The racial and cultural ecology of home and community-based services for diverse older adults.

As the overall U.S. population grows older and increasingly diverse, greater focus is needed on the various Home and Community-Based Services (HCBS), such as home health care, case management, meal delivery and preparation, and personal care, required to address the unique social and medical complexities of diverse older adults. Presently, however, there has been limited research on needs and broader dynamics associated with HCBS facilitation in this population. To address this gap, we sought to contextualize practices and barriers to care coordination for diverse homebound older adults, conducting semi-structured interviews with 41 providers of HCBS, including older adult care coordinators, in-home care workers, and physicians in greater Chicago, Illinois. Common care coordination practices included fluid processes related to engendering racial concordance in care, facilitating linguistic adaptations, and navigating relationships with clients' families. However, in certain circumstances, these practices are hindered. For example, broad client-level challenges included racialized dynamics of distrust and limited health literacy, and organizations cited ongoing obstacles recruiting and retaining diverse staff and finding HCBS providers to service low-income, minority communities often burdened by high crime rates. Continued efforts need to be made to better understand the HCBS needs of diverse homebound older adults and the associated challenges of providing culturally humble programming to this population.