An Exploratory Study of Barriers to Implementing Technology in U.S. Residential Long-term Care Settings

Background If designed and implemented appropriately, technology can potentially be effective in increasing efficiencies and enhancing the quality of care and quality of life for older people living in nursing home, assisted living, continuing care retirement communities. Yet, technologies remain rare in these settings in the United States. The purpose of this exploratory study is to identify common themes about barriers to adopting technologic innovations in U.S. residential long-term care settings. Methods We conducted semi-structured interviews with 16 individuals in the United States who had expertise with technology in residential long-term care settings. Unlike previous studies, we included four distinct perspectives: providers, technology manufacturers, regulators, and other long-term care experts. We defined technology broadly but paid particular attention to technologies for five care issues that are especially prevalent and/or costly in residential care settings-wander management, fall prevention, incontinence care, assistance call, and bathing. Using content analysis, comments were grouped into four content areas (social, financial, regulatory, and change management) and themes within each area were identified. Results We identified 12 potentially important themes for further study: lack of information about cost-effectiveness of technologies; lack of information about other aspects of technologies; lack of information about residential long-term care market; limited resources for providers to purchase technologies; concerns about liability and associated costs; lack of reimbursement for technologies in these settings; limited resources for manufacturers to develop useful technologies; lack of standards to facilitate integration; discouragement of innovation by the regulatory environment; specific regulations inhibiting new technologies; staffing-related challenges, and the challenges of managing the process of change. Conclusions There is considerable agreement across providers, manufacturers and regulators in the United States about the major barriers to implementing technologies in residential care settings. Additional research is needed to shed light on effective strategies for overcoming these barriers and increasing the effective integration of technology in residential long-term care settings.