Background Health smart home (HSH) technologies have the potential to support ageing in place and enhance quality of life. However, uptake remains limited in home-based contexts where benefit may be greatest. In parallel, older adults are experiencing prolonged wait times for formal support, with limited access to integrated digital solutions. Aim This ARIIA-funded project sought to address the gap between the potential of HSH technologies and their limited uptake by generating practice-informed insights and developing practical guidance to support decision-making by older adults, families, and service providers. Methods This project drew on real-world deployment of in-home, sensor-based health monitoring systems, combined with implementation insights and stakeholder engagement with older adults, families, and providers. Findings Practice-based insights highlighted a persistent misalignment between technological capability and real-world adoption. unclear implementation pathways, and expectations that technology will be formally provided within care systems. In practice, access through system-led pathways was often delayed, fragmented, or absent, leaving older adults and families without clear guidance on how to act. Implications These findings suggest that decisions about technology use cannot always wait for system-level provision. Supporting earlier, informed decision-making by older adults and families represents a practical pathway to enable more timely adoption. The developed guidance resources provide structured support for understanding technology options, considering fit, and navigating implementation in real-world contexts. Conclusion Reliance on aged care system-led adoption pathways may delay access to potentially beneficial technologies. In the absence of timely system integration, practical guidance that supports informed, earlier decision-making can enable more responsive and person-directed use of HSH technologies in the home.