AI in Long-Term Care: A Closed-Loop Sociotechnical Reliability Framework
Journal of Medical Internet Research ·
AI is increasingly used in long-term care (LTC), yet reliability is often judged at the level of individual models or devices. This is insufficient in LTC, where residents vary in capacity, autonomy, and preferences. Their ability to question AI outputs may fluctuate, and care delivery depends on distributed roles and finite operational capacity. We define sociotechnical reliability as the capacity of an AI-enabled care system to consistently translate resident-relevant information into appropriate and timely care actions under real-world LTC conditions, with failures that are detectable and correctable across the care pathway. In this Viewpoint, we draw on professional experience overseeing AI initiatives across LTC and hospital settings, examined in relation to a purposively mapped interdisciplinary literature, to inform the development of a reliability framework. Our aim is to reframe AI reliability in LTC as an end-to-end care system property and to provide a framework for identifying where reliability is gained, lost, and evaluated. We propose 5 reliability functions: sensing, inference, verification and contextualization, response and escalation, and learning and adaptation, with governance and accountability operating across all 5 functions. The framework highlights recurrent failures, including incomplete sensing, nonportable inference, overreliance on or dismissal of AI outputs during verification, unclear ownership or delayed response, and repeated failures without correction. The framework also makes reliability empirically examinable through questions about where the pathway fails, who has the authority to verify and act, whether response demands are sustainable within available capacity, and whether failures become visible to governance and inform learning and adaptation. Our central viewpoint is that AI in LTC should be judged not by model performance alone but by whether the surrounding care system can reliably translate AI-generated information into care.