The Business of Care: Mission Must Outweigh Margin in Disability Services

In today’s landscape of rapid consolidation, venture capital disruption and profit-at-any-cost business models, one sector remains uniquely unfit for commodification: services for persons with disabilities. And yet, that is precisely where private equity has begun to delve.

As the founder and CEO of Community Options, a national nonprofit that supports over 6,000 people with disabilities in community homes, I’ve spent the last 35 years building an organization not around scale or yield, but around dignity. I’ve watched what happens when mission-driven leadership gives way to acquisition-driven strategy. The result is predictable: vulnerable people get hurt.

A Tale of Two Models 

Running a disability services organization is not a glamorous business. It’s not a unicorn waiting for seed funding or a sector ripe for IPOs. It’s slow, complex, and deeply human. And that’s precisely why the private equity model doesn’t fit.

Private equity thrives on speed and scale. It looks for undervalued assets, bundles them, extracts value, and exits. When applied to our field, this model doesn’t just fail, it actively harms. Staff are cut, training is minimal, and care is disrupted in favor of quarterly returns.

In contrast, our nonprofit model reinvests every dollar into direct care. It allows us to pilot innovative housing solutions, support 24/7 staffing where needed and most importantly, build real relationships with those we support. That’s not just good ethics. It’s good business, too.

From Kitchen Table Startup to National Footprint 

Community Options began in the kitchen of my small row home in Bordentown, New Jersey. I mortgaged my home to start Community Options. We had no money. Our strongest asset was the shared principle that people with disabilities belong in the community, not in institutions.

Our first residents came to us from state-run institutions where they had spent decades. Many arrived with little more than a trash bag of belongings and a history of being treated like inmates rather than individuals. I distinctly remember asking one of our first residents what he hated most about institutional life. He answered, “You have to take ice-cold showers with a lot of other people.” Then added, “Going to bed at ten o’clock isn’t much fun either.”

What we offered was simple: a private bedroom, a front door key, and a say in their daily life. Over time, we grew—not because we chased scale, but because states and families were desperate for better alternatives. Every new home was a response to unmet need, not market opportunity.

Mission Is a Competitive Advantage 

In a sector increasingly invaded by profit motives, our nonprofit status has become a competitive advantage. Here’s why: unlike many private equity–backed firms, we are not beholden to investors. Our stakeholders are families, persons with disabilities, and the communities we serve.

This frees us to make long-term investments others avoid. We hire full-time behavioral therapists, pay for staff to accompany individuals on family trips, and provide job training in real businesses—from flower shops to office cooperatives.

It also means we can weather storms differently. During the COVID-19 pandemic, when other providers cut services or folded under financial strain, we ramped up. We secured PPE, shifted to home-based programming, and redeployed staff creatively. No staff were fired or furloughed. No care was denied. That’s the strength of a model rooted in purpose.

The Danger of Financial Engineering in Human Services 

What happens when financial engineers run a service designed for people who can’t advocate for themselves? In my experience: chaos.

In my soon to be released book, Silent No Longer, I detail how certain private equity-backed providers slash wages, outsource core services, and rotate staff so frequently that abuse, neglect and even death are impossible to avoid. People with disabilities need stability. Some are nonverbal, others are medically fragile. Staff turnover isn’t just an HR problem; it’s a clinical risk.

Worse, I’ve seen companies exaggerate care hours to inflate Medicaid reimbursements, house incompatible individuals together to cut costs, and avoid those with high support needs altogether. The incentive isn’t to care, it’s to game the system until it comes time bundle everything in housing shell corporations and REITs. The investors exit and profit from selling to the highest bidder.

That’s why I believe services for people with disabilities should be considered public goods, not vehicles for speculative investment. We should not allow the care of persons with disabilities to be governed by EBITDA.

Redefining ROI 

For CEOs in any field, the question of ROI is central. But in disability services, we must redefine what return means. It’s not just about cost savings or operational efficiency. It’s about quality of life.

At Community Options, I measure success by how many people graduate from group homes to independent apartments. By how many first jobs we help create. By how many individuals, once thought “too difficult,” now shop for their own groceries or attend family reunions for the first time in years.

Yes, we track data. Yes, we maintain rigorous compliance. But our truest metric is human progress. And I’d argue that any business—tech, finance, logistics—would benefit from applying that lens. When you focus on people first, profits follow in more meaningful ways.

Conclusion: The Business Case for Dignity 

To my fellow CEOs: whether or not you work in human services, you have a role to play. Private equity is not inherently evil. But when deployed in vulnerable sectors without guardrails, it becomes predatory.

That is why I urge leaders to push for ethical investment criteria in any acquisition involving disability services. Insist on transparency in outcomes. Reject deals that treat people as liabilities or labor as an afterthought. For those managing philanthropic portfolios, fund the nonprofits that are holding this fragile ecosystem together.

Ask yourself: Is this product or strategy creating real value—or just extracting it? True leadership means asking the hard questions even when the spreadsheet looks clean.

The future of care depends on what kind of business leaders we choose to be. Will we view people with disabilities as burdens to be minimized or human beings with potential to be realized? Will we prioritize quarterly gains or societal change?

With a presence in over sixty regions across twelve states and over half a billion dollars in revenue each year, Community Options is proof that you can scale compassion without compromising ethics. That you can build an efficient organization without abandoning mission. That you can, in fact, run a business where dignity is the core deliverable.

Written by Robert Stack, President & CEO, Community Options, Inc.
Have you read?
Global Health Care Index.
World’s Richest People (Billionaires).
Richest Women (Female Billionaires).
The Chief Economists magazine, UGGP News, and the CEO Policy Institute.