Digitalizing Caregiving for What? Role Dynamics of Caregivers in Nursing Homes Implementing Smart Technologies

This qualitative study investigated the perspectives and adaptation strategies of nursing home caregivers in Shanghai, China, following the integration of smart systems—including AI-powered fall detection, IoT-based health monitoring, and digital care platforms—into their work routines. Focus group discussions with 51 caregivers from nine certified “Smart Nursing Homes” and participatory observation in three were conducted. Drawing on role theory, thematic analysis revealed that smart technologies transformed caregivers’ roles by expanding them into data collection, reporting, interpretation, and selling, while creating new performance- and competition-based norms. These changes intensified role strain, manifesting as role ambiguity, role overload, intragroup skill-based strain, and job insecurity. To adapt, caregivers developed strategies to manage time pressure, create spaces outside technological surveillance, and foster stakeholder relationships. The findings underscore the complex interplay between technology and caregiving, highlighting the need for comprehensive support systems—such as targeted digital training, participatory co-design of implementation protocols, and revised performance metrics—to mitigate unintended consequences and ensure the well-being of both caregivers and residents. This study contributes to the ongoing discussions on the societal implications of technology adoption in long-term care, informing policy and practice to optimize the integration of smart systems while prioritizing the needs of caregiving workforce.