November 26, 2018

Robots to the Rescue?

Earlier this week, the New York Times featured an article entitled Meet Zora the Robot Caregiver. Zora, like her Japanese predecessors, the canine Aibo, the seal-like Paro, and the more recent humanoid Pepper, is being touted as a solution to manpower problems in geriatric caregiving. Can it work? And is it a good idea?

A friend who works in the robotics field reminded me of the potential of robotics when I wrote about the shortage of human caregivers to meet the needs of the coming wave of baby boomers entering old age. She acknowledged that today’s robots are limited in their abilities but is optimistic that when she and I may need their help—in 20 or 25 years—they may be ready. 

What exactly are robots being used for in the caregiving arena? Robots are being used for nursing home patients with dementia: they are used to calm people who are “antisocial, agitated, or sad” and asan antidote to loneliness. They provide reminders to forgetful elders to take their medications or go to the dining room for a meal. They show older people how to perform various exercises—repeatedly and with no sign of impatience. 

I have no doubt that robots are coming—this week also saw the publication of an essay in the New Yorker called Roomba Nation, which emphasizes the wide range of functions that robots can serve. Pepper, the previously alluded to  service worker in nursing homes, is also an employee of the hospitality industry. Paro (the robot seal robot) and Aibo (the robot dog) are purchased not only by nursing homes but also by facilities catering to disabled or depressed individuals. Robots clean floors in private homes and provide room service in hotels. And I have no doubt that robots can perform invaluable activities—minesweeping and disarming IEDs come to mind. 

But let’s be careful about just what tasks they replace and which functions they perform. Not that long ago, we began overhauling nursing homes so they would not serve merely as warehouses for older people, many of whom have cognitive impairment as well as physical disabilities. The practice of placing nursing home residents in wheelchairs, belting them in with restraints, and lining the chairs up in the hallway where nurses could “keep an eye on them” fell out of favor. It was replaced by an attempt (perhaps realized more often on paper than in reality, but an attempt nonetheless) to create a home-like environment where older people would feel valued and respected, and where they could find meaningful ways to spend their days. Critical to a sense of value, respect, and meaning are relationships. And relationships are between people. 

David Oliver, a geriatrician and general medical consultant in the UK, worries that the robotics industry may be driven in part by “marketing, the financial bottom line, and passive acceptance of workforce gaps.” Taking issue with the claim that robots can “provide rehabilitation…deliver personal care, and reduce social isolation,” he reminds us that “we should never forget that health and social care is a people business (emphasis added) and that those people might prefer more, not less, human contact.”

So—before we endorse the tagline, “robots to the rescue,” let’s think about the domains in which robots truly have something special to offer. In the nursing home setting, they could literally lighten the load for nursing aides, who right now have one of the highest rates of on-the-job injury in any industry, if they could lift patients out of bed and onto a wheelchair. That’s no easy task, both since we have to worry about the robot applying excessive force and crushing the person, and because frail, older people aren’t likely to remain motionless while they are lifted into the air. They could engage in monotonous, repetitive actions such as bringing lunch trays from the kitchen to their designated recipients. In the home setting, they may be able to provide 24/7 safety monitoring for older individuals with frailty or dementia, potentially allowing them to remain in their own homes with a spouse. But let’s make sure that the robots’ roles are to complement those of flesh and blood human beings. Let’s enable nursing aides and other caregivers to establish and maintain relationships with the subjects for whom they provide care. Let’s find ways to promote this newly reimagined career path to more people than are interested in today’s dead-end, low-paying, back-breaking jobs. Robots can help but they are not the solution.

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