The increasing use of real-time location systems (RTLS) in long-term care facilities for individuals with dementia is raising significant ethical questions. While promoted as a tool to enhance safety and care efficiency, concerns about privacy, data security, and resident autonomy are coming to the forefront, often overlooking the perspectives of those most affected.
Key Takeaways
- Research on the effectiveness of RTLS in improving care is limited.
- The technology raises concerns about data security, privacy, and resident control.
- Perspectives of residents, family caregivers, and direct care staff are often excluded from research.
- Consent processes may not adequately involve residents or consider their preferences.
- Staff face challenges balancing resident autonomy with their duty of care.
Understanding Real-Time Location Systems
RTLS technology functions similarly to indoor GPS. Individuals in long-term care, and sometimes staff, wear a sensor-equipped tag or bracelet. This device communicates with beacons placed throughout the facility, enabling real-time tracking of movements and collecting data. The system can also generate automated alerts, such as when a person enters or leaves a specific area.
The primary driver for RTLS adoption in healthcare settings is the potential to predict health changes by analyzing movement data, which could then inform clinical algorithms. As RTLS in healthcare continues to expand, administrators and some family caregivers believe the technology can improve safely and efficiency by allowing continuous monitoring and quicker interventions.
Challenges and Ethical Dilemmas
However, research suggests that direct, in-person checks are often simpler for care staff to locate residents. Furthermore, staff may lack the time and resources for continuous remote monitoring or to act on real-time alerts. Studies indicate that RTLS might even increase staff workload rather than alleviate it.
A significant concern is the limited awareness among administrators, staff, and caregivers regarding the ethical implications of RTLS, particularly its impact on residents. There’s a deficit in involving residents in decision-making processes.
Power, Control, and Consent
In many cases, consent for RTLS use is obtained from substitute decision-makers, typically family caregivers, due to residents’ cognitive impairments. While caregivers often consent quickly, believing it enhances safety, they may not fully consider the residents’ preferences or their obligation to align decisions with residents’ values. Some residents have explicitly refused to share their location data, finding the devices uncomfortable and lacking personal benefit.
Family caregivers often have limited understanding of the data collected, its ownership, or how it will be used beyond localization. Despite this, many believe that increased movement data is beneficial and justifies continuous surveillance. Some also believe residents forfeit privacy rights upon entering long-term care.
Staff face moral distress when navigating the conflict between respecting a resident’s refusal to wear a tracking device and overriding it based on family consent. This uncertainty highlights the difficulty in balancing resident autonomy with the duty of care.
Future Considerations
RTLS presents uncertain benefits and new challenges in an already strained sector. The technology raises ethical concerns related to surveillance and control, potentially exacerbating power imbalances and perpetuating digital ageism and ableism. Digital ageism encompasses discrimination based on age within digital economies, including biased data sets and technology designs that don’t cater to older adults.
Ethical decision-making regarding RTLS requires the full involvement of all affected parties. Before adopting such technology, residents and families should be supported in understanding:
- What information will be collected?
- Who will have access to it?
- How will it be used to improve care?
- Are these improvements worth the compromise in privacy?
This approach emphasizes transparency, collaboration, and respect for dignity.
Sources
- The ethics of using location tracking technology with people living with dementia, The Conversation.
Founder Dinis Guarda
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