Real-time location system implementation in dementia care: Stakeholder perspectives

Despite interest in using real-time location systems (RTLS) to improve quality and efficiency of care and to collect data for the development of clinical algorithms, research on their implementation and use in long-term care homes is scarce. This study examines RTLS implementation in one long-term care home identifying failure points, ethical tensions, and sociotechnical misalignments that led to abandonment.

Semistructured interviews were conducted with 47 participants (residents, care partners, direct care staff, managers, administrators) across two time points; all also completed a demographic survey. Thematic analysis of the data was guided by the Non-Adoption, Abandonment, Scale-up, Spread and Sustainability framework, and Sociotechnical Systems theory.

Initial enthusiasm for RTLS stemmed from safety and efficiency expectations, but misaligned functionalities, limited staff engagement, and ethical tensions undermined adoption. Stakeholders anticipated real-time monitoring and fall detection, neither of which were provided. Residents frequently removed the wearables, citing discomfort and privacy, while staff encountered barriers due to the limited integration of the RTLS into workflows. Ethical tensions emerged as residents' autonomy and preferences were overridden by care partners.

These failures underscore the need for iterative and participatory approaches to implementation, transparent communication, and stakeholder alignment. The findings highlight the sociotechnical complexities of implementing surveillance technologies in long-term care. Ethical concerns surrounding resident autonomy, workforce surveillance, and data governance, must be addressed in future implementations to ensure that RTLS supports rather than compromises the dignity and rights of residents and staff.