{"id":106295,"date":"2025-11-27T08:30:21","date_gmt":"2025-11-27T13:30:21","guid":{"rendered":"https:\/\/brocku.ca\/brock-news\/?p=106295"},"modified":"2025-11-27T16:05:31","modified_gmt":"2025-11-27T21:05:31","slug":"opinion-madalena-liougas-and-alisa-grigorovich-discuss-use-of-location-tracking-tools-in-dementia-care","status":"publish","type":"post","link":"https:\/\/brocku.ca\/brock-news\/2025\/11\/opinion-madalena-liougas-and-alisa-grigorovich-discuss-use-of-location-tracking-tools-in-dementia-care\/","title":{"rendered":"Opinion: Madalena Liougas and Alisa Grigorovich discuss use of location tracking tools in dementia care"},"content":{"rendered":"

This piece written by Madalena Pamela Liougas, PhD Candidate at the University of Toronto, and Alisa Grigorovich, Associate Professor of Recreation and Leisure Studies<\/span>\u00a0at Brock University<\/em>, originally appeared in The Conversation<\/a>.<\/em><\/p>\n

Imagine you\u2019re 83 years old, living with dementia in a long-term care home. Lately, your caregivers keep asking you to wear a bracelet on your wrist 24\/7. They say it\u2019s for your safety, so they can locate you quickly when needed.<\/p>\n

At first, you think it\u2019s OK, and it looks like a watch, so you go along. But you soon notice it never comes off. You must wear it everywhere, even in private spaces like your bed and bathroom. This becomes annoying, especially when you realize that it doesn\u2019t have any functions that are useful to you.<\/p>\n

What you may be unaware of is that it also collects information about your daily movements.<\/p>\n

This technology is a\u00a0real-time location system\u00a0(RTLS), and it\u2019s becoming increasingly common in hospitals and long-term care homes. They are promoted as improving physical safety and quality of care and are used for nurse calls, contact tracing, preventing unaccompanied exits\u00a0and more.<\/p>\n

Research demonstrating RTLS\u2019s worth is sparse, and its use raises questions around data security, privacy\u00a0and control. This is the case for those most affected by RTLS \u2014 older adults, family caregivers and direct care staff \u2014 whose perspectives are often overlooked in technology research.<\/p>\n

Real-time location systems<\/strong><\/p>\n

An RTLS works like an indoor GPS. Residents under care at a long-term care home (and sometimes staff) wear a tag or a bracelet with a sensor that communicates with beacons placed throughout the walls and ceilings of the building. The system enables the tracking of people wearing the sensor in real time, and collects movement data. It can also send automated geo-fencing alerts, such as when someone enters or exits a room.<\/p>\n

Interest in RTLS in long-term care and other health-care settings largely stems from the belief that they can be useful for predicting changes in health and well-being if\u00a0clinical algorithms\u00a0could be developed to analyze movement data.<\/p>\n

As part of a\u00a0larger project, our research team\u00a0conducted a study\u00a0with residents, family caregivers, direct care staff and administrators in one home that purchased an RTLS. Administrators and family caregivers told us that RTLS could make care safer and more efficient by increasing staff\u2019s ability to continuously monitor residents and enable quicker intervention.<\/p>\n

However, staff informed us that it was often simpler to locate residents in person, and that they lacked time and resources for continuous remote monitoring of residents or to investigate and respond in real time.<\/p>\n

This reinforced our findings from an\u00a0earlier study\u00a0of this technology in a hospital setting that similarly suggested that RTLS may increase staff workload. More concerningly, we found that administrators, staff and caregivers had limited awareness of this technology\u2019s ethical implications, including its impact on residents, and lacked the knowledge and skills to involve residents in decision-making.<\/p>\n

Power and control<\/strong><\/p>\n

In the setting we studied, consent for the use of RTLS came from substitute decision-makers \u2014 often a family caregiver \u2014 as most residents of the home lived with severe cognitive impairment or dementia. Many caregivers consented quickly, believing RTLS would help staff stay aware of residents\u2019 whereabouts, without fully considering residents\u2019 preferences. Few family caregivers involved residents in the consent process, despite their legal obligation as their substitute decision-makers to align decisions with residents\u2019 values.<\/p>\n

While most residents agreed to wear the bracelet, some explicitly rejected the idea of sharing their location data with family or staff. Over time, many wearers found no direct value in it and frequently described it as uncomfortable and heavy.<\/p>\n

Caregivers didn\u2019t fully know what data was collected by RTLS, who owned the data or how it would be used to improve care beyond localization. Still, most believed that having more information about residents\u2019 movements was beneficial and morally justified the continuous surveillance.<\/p>\n

Although\u00a0privacy rights\u00a0are protected by law in Canada and the United States, many family caregivers told the researchers they believed residents gave up those rights by entering long-term care. Some also sought access to RTLS data collected about their family members, expecting it would be shared to enhance transparency, although this never happened.<\/p>\n

Staff faced their own challenges. Some were unsure how to explain RTLS\u2019s benefits and risks to residents and to their families or respond to residents\u2019 concerns. They lacked guidance on whether to respect a resident\u2019s refusal to wear the tracking bracelet or override it based on family consent.<\/p>\n

This left staff uncertain about how to balance residents\u2019 autonomy with their duty of care, and contributed to\u00a0moral distress\u00a0among employees.<\/p>\n

Future considerations<\/strong><\/p>\n

Our research suggests RTLS offers uncertain benefits and creates new challenges in an already\u00a0under-resourced sector. Its use also raises ethical concerns, particularly around surveillance and control, which can exacerbate power imbalances and perpetuate\u00a0digital ageism\u00a0and digital\u00a0ableism.<\/p>\n

Digital ageism refers to discrimination on the basis of age that intersects with digital economies. Examples include limited or stereotypical representation of old age or older people in data training sets, tech design that doesn\u2019t reflect the heterogeneity of older users, the push to replace humans with technologies in caring for older adults and automated algorithmic decision-making that discriminates against older adults.<\/p>\n

Decision-making around RTLS needs to fully involve those who will be affected by these technologies. Before deciding to wear a tracking bracelet, residents and families should be supported in discussing this with care staff who help them to understand and reflect on:<\/p>\n