Domiciliary Care sector across EMEA

You've come to the right place to understand Domiciliary Care services in Europe and Emerging Markets. Here is how we can help you:
  • Detailed research report on Domiciliary Care services with marketshare and growth rates for 8 countries and information on a further 18 (HBI Intelligence)
  • Database of 18 Domiciliary Care service providers, including profile and major external investors (HBI Intelligence)
  • Merger and acquisition (M&A) intelligence showing likelihood of sale (HBI Intelligence)
  • News stories and interviews with Domiciliary Care operators (HBI Deals and Insights)
  • Events that cover healthcare services globally including Domiciliary Care (HBI 2020)
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Sector Report
Domiciliary Care Sector

Updated: May 2020

Executive Summary

Impact of Covid-19 
We are in the process of analyzing the impact of Covid on the care sector and we should have updates for every country’s growth forecasts for 2020 and 2021 by end of May. There has been a strong short-term impact with costs rising and demand falling which we have already reported in news. A serious recession may further hit demand and tariffs and leave many investors breaking their bank covenants.
Methodology & definitions

In this report, we define domiciliary care services as the paid provision of unskilled assistance with personal hygiene, cooking, domestic chores and social activities for older and disabled people. As it is paid, we are excluding from our definition all help given within family and friend networks. 

In general, many markets are dominated by not-for-profits (Netherlands, France and Italy). The for-profit sector operates either for public payors or for out of pocket payments.


“The biggest opportunity in the care market in general is the ageing population,” says Jorg Veil, managing director of Home Instead Germany. According to the United Nations, people aged 65+ outnumbered children under five for the first time in history in 2018, and the number of people aged 80+ is set to triple by 2050. 

Domiciliary care presents itself as a viable and attractive alternative to nursing homes for people with increasing dependence needs who want to live at home. Many of the biggest nursing home chains are now providing domiciliary care as an additional business stream, as are many medicalised homecare players, securing clients further up the care path before they opt into residential or more intensive care down the line.

Scope for growth & consolidation

Domiciliary care is still considered a Cinderella sector where most national markets remain undeveloped. The major for-profit players have tiny market shares.

We can see several types of players. There are the big European nursing home groups who are building domiciliary care arms, pure domiciliary care players, and franchising groups, including US’s Home Instead who are expanding across Europe. There are also large groups such as City & County Healthcare Group in the UK which are mainly working on very low margins for local authority public payors.
A few online Uber-style operators are emerging in Spain, France and the UK such as Soomville! or Hoper in France. So far, they appear to have had little impact.


The potential for domiciliary care across Europe has yet to be fully tapped. There are large addressable markets, the largest being France and Germany, where plentiful demand and a preference for domiciliary care over nursing homes plays into the sector’s favour. 
In the UK, a large and fragmented market of small providers is poised for consolidation.


The sector faces huge headaches - low margins, staff shortages and informal competition. 

Staff shortages are recorded across Europe, especially in the UK where Brexit is expected to affect recruitment from abroad and will restrict the growth of the sector if solutions are not found. All providers we have spoken to cite such shortages as the biggest challenge to business. Some providers, such as SunaCare and Promedica-24 in Germany, have based business on sourcing unskilled carers from Eastern Europe to fill the gap. Legislation in Germany is underway to make this easier, but in the long-term this will drain workforce abroad, so sustainable solutions need to be found.

The good news is that many governments are implementing wide-reaching budgetary changes, as well as labour, education and healthcare reform which will hopefully go a long way to solving the problem. The NHS’s long-term plan has made community-based care a priority and providers expect this to show in council budgets. In France, a law passed in 2015 allocated further funding to the sector and has pushed for an increase in the hours of care. 
Sample report pages and data
What we offer
-       Instant overview of the EMEA domiciliary care market and players This report gives you visibility of this important, fast-growing market across 7 countries with market data on all, as well as detailed profiles of the Top 50 players.
-       Ever green!  Updated throughout your subscription As part of our HBI intelligence platform this report is updated throughout the period of your subscription. You will also receive additional news stories and interviews on domiciliary care throughout the period.
-       Insights on business models The report is based on in-depth interviews with many operators. The report also looks at how domiciliary care players can best build customer loyalty.
-       Identify national opportunities We assess opportunities at national level based on the regulatory environment and proposed reforms.
-       Size markets This report enables you to swiftly see market sizes and market shares
-       Save time and money This report will save you weeks researching these opaque markets and enable you to swiftly identify investment opportunities, new partners and markets.

Table of Contents

Table of Contents
EMEA overview
Size of EMEA market 2018
Marketshare of major EMEA players 2018
Comparison of market sizes 2018
Comparison of market growth rates 2016-2020
Methodology & definitions   
  • Definitions from several different countries
  • Provider types
                                    - Ageing population
                                    - An alternative to nursing homes
Scope for growth & consolidation
-       Nursing homes developing domiciliary care arms
-       Franchising groups
-       “Uber”-style operators
                        - Large and fragmented markets
                        - Franchise opportunities
-       Low margins
-       Staff shortages
-       Good news: government wide-reaching budgetary changes
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
Market description and trends.
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
Market description and trends.
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
Market description and trends.
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
Market description and trends.
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
Market description and trends.
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
Market description and trends.
United Kingdom
Data sets
For-profit /private market size and growth rates 2016-2020
Marketshare of major players 2018
Market description and trends.

Domiciliary Care News & Interviews

Our indepth stories dig deep and cover profit multiples, revenue, EBITDA and CEO thinking.

163 news stories on Domiciliary Care.

Interview: James Thorburn, CEO, City & County Healthcare 1mo ago

The CEO of City & County Healthcare, the second-largest domiciliary care provider in the UK with 2019 revenue of £ 236m, tells HBI how the company is navigating the COVID-19 crisis and what prospects are now like for a sale....

UK homecare braced for "failures and consolidation" 1mo ago

The COVID-19 crisis is about to enter a new phase in the UK homecare space, as councils begin to remove emergency funding from the sector. HBI interviews the CEO of one of the country's largest providers, City & County Healthcare, and the UK Homecare Associatio...

Post-mortem on elderly care - evaluating the true impact of COVID 2mo ago

As we begin to understand the true impact of COVID-19, large disparities of outcome are emerging between countries. HBI speaks to operators and consultants across Europe to investigate how markets have been hit....

From homecare to hotels 3mo ago

In Argentina a domiciliary homecare group has taken over three hotels to offer accommodation to Covid-symptomatic patients. What does this say about the wider links between hotels and care homes in Emerging Markets?...

Cera Care to grow its workforce six-fold 6mo ago

UK homecare group Cera Care has launched a mainly online learning platform with the aim of recruiting 10,000 new care workers. It claims that new hires from retail or hospitality can be trained to pass government qualifications in 10 days. If it achieves the t...

COVID-19: Care sector confronts crisis, hospitals hit hard 7mo ago

In the second of our two-part deep dive into how COVID-19 is hitting healthcare markets across EMEA, we ask how hospitals are coping with spiralling staff sickness and a flood of patients, and whether the care and dialysis sectors can stay afloat given the ri...

Germany to reform financing of long-term care 7mo ago

Germany is on the brink of reforming the financing of long-term care insurance (LTC) which funds elderly care. The industrious Federal Minister of Health Jens Spahn could produce a draft law by the summer, and private insurers are proposing revolutionary ways ...

Attendo and Ambea's FY2019 results show there's room for improvement 7mo ago

Shares in listed Nordic care groups Attendo and Ambea dropped on publication of their FY2019 results - but there was reason to be positive for both companies....

Interview: Stefan Klussmann, co-founder of Planerio 8mo ago

Poor scheduling, especially in DRG funded models, can be financially devastating if it leads to closed facilities and wasted patient appointments. What solutions are available to the market? HBI speaks to the founder of one automated scheduling solution, Plane...

Database of 18 Domiciliary Care service providers

HBI has built a unique database of the Top 4,000 operators globally in health care services. As part of this, we have identified the top 18 Domiciliary Care operators in Europe and will soon add the major players in Emerging Markets.

Profiles include revenue/sales data as well as EBITDA and other profit margins where known. They also cover private equity ownership with dates and mergers and acquisitions.

Mergers & Acquisition (M&A) Intelligence

Our deal pipeline shows how likely all private equity and some privately companies are to sell based on algorithms and journalistic know-how.

HBI 2020 – the only CEO-level conference to cover healthcare services globally

HBI 2020 – the only CEO-level conference to cover healthcare services globally
In 2019 this event brought together 700 delegates from over 40 countries. Over 60% are CEO level and they included 150 specialist investors in health care services. HBI 2020 includes a panel discussion on domiciliary care, with panelists from a range of operators and a range of countries, including Romania, Germany and Israel.
Other sessions look at trends in the investment and merger and acquisition, digital health and telehealth.  
Contact us in the UK on 0207 183 3779 for more information.