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July 31, 2014 2 Comments

10 Reasons Why Robot Caregivers Might Not Be So Bad

My recent New York Times op-ed on robot caregivers for older adults has elicited curiosity, enthusiasm and controversy.

I have to admit that my own first reaction to the topic was captured in the NYT letter from Sherry Turkle whom I mention in the piece. I was in a meeting and turned to a colleague, clumsily patted her on the back and said, “It…is…ok. Do…not…cry…” And we all laughed.

Then I started reading about robotics and robot caregivers and thinking about what they might do for the elderly, homebound patients I care for through the UCSF Care at Home clinic. And I changed my mind.

For those who remain skeptical, here are 10 potential benefits of robot caregivers. They could (in no particular order):

1. Help with heavy lifting.

  • Caregiver injuries are common and lead to missed work for the caregiver (to say nothing of pain and potential disability) and sometimes leaves an older adult without a caregiver.

2. Serve as a communication tool

  • Technology is changing at record speeds. Kids adapt quickly and well; the rest of us not so much. If an older adult can’t (because of low vision or dementia, for example) or doesn’t want to learn to use the latest machine, they can simply ask the robot to serve that function. Imagine: “robot, call my daughter” and the robot makes the connection with skype or facetime type technology.

3. Provide reminders

  • To take medications, go to appointments, eat, exercise, and anything else relevant to each individual person. Sure, people make lists but too often they forget to check them.

4. Help with monitoring

  • Home monitoring has proven benefits in diseases such as heart failure and diabetes. Robots might monitor many medical conditions and relay that data back to a nurse or doctor who could then have a more informed meeting – in person, or via robo-chat – with the patient.

5. Preserve dignity

  • One of the most common letters I have received has been about toileting. People find help with toileting humiliating – bad if from a stranger, often worse from a family member.

6. Promote independence

  • For most older adults, their greatest fear is ending up in a nursing home, and many don’t like the idea of strangers in their house or apartment much better. A robot that helped with basic chores might delay or diminish the need for unwanted human help.

7. Decrease burden on family and friends

  • Many of my patients report that their greatest source of distress is the burden they feel they place on their families. If robots could help so that families spent more time enjoying each other’s company, rather than doing mundane chores, that would be a win-win.

8. Fill care gaps

  • The patient I described in the article had caregivers, friends and family. It wasn’t enough. In an ideal world, there would be more human solutions but many humans avoid the very old and even the most devoted family and friends have other things to attend to.

9. Offer endless patience

  • When a person has dementia, they often ask the same question over and over. Most humans lose patience answering 5, 15 or 40 times. A robot doesn’t.

10. Provide companionship

  • This is the most controversial function of robots. But the goal is NOT to replace humans; it’s to supplement and complement them. Granted there are many un- and underemployed humans as well as many humans in need of care, and a better solution would be to more appropriately reward, economically and socially, the very challenging work of caregiving. We should keep trying to move in this direction, but most of human history suggests that if this happens, it will happen slowly.
  • Equally important: diminishing the loneliness of older adults must take priority over our existential discomforts. If they get pleasure from the interaction, that’s what matters most.

Of course, there’s one more reason to consider robot caregivers: they are coming, like it or not. The best way to ensure they optimally serve the needs of older adults is to be a part of the process of their development and improvement. Here are a few things to think about:

What would you want in a robot?

What would you find unacceptable or distressing?

How can we use them to make humans and old age better?

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2 Responses to 10 Reasons Why Robot Caregivers Might Not Be So Bad

  1. Shawn Eng August 7, 2014 at 8:33 pm #

    I am so glad that you brought the concept of robotic caregivers from a relatively obscure field into the mainstream conversation with your wonderful NYT piece. I am not an academic but a sci-fi fan and casual observer of technology trends and have been caregiver to my late parents as they succumbed to age. I do not believe robotics technology is mature enough to be fully autonomous but I hope to be proved wrong in the near future. My concern mirrors the concern over self-driving cars. Will a robot recognize hazardous conditions like the whistling of a tea kettle? Will a robot recognize the sound of a medicine bottle hitting the floor and then executing the movements to recover it from the floor? Will it have the force feedback intelligence to recognize when a grip is too soft to support the patient or too hard that it hurts?

    Also, the computing power needed for simple tasks may be surprisingly intensive. For us, folding laundry or organizing a closet seems simple but a robot may not be able to have a simple leap of intuition that we are capable of when approaching a unique, one-in-a-million challenge that A.I. programmers didn’t anticipate.

    This is why I’ve been contemplating an interim solution to autonomous robotic caregivers and suggested tele-operated caregivers instead. Here’s what I proposed to some of the top robotics companies in the world:

    The robot will be controlled by a caregiver wearing a motion-capture suit and an Oculus-Rift-like virtual reality visor that receives the video and audio feed from the robot. The robot will mirror your motions. The motion-capture suit will also be made of a mechanically compressible fabric that receives tactile signals from the robot. For example when your robot puts its arm around a subject, its arm will send signals to your suit and the compression fabric will apply pressure to your arm, similar to how remote surgical robots provide force feedback to the surgeon.

    The robot may have a video screen in lieu of a robotic face. It may display the face of the human operator so the robot doesn’t seem like an alien presence. The best thing about tele-operation is that control can be transferred between operators, who can be thousands of miles away. For example, one caregiver can control the robot for household chores and when a “visiting nurse” service is checking in, the nurse, who’s wearing her own motion-capture suit can take control. After the nurse completes her diagnostics, the patient may want to consult a doctor. No problem, control can then to transferred to the doctor.

    Whoever the caregiver is, they do not have to physically travel to the patient to interact with them. Caregivers may even work from home, saving untold resources for transportation. If a patient needs 24 hour care, the evening and midnight shifts can be handled by tele-operators on the other side of the world. This allows the matching of caregivers with patients that have language barriers.

    Now what if the patient’s sink is leaking? The robot can be passed to a plumber who doesn’t even have to come out. An Amazon drone can deliver the parts and the tele-plumber will fix the problem. Now what if the robot has a malfunction? Maybe the caregiver organization controls another robot in the same housing complex or neighborhood? A repair technician can “borrow” a neighbor’s robot, come over to fix the problem robot. In economics terms, tele-operated robots, if inexpensive enough to become ubiquitous, makes non-tradeable labor tradeable.

    A darker side to this for a caregiver firm to offer jobs to the lowest bidder. As a caregiver, you may have to go to a website that has all the available shifts and you must underbid on wages to get a tele-operating assignment.

    Other ideas include putting medical scanning systems on trucks and just driving them to the patient’s homes instead of bring them all the way to a clinic or hospital.

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Resources:

New York Times Health: http://newoldage.blogs.nytimes.com/ and http://well.blogs.nytimes.com/

Health in Aging: http://www.healthinaging.org/

Family Caregiver Alliance: http://www.caregiver.org/

Talking to Your Doctor: http://www.nih.gov/clearcommunication/talktoyourdoctor.htm

Kaiser Health News: http://www.kaiserhealthnews.org/

NYU Literature, Arts and Medicine Database: http://litmed.med.nyu.edu/Main?action=new

Physician/student/health professional resources

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