Privacy-Preserving Framework for Multi-Institutional Medical Time-Series Analysis via Homomorphic Encryption: Design and Development Study.

The integration of digital technologies into nursing homes has emerged as a cornerstone of global strategies to address the dual crises of aging populations and chronic caregiver shortages. In China, these crises are distinctly amplified. The traditional model of family-based care has been severely strained by the 4-2-1 family structure [], driving an unprecedented surge in demand for institutional care. To bridge this widening care gap, the Chinese government has aggressively promoted Smart Eldercare initiatives, heavily subsidizing the deployment of digital health technologies such as sensor-based detection systems across long-term care facilities []. Furthermore, in the Chinese sociocultural context, the shift from family-based filial piety (xiao) to institutional care creates unique expectations. Families often expect facilities to maintain a high degree of relational warmth [], making the integration of cold, automated monitoring technologies a culturally sensitive challenge. Yet, their implementation of these technologies often reveals profound tensions between the technical promise of these systems and the relational, ethically charged realities of caregiving [,]. While these technologies promise scalability, their rigid designs often clash with the fluid rhythms of care work [], aging bodies’ heterogeneity [], and residents’ self-efficacy []. In hybrid spaces such as nursing homes, bed sensors intended to ensure safety may inadvertently surveil private moments [], and automated alerts touted as labor-saving tools frequently impose new forms of invisible work on frontline caregivers []. Dominant narratives in gerontechnology research often frame technology use as a binary outcome—tools are embraced for their perceived utility or rejected due to inefficacy []. Within this paradigm, existing studies have extensively explored caregivers’ roles, primarily focusing on their perceptions toward specific technology [], encountered challenges [], diverse interactions between caregivers and the selected technology [], decision-making and learning processes [], ethical concerns regarding safety or autonomy [], and the meanings that caregivers assign to the selected system []. While providing valuable insights into the social aspects of technology integration, the body of work predominantly frames caregivers’ labor as reactive workarounds or deviations from prescribed use []. Consequently, institutional stakeholders often overlook caregivers’ tacit expertise, dismissing their everyday actions [].