrument variable interest rate margin				0.50%
Credit Agreement [Member] \| Capital One, National Association [Member] \| London Interbank Offered Rate (LIBOR)
Debt Instrument [Line Items]
Debt instrument variable interest rate margin				1.00%
Credit Agreement [Member] \| Capital One, National Association [Member] \| London Interbank Offered Rate (LIBOR) \| Minimum [Member]
Debt Instrument [Line Items]
Debt instrument variable interest rate margin				0.00%
Credit Agreement [Member] \| Capital One, National Association [Member] \| Based On Applicable Senior Leverage Ratio \| Minimum [Member]
Debt Instrument [Line Items]
Debt instrument variable interest rate margin				0.75%
Credit Agreement [Member] \| Capital One, National Association [Member] \| Based On Applicable Senior Leverage Ratio \| Maximum [Member]
Debt Instrument [Line Items]
Debt instrument variable interest rate margin				1.50%
Credit Agreement [Member] \| Capital One, National Association [Member] \| Based On Applicable Leverage Ratio [Member] \| Minimum [Member]
Debt Instrument [Line Items]
Debt instrument variable interest rate margin				1.75%
Credit Agreement [Member] \| Capital One, National Association [Member] \| Based On Applicable Leverage Ratio [Member] \| Maximum [Member]
Debt Instrument [Line Items]
Debt instrument variable interest rate margin				2.50%
Credit Agreement [Member] \| Capital One, National Association [Member] \| Restriction on Dividends [Member] \| Maximum [Member]
Debt Instrument [Line Items]
Aggregate amount of dividends and distributions					$ 7,500,000
Credit Agreement [Member] \| Revolving Credit Loan [Member] \| Capital One, National Association [Member]
Debt Instrument [Line Items]
Maximum aggregate loan amount available	$ 300,000,000.0			$ 250,000,000.0
Increase in credit facility	50,000,000.0
Debt issuance costs	$ 400,000
Line of credit outstanding amount					$ 178,500,000	$ 43,400,000
Debt instrument stated interest rate					1.90%	3.44%
Credit Agreement [Member] \| Revolving Credit Loan [Member] \| Capital One, National Association [Member] \| Queen City Hospice [Member]
Debt Instrument [Line Items]
Proceeds from line of credit					$ 135,000,000.0
Credit Agreement [Member] \| Revolving Credit Loan [Member] \| Capital One, National Association [Member] \| Minimum [Member]
Debt Instrument [Line Items]
Fee charged on unused portion of revolving credit facility					0.20%
Credit Agreement [Member] \| Revolving Credit Loan [Member] \| Capital One, National Association [Member] \| Maximum [Member]
Debt Instrument [Line Items]
Fee charged on unused portion of revolving credit facility					0.35%

Income Taxes (Current and Deferred Federal and State Income Tax Provision from Continuing Operations) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Current
Federal	$ 10,230	$ 5,876	$ 2,883
State	3,312	2,442	1,562
Deferred
Federal	(3,690)	(734)	(265)
State	(1,043)	(225)	(84)
Provision for income taxes	$ 8,809	$ 7,359	$ 4,096

- Definition

Amount of current income tax expense (benefit) and deferred income tax expense (benefit) pertaining to continuing operations.

+ References + Details

Income Taxes (Deferred Tax Assets And Liabilities) (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Income Tax Expense Benefit Continuing Operations Income Tax Reconciliation [Abstract]
Deferred Tax Assets, Accounts receivable allowances	$ 14,023	$ 9,256
Deferred Tax Assets, Accrued compensation	3,580	2,765
Deferred Tax Assets, Accrued workers' compensation	3,220	3,327
Deferred Tax Assets, Transactions Costs	1,677	1,311
Deferred Tax Assets, Restructuring costs	108	135
Deferred Tax Assets, Stock-based compensation	833	793
Deferred Tax Assets, Government stimulus advances	1,933
Deferred Tax Assets, Operating lease liabilities	12,123	5,896
Deferred Tax Assets, Other	1,269	584
Total long-term deferred tax assets	38,766	24,067
Deferred Tax Liabilities, Goodwill and intangible assets	(18,891)	(15,079)
Deferred Tax Liabilities, Property and equipment	(3,217)	(1,037)
Deferred Tax Liabilities, Prepaid insurance		(534)
Deferred Tax Liabilities, Operating lease assets, net	(10,052)	(5,606)
Deferred Tax Liabilities, Other	(82)	(164)
Total long-term deferred tax liabilities	(32,242)	(22,420)
Total net deferred tax assets	$ 6,524	$ 1,647

Income Taxes (Narrative) (Details)	12 Months Ended
Income Taxes (Narrative) (Details)	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Statutory federal tax rate	21.00%	21.00%	21.00%
Effective income tax rate	21.00%	22.20%	20.10%
U.S Federal authorities [Member] \| Minimum [Member]
Tax year open for examination	2017
U.S Federal authorities [Member] \| Maximum [Member]
Tax year open for examination	2019
State authorities [Member] \| Minimum [Member]
Tax year open for examination	2015
State authorities [Member] \| Maximum [Member]
Tax year open for examination	2019

Income Taxes (Reconciliation of Statutory Federal Tax Rate) (Details)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Components Of Income Tax Expense Benefit Continuing Operations [Abstract]
Federal income tax at statutory rate	21.00%	21.00%	21.00%
State and local taxes, net of federal benefit	6.00%	6.40%	6.30%
Jobs tax credits, net	(5.10%)	(8.30%)	(10.70%)
162(m) disallowance for executive compensation	6.00%	7.50%	4.50%
Nondeductible permanent items	0.40%	0.70%	2.20%
Nondeductible penalties		1.30%
Excess tax benefit	(5.60%)	(6.70%)	(2.70%)
Federal/state return to provision	(1.60%)	0.60%	0.20%
Other	(0.10%)	(0.30%)	(0.70%)
Effective income tax rate	21.00%	22.20%	20.10%

Stock Options And Restricted Stock Awards (Narrative) (Details) - USD ($) $ / shares in Units, $ in Millions	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock option compensation expense	$ 6.0	$ 5.8	$ 4.1
Stock Options [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options, Granted shares	0
Stock option compensation expense	$ 2.0	2.5	2.0
Unrecognized compensation cost	$ 2.6
Unrecognized compensation cost recognition period	1 year 6 months
Intrinsic value on vested stock options	$ 27.0
Intrinsic value on outstanding stock options	$ 12.5
Share-based compensation number of shares vested	312,499
Share-based compensation number of shares unvested	193,221
Intrinsic value on exercised stock options	$ 7.5	7.3	1.8
Restricted Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock option compensation expense	4.0	$ 3.3	$ 2.1
Unrecognized compensation cost	$ 9.8
Unrecognized compensation cost recognition period	1 year 8 months 12 days
Fair market value of vested restricted stock awards	$ 6.0
2017 Omnibus Incentive Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Maximum shares of stock awards authorized for issuance	1,182,270
Share-based compensation number of common stock available for grant	614,888
2017 Omnibus Incentive Plan [Member] \| Stock options or stock appreciation rights "SARs" [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Maximum shares of stock awards authorized for issuance	500,000
2017 Omnibus Incentive Plan [Member] \| Awards denominated in shares of common stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Maximum shares of stock awards authorized for issuance	300,000
2017 Omnibus Incentive Plan [Member] \| Stock Options [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based payment award, expiration period	10 years
Exercise prices of stock options outstanding, lower range limit	$ 8.91
Exercise prices of stock options outstanding, upper range limit	$ 87.80
2017 Omnibus Incentive Plan [Member] \| Stock Options [Member] \| Minimum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based payment vesting period	3 years
2017 Omnibus Incentive Plan [Member] \| Stock Options [Member] \| Maximum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based payment vesting period	4 years
2017 Omnibus Incentive Plan [Member] \| Restricted Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based payment award, expiration period	10 years
2017 Omnibus Incentive Plan [Member] \| Restricted Stock [Member] \| Minimum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based payment vesting period	1 year
2017 Omnibus Incentive Plan [Member] \| Restricted Stock [Member] \| Maximum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based payment vesting period	4 years

Stock Options And Restricted Stock Awards (Summary of Stock Option Activity and Weighted Average Exercise Price) (Details) - Stock Options [Member]	12 Months Ended
	Dec. 31, 2020 $ / shares shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options, Outstanding, beginning of period shares	648,000
Options, Granted shares	0
Options, Exercised shares	(127,000)
Options, Forfeited/Cancelled shares	(15,000)
Options, Outstanding, end of period shares	506,000
Weighted Average Exercise Price, Outstanding, beginning of period \| $ / shares	$ 37.43
Weighted Average Exercise Price, Exercised \| $ / shares	31.07
Weighted Average Exercise Price, Forfeited/Cancelled \| $ / shares	37.25
Weighted Average Exercise Price, Outstanding, end of period \| $ / shares	$ 39.03

Stock Options And Restricted Stock Awards (Weighted-Average Estimated Fair Value of Employee Stock Options Granted) (Details) - Stock Options [Member] - $ / shares	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Weighted average fair value	$ 29.78	$ 14.72
Risk-free discount rate, minimum	1.72%	2.32%
Risk-free discount rate, maximum	2.29%	2.84%
Volatility	43.00%	45.00%
Minimum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected life	4 years 2 months 12 days	4 years 1 month 6 days
Maximum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected life	4 years 4 months 24 days	4 years 2 months 12 days

Stock Options And Restricted Stock Awards (Summary of Status of Unvested Restricted Stock Awards Outstanding) (Details) - Restricted Stock [Member] shares in Thousands	12 Months Ended
	Dec. 31, 2020 $ / shares shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unvested restricted stock awards at beginning of period \| shares	149
Awarded \| shares	88
Vested \| shares	(77)
Forfeited \| shares	(6)
Unvested restricted stock awards at end of period \| shares	154
Weighted Average Grant Date Fair Value beginning of period \| $ / shares	$ 51.10
Weighted Average Grant Date Fair Value, Awarded \| $ / shares	101.96
Weighted Average Grant Date Fair Value, Vested \| $ / shares	45.67
Weighted Average Grant Date Fair Value, Forfeited \| $ / shares	45.65
Weighted Average Grant Date Fair Value end of period \| $ / shares	$ 83.30

Employee Benefit Plans (Narrative) (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
401(k) Retirement Plan [Member]
Defined Contribution Plan Disclosure [Line Items]
Company matching contribution amount	$ 0.3	$ 0.2	$ 0.3

Commitments and Contingencies (Narrative) (Details) - USD ($) $ in Thousands	3 Months Ended								8 Months Ended	11 Months Ended	12 Months Ended
	Dec. 31, 2020	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 27, 2020	Mar. 31, 2021	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Commitments And Contingencies [Line Items]
Net service revenues	$ 195,996	$ 193,987	$ 184,576	$ 190,216	$ 192,376	$ 168,993	$ 148,915	$ 138,507			$ 764,775	$ 648,791	$ 516,647
Home Health [Member]
Commitments And Contingencies [Line Items]
Net service revenues											16,245	14,462	6,856
Hospice [Member]
Commitments And Contingencies [Line Items]
Net service revenues											101,297	$ 53,601	$ 18,850
PPPHCE Act [Member]
Commitments And Contingencies [Line Items]
Authorized fund to be distributed to health care providers									$ 178,000,000
PPPHCE Act [Member] \| Forecast [Member]
Commitments And Contingencies [Line Items]
Percentage of reduced payments to Medicare providers										2.00%
PPPHCE Act [Member] \| Home Health [Member]
Commitments And Contingencies [Line Items]
Net service revenues											200
PPPHCE Act [Member] \| Hospice [Member]
Commitments And Contingencies [Line Items]
Net service revenues											$ 1,300

- Definition

+ References

+ Details

Segment Information (Narrative) (Details)	12 Months Ended
Segment Information (Narrative) (Details)	Dec. 31, 2020 segment
Segment Reporting [Abstract]
Number of business segments	3

Segment Information (Summary of Segment Information) (Details) - USD ($) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2020	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Segment Reporting Information [Line Items]
Net service revenues	$ 195,996	$ 193,987	$ 184,576	$ 190,216	$ 192,376	$ 168,993	$ 148,915	$ 138,507	$ 764,775	$ 648,791	$ 516,647
Cost of services revenues									538,538	469,553	379,843
Gross profit	59,104	56,301	54,997	55,835	57,542	45,176	39,693	36,827	226,237	179,238	136,804
General and administrative expenses									169,679	133,912	105,335
Operating income from continuing operations	$ 11,716	$ 12,523	$ 9,607	$ 10,661	$ 14,530	$ 7,335	$ 7,391	$ 5,496	44,507	34,752	22,827
Operating Segments [Member]
Segment Reporting Information [Line Items]
General and administrative expenses									89,635	72,491	50,015
Operating income from continuing operations									136,602	106,747	86,789
Personal Care [Member]
Segment Reporting Information [Line Items]
Net service revenues									647,233	580,728	490,941
Cost of services revenues									480,191	432,413	365,264
Gross profit									167,042	148,315	125,677
Personal Care [Member] \| Operating Segments [Member]
Segment Reporting Information [Line Items]
General and administrative expenses									60,468	56,887	44,728
Operating income from continuing operations									106,574	91,428	80,949
Hospice [Member]
Segment Reporting Information [Line Items]
Net service revenues									101,297	53,601	18,850
Cost of services revenues									47,197	27,203	10,010
Gross profit									54,100	26,398	8,840
Hospice [Member] \| Operating Segments [Member]
Segment Reporting Information [Line Items]
General and administrative expenses									25,394	12,399	3,742
Operating income from continuing operations									28,706	13,999	5,098
Home Health [Member]
Segment Reporting Information [Line Items]
Net service revenues									16,245	14,462	6,856
Cost of services revenues									11,150	9,937	4,569
Gross profit									5,095	4,525	2,287
Home Health [Member] \| Operating Segments [Member]
Segment Reporting Information [Line Items]
General and administrative expenses									3,773	3,205	1,545
Operating income from continuing operations									$ 1,322	$ 1,320	$ 742

Segment Information (Segment Reconciliation to Totals reported in the accompanying Consolidated Financial Statements) (Details) - USD ($) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2020	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Segment Reporting Information [Line Items]
Operating income	$ 11,716	$ 12,523	$ 9,607	$ 10,661	$ 14,530	$ 7,335	$ 7,391	$ 5,496	$ 44,507	$ 34,752	$ 22,827
Other general and administrative expenses									80,044	61,421	55,320
Depreciation and amortization									12,051	10,574	8,642
Interest income									(624)	(1,523)	(2,592)
Interest expense									3,189	3,105	5,016
Income from continuing operations before income taxes									41,942	33,170	20,403
Operating Segments [Member]
Segment Reporting Information [Line Items]
Operating income									$ 136,602	$ 106,747	$ 86,789

Significant Payors (Revenue by Payor Type) (Details) - USD ($) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2020	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Net service revenues	$ 195,996	$ 193,987	$ 184,576	$ 190,216	$ 192,376	$ 168,993	$ 148,915	$ 138,507	$ 764,775	$ 648,791	$ 516,647
Personal Care [Member]
Net service revenues									647,233	580,728	490,941
Personal Care [Member] \| Revenues [Member] \| Customer Concentration Risk [Member]
Net service revenues									$ 647,233	$ 580,728	$ 490,941
Concentration risk, percentage									100.00%	100.00%	100.00%
Personal Care [Member] \| Revenues [Member] \| Customer Concentration Risk [Member] \| State, Local And Other Governmental Programs [Member]
Net service revenues									$ 324,670	$ 303,479	$ 285,973
Concentration risk, percentage									50.20%	52.20%	58.20%
Personal Care [Member] \| Revenues [Member] \| Customer Concentration Risk [Member] \| Managed Care Organizations [Member]
Net service revenues									$ 287,032	$ 239,559	$ 173,391
Concentration risk, percentage									44.30%	41.30%	35.30%
Personal Care [Member] \| Revenues [Member] \| Customer Concentration Risk [Member] \| Private Pay [Member]
Net service revenues									$ 20,398	$ 21,765	$ 20,003
Concentration risk, percentage									3.20%	3.70%	4.10%
Personal Care [Member] \| Revenues [Member] \| Customer Concentration Risk [Member] \| Commercial Insurance [Member]
Net service revenues									$ 9,991	$ 9,204	$ 6,173
Concentration risk, percentage									1.50%	1.60%	1.30%
Personal Care [Member] \| Revenues [Member] \| Customer Concentration Risk [Member] \| Other [Member]
Net service revenues									$ 5,142	$ 6,721	$ 5,401
Concentration risk, percentage									0.80%	1.20%	1.10%
Hospice [Member]
Net service revenues									$ 101,297	$ 53,601	$ 18,850
Hospice [Member] \| Revenues [Member] \| Customer Concentration Risk [Member]
Net service revenues									$ 101,297	$ 53,601	$ 18,850
Concentration risk, percentage									100.00%	100.00%	100.00%
Hospice [Member] \| Revenues [Member] \| Customer Concentration Risk [Member] \| Medicare [Member]
Net service revenues									$ 94,068	$ 49,649	$ 17,652
Concentration risk, percentage									92.90%	92.60%	93.60%
Hospice [Member] \| Revenues [Member] \| Customer Concentration Risk [Member] \| Managed Care Organizations [Member]
Net service revenues									$ 4,931	$ 2,768	$ 1,047
Concentration risk, percentage									4.90%	5.20%	5.60%
Hospice [Member] \| Revenues [Member] \| Customer Concentration Risk [Member] \| Other [Member]
Net service revenues									$ 2,298	$ 1,184	$ 151
Concentration risk, percentage									2.20%	2.20%	0.80%
Home Health [Member]
Net service revenues									$ 16,245	$ 14,462	$ 6,856
Home Health [Member] \| Revenues [Member] \| Customer Concentration Risk [Member]
Net service revenues									$ 16,245	$ 14,462	$ 6,856
Concentration risk, percentage									100.00%	100.00%	100.00%
Home Health [Member] \| Revenues [Member] \| Customer Concentration Risk [Member] \| Medicare [Member]
Net service revenues									$ 12,765	$ 11,218	$ 6,034
Concentration risk, percentage									78.60%	77.60%	88.00%
Home Health [Member] \| Revenues [Member] \| Customer Concentration Risk [Member] \| Managed Care Organizations [Member]
Net service revenues									$ 3,188	$ 2,942	$ 752
Concentration risk, percentage									19.60%	20.30%	11.00%
Home Health [Member] \| Revenues [Member] \| Customer Concentration Risk [Member] \| Other [Member]
Net service revenues									$ 292	$ 302	$ 70
Concentration risk, percentage									1.80%	2.10%	1.00%

Significant Payors (Revenue by Geographic Location) (Details) - USD ($) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2020	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Net service revenues	$ 195,996	$ 193,987	$ 184,576	$ 190,216	$ 192,376	$ 168,993	$ 148,915	$ 138,507	$ 764,775	$ 648,791	$ 516,647
Revenues [Member] \| Geographic Concentration Risk [Member] \| Illinois [Member]
Concentration risk, percentage									37.70%	38.20%	45.00%
Personal Care [Member]
Net service revenues									$ 647,233	$ 580,728	$ 490,941
Personal Care [Member] \| Revenues [Member] \| Geographic Concentration Risk [Member]
Net service revenues									$ 647,233	$ 580,728	$ 490,941
Concentration risk, percentage									100.00%	100.00%	100.00%
Personal Care [Member] \| Revenues [Member] \| Geographic Concentration Risk [Member] \| Illinois [Member]
Net service revenues									$ 288,326	$ 247,524	$ 232,518
Concentration risk, percentage									44.60%	42.60%	47.30%
Personal Care [Member] \| Revenues [Member] \| Geographic Concentration Risk [Member] \| New York [Member]
Net service revenues									$ 115,510	$ 108,403	$ 65,117
Concentration risk, percentage									17.80%	18.70%	13.30%
Personal Care [Member] \| Revenues [Member] \| Geographic Concentration Risk [Member] \| New Mexico [Member]
Net service revenues									$ 86,618	$ 75,666	$ 58,914
Concentration risk, percentage									13.40%	13.00%	12.00%
Personal Care [Member] \| Revenues [Member] \| Geographic Concentration Risk [Member] \| All Other States [Member]
Net service revenues									$ 156,779	$ 149,135	$ 134,392
Concentration risk, percentage									24.20%	25.70%	27.40%
Hospice [Member]
Net service revenues									$ 101,297	$ 53,601	$ 18,850
Hospice [Member] \| Revenues [Member] \| Geographic Concentration Risk [Member]
Net service revenues									$ 101,297	$ 53,601	$ 18,850
Concentration risk, percentage									100.00%	100.00%	100.00%
Hospice [Member] \| Revenues [Member] \| Geographic Concentration Risk [Member] \| New Mexico [Member]
Net service revenues									$ 42,648	$ 38,790	$ 18,850
Concentration risk, percentage									42.10%	72.40%	100.00%
Hospice [Member] \| Revenues [Member] \| Geographic Concentration Risk [Member] \| All Other States [Member]
Net service revenues									$ 58,649	$ 14,811
Concentration risk, percentage									57.90%	27.60%
Home Health [Member]
Net service revenues									$ 16,245	$ 14,462	$ 6,856
Home Health [Member] \| Revenues [Member] \| Geographic Concentration Risk [Member]
Net service revenues									$ 16,245	$ 14,462	$ 6,856
Concentration risk, percentage									100.00%	100.00%	100.00%
Home Health [Member] \| Revenues [Member] \| Geographic Concentration Risk [Member] \| New Mexico [Member]
Net service revenues									$ 16,245	$ 14,462	$ 6,856
Concentration risk, percentage									100.00%	100.00%	100.00%

Significant Payors (Narrative) (Details)	12 Months Ended
Significant Payors (Narrative) (Details)	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Revenues [Member] \| Illinois Department On Aging [Member]
Concentration Risk [Line Items]
Concentration risk, percentage	23.00%	25.30%	31.70%
Revenues [Member] \| Geographic Concentration Risk [Member] \| Illinois [Member]
Concentration Risk [Line Items]
Concentration risk, percentage	37.70%	38.20%	45.00%
Accounts Receivable [Member] \| Illinois Department On Aging [Member]
Concentration Risk [Line Items]
Concentration risk, percentage	15.90%	25.10%

Unaudited Summarized Quarterly Financial Information (Schedule of Quarterly Results of Operations) (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2020	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Quarterly Financial Information Disclosure [Abstract]
Net service revenues	$ 195,996	$ 193,987	$ 184,576	$ 190,216	$ 192,376	$ 168,993	$ 148,915	$ 138,507	$ 764,775	$ 648,791	$ 516,647
Gross profit	59,104	56,301	54,997	55,835	57,542	45,176	39,693	36,827	226,237	179,238	136,804
Operating income	11,716	12,523	9,607	10,661	14,530	7,335	7,391	5,496	44,507	34,752	22,827
Net income from continuing operations	8,449	9,119	6,907	8,658	10,737	5,486	5,292	4,296	33,133	25,811	16,307
(Loss) earnings from discontinued operations						(574)				(574)	126
Net income	$ 8,449	$ 9,119	$ 6,907	$ 8,658	$ 10,737	$ 4,912	$ 5,292	$ 4,296	$ 33,133	$ 25,237	$ 16,433
Average shares outstanding:
Basic	15,664	15,618	15,582	15,519	15,435	13,766	13,044	12,995	15,596	13,816	12,049
Diluted	16,013	15,957	15,916	15,907	15,881	14,203	13,433	13,381	15,956	14,248	12,383
Basic
Continuing operations	$ 0.54	$ 0.58	$ 0.44	$ 0.56	$ 0.70	$ 0.40	$ 0.41	$ 0.33	$ 2.12	$ 1.87	$ 1.35
Discontinued operations						(0.04)
Basic income per share	0.54	0.58	0.44	0.56	0.70	0.36	0.41	0.33	2.12	1.83	1.36
Diluted net income per share
Continuing operations	0.53	0.57	0.43	0.54	0.68	0.39	0.39	0.32	2.08	1.81	1.32
Discontinued operations						(0.04)
Diluted income per share	$ 0.53	$ 0.57	$ 0.43	$ 0.54	$ 0.68	$ 0.35	$ 0.39	$ 0.32	$ 2.08	$ 1.77	$ 1.33

Subsequent Events (Narrative) (Details) - USD ($) $ in Thousands		3 Months Ended								12 Months Ended
	Feb. 11, 2021	Dec. 31, 2020	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Subsequent Event [Line Items]
Net service revenues		$ 195,996	$ 193,987	$ 184,576	$ 190,216	$ 192,376	$ 168,993	$ 148,915	$ 138,507	$ 764,775	$ 648,791	$ 516,647
Consumer Directed Personal Assistance Program [Member] \| Subsequent Event [Member]
Subsequent Event [Line Items]
Net service revenues	$ 52,000
Consumer Directed Personal Assistance Program [Member] \| Minimum [Member] \| Subsequent Event [Member]
Subsequent Event [Line Items]
Estimated transition period	6 months
Consumer Directed Personal Assistance Program [Member] \| Maximum [Member] \| Subsequent Event [Member]
Subsequent Event [Line Items]
Estimated transition period	12 months

- Definition

+ References

+ Details