You might imagine that providing quality long-term care in a country where nearly a third of the population is 65 or older — and one in 10 people is over 80 — would present some formidable challenges. And you’d be correct: Japan is aging at a frightening rate, a pace that has placed extreme pressure on nursing homes, independent-living facilities, and all aspects of institutional caregiving.
Those challenges are, in many ways, offering a glimpse into the future of long-term care in the United States, where some 10,000 people turn 65 each day and face the frightening prospect of eventually relying for their care on an industry struggling to maintain adequate staffing and dominated by companies focused more on bottom-line earnings than on quality services. The difference between the Japanese situation and our own, however, is that policymakers there seem to have identified some plausible solutions. And the most surprising of these involves an innovation that industry and policymakers in this country have barely begun to consider: Yes, I’m talking about robots.
A team of researchers, led by Yong Suk Lee, PhD, an associate professor of technology, economy, and global affairs at Notre Dame, surveyed Japanese nursing homes in early 2020 and again in 2022 to learn how three types of robots have affected workplace staffing, quality of care, and management practices. The results, published last week in the journal Labour Economics, suggest that this technology, when utilized strategically, could ease worker burnout and provide better care to residents.
“Our research focused on Japan because it is a super-aging society that provides a good example of what the future could entail elsewhere — a declining population, a growing share of senior citizens, and a declining share of working-age people,” Lee explains. “We need to be ready for this new reality.”
Almost three-quarters of Japan’s nursing homes reported using at least one of the three varieties of robots — transfer, mobility, and monitoring — in 2022, with monitoring robots being the most popular technology. Though this option doesn’t resemble what we tend to think of as a robot, its video screens, bed pads, and various sensors play a key role in residents’ safety by monitoring their mobility and sleep patterns. They alert care workers when a resident is in danger of falling out of bed, for instance, or experiencing some other safety crisis.
Monitoring robots also help residents communicate with staff and family members, Lee notes, easing the feelings of loneliness that often plague nursing home inhabitants.
“The complementarity between robot adoption and nursing home staffing is most prominent for monitoring robots,” Lee writes. “[It] could be driven by robots alleviating care workers’ physical burden and demands on their time, thereby improving the perceived work amenities at a given facility and reducing the persistent staffing shortages that facilities face.”
The other two robot options have also proven to be popular. About 26 percent of Japan’s nursing homes have adopted mobility robots, which help frail residents get from point A to point B and assist them when using the toilet or bathing. And transfer robots, which care workers use to lift, reposition, or move residents from bed to wheelchair, have found a place in a similar portion of facilities.
Adoption of the robots has produced some not-so-surprising results: Nursing home operators were able to reduce their labor costs, Lee notes, because mobility robots reduced the demand for higher-paid, more experienced care workers, and monitoring robots reduced the demand for less-experienced staff. Overall, however, these facilities tended to shift toward hiring fewer full-time experienced workers, which eased their payroll burden.
“We found that robot adoption complements care workers by reducing quit rates,” Lee reports. “This is important because turnover is a big concern in nursing homes. Workers typically experience a great deal of physical pain, particularly in their knees and back. The work is hard and the pay is low. So robot use was associated with employee retention.”
More surprising, perhaps, was the improvement in staff morale after the robots arrived. “We found that robot adoption complements care workers by reducing quit rates,” Lee reports. “This is important because turnover is a big concern in nursing homes. Workers typically experience a great deal of physical pain, particularly in their knees and back. The work is hard and the pay is low. So robot use was associated with employee retention.”
In addition to freeing workers from the physical rigors of the job, the robots enhanced the quality of care in the facilities by monitoring residents more closely. Lee’s survey reported less reliance on patient restraints, fewer bed sores and pressure ulcers among residents, and a salutary shift in worker focus.
“Robots can improve productivity by shifting the tasks performed by care workers to those involving human touch, empathy, and dexterity,” he concludes. “Ultimately, robots can help workers provide a higher level of patient care.”
But can they work the same magic here in the United States, where long-term care is more of an afterthought than a priority? Unlike in Japan, there’s no government-funded long-term care insurance, nonprofit facilities represent a tiny portion of the marketplace, and stifling immigration barriers squeeze an already pinched workforce.
Government-mandated staffing levels have done little to improve care, as enforcement is every bit as lax as compliance, and there’s little evidence to suggest that the profit-obsessed chains that dominate the industry — while complaining of paltry government reimbursement rates — are willing to invest the capital required to send robots to the rescue. Quality care is simply not a priority.
As The New York Times recently reported, one privately owned chain based in New York allegedly siphoned $83 million in Medicaid funds to pay for nonexistent labor along with inflated fees and rents to other companies the chain owned — while reporting a bottom-line loss of more than $430,000.
These types of companies have been claiming for years that they’re losing money, Mark Miller, the District of Columbia’s long-term care ombudsman, tells The Times. And any workplace issues are mostly of their own making. “There’s no staffing shortage,” he argues. “There’s a shortage of good paying jobs.”
And that’s something not even the smartest robot is going to fix.
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