When I started my career 30 years ago, our industry was a different world. People smoked in the buildings — staff and residents alike. But beyond the haze of the smoking rooms, the clinical landscape was fundamentally different. Buildings were staffed primarily by RNs, acuity was manageable, and technology was virtually nonexistent.
As we stand in early 2026, the smoke has cleared, but the visibility is worse than ever. We are facing a “Silver Tsunami” of higher-acuity residents entering facilities staffed by fewer, less experienced caregivers. While the industry breathed a collective sigh of relief when the federal staffing mandate was repealed last month, we must not mistake a reprieve for a solution. The mandate is dead, but the crisis is alive.
The crisis is threefold: demographics, clinical complexity and workforce collapse. Baby boomers are aging into long-term care at unprecedented rates while living longer with multiple chronic conditions — Alzheimer’s, COPD, diabetes, heart failure.
Meanwhile, the caregiver pool is still underwater. Even after meaningful job gains in 2025, nursing homes remain about 26,000 workers — 1.7% — below pre‑pandemic staffing levels, and 9 in 10 providers report ongoing recruitment challenges.
We cannot hire our way out of this. The bodies simply do not exist. This leaves us with a stark choice: continue to operate reactively and risk negligence, or fundamentally change the paradigm of how we watch over our residents.
The ‘blind spot’ standard of care
In the mid-1980s, the WanderGuard system — a simple wristband alarm that prevents residents with dementia from leaving the facility unattended — was introduced. Before that, preventing elopement was a manual, error-prone task.
Today, operating a facility without a wander management system would be unthinkable, likely citing grounds for immediate jeopardy. It shifted from a “nice-to-have” gadget to the absolute standard of care.
We are at that same inflection point with clinical monitoring.
Currently, we rely on intermittent vital checks — sometimes once a shift, sometimes once a month for long-term care residents. In the time between those checks, sepsis sets in, pneumonia develops, and conditions deteriorate silently. Asking a shrinking workforce to catch these subtle changes by rote is like driving a car on the highway with your eyes closed for ten seconds at a time.
Technologies like passive radar monitoring and predictive analytics are the modern equivalent of the WanderGuard. They are the “blind spot monitoring” for clinical decline. Just as your car’s radar passively watches the lane next to you without you asking it to, these systems watch for changes in heart rate, respiration, and sleep quality 24/7.
In our future state, a facility without continuous, passive monitoring will look as negligent as a facility today with unlocked doors and no WanderGuard.
Making the technology invisible
The biggest barrier to this future isn’t the technology itself; it’s the culture. There is a palpable fear among staff that new systems will replace them or make their jobs harder.
The lesson for operators is clear: Stop selling buzzwords. Sell the outcome.
We don’t need nurses to be data scientists; we need them to be empowered clinicians. By using passive monitoring tools to identify the 10% or 20% of residents who are actually sick (the Pareto principle), we allow staff to stop wasting time on rote checks for stable patients and focus their limited energy on those who need it most.
This isn’t about replacing the nurse; it’s about giving them the “blind spot warning” that prevents the crash — and they don’t need to know it’s radar or algorithms doing the work. They just need to know who to prioritize.
Funding the transition: A two-lane highway
Historically, skilled nursing has been the stepchild of healthcare innovation. When hospitals received billions for “Meaningful Use” to adopt Electronic Health Records in the 2010s, SNFs were statutorily excluded. The consequences of that neglect are now visible.
Since 2023, nearly 4,000 nursing homes lost at least one quality star in CMS’s rating system. Facilities cited for serious deficiencies — including serious harm or Immediate Jeopardy — climbed from 17% to 28% between 2014 and 2024. Civil monetary penalties increased 18% year-over-year in 2024, costing the sector $66 million in fines for Double G citations alone. We cannot afford to let that history of technological neglect repeat itself.
The Centers for Medicare & Medicaid Services recently issued a Request for Information on how to pay for AI in healthcare. This is a promising signal. We need a “Meaningful Use 2.0” specifically for post-acute care—funding that recognizes that continuous monitoring is not a luxury, but a safety requirement.
However, operators cannot afford to wait for Washington. The liability risks and the labor costs are present today.
The good news is that the financial pathways already exist, provided operators look for the right partners. While facilities themselves typically cannot bill for remote patient monitoring or chronic care management, they can collaborate with tech-enabled medical groups that do. These clinical partners can fund the implementation of these technologies through their own reimbursement streams, effectively subsidizing the safety net for the facility.
But this should not remain optional. Just as WanderGuard became a de facto regulatory requirement, continuous monitoring technology should be recognized as the new standard of care. CMS must fund it — and then mandate it — to ensure equitable access to life-saving technology across all facilities, not just those savvy enough to navigate billing codes.
The inevitable future
The staffing mandate battle was about inputs and how many hours of care we provide. The future is about outcomes: how safe that care actually is.
We are moving toward a world where technology doesn’t just support the workflow; it is the workflow. Whether funded by a forward-thinking CMS or by operators savvy enough to use existing reimbursement codes, the destination is the same. The “WanderGuard” of 2026 isn’t on a wristband; it’s in the cloud, it’s on the wall, and it’s saving lives. It is time we embraced it — and made it mandatory.
Mordy Eisenberg is the co-founder and chief growth and product officer at Tapestry Health.
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.
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