Does AI-driven tech remove the "care" from caregiving? 🤖
Is there a point at which shifting the burden away from human caregivers risks our humanity itself?
My dad used to be the tech guy in the family. He learned about the latest computers, knew how to fix them, prided himself on knowing about all the latest gadgets and always had a strong opinion about them (which is maybe why we teased him for years for being squarely on the losing side of the VHS vs. Beta ‘videotape format war’). Now he doesn’t even check his email, it’s all gotten too complicated as his cognition declines. I’ve been thinking a lot about what types of tech would actually be useful to his caregiving without causing unnecessary complication, burden or further isolation. My mom and brother both live in assisted living arrangements with built-in caregiving, and while I have learned that this does not mean that outside support isn’t required (more on that later), I don’t feel any urgency to find new technologies to support them. My dad, however, lives with his husband in their home in a rural area, and it is becoming increasingly difficult for them to manage alone. The idea of a technology that could remove some of the burdens of his care from his elderly partner - and in turn, from me, as the nearby overwhelmed-but-capable daughter - is highly tempting. So what tech tools are actually out there, and what tasks can they effectively take over?
Care tech can increase independence and reduce human care burdens
Caregivers looking after people whose activities of daily life depend on them can have a long list of duties such as: picking up and managing medications, scheduling and transport to appointments, physical transfers, hygiene, meal prep and feeding, financial management and so much more. They often, by default, also become the main point of human contact and emotional support for those they care for. A number of technologies have successfully been able to aid in - but not replace - many of these activities, as well as increase safety. Going back to the earliest tech solutions, I think of the Life Alert (“I’ve fallen and I can’t get up!”), an iteration of which my mom wears around her neck today - and that she has used when she has fallen. Other technologies that have wider uses but that can be incredibly helpful include home cameras, motion sensors, GPS devices and apps for virtual health and medication tracking. These are fairly straightforward, many find them to be useful, and there isn’t much concern around them other than that they may be more expensive or work to use than they are worth.
Like in so many spheres right now, the introduction of artificial intelligence changes the conversation. Newer robot-like technologies are attempting to take on the more human aspects of caregiving. One called ElliQ looks like a desk lamp and uses AI to learn its users needs and routines to proactively communicate with them. It strikes me as a more care-tailored and advanced Alexa. Robear and Pepper are both Japanese care robots. Robear looks like - you guessed it - a giant robot bear. It is used for helping with some of the physical demands, such as transferring people between a bed and a wheelchair. Pepper is more of a humanoid, with the (supposed) ability to read emotion, converse, lead exercises and even buddhist chants. Despite selling out within a minute of its release in 2015, after several “botched jobs” and subsequent weak demand, production ceased in 2021.
Paro, the robotic seal being used with elderly dementia patients, is another Japanese care tech innovation. The robotic stuffed animal is used to soothe, provide comfort and reacts to touch and voice. It has received high praise from caregiver staff, as well as in research study results, but comes at a hefty price tag. I can’t help but agree with one video commenter:
“$6,000? Can’t you just get a dog??”
It seems carebots thus far have mostly missed the mark, failing to effectively complete the tasks they were created for. In some cases they have unintentionally created more work for caregivers. The robots themselves required care, and this simply shifted caregivers’ time away from patients to robot-related tasks. But surely we will see more iteration on models to reduce caregiver burden.
Even if they work to save time and energy, there may be other unintended consequences
Similar to using Chat GPT to replace human writers, there’s a quality and accuracy risk in removing the human brain from the care equation. But care requires reciprocity, empathy and love, and removing those things has risks on both parties involved. Even if Pepper had successfully registered emotions, it would never feel them. It will never be able to intuit the needs of a human and respond in a holistic, reciprocal way. I know - never say never - but we aren’t there yet.
Aside from more or less work, how does is the caregiver changed by these technologies, and the loss of these human interactions? When we outsource caregiving activities, do we risk removing intangible but important human connection that goes along with them? As humans who live in family and community structures, we are strongly compelled to care for those in we are close to, even when it is hard.
I have been told that I changed a lot after having kids - and I agree. I think it’s been a good thing. While the day-to-day of caregiving can be a slog, caring for others has proven benefits on the carer, too. While one landmark study documented the extreme stress faced by caregivers and even reported higher mortality rates, several more recent studies have shown the opposite: reduced mortality, greater longevity increased empathy. The self-reported impacts on caregivers themselves is also striking: studies show that the majority - whether parents caring for disabled children, or adults caring for elders with dementia, for example - experience satisfaction, a sense of purpose and greater closeness to those they care for.
It makes sense: babies fail to thrive if they are deprived of human love, eye contact and touch. Incubators, baby swings and other tech that mimics human warmth and movement can’t replace them. Through this research, I now know that there are nanny robots being developed as well - something I had never heard of as a parent of three, and which in my gut just feels so wrong. Would humans even keep having babies if they no longer cared for them? I mean, there must be a physiological reason why since becoming a mom, I’ve fantasized that when I retire I’ll be one of those volunteers who cuddles NICU babies. Adults isolated from human connection are also known experience higher rates of depression and poorer health indicators. A robot simply can’t reproduce holistic, contextual, reciprocal care. Love. Human touch.
Emily Kenway has written about care tech in the media as well as dedicating significant space to it in her recent book Who Cares? The Hidden Costs of The Caregiving Crisis and how to Solve it and she captures the essence of the care tech paradox:
“The technologies being developed on behalf of caregivers to free them from their “burden” may have an unexpected cost: the loss of important human capabilities. But experts are clear that technology can be vital for reducing caregivers’ load, too. Paradoxically, then, while tech may prevent us reaping the rewards of caregiving, it may also enable them.”
Last week I talked about some of the other non-transferrable aspects of caregiving. Again, I’d love to see more innovations that support the caregiver’s needs, without simply trying to shift their load elsewhere. Are there technologies that help you as a caregiver? What is the #1 area where you would benefit from some type of technology to help you (even if you can’t imagine what that technology would be)?
📚 Reads
Inside Japan’s Long Experiment in Automating Eldercare
The High wire Act of Caregiving and Saving for Retirement
As always, thanks so much for being here! xo, Anna
For me, this post gestures at some of the most complicated, and difficult-to-speak-about aspects of care. Most of what I read about the care economy, for good reason, focuses about the burden, load, and stress of caregiving. I think that your fantasies about being a volunteer baby cuddler also points to the joys and nourishment of care. I share your species-centrism about the special bond between humans that no robot (or animal) could ever replace, but I try not to impose by views on others. I respect that for some people, their pets really are their family. (https://www.theguardian.com/lifeandstyle/2023/aug/21/theyre-my-kids-pet-theft-pet-detectives-and-the-rise-of-the-multispecies-family) And I’ve read some interesting vignettes on Reddit by folks with autism who say they feel more accepted and understood by AI chatbots than they’ve ever felt by a bones-and-flesh human. In a way, expanding the circle of empathy to animals and software might not be such a terrible thing … especially if it help us focus our human-to-human care on more of the activities that give us joy and fewer that give us stress.
I very much want to read Maggie Nelson’s On Freedom. In the intro, she describes how she set out to write a book about cruelty, which turned into a book about freedom, which then turned into a book about care. Describing the pivots, she quotes a friend: “I used to care about freedom, but now I mostly care about love.” (There are copies floating around: https://static.fnac-static.com/multimedia/PT/pdf/9781787332690.pdf)
Yet again, really enjoying your writing.