As health care market shifts, the nonprofit Visiting Nurse Association of Greater Philadelphia, founded in 1886, is closing Monday

Amid increased competition from national for-profits and big Philadelphia-area health systems, the nonprofit Visiting Nurse Association of Greater Philadelphia is closing Monday after 138 years of caring for patients in their homes, often during the end of life.

The Visiting Nurse Association became part of Philadelphia’s Public Health Management Corp., a large health and social services provider, in 2022 after losing money for three of the previous four years. But the move was not enough to save the organization, which employed 114 when it filed its closure notice with state regulators.

“This difficult decision to discontinue VNA’s hospice and home health programs was made as a result of continued and unsustainable losses,” PHMC said in a statement. PHMC blamed consolidation, but did not respond to a question about specific examples of deals that made it hard for VNA to compete.

Private-equity firms have been active in the Philadelphia region’s home care and hospice market. Big private-equity firms like Bain Capital, Madison Dearborn Partners, and Thomas H. Lee Partners are among those with companies that compete with VNA.

Big nonprofit health systems like Jefferson Health and the University of Pennsylvania Health System also see home care as increasingly important. Insurers want providers to take more responsibility for the results of their patients’ care.

Jefferson put its home health-care and hospice business into a joint venture with Bayada, a Moorestown nonprofit that is one of the nation’s largest home-care companies, in a deal valued at $31.7 million for Jefferson.

Main Line Health has a home health and hospice business with $76 million in revenue in the year ended June 30, 2023, up from $62 million five years earlier, according to its 990 tax form. VNA’s revenue, by contrast, fell to $18 million from $32 million over the same period.