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Emily Beater

Freelance journalist

Do social care robots expose the loneliness of the elderly?

Pillo the home health robot has staring blue eyes, a pixelated smile, and an intimate knowledge of your medical needs. Complete with artificial intelligence and a camera to track your face, Pillo perches on kitchen counters and table-tops, watching everyone in the house and dispensing their medication. “Enjoy your yoga class, Lisa,” Pillo says, plopping out a vitamin pill to a pale-haired woman. “Wait,” he says to an elderly man, “Don’t forget your blood pressure medication!”

Pillo is useful. He knows the exact number of calories in a carrot. He can sync with any wearable device, logging your exercise goals. But crucially, Pillo is designed to help the elderly, and those who need support at home. He can dispense tablets at the right times, chat to his users and contact their family members in case of emergencies.

Pillo, with his roving eyes and smile, is also company. With nearly a fifth of the UK population suffering from loneliness, devices like Pillo offer a digitised imitation of human connection – a more advanced form of turning on the TV for company.  

“I go six days without seeing or hearing another human being,” one woman tells me. She’s lived with chronic health conditions for years and is often confined to the house. “I feel like I’m not part of this world.”

Since 2010, the government has cut social care funding by 49 per cent, stripping the elderly and vulnerable of day centres, hourly carers and human contact. The Association of Directors of Adult Social Services (ADASS) says that, due to budget cuts, councils are increasingly unable to meet their legal obligations to provide care.

There is rising interest among care-workers and academics to explore robots as a means of easing the pressure in social care. Rather than funding more human carers, it may become the norm for automated voices and artificial smiles to break the isolation of the chronically lonely. 

In supporting the elderly, devices like Pillo save money. A Pillo advert describes Pillo as an ‘at home doctor’s visit’, able to connect his users with a doctor via video link. This sounds positive at first. People over 65 are more likely to visit A&E and their GP out of loneliness., and the NHS, already struggling financially, could use video chats with doctors to free up these appointments.

But reducing doctor’s visits to video conferences also threatens to increase isolation. Elderly people will no longer travel to GP surgeries full of outdated magazines and sticky-kneed children, for what might be their only outing of the month. They will no longer sit in doctor’s offices and talk over their allocated ten minutes, taking up time with their human need. Given the government’s inaction on the social care crisis, they might use social care robots as an excuse to privatise the issue of loneliness, concealing it within the home so that it is no longer a collective responsibility. The designers of devices like Pillo insist that robots should never be used to replace human carers. But with over 110,000 vacancies in the social care workforce and the increasing threat of privatisation of the NHS, the government may soon be tempted to outsource care to machines. 

“Social care is collapsing,” says Dr Chris Papadopoulos, principal lecturer in public health at the University of Bedfordshire. As part of the international project CARESSES, which is investigating robotics in social care, he is trialling a culturally competent robot in UK care homes, which can interact with residents – the 4ft tall Pepper.

“The staff who come into contact with elderly people are overstretched and don’t necessarily prioritise loneliness. And loneliness is poison to our mental health. That’s something we think our robot can help with”.

Dr Papadopoulos shows me a video of Pepper. I watch the robot lift its arm and extend its silicone fingers to an elderly man in an armchair. 

“Very good!”, the man laughs.

“Hello,” Pepper says in its carefully modulated, American tones. “Can you tell me about your family?”

The man’s eyes light up. He tells Pepper about his children. He asks Pepper to play a song by Eva Cassidy. When the robot obliges, the man leans back, delighted.

Pepper, a product of Softbank Robotics, softens every interaction with its manufactured cuteness. The robot’s gumdrop eyes give it a friendly expression, making it easier for clients to accept it in place of a human being. But Dr Papadopoulos says that Pepper is not intended to replace humans in social care but to work alongside them, making it easier for them to do their jobs. So far, responses to the trial have been largely positive.

“The truth is that elderly people are left on their own a lot in social care settings’ he says. “Pepper is intended to reduce this loneliness and, we hope, produce improved health outcomes.”

The CARESSES international team have wired instructions about human relationships into it, enabling it to hold conversations, ask about reading and music, and even make stilted jokes. Dr Papadopoulos tells me that encouraging people to talk boosts cognitive health – even talking to a robot.

Yet, a demand for algorithms that imitate human interactions is surely a serious sign of the loneliness in our culture. CARESSES have developed a culturally competent artificial intelligence for Pepper, allowing it to engage well with people from any culture. The NHS has a severe shortage of human nurses, which makes the use of robots in healthcare more likely. People are more likely to warm to robots who are emotionally and culturally sensitive, to welcome the presence of wires and smooth plastic in the fabric of their relationships.

“In my personal opinion, we wouldn’t need to be exploring robots if social care was properly and fully funded”, says Dr Papadopoulos. “Humans can do everything that robots can do, and better. But the reality is that it isn’t funded, and we do have big problems”.

But why is social care – the care of those who are most at risk in our society – so undervalued? If we didn’t care for the vulnerable, we would have mass deaths on our hands. Yet, carers are poorly paid, often receive little or no training, and few stay long-term in the profession. 

Caring is a job largely done by women, and female-dominated jobs are less likely to be well paid. Unpaid caring, for example, for elderly family members, has been, for centuries, a traditionally female role. Perhaps we don’t see care as vital, because we are used to it happening for free behind the scenes, propping up our economy, eating invisible hours into women’s leisure time and sleep. 

“I’ve never felt so undervalued by my employer and so valued by my customers,” says Casey*, a care worker who makes as little as £700 a month.

“They just don’t want to pay us in the end. I think they’d prefer it if we were robots. You don’t have to pay a robot. Companies get away with it, because carers work alone and have less chance of meeting up and complaining.”

Casey’s caring job is already eerily automated. Her company have started tracking its workers via an app called CellTrak, monitoring them wherever they go. When advertising to clients, companies call Casey’s job a “care package”, as if the human support she provides is just an object to be marketed and sold. There is something lucrative and mass-market about this perception of human emotional connection, something robotic about the role of care-workers to their employers. 

If we continue to devalue social care as a society, emotional wellbeing and human contact will become increasingly dispensable. Unless we start to value human carers and pay them a proper living wage, we may enter a society where all social care is digitised, and only the richest can pay for human care. Perhaps the foibles and asymmetries and spontaneity of human beings will become a coveted luxury. 

The lady that Casey looks after likes it when she pours her a glass of wine, when she looks in the freezer and notices that she’s running low on her favourite ice-cream. A home health robot would be useful. The client would never run out of ice-cream; the robot would pre-order it and the freezer would always be fully stocked. But the client would miss out on Casey remembering her, on the pleasure of another human being knowing her. 

*A pseudonym has been used to protect the individual’s identity

Emily Beater is a freelance journalist and a student at the University of Oxford. Follow her on Twitter @EmilyKBeater