My mother, an Alzheimer’s patient, was in a skilled nursing facility. As the disease progressed, she could do less for herself. One day on a visit, I found her in the hallway, alone. The hallway lights were dim; no one in sight. In the after lunch rush, they had forgotten about her. She needed was someone to watch over her when nursing staff and family were absent.
She needed an assistive robot.
In the United States, we are reaching epidemic proportion of older adults who will need healthcare later in their lives. By 2030, that population will grow from 35 million to 72 million, close to a 20 percent increase in the U.S. population with a global increase of more than 60 percent. Unfortunately, most older adults now die of a chronic or long-term illness in a skilled healthcare facility. Adults 85-plus are almost twelve times as likely to reside in one, while higher numbers of older adults are living in assisted living.
Along with that, an impending nursing and geriatrician shortage is predicted. In 2014, there was only 7,000 certified U.S. geriatricians; that’s one for every 2,600 patients age 75-plus, and studies estimate that by 2030 30,000 geriatricians will be needed.
Because of these shortages, high mortality rates and re-admission likely will occur unless we get help. So if there was ever a time for assistive robots to step in, now would be the time.
Assistive Robots Face a Number of Challenges
Japan has the oldest population in the world. From soft cuddly robotic seals named Paro, to Robear the giant lifting bear, to Pepper the humanoid robot, Japan is incorporating an assistive robotic culture to solve their healthcare needs. The U.S. has been more reluctant to adopt assistive robots, however, for a number of reasons.
1. Some experts argue that using robots as healthcare assistants creates an artificial relationship between the patient and the caregiver. Mark Meadows of Botanic, believes that we have already outsourced care-giving, saying that the sentimentality behind this thinking is something that is long gone.
2. From a design and engineering standpoint, current assistive robots are just navigating the unstructured setting challenges and ethical decision-making that elder care presents.
3. Cost is another factor, too. Assistive robots are expensive, which makes healthcare even more expensive. How patients and health professionals will adapt to robots is also an issue.
4. Most healthcare professionals believe assistive robots are inevitable to the future of care-giving. But the distinction falls between assistance and professional judgment. In most facilities, says Carol Huston, nursing professor, California State University, professional time is often spent on non-professional activities. This is where Huston believes robotic caregivers work best – as an extender of care for nurses.
“I see them as a clear alternative to giving health care providers more time to do things that they are trained to do,” said Huston. Ultimately, this technology must encompass the environmental context, the physical structures, and their constraints, as well as the end users and their health or professional needs.
How Assistive Robots Can Help
Meadows believes that robots can serve three basic needs: surveillance, privacy and companionship. But the mistake, he thinks, is focusing purely on the technology. These problems, he says, are cultural and once we address these issues culturally, we can focus on the end user’s needs. Siddhartha Srinivasa of Carnegie Mellon University, pioneer of Herb the Butler, agrees. “I think we are at fault for focusing too much on technology to make able-bodied people more capable and neglect our social and ethical duties to care for people in need.”
How those end users, the patients, accept and adapt to this technology is also a question. While studies have been limited, they show that the attitude of older adults is generally positive towards assistive robots. This, however, may depend on their environment and health status.
For those living in a facility, some may need help with activities of daily living, like bathing, going to the bathroom, dressing and eating. For those with advanced care needs, they may need help turning in bed to avoid bedsores, extensive rehabilitation assistance, dementia care, or feeding assistance. Designers must take into account that needs range over a spectrum of elder care. As a result, a range of characteristics in robotic assistants must contain a mix of advanced manipulation abilities, voice, image and facial recognition, natural language processing, haptic sensing, sound and image analysis and others.
A Gradual Ramp-up to Assistive Robots
While research continues, what’s expected to be on the horizon are targeted assistive technologies that will be more affordable, says Daniel Siewiorek, Director of the Quality of Life Center at CMU. “I see more of these coming along initially as opposed to having one totally integrated unit that does everything,” he said. Srinivasa echoes Siewiorek, seeing a gradual ramp-up to intelligent assistive technology.
Srinivasa and his team have advanced Herb’s manipulation abilities and are partnering with Kinova and the Rehab Institute of Chicago on a new robotic arm, the Assistive Dexterous Arm, that will help patients with spinal cord injuries.
In terms of avatars, Sophie from Botanic is dressed as a healthcare professional, complete with a stethoscope, and can have a conversations with patients, gather healthcare data, and provide advice in terms of prescriptions and sentiment. She can listen, gather information, and share that information with healthcare professionals.
In the end, we need to develop assistive robots that will complement a healthcare professional’s job so they can do patient care, even though our most critical objective must be meeting the vast needs of an aging population.