Each time I make a house call, I stay much longer than I should. I can’t leave because my patient is holding my hand, or because she’s telling me, not for the first time, about when Aunt Mabel cut off all her hair and they called her a boy at school, or how her dad lost his job and the lights went out and her mother lit pine cones and danced and made everyone laugh. Sometimes I can’t leave because she just has to show me one thing, but getting to that thing requires that she rise unsteadily from her chair, negotiate her walker through the narrow hallway, and find whatever it is in the dim light of her bedroom.
I can, and do, write prescriptions for her many medical problems, but I have little to offer for the two conditions that dominate her days: loneliness and disability. She has a well-meaning, troubled daughter in a faraway state, a caregiver who comes twice a week, a friend who checks in on her periodically, and she gets regular calls from volunteers with the Friendship Line.
It’s not enough. Like most older adults, she doesn’t want to be “locked up in one of those homes.” What she needs is someone who is always there, who can help with everyday tasks, who will listen and smile.
What she needs is a robot caregiver.
That may sound like an oxymoron. In an ideal world, it would be: Each of us would have at least one kind and fully capable human caregiver to meet our physical and emotional needs as we age. But most of us do not live in an ideal world, and a reliable robot may be better than an unreliable or abusive person, or that no one at all.
Caregiving is hard work. More often than not, it is tedious, awkwardly intimate and physically and emotionally exhausting. Sometimes it is dangerous or disgusting. Almost always it is 24/7 and unpaid or low wage and has profound adverse health consequences for those who do it. It is women’s work and immigrants’ work, and it is work that many people either can’t or simply won’t do.
Many countries have acknowledged this reality by investing in robot development. Last year in Japan, where robots are considered “iyashi,” or healing, the health ministry began a program designed to meet workforce shortages and help prevent injuries by promoting nursing-care robots that assist with lifting and moving patients. A consortium of European companies, universities, and research institutions collaborated on Mobiserv, a project that developed a touch-screen-toting, humanoid-looking “social companion” robot that offers reminders about appointments and medications and encourages social activity, healthy eating, and exercise. In Sweden, researchers have developed GiraffPlus, a robot that looks like a standing mirror cum vacuum cleaner monitors health metrics like blood pressure and has a screen for a virtual doctor and family visits.
Researchers in the United States are developing robot-caregiver prototypes as well, but we have been slower to move in this direction. Already, we have robots to assist in surgery and very basic “walking” robots that deliver medications and other supplies in hospitals. Robots are increasingly used in rehabilitation after debilitating events like strokes. But a robot that cleans out your arteries or carries linens isn’t the same as a robot meant to be your friend and caregiver. Even within the medical community, this idea that machines could help fulfill more than just physical needs meets largely with skepticism, and occasionally with outrage.
As Jerald Winakur, a San Antonio internist and geriatrician, put it, “Just because we digitally savvy parents toss an iPad at our kids to keep them busy and out of our hair, is this the example we want to set when we, ourselves, need care and kindness?”
And yet, search YouTube and you can watch developmentally delayed children doing therapy with acute blue-and-yellow CosmoBot that also collects information about their performance. Or you can see older Japanese people with dementia smiling and chatting happily with a robot named Paro that looks like a baby seal and responds to human speech. Sherry Turkle, an M.I.T. professor and technology skeptic, questions such as artificial emotional relationships in her book “Alone Together: Why We Expect More From Technology and Less From Each Other.” Yet after watching a 72-year-old woman named Miriam interact with Paro, she noted that the woman “found comfort when she confided in her Paro. Paro took care of Miriam’s desire to tell her a story.”
One proof of the social and emotional potential of robot caregivers is probably right in front of you. If you have walked down any street recently, or sat in a restaurant, or entered a workplace, you’ve probably seen numerous people oblivious to the humans with or around them, while fully engaged with the machines in their hands or on their desks. Admittedly, such people are often interacting with other humans via their machines, but the fact remains that the primary interaction is between person and machine, and despite compelling protests that such interactions do not constitute meaningful, empathic relationships, they seem to provide stimulation and satisfaction to millions, if not billions, of us. Maybe you are one of those people, reading this article on a device.
But the biggest argument for robot caregivers is that we need them. We do not have anywhere near enough human caregivers for the growing number of older Americans. Robots could help solve this work-force crisis by strategically supplementing human care. Equally important, robots could decrease high rates of neglect and abuse of older adults by assisting overwhelmed human caregivers and replacing those who are guilty of intentional negligence or mistreatment.
In the next decade, robot caregiver prototypes will become much more sophisticated. According to Jim Osborn, the executive director of the Quality of Life Technology Center at Carnegie Mellon, the current limitation is not the technology, but finding a viable business model to make it affordable. He said, “I really expect there will be a robot helping me out when I retire. I just hope I don’t have to use all my retirement savings to pay for it.”
In that new world, my lonely, disabled patient’s life would be improved by a robot caregiver.
Imagine this: Since the robot caregiver wouldn’t require sleep, it would always be alert and available in case of a crisis. While my patient slept, the robot could do laundry and other household tasks. When she woke, the robot could greet her with a kind, humanlike voice, help her get out of bed safely and make sure she was clean after she used the toilet. It — she? he? — would ensure that my patient took the right medications in the right doses. At breakfast, the robot could chat with her about the weather or news.
And then, because my patient loves to read but her eyesight is failing, the caregiver robot would offer to read to her. Or maybe it would provide her with a large-print electronic display of a book, the lighting just right for her weakened eyes. After a while, the robot would say, “I wonder whether we should take a break from reading now and get you dressed. Your daughter’s coming to visit today.”
Are there ethical issues we will need to address? Of course. But I can also imagine my patient’s smile when the robot says these words, and I suspect she doesn’t smile much in her current situation, when she’s home alone, hour after hour and day after day.
An associate professor of geriatrics at the University of California, San Francisco, and the author of a collection of stories, “A History of the Present Illness.”
By Louise Aronson