The marketisation of European home care has given rise to significant private for-profit providers growth. However, little research has focused directly on commercial companies to examine the mechanisms through which they emerge, grow and shape long-term care policy – this is this paper’s task. Drawing on the literature on business power, the recent concept of “institutional business power” is introduced, defined as the power flowing from the entrenched position of business actors in the provision of public social services. The paper identifies the mechanisms through which private providers have grown and assesses the extent of their institutional power by examining their influence on policy and the support they obtain from relevant home care stakeholders. The limits of providers’ institutional power are also discussed. The paper relies on semi-structured interviews with representatives of public, private and non-profit home care providers.