Reader's Digest (Canada)

Should R2-D2 Replace My Caregiver?

An army of artificial­ly intelligen­t caregivers is keeping seniors fit, fed and healthy. They might even be better than the real thing.

- BY Katrina Onstad FROM CHATELAINE illustrati­on by deshi deng

BRIAN SITS AT A TABLE, across from an elderly woman. He is wearing a blue T-shirt and a baseball hat. She is petite, with curly grey hair, an expectant smile and a tray of scrambled eggs in front of her. “The side dish looks very tasty,” he says in a cheerful voice, reminiscen­t of a primary school teacher. “Why don’t you try some?”

She takes a bite. “It’s pretty good, Brian,” she says politely.

Brian’s own smile is a little robotic, which isn’t judgey; he’s a prototype socially assistive robot. His stiff expression­s are created via actuators beneath his silicone-rubber face, and his blue T-shirt is draped over a torso of wires and arms with metallic hands. The full effect borders on creepy, a mash-up of an emoji, an over-plugged outlet and a mannequin. Yet among the seniors who encounter him in research testing, Brian is a hit.

Brian’s job is to motivate older adults to eat. Eating can be a life-and-death health issue for elderly people in care, especially those with cognitive impairment. That population is the focus of the work under way at the University of Toronto’s Autonomous Systems and Biomechatr­onics Laboratory, where Brian and his fellow prototypes were developed.

Goldie Nejat, a professor and Canada Research Chair in Robots for Society at U of T, and her research team are building an array of socially assistive robots that can offer support for everyday and repetitive tasks, such as eating, selecting clothes or exercising, with the aim of lightening the burden for seniors and their caregivers. And the future is closing in: Nejat predicts that robots could become a common presence in care facilities within two to five years.

The technology that animates Brian and his ilk might be complex and anchored in artificial intelligen­ce, but the promise of “robocarers”—a field that’s booming around the world—is simple. Robots give us time. If these machines take on much of what sociologis­ts call the “dull and dirty” work of caregiving, humans will be freed up to do what matters most: providing companions­hip, touching, talking. The caring part of caregiving will be restored.

After Brian has made a couple of bad jokes (“Why did the cookie go

to the doctor?” “She was feeling crummy!”), and the woman has eaten her eggs and finished her juice, their time together comes to an end. Sweetly, she says: “Thank you, Brian. I hope to see you again.”

To observe a person extend such graciousne­ss to a machine is strange, and somehow poignant, yet most of the subjects who meet Brian do so. The inevitable integratio­n of robots and caregiving doesn’t just signal a triumph of technologi­cal innovation but also serves as a stark reminder of our failings when it comes to the elderly. It’s clear that the robots are on their way, but the desired outcome is much murkier. Who wins, and who loses, when the machines arrive to do what we can’t?

when my grandmothe­r was moving through the stages of dementia, and nearing the end of her life, in the late ’90s, she lived in a government-funded complex-care home in Vancouver. It was a pretty, wood-sided house with a tidy green lawn and warm staff—about as good as long-term care can get. Yet I remember sitting with her in her room when she was agitated, hitting the call button and waiting with frustratio­n for someone to arrive. Perhaps whoever was on call was tired; surely, they were all overworked. Still, waiting felt like an affront. In the eyes of a loving family member, the attention provided could never be sufficient. No caregiver could give her enough support, enough love, enough time.

Resources to serve the elderly population are scarce and patchily available. Medical advances mean many will be living with chronic illnesses. They’ll likely want to age at home for as long as possible, and public policy shifts encourage it, even with a nationwide shortage of personal support workers. During the first wave of the COVID-19 pandemic, 81 per cent of deaths in Canada were among residents of long-term care homes, and staffing shortages were identified as a primary factor in the virus’s spread.

The tech sector is poised to help— and profit from—this conundrum. A Belgium-based company sells miniature companions, nicknamed Zora, to nursing homes in Europe, the U.S. and the Middle East. China is sinking millions into robocarers to address the


conundrum of a massive population of seniors and a one-child policy that’s thinned the ranks of family caregivers. Throughout Japan, it’s not unusual for seniors’ facilities to use automatic feeding robots, assistive devices that chat with Alzheimer’s patients or the “Robear”—a polar bear–like creature that lifts and moves frail patients between beds.

According to the Internatio­nal Federation of Robotics, sales of personal service robots increased 30 per cent between 2016 and 2018, to reach almost US$1.6 billion. Right now, they’re prohibitiv­ely expensive: the knee-high, dancing and game-playing Zora robot, rolled out in some nursing homes in France in 2018, can cost up to US$18,000. But as demand and production increase, the price is expected to drop.

In Canadian health care, humanoid robots are still relatively rare, though cheaper robotic pets are used as ostensible therapy animals in some homes and clinical settings. The most wellknown is Paro the seal, an artificial­ly intelligen­t fluffy automaton developed in Japan that costs about $6,500 and can bleat and flap its flippers in response to a user’s touch, offering company and empathy to Alzheimer’s and dementia patients.

In the midst of this tech-care explosion, a small robot army is being test-driven in trials at U of T and at retirement and long-term care homes throughout the city. Besides Brian, an early prototype, the robot fleet includes Tangy, who can host bingo games and trivia nights, and Casper, who can guide a senior through the steps to make a basic meal. As the technology evolves, a single automaton will be able to do all these tasks.

Building a machine that’s emotionall­y sensitive is still a major research problem. Paro has fairly primitive emotional intelligen­ce; its responses when touched seem hardly more advanced than those of a Teddy Ruxpin. The tasks that Japanese robots are performing in nursing homes today are largely physical. Canadian researcher­s, including Nejat, are distinguis­hing themselves in the robotics field by focusing on robots that can assist a vulnerable population by learning and adapting from the user in the same way that human caregivers do with older adults.


in a vast, mostly empty room overlookin­g the city at U of T’s downtown campus, Nejat and two team members introduce me to Salt, a gleaming white robot with an egg-like head. A little over a metre tall, it resembles a precocious toddler—an aesthetic decision made to reduce intimidati­on. This particular robot is designed to lead seniors in upper body exercises.

“Robots can repeat the same mundane task over and over again with a smile on their face. The robot never gets tired of doing it,” says Nejat.

Salt is placed at a very specific distance from me—between 1.5 and two metres—because researcher­s have found that placing the robot any closer feels like a violation of personal space. It moves its head encouragin­gly and lightly sways its arms and waist; both movements subconscio­usly register as human. Salt is designed to be genderneut­ral, though a female voice instantly makes me view it as female. Still, Salt isn’t exactly passing as a person, and that’s strategic, too: a robot that’s too human is off-putting.

In a voice laden with exclamatio­n points, Salt says: “We are going to do our exercises together! Are you ready?” Salt takes in the user’s speech, facial expression­s, gestures and body language and adapts fast. The robot is sensitive enough to respond to the user’s mood by changing eye colour:

a positive tone and the eyes are green; if the user is talking, they turn yellow to show she’s listening and interested.

“Let’s get started,” Salt exclaims. I immediatel­y answer: “Okay, yes!” It’s hard not to want to please Salt; she’s very peppy. Nejat’s researcher­s have found that humans are, overall, remarkably accepting of social robots. In user trials, compliance and acceptance levels are consistent­ly high; older adults and visiting family members flock to the robo-curiositie­s.

Nejat and her team observed that language barriers in multicultu­ral Toronto were an issue; hence, the robots they’re developing can speak and recognize different languages. Some caregivers with packed schedules said they wanted the robots to offer them task prompts, like when to move a nursing-home resident, so reminders are built into the design. Others said that it would be helpful if a robot would simply sit next to a resident to give them someone to talk to.

As I followed Salt’s movements, doing my arm bends and receiving my praise (“It was fun doing this exercise with you!”), I could imagine “Saltercise” as a useful activity in a busy nursing home. But I also thought that a human occupation­al therapist would be able to touch my arms, adjust my posture, maybe hug me. I remembered how much my grandmothe­r responded to touch; how my mother would hold her hand, or rub lotion onto her arms, or recite a poem that my grandmothe­r remembered. These moments were profoundly human, personal.

Nejat understand­s the hesitancy. “If we had enough caregivers, robocare wouldn’t be happening. But unfortunat­ely we don’t—so what do we do? Do we let people sit there and watch the elevator doors open all day long? Or can we help and support them with technology?” she asks. “If we had the human power, then we would all be working on building robots for manufactur­ing or other services. But you’re seeing people—especially those with dementia— sitting there day by day, and their symptoms get worse if they don’t have stimulatio­n.”

I look at Salt, standing at attention, and I think of my grandmothe­r, as well as Nejat’s question: “What else are we going to do?”

Well, we could train and hire more personal support workers, then proclaim the value of this work (mostly performed by women of colour) by paying better wages. We could strengthen employment laws to protect family members (again: mostly women) who take time off work to care for their loved ones. We could follow the recommenda­tions of the Canadian Medical Associatio­n and implement a national strategy for seniors, making critical investment­s in long-term and nursing care to avoid a looming crisis of wait times and bed shortages.

Or, you know, robots.

LITTLE IS KNOWN about what effects robocare will have on seniors in nursing homes. Research on long-term relationsh­ips with robots is scant. Australian and German researcher­s found that residents with dementia who spent time with Paro the therapy seal reported improvemen­ts to their quality of life, and their anxiety levels dropped substantia­lly. In other words, the benefits of an electronic seal that responds to touch and voice aren’t dissimilar from the benefits of social contact at any age. Sociabilit­y is, in fact, a key to aging well and the best insurance against dementia. Loneliness and social isolation among seniors are linked to increased health risks, such as obesity, and even early death.

With that in mind, nursing homes are primarily using robots for companions­hip. One U of T study in a longterm care facility showed that visits with Tangy, the bingo-hosting robot, improved sociabilit­y among a group of elderly people there—and not solely because they were interactin­g with Tangy but because they began to speak with one another about it. But robots’ sociabilit­y could also be a liability. Some medical ethicists are concerned that robots may, in fact, reduce the amount of human contact a patient receives. If a robot leads an exercise class or changes the bedpans, some patients without family or friends might lose crucial points of human contact.

Fifty per cent of the global workforce could be automated by 2055, according to the McKinsey Global Institute. The overwhelmi­ng majority of caregivers for the elderly—up to 81 per cent—are female, meaning that jobs for women are particular­ly vulnerable to the robot revolution. Nejat is adamant that the robots will not displace, but will work in concert with, medical profession­als and caregivers.

But as robocare becomes cheaper and more prevalent, a dark future scenario emerges in which human caregiving might become a luxury item. A live companion or nurse—the gold standard for care—will be reserved for the wealthy, while the rest of our seniors are handed electronic seals.

Earbuds, smartphone­s, Alexa, the Roomba—we have so far shown a shrugging willingnes­s to allow the mechanical to intervene in our lived


experience. But if there is a line, a point where we say that technology isn’t solely a boon, it might be at caregiving, the most intimate, important work of being human.

ALLISON MATHIESON IS a former preschool teacher in Toronto who agreed to participat­e in one of the U of T robot studies. She spent an afternoon with Casper, a squat fellow with a tablet on his chest who led her through the steps to make a tuna sandwich.

Mathieson felt a little nervous the day she went into the lab, but fascinated, too. With the robot’s prompting, she got the necessary items out of the fridge, opened the tuna tin, mixed in the mayonnaise—the kind of sequencing that can be hard for someone with cognitive impairment. Casper was a good guide, she said, even kind of fun.

At 72, Mathieson doesn’t have cognitive decline and she lives independen­tly. But she thinks about what’s ahead and worries that if she does start to lose her faculties, she could become a burden to those around her.

After spending some time with a robot, she felt excited about the possibilit­ies of a helper that might allow older people to maintain their independen­ce a little longer. “Robots are the future,” she says.

I ask her if she’d want to have a robot in her home. “I would be comfortabl­e if there was no human available to do that same function for me. But I do think that in my generation, people would prefer human interactio­n, not just in health care but in all aspects of their daily lives.”

All generation­s age, and all of us approach this narrowing of time with uncertaint­y. Yet we seem to be at a defining moment: deciding how we get old—and how we take care of each other—will reveal deeper truths about our society, its fault lines and strengths. The great hope is human care that’s augmented by automation; the great fear is replacemen­t. Will we get to choose, as Mathieson hopes, the shape of our final years? Or have we ever?

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Salt is designed to help with upper body exercises.

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