Installing RTLS in an Older Hospital: Retrofit Challenges in Buildings That Were Never Designed for It

By the MGM Solutions team — life-safety RTLS specialists since 2002.

Vendor demonstrations are performed in new construction. Real deployments happen in a 1962 tower
with a 1978 addition, a 1994 connector, and a patient wing that has been continuously occupied for
forty years. The gap between those two environments is where RTLS projects go over budget and past
schedule.

Older buildings are not merely harder to wire. They change how radio behaves, they constrain where
devices can physically go, and they impose infection-control and occupancy rules that dictate the
sequence of the entire installation. A hospital RTLS retrofit is a construction
project with a technology component, and treating it the other way around is the most common planning
error we see.

What Older Construction Does to Radio

Buildings from different eras attenuate signal differently, and the differences are large enough to
change a design.

Lath and plaster with metal mesh behaves like a partial Faraday cage. Common in
pre-1950s construction and far more attenuating than modern drywall.
Poured concrete and heavy rebar in mid-century towers attenuates strongly floor
to floor, which is exactly the direction you need coverage.
Lead-lined imaging suites are effectively RF holes. Every facility has them, and
they are rarely marked on the drawings you are handed.
Terra cotta block, structural clay tile, and masonry interior walls attenuate far
more than the stud partitions a coverage model assumes.
Later additions and connectors mean the building does not behave uniformly. Each
construction era needs its own assumption.

This is where operating frequency stops being a specification detail and becomes a budget line.
Lower frequencies penetrate building materials better than higher ones. A 2.4 GHz system — Wi-Fi
or BLE — is fighting the worst of these conditions and compensates with device density, which in
an occupied older building means more ceiling penetrations, more conduit, and more after-hours labor.
SecurTRAK uses 433 MHz active RFID for the building-wide link precisely because it
travels through walls and floors that stop higher-frequency signals, with infrared
providing room-level confirmation and low frequency handling doorway chokepoints.
The physics is covered in
BLE vs 433 MHz for
hospital RTLS and
why Wi-Fi, BLE, and 900 MHz fall
short.

One clarification worth making: infrared is not disadvantaged by old construction. IR is confined
by walls by design — that is the entire point — so a room-level read is as reliable in a
1955 plaster-walled room as in new construction, provided line of sight inside the room is respected.

The Physical Constraints Nobody Budgets For

Constraint	Why older buildings make it worse	What it does to the project
No accessible ceiling	Hard-lid plaster ceilings; no plenum in older wings	Surface raceway, or cutting and patching with ICRA controls
Congested plenum	Decades of layered cable, ductwork, and abandoned conduit	Slower pulls; abandoned-cable removal may be required by code
Asbestos and lead	Common in pre-1980 construction materials	Survey before any penetration; abatement adds schedule and cost
Limited electrical and IDF capacity	Older closets are full, hot, or unsuitably located	PoE switch capacity, UPS, and sometimes new closet space
Fire and smoke barriers	Rated assemblies not always documented accurately	Firestopping at every penetration; inspection sign-off
Continuous occupancy	No swing space in a full hospital	Work in small phases, often nights; infection control barriers
Drawings that do not match reality	Undocumented renovations across decades	Field verification is mandatory, not optional

Every one of these is manageable. None of them is free, and the estimate that ignored them is the
one that produces change orders in month three.

Infection Control Governs the Schedule

In an occupied healthcare facility, any activity that disturbs a ceiling or a wall triggers an
infection control risk assessment. Depending on the classification, that can mean containment
barriers, negative air machines, HEPA filtration, dedicated routes for workers and debris, and
restricted work hours near immunocompromised patients.

Plan for this at design time, not at mobilization. The two decisions that most reduce ICRA burden
are choosing device locations that minimize ceiling penetrations, and grouping work so a containment
setup covers multiple installations. The design that looks cleanest on paper is often not the one that
installs fastest in a live unit — a receiver placed six feet away in an accessible location can
save a full day of containment.

Phasing: Life Safety First

Enterprise-wide, all-at-once deployments are the wrong shape for an older campus. Phase by risk.

Survey before you design. Walk the building with test equipment and validate
attenuation in each construction era, on each floor, including stairwells, elevator lobbies, and the
imaging suites. Do not accept a coverage model built from drawings alone.
Start with the highest-risk life-safety application. Usually elopement
prevention on behavioral health or a memory unit, or duress in the emergency department. These have
the clearest harm case and the strongest internal support.
Secure the boundary before instrumenting the interior. Exterior doors, stairwells,
elevator lobbies, and connectors first. Room-level coverage on interior units can follow.
Extend outdoors early, not last. Parking areas, courtyards, and inter-building
routes are usually easier than the interior work and close the gap where most systems go dark.
Add the remaining use cases on the same infrastructure. Infant security, asset
tracking, and temperature monitoring reuse what is installed, which is what makes the incremental
phases cheap.
Re-verify after every major renovation. A new lead-lined room or a rebuilt
partition wall changes RF behavior. Coverage is not a one-time measurement.

The financial argument for phasing is straightforward: each phase produces a working safety
capability that can be evaluated and defended, rather than an eighteen-month project with no
deliverable until the end. Our
business case
guide covers how to structure that internally.

Why One Infrastructure Matters More in an Old Building

In new construction, running separate systems for wander management, duress, infant security, and
asset tracking is merely wasteful. In a 1960s building it is punitive: four sets of devices, four sets
of ceiling penetrations, four ICRA setups, four firestopping inspections, and four vendors
coordinating around the same occupied units.

SecurTRAK delivers every life-safety use case — elopement prevention, staff duress,
infant security, and asset tracking — on a single infrastructure, indoors and outdoors.
One installation event per area, one set of penetrations, one commissioning process. In a retrofit,
the consolidated infrastructure often saves more in installation labor and disruption than in
hardware. See how we are different and
campus-wide
elopement prevention.

It is also why the same approach works in corrections facilities, where construction is heavier
still and occupied-space constraints are tighter. See
corrections facility
solutions.

Frequently Asked Questions

Can RTLS be installed in a hospital built in the 1960s?

Yes, and most of our deployments are retrofits rather than new construction. The requirements are a real RF survey per construction era rather than a drawing-based model, a device layout that minimizes ceiling penetrations, an infection control plan, and phased installation in occupied units. Lower-frequency RF such as 433 MHz penetrates older construction materially better than 2.4 GHz systems.

How long does a hospital RTLS retrofit take?

It depends far more on access and phasing than on the technology. Work in occupied units with infection control containment and night-shift restrictions proceeds slowly, which is why we phase by risk – a single high-risk unit can be live in weeks while a full campus rollout runs across quarters. Insist that any schedule you are given states its assumptions about access hours and ICRA classification.

Do we have to close units during installation?

Normally no. Retrofits in occupied buildings are done in small phases with infection control barriers, often on off-shifts, one area at a time. The design should be evaluated for installability, not just coverage – moving a device a few feet to an accessible location can eliminate a containment setup entirely.

Does lead-lined imaging block RTLS?

Lead shielding blocks radio signals, so a tag inside an imaging suite generally will not be heard by receivers outside it. This is handled in design by treating those rooms as their own coverage zones with dedicated devices and by placing chokepoint detection at their entrances, rather than by hoping signal penetrates. Identify every shielded room during the survey, because they are frequently missing from as-built drawings.

Can we reuse existing cabling or network infrastructure?

Often partially. Modern receivers are typically PoE devices, so usable existing runs and available switch ports reduce cost – but older closets are frequently at capacity, unconditioned, or poorly located, and abandoned cable may need removal to comply with code. Have the electrical and IDF capacity assessed during the survey rather than assuming reuse.

Talk to an RTLS Expert

M.G.M. Computer System, Inc. (dba MGM Solutions) has delivered life-safety RTLS to VA medical
centers, hospitals, and corrections facilities since 2002 — with 99.8% uptime and 40+ VA
projects as prime contractor. We are a CVE-verified Service-Disabled Veteran-Owned Small Business.

Tell us what you are trying to protect and we will tell you, honestly, whether SecurTRAK is the
right fit — and what it would take to cover your whole campus, indoors and outdoors.

Email:
sales@mgm-solutions.com •
Phone: (856) 371-3764 •
Request a consultation