PUMPING IRONY: Robots to the Rescue?

The much-maligned U.S. nursing-home industry has been taking more lumps than usual lately. The pandemic, of course, has revealed breathtaking deficiencies in infection control, staffing, and resource management, but public-health agencies are just now beginning to respond. The Biden administration in February proposed an ambitious package of reform measures designed to improve resident care. And last month, the National Academies of Sciences, Engineering, and Medicine (NASEM) issued a scathing report decrying the industry’s “underinvestment in ensuring the quality of care and a lack of accountability for how resources are allocated.”

Writing in JAMA, Joan Stephenson, PhD, notes that the NASEM paper is the first comprehensive review of the industry since a 1986 Institute of Medicine report, and she basically argues that nothing has changed in the intervening years: “Factors such as poor pay and benefits and inadequate training for nursing home staff, weak support for oversight and regulatory activities by state agencies, and lack of transparency about finances, operations, and ownership of nursing homes have not been addressed, to the detriment of care delivered by the nursing home sector.”

None of this should be particularly surprising to anyone who’s been forced by unhappy circumstances to commit a loved one to the care of one of these facilities. No one really wants to live there, no one really wants to work there, and no one really seems willing to fix what’s broken.

To hear some industry leaders tell it, however, help is on its way: The robots are coming.

“Robots are going to play a major role in reminding us to take our medications, keeping us socially engaged, helping us if we fall and can’t get up, navigating getting food delivered to the home.”

As John Leland reports in the New York Times, COVID has fueled a newly energized campaign to design and deploy robots and other technologies in an industry that has lost some 400,000 workers since 2020. “Virtual assisted living is already here,” Joseph Coughlin, PhD, director of the AgeLab at the Massachusetts Institute of Technology, tells Leland. “Robots are going to play a major role in reminding us to take our medications, keeping us socially engaged, helping us if we fall and can’t get up, navigating getting food delivered to the home. Toilets will give you a checkup a day and tell you if you’re not taking your pills or getting nutrition. Pretty soon your toilet will be talking about you.”

There are no talking toilets in the lab of Arshia Khan, PhD, at the University of Minnesota Duluth (UMD), but the 16 robots the computer-science professor and her research team have programmed will soon be working at eight nursing homes around the state. One is designed to lead yoga, tai chi, and strength-training classes; the other will simply hang out with residents, crack some jokes, and play games.

Khan and her crew are hoping to emulate the impact made by a robot named Stevie, which took the Knollwood Life Plan Community in Washington, D.C., by storm back in 2018. Residents loved the novel caretaker’s stories, jokes, karaoke tunes, and remembrance therapy; management appreciated its ability to roam from room to room killing germs with its ultraviolent lights. Staff, however, were less than thrilled, recalls Knollwood’s VP of development James Michels.

“Residents felt they were a part of something new,” he says. “Caregivers needed to understand that it was meant to be a research tool for them, not a replacement.”

Stevie made the cover of Time magazine before exiting when the two-year grant expired, just before the plague struck, but the experiment — and especially COVID — opened some eyes, Khan notes. “The pandemic has given us a jump-start and opened up our minds to using technology more than we used to,” she explains. “Before the pandemic, people weren’t as accepting of robotics. When I started applying for grants, the reviewers were saying things like, ‘She’s going to unleash her robots on these poor, vulnerable people.’”

Residents seem to find the machines to be entertaining, if Leland’s reporting is any indication, but it’s too soon to determine whether their presence will cause more problems than they solve. UMD philosophy professor Alexis Elder, PhD, a member of Khan’s team, wonders who will have access to the monitoring data the robots will collect from residents, for instance. And will they eventually erode the human-to-human relationships that are central to caregiving?

Gender and ethnicity issues may also crop up, Elder adds. Despite their machine-like presence, robots generally talk like white people, creating what she calls “an interesting challenge.” She also worries that they may present as female and subservient, perhaps encouraging residents to treat women workers with less respect.

It’s nursing-home staff, of course, who may be most affected by the trend toward mechanized caregiving. Marc Halpert, CEO of Monarch Healthcare Management, whose homes eventually will be welcoming Khan’s robots, tells Leland he has no interest in test-driving the machines as a precursor to staff cuts. “But if these robots can help us fill in gaps to help meet the needs of the residents, that’s what we’re looking for.”

It doesn’t take much imagination to foresee a time when this profit-hungry industry begins to invest heavily in robotics to cut labor costs and boost its sagging bottom line, but I’m guessing that workers still have plenty of time to shift careers before robots usher them out the door. Khan’s computers still display enough glitches — talking without prompting, crashing mid-program, toppling over — to offer some hope to those of us who prefer to envision a future in which humans still get to take care of one another.

And use toilets that don’t talk about us.

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