Cliff and Christine Nelson·February 17, 2025

Behind Every Great Searcher: A Wife's Journey Into Search | Cliff and Christine Nelson Interview

Cliff Nelson, a Chicago-based former consultant and private equity professional who began exploring search funds in business school, acquired Psychogeriatric Services (PGS) — a mental and behavioral health services company serving nursing home residents across Maryland, DC, Virginia, and Pennsylvania — in November 2022 through a traditional search fund. The business had just over $15m in revenue and ~120 clinicians at acquisition. The deal's closing on November 4th, 2022 — five days before the birth of his and wife Christine's first child — created an extreme dual-crisis: Cliff couldn't be present in Maryland to lead the transition in person, and Christine was left largely alone as a new mother while recovering from mastitis and postpartum depression in an unfamiliar city. The episode features both Cliff and Christine in separate one-on-one interviews, making it as much a documentary of the partner experience as a standard acquisition story; Christine describes the emotional toll of moving from Chicago to Columbia, Maryland with a newborn on no notice, without friends or family nearby, and the personal growth she credits to surviving the ordeal. Two years post-close, PGS is in a J-curve — still building out the infrastructure (recruiting, HR, operational systems) underinvested by the founding psychiatrist-owner — but Cliff views the business fundamentals (sticky Medicare/Medicaid revenues, mission-driven staff, capital efficiency) as solid, and Christine has found a new job, made friends, and considers the journey a net positive for her own resilience and the couple's relationship.

Deal facts

sde ebitda: ~$3m EBITDA (implied: ~20% margin on $15m revenue, though noted to be lower at steady state)
revenue: $15m (just north of $15m at acquisition)
financing structure: Traditional search fund (SBA and investor capital implied; no-money-down personal guarantee avoided via traditional search structure)
notes: Business: Psychogeriatric Services (PGS), mental and behavioral health services to nursing home and long-term care residents in Maryland, DC, Virginia, and Pennsylvania. ~100 providers + ~25 admin at acquisition; ~150 total employees at time of interview. Margins noted at ~20% but expected lower at steady state due to underinvestment in infrastructure. Traditional search fund structure used; closed November 4, 2022.

Why this business

Cliff was drawn to the mission — universally when he tells people what PGS does, they think of an aging relative with cognitive decline or depression in a nursing home. He saw it as a critical, underserved service for a vulnerable population. He also valued the business fundamentals: healthy growth, good margins, sticky and predictable revenues, and capital efficiency. The payer is primarily Medicare and Medicaid, removing pricing pressure from the customer relationship.

What's working

Strong mission alignment: mental health services for nursing home residents is widely understood as critical and underserved, which resonates with staff, facilities, and investors
Sticky, recurring revenue from Medicare/Medicaid with no pricing pressure from the facilities being served
Traditional search fund board structure providing accountability and mentorship without excessive investor interference — board insulates the CEO from direct investor anxiety about the J curve
Culture of flexibility and autonomy for clinical staff (many part-time, caring for family members themselves) reinforced unexpectedly by Cliff's own visible family obligations during the rocky transition
Scale (~150 employees) large enough to cover clinician absences across most regions, yet small enough for the CEO to personally know every employee

What's hard

Significant J-curve post-acquisition: heavy infrastructure investment required (e.g., recruiting team grew from 1 to 4, plus HR generalist and HR support) that was underestimated and not fully modeled in the financial projections
People-intensive healthcare services business means limited scale leverage compared to other sectors; staffing and recruiting are constant operational challenges
Government reimbursement (Medicare/Medicaid) means no ability to raise prices even when delivering excellent outcomes
Business had been 'held together with Scotch tape' in many operational areas — the extent of underinvestment was greater than anticipated even knowing infrastructure work was needed
Closing the deal simultaneously with the birth of their first child created an acute personal and professional crisis: Cliff couldn't be in Maryland to manage the transition in person, couldn't make a strong first in-person impression with 150 nervous employees (prior competitor had gone bankrupt), and Christine was left largely alone as a new mother
Christine developed mastitis twice immediately after the move, causing a near-cancellation of the planned relocation to Maryland; she also experienced postpartum depression after arriving in an unfamiliar city with no social network
Recruiting and replacing the seller's many informal roles (the founding psychiatrist wore a million hats) cost significantly more in headcount than projected

Notable quotes

I run a mental health business now — two years into being CEO of a mental health company I've spent a lot of time reflecting on my own mental health journey through this whole search because it is challenging. There has been lots of ink spilled, lots of podcasts about the grit it takes from a Searcher entrepreneur, but a lot less said about the grit that you're basically asking your partner to go through. Like, all those ups and downs are shared, all of the risk is shared. So really, I mean, they're entrepreneurs too in this.

A board member had prepped me for this going in and he's like, 'You're going to feel like you're being a bad father and a bad CEO at the same time.' And that's true.

I felt like I could not do a lot of things that naturally my body was telling me to do. Let's set up a nursery, let's buy a house, let's put down roots — because this baby is coming and I'm a first-time mom, I don't know what I'm doing. But let's try to create the right space and we really couldn't.

I definitely don't want to repeat what we did, I wouldn't live through it again, but I'm honestly extremely thankful that we did it. I am a different person than I was in 2019 when we started this. I'm a lot stronger. I can deal with ambiguity and change and risk a lot more, and those are things that I'm proud of.