Private equity companies have gobbled up group homes and other services for people with disabilities, attracting the attention of state and federal regulators across the nation and alarming advocates.

A regulatory agency in Georgia might shut down all the group homes owned by a certain company, for example, but those regulators can’t do anything about the company’s abuses in, say, Montana. With branches in multiple states, a company is better able to withstand sanctions or even a loss of license in one state, he said.

People with intellectual or developmental disabilities have suffered abuse, neglect and even death while under the care of private equity-owned providers, according to a recent report from watchdog group Private Equity Stakeholder Project.

“Private equity firms are, more than many other types of investors, laser-focused on maximizing their cash flow, often trying to double or triple their investment over a relatively short period of time, usually just a handful of years,” said Eileen O’Grady, the report’s author. “The way that private equity firms will often do that is to cut costs.”