Contextual forces shaping home-based healthcare services between 2010 and 2020: Insights from the social-ecological model and organizational theory.

Demands for home-based care have surged alongside population aging, preferences for aging in place, policy-driven reforms incentivizing lower hospital utilization, and public concerns around COVID-19 transmissions in institutional care settings. However, at both macro and micro levels, sociopolitical and infrastructural contexts are not aligned with the operational needs of home healthcare organizations, presenting obstacles to home healthcare equity. We integrate the social-ecological model and organizational theory to highlight contextual forces shaping the delivery of home-based care services between 2010 and 2020. Placing home-based healthcare organizations at the center of observation, we discuss patterns and trends of service delivery as systematic organizational behaviors reflecting the organizations' adaptations and responses to their surrounding forces. In this light, we consider the implications of provision and access to home care services for health equity, discuss topics that are understudied, and provide recommendations for home-based healthcare organizations to advance home healthcare equity. The paper represents a synthesis of recent literature and our research and industry experiences.