Health Smart Homes provide various forms of assisted living support, by monitoring the activities and health status of their occupants to generate flows of information and sometimes interventions involving the occupants and their careers. Technologies of varying complexity must be combined to produce the underlying Health Smart Home system, and processing of the resulting data may require methods of varying sophistication. These aspects have been well studied, but no widely-adopted approaches for practical implementation of systems or systematic processing of data have been developed. Also, the integration of Health Smart Home services with the overall health care system has not been regularized. This paper identifies and categorizes the emerging high-level challenges beyond those in the basic technical and algorithmic spaces. These challenges will influence future directions for Health Smart Homes and their wider adoption and integration with health systems.