In Japan: thinking twice about Caring with Robots

In the process of trying to understand how different cultures are preparing for demographic ageing, I recently took a flight to Tokyo for a line up of meetings with key players working in technology for care services in Japan. Here is a five minute read about my findings and some considerations that care services, communities and technology designers need to take into account to ensure future sustainability.

A tradition of care being provided by relatives, a strong resistance to immigration, the roll out of several political measures to improve gender equality by bringing more women to the workplace are leading to a dramatic shortfall in the number of carers needed to support older people with frailty. Care homes are frowned upon; yet, have waiting lists longer than a year and growing.

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The Japan Times, 13th of July 2016

Japanese people have a long held belief that if you have a problem you can build a machine to fix it. So when the demographics of the country showed the fastest ageing population worldwide - authorities, companies and society at large rolled up their collective sleeves.

Over the last two decades, successive governments partnered with large companies in the country and awarded a number of grants to encourage the creation of robots to take up the role of carers. This resulted in plenty of machines being produced. Research groups designed complicated mechanics, electronics and software. But despite these efforts, very few developments made it to products available in the market. Robots such as the Mitsubishi Wakamaru, or a more recent Robear, are expensive first attempts of replacing a human. Their shortcomings introduce several fundamental questions about the suitability of this approach.

Replacing a human in a care function is going to take a lot longer than ever anticipated, if feasible or desirable at all. Realising this, there is a strong shift in how authorities, building agencies and society at large are tackling these challenges. Interventions are becoming more focused, pragmatic and accepted by wider groups of people living with frailty.

There are two areas where real progress seems to be around the corner: devices to mitigate the effects of social isolation and to assist where there is loss of mobility.

Social Isolation

The most immediate result of Japan’s fast changing demographics is a sharp rise in the social isolation of its older citizens. In 2014, Kayoko Tamura, from the Local Government Centre and Hagi City Government presented statistics showing that there are over 4.5 million single occupancy households in the country.

Companion robots try to tackle loneliness: Pepper, sold by SoftBank, offers basic conversation skills combined with the ability to establish a voice or video connection. Most of these devices also feature basic fall detection capabilities.

Pepper, from a SoftBank store in central Tokyo

Therapy robots are those that prompt conversation, are designed to be engaging and that are found to be particularly effective at keeping people living with dementia emotionally engaged. The best example in this category is PARO, marketed by Intelligent System Co. The robot aims to achieve therapeutic outcomes similar to pet therapy, it can show surprise, happiness and anger and will cry if it is not receiving enough attention. With over 3000 units sold, this is one of the most successful robot projects related to care of older people.

Large technology companies such as NTT Docomo and SoftBank are tracking this trend, and with SoftBank acquiring French robot maker Aldebaran in 2012, it is clear that companion robots fuel the imagination of the industry. But achieving a product that is financially sound is a different matter. In 2014, SoftBank’s relationship with Aldebaran’s team had soured, and it was acknowledged that the actual robot’s abilities are very limited compared to the expectations set in the media.

Loss of mobility

Mobility assistive robots

These can help a person moving, or transferring (e.g. from bed to a wheelchair); some of them are also capable of performing tasks such as keeping floors tidy by removing trip hazards.

Robobear

But the automation of these tasks is found to be extremely complex. In those instances, when companies launched products based on these technologies, they were found to be immature and failed to address the stark realities of unreliable connectivity in people’s homes, existence of stairs, or other common obstacles such as thick carpets or pets. By failing to address so many aspects found in real-life environments, these robots are arguably decades away from the market.

Exoskeletons

Panasonic Exoskeleton

Exoskeletons are a specific category of robot that can assist a person by easing the effort required to lift heavy objects. These find many applications in occupations that tend to cause constant muscle strain. Increasingly, companies are raising hopes that exoskeletons could extend the working life of people with reduced mobility or decreased muscle and skeletal functions. It is also foreseeable that these devices will lead to increased effectiveness in physiotherapy and reablement interventions, leading to significant extension to active life. Panasonic has launched an exoskeleton for commercial use, but only time will tell if these will find market demand.

My Thoughts about the Next Big Thing: Smarter Environments

Neighbourhoods and Communities

Considering that much of the future care home supply in Japan is yet to be built, and that home care is not viable due to the constrained supply of carers, it is clear to me that most of the social isolation needs to be tackled through other means. Architecture can play a significant role in bringing people together. Japan has a long history of promoting multigenerational mingling, and this needs to be reinforced in housing development projects. The idea of “retirement villages” where only older people live is not ideal to tackle these challenges. With the right architecture, older people will often be able to play an active role in their neighbourhoods. With the right architecture, older people will often be able to play an active role in their neighbourhoods. This is true if people still live independently but live amongst working families and as frailty progresses when care homes can be located next to schools.

Ponyo, a mainstream movie where older and younger spend time together
Ponyo, Studios Ghibli

These architectural choices are not unusual in Japan’s past, and authorities need to build on these good examples to avoid segregation of older people at all costs.

Daiwa, the largest house builder in Japan, is well aware of these challenges.

GRAN COSMOS Musashiurawa
Gran Cosmos Musashiurawa: a condominium designed for being inclusive of older residents (Daiwa Housing Corp).

Their annual report lists several examples, such as the lifestyle project “GRAN COSMOS Musashiurawa”, operating common-use facilities to facilitate communication between residents, as well as a restaurant and medical clinic.

Connected Smart Everything

Instead of multifunction robots, there are early signs that the most pragmatic way to use robotic technologies to assist people who live with frailty is to adapt everyday objects either extending their functionality or adding instrumentation that brings in a monitoring capability. It is a given that people will not adopt technology if it doesn’t bring significant improvements to their lifestyle. So allowing people to maintain their routines unchanged, while supporting them and carers in addressing needs resulting from their frailty can have a significant impact. This could be through the use of assistive technology on existing furniture (e.g. a platform under a mattress to help a person with reduced mobility in getting up), monitoring of movement or presence in living environments, combined with biometric readings, which may provide good early indicators in degradation of chronic conditions, helping the person and their carers averting acute episodes where possible, and detecting when a person and their family cannot cope without support. This could lead to care provision on-demand instead of early admissions to care homes, which will happen as a result of long waiting lists and people preferring to be admitted early rather than later.

Daiwa is again taking a leap forward, creating competence in smart environments and robotics as part of its strategy.

Final Remarks

Just because we can create empathy through algorithms, doesn’t mean we should

With focused research projects, some groups are reaching promising results in creating empathetic interactions between a person and a robot. While this is an admirable achievement, it means that the creation of emotional ties and dependency between a person and a machine is likely to become a challenge in terms of ethical acceptability of products. What happens when a person develops a significant degree of emotional dependency sees their life as being controlled by a robot? There is a thin line between being helpful and respectful, or being over-supportive. Providing too much support creates new dependencies which may lead to a reduction in independence. The real difficulty lies in the fact that the line is different for each person. What may be deemed as over-supportive for a person living with temporary frailty, may be deemed adequate for supporting a person with permanent frailty.

The creation of new dependencies, sometime emotional dependencies, and delay in recovering from temporary frailty are just some of the potential unintended consequences of “smart environments”. Product designers involved in these domains should tread carefully.

Give care careers the credit they deserve

Regardless of how well the mix of communities, technology and home care services manage to prolong people’s ability to live independently it is very clear that Japan will need to recruit more people to the care industry. This will require a coordinated effort to raise the profile of care as a career.

Our Little Sister, by Hirokazu Koreeda

In the recent Cannes-nominated Japanese movie “Our Little Sister”, the lead character Sachi Kouda, a nurse, makes a decision to embrace a career in palliative care — and to do it she had to ignore the advice from her boyfriend; a doctor who in pursuing a career in paediatrics tried to convince her this was worthier than caring for older people. Collective perceptions like this need to be challenged, and the noble aspects of the jobs need to be brought to the fore.