Can Robots Replace Human Caregivers in Long-Term Care? The Case for Human Touch.
by Don Drake, Connelly Law Offices, Ltd. 8.14.24
"The rising need for home health aides and other institutional healthcare professionals to provide support for the increasing elderly population represents a significant concern that demands immediate attention to avert a crisis," stated professional fiduciary and certified elder law Attorney RJ Connelly III. "According to the U.S. Census Bureau, nearly one in four Americans will reach the age of sixty-five by 2060, resulting in an additional forty-eight million elderly individuals in this country. In addition, the National Center for Health Statistics reported that birth rates in the U.S. have been declining since 2008, potentially impacting the country's demographic balance and workforce sustainability."
These demographic shifts have significant implications for the workforce and government resources. With fewer people in the workforce, the government's ability to fund social security and Medicare for an expanding senior population is at risk. Further, the declining birth rates could present challenges in replacing the workforce and providing necessary support for the elderly.
Many developed countries experiencing similar issues are exploring integrating technology, particularly robots, to address the projected worker shortage and meet seniors' care needs. While this approach may offer potential benefits, there are valid concerns and considerations regarding the widespread implementation of robots in elder care. Thus, the question is, can robots replace human caregivers in long-term care? Read on.
Warm Hands Versus Cold Hands
Technology advancements have revolutionized how seniors can live independently in their homes. Various devices connected to phone lines can now monitor medical hardware, such as pacemakers and defibrillators, reducing the need for seniors to move into long-term care facilities. However, it's not just medical assistance that seniors living independently require; they also need help with everyday tasks like cooking, cleaning, and managing finances.
Relatives often cannot provide the necessary support, leading to a growing demand for professional home health care services. However, these services are also struggling to meet the increasing demand due to a shortage of trained professionals. As a result, there is a rising interest in using robots to care for seniors. Robots are seen as a cost-effective and consistent solution, as they do not call in sick or quit, require medical insurance or other benefits, and offer reliable care without the emotional complexities of human caregivers.
Nursing homes and assisted living facilities encounter comparable challenges. The sector suffers from a deficiency of healthcare professionals and frontline personnel, including certified nursing assistants (CNAs), maintenance workers, and dietary staff. Mandates stipulating minimal staffing levels often lead to compulsory overtime and contribute to workforce fatigue and inadequacies.
Given these concerns, many view using robots in elder care as inevitable, but concerns remain regarding the lack of human touch that robots cannot provide. Some argue that daily caregiver interactions serve as the only human contact many elders have, and the absence of human interaction could lead to further isolation and declining health, as seen during the recent COVID pandemic. This debate raises important questions about the role of technology in senior care and the value of human touch in the caregiving process.
The Need for Human Touch
In the early 1900s, the landscape of the United States was dotted with numerous orphanages where infants and young children, often unwanted, were left. Despite the institutions being well-kept, warm, and providing adequate sustenance, a heartbreaking pattern emerged: nearly half of the infants placed in these facilities passed away before reaching seven months of age. Medical professionals observed that while the children did not exhibit signs of illness and were fed regularly, they seemed to inexplicably waste away, a condition labeled "marasmus."
During this period, a pediatrician named Luther Emmett Holt introduced a ground-breaking concept in child-rearing – advocating for minimal physical contact with babies. Dr. Holt attributed infant mortality to excessive coddling and carrying of children by their parents, prescribing a more detached and hands-off parenting style. Many new parents embraced Dr. Holt's philosophy, believing it to be the best approach for raising healthy children. However, a disturbing trend soon emerged as pediatricians across the nation noted a significant increase in infant deaths among babies who appeared to be in good health.
Subsequently, it became evident that these tragic deaths were linked to a condition known as "failure to thrive," partly due to insufficient human touch. During this period, research aligned with Holt's teachings and studies on infants in orphanages revealed that babies deprived of physical contact were significantly smaller than their counterparts who received adequate nurturing.
When Dr. Holt's methods were discarded, and children were relocated from institutions to environments where they received the vital physical affection they needed, the outcomes were profound. The seemingly irreversible "marasmus" condition was, in fact, reversed as these children began gaining weight and flourishing. The unequivocal conclusion drawn from this poignant chapter in history is that touch is indispensable for the survival and well-being of the very young – and, based on currently available research and theory, the elderly.
Touch and the Elderly
"As children, our first experiences with the world are often navigated with the guidance and comfort of nurturing caregivers," said Attorney Connelly. "Their touch provides a sense of safety, creating patterns of consistency during vulnerable times and reinforcing our value to those around us. Even as we age, the need for touch doesn't diminish. Human-to-human contact continues to play a vital role in our well-being. As we grow older, the importance of touch becomes even more pronounced as we rely on others to provide us with a sense of safety and nurturance in our final days."
Attorney Connelly's words are supported by research. A study from the University of Miami’s Touch Research Institute discovered that touch can significantly lessen pain, lower blood glucose levels, slow heart rate, reduce blood pressure, improve pulmonary function, enhance the immune system, and boost alertness and performance, reducing the need for excessive medication.
Other studies demonstrate that hugs can elevate mood, reduce stress, and potentially prevent or reduce some symptoms of Parkinson’s disease. Furthermore, something as simple as eye contact and a pat on the back from a healthcare professional can potentially increase the survival rate of patients with complex conditions.
Therapeutic touch has also been shown to have a calming effect on people with dementia. Additionally, touch can influence how people perceive us, making individuals appear more trustworthy and fostering agreeableness when requests are made.
The Methodist Home in Chicago conducted a program that shed light on the significance of touch. During a six-month pilot program on massage therapy for Alzheimer's patients, researchers discovered that gentle touch could help alleviate anxiety and minimize angry outbursts in these patients.
The study indicated that back rubs were beneficial for wheelchair-bound individuals, chronic pain sufferers, and those displaying irritability or anger. Foot massages were helpful for patients exhibiting hyperactive behavior, restlessness, and wandering tendencies. Hand massages and face stroking were shown to have a calming effect on those dealing with anxiety, worry, sadness, and fearfulness. Meanwhile, massaging the temples, scalp, and forehead provided relief from headaches and tension. Additionally, shoulder and neck massages alleviate tiredness, irritability, and mild upset.
With communication difficulties exacerbating anxiety and frustration for dementia patients, using touch as a nonverbal form of communication and employing therapeutic treatments such as massage to induce relaxation was successful.
In a separate study, individuals with Alzheimer's disease who received hand massages and comforting verbal interactions experienced decreased pulse rates and reduced inappropriate behavior. Healthcare professionals believe that massage therapy could benefit dementia care because it is relaxing and offers a form of social interaction that is often lacking for these patients.
Attorney Connelly, who serves as a guardian for scores of clients, has experienced the significance and power of physical touch. In his regular visits to his wards, Attorney Connelly often experiences emotional moments with them. He describes how a simple gesture like a handshake can profoundly impact him and the seniors he works with. This simple act of reaching out and holding their hands allows him to sense their loneliness, gratitude, and emotional vulnerability and increase their trust and confidence in him.
The potential for robots to fulfill the interpersonal and tactile needs of elderly individuals is yet to be determined. Can a robot companion effectively provide a comforting touch, understand the concerns of someone with dementia, and spontaneously exhibit empathy?
"Besides the diminished human touch, numerous ethical concerns are associated with using robots in senior care," said Attorney Connelly. "Issues include loss of privacy and personal choice, feelings of objectification and loss of control, and the risk of unauthorized access to patient records or financial information through hacking into robotic control systems."
A Final Word
"The use of robots raises the essential question regarding how much we are willing to prioritize numerical efficiency over human touch," said Attorney Connelly. "While leveraging robots for delivering necessary services can enhance the quality of life for seniors, the potential lack of human interaction prompts reflection on whether this aligns with the desired standard of care for our elders and, ultimately, ourselves."
"Though the widespread implementation of robot care is not yet a reality, its plausibility within the next decade necessitates a balanced assessment of its benefits and ethical considerations," Attorney Connelly continued. "The decisions we make now regarding elder care will shape the future care landscape we will inevitably encounter. The daunting scenario of being greeted by a robotic entity devoid of human warmth should leave us contemplating the level of comfort such a future would afford."
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