How a regional senior care operator became national and unlocked growth through a more flexible and customized PEO

As one senior care operator attempted to expand rapidly across markets, its legacy national healthcare-focused PEO model began creating friction and could not support its growth. High administrative fees, rigid bundled services, inconsistent account management, and limited customization around key operational objectives were no longer aligned with the organization’s trajectory.

By partnering with Adams Keegan, the company transitioned to a more adaptable, scalable operating approach that preserved the compliance and administrative advantages of a PEO while opening the door to better cost control, stronger claims visibility, and more strategic insurance options. The shift reduced initial operating costs significantly, improved benefits flexibility, and lowered workers’ compensation premiums by 30%. Most importantly, the new system created the foundation for expansion from seven communities and 600 employees to more than 35 communities and 2,500 employees in four years.

Before Adams Keegan
As the organization grew, its existing PEO model began to show its limitations, becoming increasingly restrictive as it moved into new markets and added complexity to its operations.

Administrative fees were high and became difficult to justify at scale. The bundled nature of the PEO required adopting a fixed set of services, including health plans, workers’ compensation structures, and internal systems, with little opportunity to tailor solutions to its evolving needs.

Service inconsistency added another layer of frustration. Frequent turnover among client service representatives and vendor contacts meant teams were often reestablishing relationships and re-explaining operational needs. At the same time, agreed-upon items were not always executed reliably, creating gaps between expectations and delivery.

As the company expanded into new states, stakeholders also began to question whether the current model could facilitate multi-state growth in a cost-effective and scalable way, particularly as concerns around tax setup, compliance, and long-term flexibility became more pronounced.

The Adams Keegan solution
Adams Keegan worked closely with the organization to transition into a more custom, transparent, and comprehensive service approach designed to scale alongside the business. The transition preserved the administrative advantages that leadership valued, including payroll processing, compliance oversight, tax management, and multi-state guidance. At the same time, Adams Keegan introduced a more adaptable framework that allowed movement beyond the limitations of a bundled model.

By leveraging Adams Keegan’s existing tax infrastructure and compliance expertise, the company was able to quickly expand into new markets without the burden of rebuilding systems. This provided immediate support for growth while reducing administrative complexity.

Adams Keegan also developed custom health and workers’ compensation structures tailored to the organization’s workforce locations, claims history, and long-term goals. This opened the door to more strategic insurance options, including level-funded workers’ compensation programs and future pathways toward self-insured health plans.

Beyond benefits and insurance, Adams Keegan strengthened visibility and assistance across key areas, including claims management, loss control, unemployment claims, garnishment management, and administrative reporting. Dedicated experts worked closely with both executive leadership and on-site community teams, ensuring consistent guidance at every level. The result was an arrangement designed to aid current operations and to grow with the client over time.

The Adams Keegan difference
The organization realized more than $250,000 in immediate operational savings, with projected savings exceeding $1.25 million annually at its current scale. Workers’ compensation premiums were reduced by 30%, and access was gained to more flexible, employee-centered benefit options.

Improved claims visibility across both workers’ compensation and health insurance allowed a more proactive approach to risk management and cost control. Enhanced loss control infrastructure offered additional stability in a high-risk senior care environment.

Equally important, the company experienced a shift in service delivery. A dedicated Adams Keegan team created consistency, accountability, and a stronger working relationship, supporting both executives and business office managers, ensuring alignment across teams.

With a more customized and scalable operating model in place, the client was able to grow from seven communities to more than 35, while extending its workforce from 600 employees to 2,500 in just four years. The new structure also facilitated an increase in management contracts and accelerated expansion into new markets.

Key takeaway: For senior care operators, the right people operations system should reduce cost today while creating the flexibility and compliance foundation needed to scale with confidence tomorrow.