Overcoming the Hurdles of Modernizing Long-Term Care

Long-term care (LTC) facilities could greatly benefit from emerging healthcare technologies. This ranges from electronic health records to rehabilitation devices.

However, adoption in this sector lags behind other healthcare settings. Nursing homes were excluded from federal EHR (Electronic Health Records) incentive programs. This led to a digital divide in which LTC providers lack the funding and infrastructure to fully participate in health information exchange.

As a result, even though more than 80 percent of U.S. nursing homes have implemented EHR systems, true interoperability and advanced technology use remain limited. LTC administrators are confronted with a unique set of barriers in identifying, selecting, and implementing new technologies. Below, we break down the major obstacles, from workforce awareness to regulatory gaps, and then provide evidence to support it.

Lack of Awareness and Training Among Staff and Caregivers

One fundamental barrier is a knowledge gap among LTC staff and caregivers regarding available technologies and their benefits. Many frontline caregivers are not fully aware of what modern LTC technologies can achieve or how to use them effectively. Studies on health IT adoption have noted “insufficient knowledge about benefits afforded by the technology” as a significant barrier, often coupled with general apprehension about change.

In nursing homes, technology advocates, as well as IT specialists, are rare. Instead, implementations often rely on motivated staff or department heads to drive change. Without formal training and awareness programs, staff may adhere to familiar routines and fail to identify or advocate for useful innovations. This lack of awareness can lead to low utilization even when technology is available.

For example, a LeadingAge survey found that while many nursing homes have basic EHRs, they under-utilize advanced features due to limited staff knowledge and training resources. In short, if caregivers are not educated about new tools (and not confident in using them), then technology adoption will stall at the ground level.

• Insufficient Training – A shortage of IT training in LTC facilities means many employees have poor computer skills, meaning they will likely be uncomfortable working with new digital tools. Frontline workers often learn “on the job” and may not receive dedicated instruction on health technology systems. This lack of preparedness can cause frustration or misuse of the technology, which could undermine its potential benefit.

• Need for Leadership and Champions – Because formal IT roles are limited, successful tech adoption often depends upon internal champions. Research funded by HHS (Health and Human Services) observed that when a Director of Nursing (DON) or other leader actively supported a tech implementation, it was far more likely to succeed; without that support, projects lagged and staff motivation suffered. Engaging management and identifying tech champions among your LTC staff are crucial steps to raising awareness and maintaining adoption efforts.

• Overcoming the Awareness Barrier – Industry groups recommend building a pro-technology culture through communication and training. For example, LeadingAge advises involving staff early in tech decisions, offering hands-on training, and consistently communicating the organization’s commitment to digital innovation. By ensuring all your team members understand the “why” behind a new system and feel confident in its use, your LTC facility can increase buy-in and reduce the knowledge gap that impedes adoption.

Accessibility Issues

Not all technologies are designed with the aging population and diverse abilities of LTC residents in mind. Accessibility and universal design challenges pose another barrier to implementation: if a tool is not usable by a wide range of patients (or easily operable by staff of varying physical abilities), it will see limited uptake in a long-term care setting.

Usability and User-Centered Design

Technologies often lack a user-centered design that is tailored to older adults’ needs. A U.S. health workforce study noted that too many products are created “without [considering] the needs and characteristics of the user”, i.e. without input from actual caregivers or elderly users. Poor usability (small touchscreens, complex interfaces, or uncomfortable hardware) can alienate seniors and overburden your LTC staff. If a resident with poor vision or arthritis cannot easily interact with a device, or if a nurse finds a software system unintuitive, the technology’s intended benefits will be lost. Universal design principles (e.g. large text, voice interfaces, adjustable equipment) are essential but not always implemented in healthcare technology practices.

Concerns Over Cost, Usability, and Interoperability

Even when technologies are available, LTC organizations may be reluctant or unready to adopt them due to various concerns. Administrators and staff often weigh the risks of change, and several perceived challenges can cause hesitation.

Fear of Technology and Workflow Disruption

In LTC (as in healthcare generally), there is often resistance to change. Staff and managers may worry that a new system will disrupt established workflows or be too difficult to learn. This “apprehension about change” can manifest as passive resistance or active pushback against new tech. For example, a study on nursing home EMR rollouts found that fear and uneasiness with technology among staff was a significant barrier. In fact, many, including senior staff, felt uncomfortable with computers and were suspicious of the new systems. Such attitudes can derail an implementation (“physician rebellion” in a hospital context has been known to entirely halt a CPOE project). Overcoming this requires not just training (as above) but also change management: clear communication, demonstrating quick wins, and addressing fears (like the fear of being replaced or making errors with a new system).

Usability and Reliability Concerns

Reluctance is reinforced if the technology itself is seen as not user-friendly or reliable. Long-term care providers have expressed frustration when vendor products do not fit their needs or require extensive customization to work in the LTC environment. If a therapy device or software is glitchy, hard to navigate, or doesn’t align with nursing home workflows, staff will understandably be hesitant to embrace it. For instance, in one survey of hospital IT implementations, “product/vendor immaturity” – systems not refined enough for practical use – was cited as a major barrier, alongside cost. LTC providers similarly worry about investing in unproven or poorly designed tech.

Interoperability and Integration Worries

Long-term care facilities do not operate in isolation. They need to exchange information with hospitals, pharmacies, and family caregivers. A common concern is whether a new technology will play nicely with existing systems. Lack of interoperability (the ability of different IT systems to communicate) is a “key barrier to the full and effective use” of EHRs in nursing homes. Providers might fear that adopting a new electronic documentation system or sensor platform will result in yet another data silo that doesn’t connect to their main software. Indeed, an HHS report found “pervasive frustration among providers, manufacturers, and regulators alike with the lack of standards to facilitate integration” of technology in LTC settings. This concern can make administrators reluctant to invest, as they anticipate compatibility headaches or expensive integrations. The absence of universal standards in the LTC tech industry (unlike the standardized EHR systems in hospitals) means this reluctance is often justified. Vendors and policymakers are working to improve interoperability, but in the meantime, fear of buying a system that won’t talk to the pharmacy software or the state reporting system is a real adoption barrier.

In summary, reluctance to adopt new LTC technology often stems from fear of change, skepticism about usability, and uncertainty about integration. Building confidence through pilot programs, user testimonials, and demonstrations of interoperability can help alleviate these concerns.

Financial Constraints and Labor Limitations

Perhaps the most tangible barriers are the resource limitations faced by long-term care facilities. Many nursing homes operate on thin margins and with stretched staff. This makes it difficult to allocate funds, time, or personnel for new technology projects.

• High Upfront Costs – Budget constraints are a major hurdle. Nursing homes consistently report the high initial cost of technology, whether it’s purchasing new equipment or installing an IT system, as a top barrier to adoption. Unlike hospitals, LTC facilities were not subsidized for EHR adoption under federal programs, so any tech investment comes out of operating budgets that are often already tight. In a systematic review, cost was identified as the single biggest impediment to health IT adoption, especially in smaller healthcare settings. This is exacerbated by a misalignment of incentives: LTC providers must pay for the technology, but some benefits (e.g. reduced hospitalizations) accrue to payers or the healthcare system at large. Administrators may thus view the return on investment (ROI) as uncertain or too long-term to justify the expense.

• Limited Financial Incentives – In addition to direct costs, the lack of financial incentives or reimbursement mechanisms in LTC makes technology adoption harder. There are few reimbursement pathways for technology use in long-term care (for example, Medicare and Medicaid historically provided no direct reimbursements for using EHRs or telehealth in nursing homes). One HHS report highlighted “no reimbursement for using health IT” as a barrier, alongside lack of capital – meaning facilities see little immediate financial payback for tech utilization. The recent expansion of telehealth reimbursement in skilled nursing (e.g. during the COVID-19 pandemic) shows how policy can influence adoption. When CMS temporarily paid nursing homes for telehealth visits at parity with in-person visits, it removed a barrier and led to rapid uptake of telemedicine services. Absent such incentives, however, investing in technology often falls low on the priority list for cash-strapped LTC centers.

• Labor Constraints – Beyond money, staffing limitations impede technology projects. Long-term care operates with lean staffing; nurses and aides have very little slack time for additional duties. Implementing a new technology, whether it’s an electronic record or a patient lifting device, requires training time, workflow adjustments, and ongoing maintenance, all of which demand staff time and effort. In many nursing facilities, there is simply “very limited time for additional work”. This means even if a device is purchased, it might sit unused because staff cannot spare time to learn or incorporate it into their routine. Additionally, many facilities lack dedicated IT support personnel. As noted, technical responsibilities often fall to clinicians or managers who already have full-time roles. This lack of HIT expertise on staff can slow down troubleshooting and lead to under-utilization of the technology. In short, human resources, both in terms of headcount and skillsets, are a limiting factor. Any tech adoption plan in LTC must account for training, change management, and possibly hiring or consulting IT specialists, which small facilities may struggle to afford.

• Maintenance and Ongoing Costs – Another financial consideration is the ongoing cost of technology. Even after the initial investment, there are maintenance fees, software subscriptions, updates, and potential repairs. For example, license renewals for software or calibration for advanced medical devices add annual expenses. If these costs are not budgeted, facilities might let a technology fall into disuse. Unlike larger health systems, many LTC providers do not have capital reserve funds for technology updates, meaning a breakdown can render a system defunct. The total cost of ownership is a real concern that can deter adoption from the outset.

Regulatory and Policy Gaps

The policy landscape in long-term care technology is still catching up, and this creates uncertainty that can hinder adoption. There are gaps in standards, regulations, and evaluation frameworks that leave LTC providers without clear guidance or incentives.

Lack of Standardization and Guidelines

Unlike acute care, which has seen robust standard-setting (e.g. ONC certification for EHRs, Meaningful Use criteria), the LTC technology space is comparatively under-standardized. As mentioned, the industry suffers from a “lack of standards to facilitate integration”, whether it’s for health data exchange or for device interoperability. For LTC administrators, this Wild West environment means it’s harder to choose a reliable product. There may be dozens of vendors (say, nurse-call systems or remote monitoring) each using proprietary systems. In the absence of clear standards or endorsements, facilities risk investing in technologies that could become obsolete or incompatible with future systems. Moreover, regulatory oversight on new tech (such as assistive robots or AI tools for eldercare) is still evolving – providers might be unclear on what is approved, what meets privacy/HIPAA requirements, or how to handle data governance. This uncertainty and lack of guidance is a barrier: many prefer to wait until regulations and standards are established to avoid compliance pitfalls.

Gaps in Reimbursement and Incentives

As noted under financial barriers, policy has not provided the same incentives in LTC as in other settings. Nursing homes “have not benefited from the significant financial support for EHR adoption” that hospitals did, due to exclusion from programs like the HITECH Act. The result is a persistent gap: without government grants or bonus payments, there is less external push to adopt technology. Additionally, payment models in long-term care (Medicaid daily rates, Medicare post-acute bundles, etc.) historically did not account for technology use. If a skilled nursing facility implements, for example, a falls prevention sensor network, there’s no direct reimbursement for that investment, even if it improves care, the financial returns are indirect (fewer hospitalizations, which mainly benefit payers). The absence of value-based or reimbursement mechanisms for tech creates a disincentive to innovate. Forward-looking policy recommendations have called for new funding streams, noting that “monetary incentives, policy requirements, or a strong business case” are needed to drive interoperability and tech utilization in LTPAC settings. Until such policies materialize (e.g. grants or higher reimbursement tied to tech-enabled care), many facilities will adopt a cautious, minimal approach.

Lack of Evaluation Frameworks and Evidence

Another subtle barrier is the shortage of evaluation procedures and evidence to guide technology selection. LTC administrators often ask: will this tool actually improve outcomes or save money? Unfortunately, there is limited research specific to long-term care settings to answer that. A 2018 UCSF review pointed out that “little research exists on which technologies will have the greatest potential” impact in LTC. For emerging solutions (telehealth, AI monitoring, etc.), rigorous studies in nursing homes or assisted living are sparse. Without standardized evaluation metrics or pilot data, facilities struggle to compare options or justify the investment to their boards. Additionally, unlike acute care where quality metrics (readmissions, falls, etc.) are closely tracked, LTC lacks comprehensive tech-related outcome measures. This makes it harder to quantify the ROI or clinical benefit of a new system, contributing to the perceived risk of adoption. In some cases, administrators rely on vendor claims or anecdotes, which may not be convincing enough to overcome skepticism. The situation is slowly improving. For example, CMS’s Innovation Center and AHRQ have funded some demonstration projects. But a clearer evidence base and evaluation toolkit for LTC tech would help administrators make informed decisions.

Regulatory Uncertainty

Finally, the complex regulatory environment in long-term care can itself be a barrier. Providers worry about inadvertently running afoul of HIPAA or other regulations when implementing technology. For example, health information sharing in LTC involves navigating privacy rules: one report found that organizations perceived “risks of sharing patient information in a complex regulatory environment” as a strong barrier, with each institution interpreting privacy requirements differently. This is particularly relevant for technologies like health data analytics or cross-provider platforms. Additionally, when regulations do not explicitly address a technology (e.g. remote monitoring devices or electronic care-planning tools), providers may hesitate without clear legal guidance. Advocacy groups like LeadingAge have been urging regulators to update standards and provide clarity. They have recommended, for example, that CMS develop interoperability rules tailored to LTC and not penalize facilities that are still catching up. Progress on these fronts could remove uncertainty and give LTC providers more confidence to invest in modern systems.

Workforce Injuries and Resistance to Operational Change

Long-term care is a labor-intensive field, and the human factor presents two related barriers: the prevalence of caregiver injuries in current practices, and a corresponding resistance to changing those practices. While new technology (such as lifting devices or automated aids) could alleviate staff injuries, convincing the workforce to alter their routines and trust these tools can be challenging.

High Rate of Caregiver Injuries

Nursing home staff perform physically demanding work – lifting, transferring, and repositioning dependent adults daily. This leads to extraordinarily high injury rates. In fact, nursing assistants in long-term care have an incidence of musculoskeletal injuries over five times the average for all industries. Sprains and strains (especially of the back and shoulders) are common, often caused by repeated manual lifting and awkward postures during patient transfers. The consequences are severe: chronic back pain, high turnover, absenteeism, and increased workers’ compensation costs. OSHA reports that as many as 20% of nurses who leave direct care positions do so because of injury risk, and back injuries among healthcare workers cost an estimated $20 billion annually in direct and indirect costs. This status quo is clearly unsustainable – it underlines the need for safer patient handling technologies (ceiling lifts, sit-to-stand aids, etc.). Indeed, patient transfer devices are proven to significantly reduce caregiver injuries. However, implementing these solutions is not just a matter of buying equipment; it also requires operational changes in how care is delivered.

Resistance to Change in Practices

Despite the dangers of manual handling, introducing new equipment or procedures can meet resistance from staff. Caregivers may be accustomed to “the way we’ve always done it” and skeptical of new devices. Some common sentiments include: “Using the lift takes too long”, “I trust my own technique more”, or simply discomfort with unfamiliar technology. This ties back to fear and training – many staff are uncomfortable with new tools and may initially find them cumbersome. For example, early adopters of safe lifting programs have noted that if leadership and peers are not encouraging usage, staff may revert to old habits, even if those are riskier. Resistance also arises from workflow disruption; using a mechanical lift or transfer platform might require coordinating two staff or charging a battery – changes that can be seen as inconveniences initially. Furthermore, operational change often means confronting a facility’s culture. Without strong management commitment and clear policies, even provided equipment might gather dust. OSHA emphasizes that management must commit to a safe patient handling program, including training and involving workers in equipment selection, to overcome such resistance. In essence, while workforce injuries highlight the need for technology, real-world adoption demands addressing the human element – convincing and training staff to integrate new practices into their daily routine.

Change Management Examples

Some LTC facilities have successfully navigated this by appointing “safe handling champions” and setting protocols that mandate use of lifts for certain tasks. Peer mentorship can help, as can demonstrating quick benefits (e.g., an injured aide returning to work sooner because the new device eased their tasks). It’s also important to frame technology as an aid, not a replacement, to reduce fear. When staff see that a device protects their health and makes their job a bit easier, they become more open to it. Change is always hard in healthcare, but given the stakes, it’s a barrier worth overcoming.

Having examined the barriers, from cultural to financial, it’s clear that implementing technology in long-term care is a complex challenge. However, it’s not insurmountable. Many of these barriers can be addressed with the right solutions and strategies.

Overcoming Barriers with the Barihab™ Platform

While the challenges are significant, technologies like the Barihab™ treatment and assessment platform show how they can be overcome in practice. The Barihab™ is a specialized rehabilitative device designed for long-term care and rehab settings. By focusing on safety, versatility, and ease of use, it directly addresses many of the barriers discussed above, offering a transformative solution for LTC facilities. Key benefits of the Barihab™ platform include:

• Enhanced Safety & Fewer Injuries – Barihab™ is engineered to help eliminate risky patient transfers during therapy. Its sit-to-stand convertible design allows patients to be moved and treated with far less manual lifting by staff. This significantly reduces overexertion injuries to caregivers. In fact, facilities report that with the Barihab™, “heavy, multiple-therapist lifting has been virtually eliminated,” greatly lowering the risk of lift-related injuries for therapists. By providing a stable, supported way to mobilize patients (even bariatric patients), the platform protects both patients and staff. This addresses the workforce injury barrier, so staff can deliver care confidently without fear of hurting themselves or the resident.

• Labor Efficiency & Lower Staffing Burden – The platform’s unique design often enables one staff member to do the work of two or three, which is game-changing for labor-strapped facilities. For example, the Barihab’s transfer bars and powered adjustments mean even a single, smaller therapist can safely handle a very large patient. One nursing home administrator noted that, “we no longer need three or more therapists to help physically lift our bariatric patients”, as the device does the heavy lifting. This not only eases staff scheduling (critical when dealing with shortages) but also cuts labor costs. Fewer staff are needed for each session, and those staff are less likely to be out due to injury. The overall effect is improved productivity. In fact, many facilities find that “the Barihab pays for itself” in a short time through these efficiencies. With typical use, the platform has an ROI of around 12 months – essentially replacing the cost of an additional full-time aide or therapist over a year.

• Real-Time Data Tracking & Better Documentation – The Barihab™ includes digital read-outs (for metrics like weight-bearing, angles, etc.) that therapists can use to monitor patient progress in real time. This data can be documented directly, streamlining the reporting process. As one administrator testified, “the electronic read-out features allow the therapist to more accurately document the patients’ progress and more effectively communicate with physicians and families” about outcomes. In other words, Barihab™ helps close the loop on documentation and interoperability: data from therapy sessions can be recorded and shared, supporting the facility’s quality tracking and potentially integrating with electronic records. This directly addresses concerns about interoperability and evaluation. This Barihab™ platform makes it easy to gather evidence of improvement, strengthening the business case for its use. In fact, administrators can measure patients’ gains.

• Universally Designed for Diverse Patients – A critical feature of Barihab™ is its versatility for different patient needs. It can accommodate patients up to 1,000 lbs and adjusts to various heights and positions. Therapists have a range of interchangeable parts (backrests, grab bars, knee supports) to customize therapy for each individual. The result is a device that works for “95% of our population…with all body types,” according to one rehab director. This universality means accessibility is built-in – bariatric residents, wheelchair users, and more ambulatory seniors can all use the same equipment safely. The design is also intuitive. Caregivers describe it as a “user friendly piece of equipment” that patients actually enjoy using. By fostering patient comfort and confidence (patients feel safe from falls, which reduces their anxiety), Barihab™ also improves patient engagement in their rehab therapy. In practice, facilities observe boosts in patients’ self-esteem and motivation when using the device – they are more eager to participate, which leads to faster rehabilitation. This addresses the barrier of accessibility and acceptance among patients: the technology is not intimidating but empowering, even for those who are typically tech-averse or have special needs.

• Demonstrated Outcomes and ROI – Importantly, the Barihab™ platform comes with assessable impact that helps overcome skepticism. Testimonials and data from user facilities show concrete improvements. Patients using Barihab have shown quicker recoveries – one administrator noted it “gets patients walking in half the time” compared to traditional methods. Therapists are able to deliver more intensive and frequent therapy sessions because the device reduces the physical strain on them. This leads to better clinical outcomes (e.g. more patients regaining the ability to stand or transfer independently) and also financial benefits (e.g. shorter lengths of stay, which can improve facility throughput or Medicare metrics). Several facilities report achieving a full return on investment within less than 12 months of purchase through labor savings and reduced injury costs.

Conclusion

While long-term care has historically been slow to adopt new technology due to the many barriers outlined (from awareness and design challenges to cost and policy issues), solutions like the Barihab™ platform demonstrate a path forward. By prioritizing safety, ease of use, and measurable outcomes, the Barihab™ addresses key pain points. It improves staff and patient safety, reduces workload and costs, provides data for decision-making, and works with the realities of small staff and diverse resident populations.

For LTC administrators, the message is optimistic: by identifying the right technology tailored for long-term care and by proactively managing the change process (through staff training, seeking funding opportunities, and advocating for supportive policies), it is possible to overcome barriers. In doing so, facilities like yours can transform your operations, enhancing care quality, protecting your workforce, and achieving better financial sustainability.

The example of the Barihab’s success in multiple nursing facilities, with therapists becoming “loyal advocates” and residents making remarkable progress, shows that the effort can truly pay off. Technology in long-term care is no longer a question of if but when, and removing these barriers will make possible a safer, more efficient, and higher-quality future for LTC providers and their residents.