Business Models and Technologies of Leading Home Care Providers for Older Adults: A Multi-Country Comparative Study

BackgroundGlobal population ageing is accelerating due to declining fertility rates and rising life expectancy. Home care plays a central role in supporting older adults to remain in their own homes while managing ongoing care needs. However, home care provision is under mounting pressure, intensified by severe workforce shortages. Scalable, person-centred, and digitally supported home care services are therefore urgently required. This study addresses three questions: (RQ1) Who are the leading providers of home care for older adults? (RQ2) What business models do they employ? and (RQ3) What technologies do they use to deliver scalable care services? MethodsThis study used a mixed-methods, multiple case study design to investigate the business models of leading home care providers. To address RQ1, countries were identified using demographic and health system criteria, including the Global Innovation Index and population ageing indicators. Within each country, leading providers were selected through a purposeful, criterion-based sampling procedure informed by revenue, client volume, and expert validation. To address RQ2 and RQ3, we drew on four complementary data sources: (a) publicly available service descriptions, (b) provider information, (c) market and industry reports (including media and analyst coverage), and (d) semi-structured interviews with provider representatives and domain experts. Data were analysed using qualitative content analysis informed by the Business Model Canvas framework. A combined deductive and inductive coding approach was applied to identify business model patterns of technology integration across cases. ResultsThis study examined leading home care providers in the most innovative countries Singapore, Switzerland, Sweden, the United Kingdom, and the United States, focusing on the three largest or most established providers in each country. Across the 15 cases, five recurring business model patterns were identified: (1) Franchise, (2) Fee-for-Service, (3) Diversified Customer Portfolio, (4) Community-based model, and (5) Performance-Based Contracting. Most providers adopted standard operational and clinical software (e.g., electronic medical records, scheduling, and billing systems). However, only a subset of providers - primarily in Singapore, Sweden, and the United States - implemented advanced digital solutions, such as predictive analytics, remote monitoring, robotic medication dispensers, and digital therapeutics. ConclusionThis study provides the first cross-national comparison of home care business models and their use of digital health technologies, showing that digitalisation is driven mainly by operational efficiency. Scalable technology integration requires alignment between digital solutions, financing models, and ecosystem partnerships.