Could robotics and AI technologies help to alleviate Australia’s looming aged care crisis? Helen Dickinson and Catherine Smith consider how COVID-19 may be opening people’s minds to the possibility.
While the COVID-19 pandemic has highlighted several systemic vulnerabilities in our aged care sector, there’s a growing sense of anticipation about the potential for robots and other AI technologies to protect our older citizens from future public health emergencies.While a number of care facilities already operate under tight fiscal constraints, our rapidly ageing population is facing a gathering storm of challenges – from the recruitment of qualified care staff and growing consumer expectations, to the clinical challenges of more complex chronic illness and disease.In recent years, robots have become a more prominent feature of our care services – capable of fulfilling a number of roles from manual tasks to social interactions. Their growing acceptability in Japanese nursing homes has helped that country cope with a swelling aged population and a dwindling care workforce – assisted by a consistently positive media depiction of robots as friendly and handy helpers.The COVID contextThere’s no doubt that COVID-19 has exacerbated many of our workforce issues. Where those who work in care roles have become sick or have had contact with someone with symptoms, they have been unable to carry out their typical duties. This is obviously more important when working with groups who are at higher risk because they are older or more likely to be immunocompromised.Reducing human-to-human contact is the first order in reducing likely infections. Robots have the potential to be deployed in a number of tasks such as disinfecting rooms, delivering food and supplies to people in quarantine, taking temperatures and assessing for other symptoms. Some of these applications are being trialed in different parts of the world, although they do not have many Australian applications as yet.One application we have seen in Australian care facilities aims to tackle the social isolation that has resulted from the widespread ban on visitors. A number of facilities are now using Paro – a therapeutic robot that looks and sounds like a baby harp seal. Paro interacts by moving its head, heavily-lashed eyes and flippers, making sounds and responding to particular forms of touch on its furry coat. Paro has been used extensively in aged care in the United States, Europe and parts of Asia – typically among people living with dementia.The COVID pandemic will likely generate greater pressure for such technologies to come to market. While there are many good things that this shift can potentially provide, we also believe that we need to take care in this process.A double-edged swordWhile robots are capable of enhancing productivity and improving safety, there is a potential for misuse or unintended consequences. Concerns have been expressed about the use of robots potentially reducing privacy, exposing people to hacking, or even inflicting physical harm. We also lack evidence about the potential long-term implications of human-machine interactions.Our research has explored the roles robots should and, even more critically, should not play in care delivery. We have also investigated the role of government as a steward in shaping this framework through interviews with 35 policy, healthcare and academic experts from across Australia and New Zealand.We found that despite these technologies already being in use in aged care facilities, schools and hospitals, government agencies don’t typically think strategically about their use, and often aren’t aware of the risks and potential unintended consequences.This means that the sector is largely being driven by the interests of technology suppliers. Providers in some cases are purchasing these technologies to differentiate them in the market – but are not always engaging in critical analysis.Our study participants identified that robots were “leveraged” as something new and attractive to keep young people interested in learning – or as “a conversation starter” with prospective customers of aged care facilities.Drawing on research in other emerging technologies, our participants raised concerns about addiction and reliance on robots. What would happen if a robot broke or became obsolete, and who would be responsible if a robot caused harm?As artificial intelligence develops, robots will develop different levels of capabilities for “knowing” the human subjects they are caring for. This raises concerns about potential hacking and security issues. On the flip-side, it also raises questions of inequity if different levels of care are available at different price points.Several of our study participants also expressed concern about the unintended consequences of robot relationships – for example, if a family feels that a robot proxy is sufficient companionship, will they be more inclined to leave their aged relative alone?What should governments do?Governments clearly have an important role to play by regulating this rapidly evolving market. We suggest a responsive regulatory approach, which relies on the sector to self- and peer-regulate, and to escalate issues as they arise for subsequent regulation. Such engagement will require education, behaviour change, and a variety of regulatory measures that go beyond formal rules.Governments also have an important role to play in helping providers understand the different technologies available and their evidence base. Care providers often struggle to access good evidence about technologies, and as such can be more informed by the market than high-quality evidence.Many of the stakeholders we spoke to also see a role for government in helping to generate an evidence base that’s accessible to providers. This is particularly important where technologies may have been tested, but in a different national context.Many respondents called for the establishment of industry standards to protect against data and privacy threats, and the loss of jobs.Finally, governments must have a responsibility to ens ure that vulnerable people aren’t exploited or harmed by new technologies. And they must ensure that robots don’t replace human care and lead to greater social isolation.Helen Dickinson is Professor of Public Service Research and Director of the Public Service Research Group at the School of Business, University of New South Wales in Canberra. Catherine Smith is a research fellow in the Youth Research Centre at the Melbourne Graduate School of Education, University of Melbourne. Part of this article is based on a research paper, Robots and the delivery of care services: What is the role for government in stewarding disruptive innovation?, published by ANZSOG: