Pearl is a prototype for a robotic personal assistant, with origins in a collaborative research and design experiment conducted by computer scientists, nurses, gerontologists, and psychologists at Carnegie Mellon and Stanford universities. Sebastian Thrun, who organized the project in Pittsburgh and now directs the artificial intelligence laboratory at Stanford, says that building machines that can live with and adapt to human beings is now “the cutting edge in robotics.” In a research paper, he and his colleagues, who have also engineered a robotic nurse prototype called Flo (in honor of Florence Nightingale), offer a simple explanation for why they focus on developing machines for the elderly and the isolated: The population of old and very old people (age eighty-five and above) is soaring, the costs of home care and health care are skyrocketing, and there is little political will to provide more help. “Thus,” they explain, “we need to find alternative ways of providing care . . . The vast majority of independently living elderly people is forced to live alone, and is deprived of social interaction. Social engagement can significantly delay the deterioration and health-related problems. While robots cannot replace humans, we seek to understand the degree at which robots can augment humans, either by directly interacting with the person, or by providing a communication interface between different people that is more usable than current alternatives.”5
According to new research led by the gerontologist William Banks and his wife, Marian, a nurse at the Veterans Affairs Medical Center in St. Louis, robotic pets can be just as effective as living ones—at least when it comes to reducing loneliness and establishing feelings of attachment. The Bankses arranged for one group of residents in a long-term nursing home facility to have weekly thirty-minute one-on-one visits with a floppy-eared, trained therapy dog named Sparky, while another had the same number of visits with AIBO, a robotic dog (made by Sony) that wags its tail, vocalizes, and blinks lights when spoken to or touched. A control group had no exposure to either Sparky or AIBO. Marian, who delivered the dogs to the nursing home, did not make personal contact with the residents, but she observed that those who visited with Sparky were quick to build rapport with the canine, whereas those who were placed with AIBO took a week to pet him and talk with him as they would a living dog. Surprisingly, at the end of the eight-week study, the groups who visited with Sparky and AIBO reported similar levels of relief from loneliness and attachment to the dogs, while those who didn’t visit with a dog reported that they were just as lonely as they had been when the experiment began.
When I visit the Stanford University artificial intelligence laboratory, a team of young researchers led by Thrun and Andrew Ng convey great interest in the Sparky experiment. They’re even more excited about their own machines, whose components are scattered around the lab like auto parts in a repair shop, with a few more polished projects on display in a large central room. “We’ve lived with robots for a long time,” Ng tells me. “We call them things like dishwasher, dryer, and microwave. Now we have machines that are mechanically capable of doing household chores and even providing some interaction. But they can’t be all that helpful until we develop software that makes them smarter. We need them to hear and understand, to find the bathroom or know what to pick up. When they can do that, it’s going to be a very exciting change.”
Not everyone shares this enthusiasm for robotic companionship. “The prospects for the ethical use of robots in the aged-care sector are far fewer than first appears,” write the ethicists Robert and Linda Sparrow. They perceive “a profound disrespect for older persons” in even the most well-meaning artificial intelligence research, because it ignores old people’s strong preference for human caretakers and advances projects that will substitute machine companions for human ones. The Sparrows acknowledge that social robotics is a flourishing field, and they recognize that machines could be helpful for certain routine tasks, such as using appliances, opening doors, and fetching food. But they warn that robot designers have a long history of setting unrealistic expectations, and they doubt that there is a technological solution to the problem of caring for the isolated.6
The questions raised by critics like the Sparrows should be directed at all of us, not merely at artificial intelligence researchers: Is there really a shortage of living pets to accompany people? Will robots ever be able to meet the complex needs of people, particularly those who suffer from a lack of social interaction and long for emotional connection? Will machines be able to navigate through the often cluttered rooms of homebound people, let alone clean the floors? Will robotic pets provide enough stimulation and affection to sustain their owners’ interest when the novelty wears off? (The nursing home residents in the robotic dog study had access to AIBO for only eight thirty-minute sessions.) If the robots can be turned on and off, won’t that make it impossible for them to establish what the Sparrows call “the independent presence that is a necessary condition of meaningful relationships”? If the robots can’t be turned on and off, will that make them threateningly invasive, and unappealing?
Skeptics of robot care for the elderly and frail also argue that machines capable of interacting with singletons will be prohibitively expensive—unless, as they predict, the robots ultimately displace human caretakers, deepening the isolation of those they serve. After all, many of the most vulnerable older people we interviewed report that paid caretakers, from cleaners to meal delivery workers and home health attendants, are their most regular sources of social contact. They value the presence of another human being just as much as the labor that the person provides, and they long for more company, not less. Substituting a machine for these already rare visitors would be devastating. Hence the Sparrows’ emphatic conclusion: “We believe that it is not only misguided, but actually unethical, to attempt to substitute robot simulacra for genuine social interaction.”7
But machines need not substitute for social interaction, and with the right design they can even promote it. Consider Kompaï, a robotic companion being developed by the French company Robosoft. Although the machine is still a work in progress, its 2010 incarnation featured a short, sleek human form with a head, a cartoon face, and a video camera on top; a box with two large wheels at its base; and a large touch-screen monitor at its midsection, which its human companions could use for a wide range of Internet-mediated communications. The designers of Kompaï envision the family, friends, and health providers of the machine’s user contacting them through an Internet-based program such as Skype or Facebook or an instant messaging service. When completed, Kompaï will be able to locate and move to its owner, and its speech recognition software will allow physically impaired people to communicate by voice.8
Machines like Kompaï may appeal to homebound and elderly singletons because they provide greater access to a kind of communication that people who live alone are already enjoying. (And by the time the current generation of young adults reaches old age, their comfort with machines will make robotic companions even more attractive.) Senior citizens are not only the fastest-growing segment of Internet users, they are also heavy users of its interactive features, from e-mail to dating and social networking sites to video calling programs, which they now use to enrich their communications with family and friends. There’s not much good research on the effects of this activity. But one report, by economists at the Phoenix Center for Advanced Legal and Economic Public Policy Studies, finds that older people who used the Internet experienced a 20 percent reduction in depression and that the change was actually caused by their online activity.9 Not all old people have good access to the Internet, and many who do lack the training they need to master its most important social features. But there are clear payoffs to helping them get online, and projects designed to do this—from the British old-age advocate Valerie Singleton’s six-button touch-screen desktop computer, the SimplicITy, to state-subsidized programs that bring Internet access to public housing for seniors—will deliver immediate rewards.
There’
s also no questioning the value of using machines to link isolated or homebound seniors with health care providers and social workers. Videoconferencing with doctors and nurses is never as good as a face-to-face consultation, but it can be helpful, if only as a way to maintain better contact between visits or to evaluate whether patients are following medical advice at home. New technologies are already enhancing these interactions. Increasingly, health care providers are giving their more frail and isolated patients wireless monitors that convey vital physiological information—pulse, temperature, and breathing levels—to a remote office, where medical technicians can detect potentially serious conditions before they become emergencies. Elderly singletons who are in good health but still worry about a sudden fall (approximately 13 million older Americans fall each year) or some other crisis can benefit from more mundane technologies, like the medical alert systems activated by the touch of an alarm that fits into a pocket or around the neck. And since devices like these bring some peace of mind to those who love or care for seniors who live alone, the rest of us benefit from them, too.
NO MACHINE, be it a compact alert bracelet or a human-size robot, can provide what so many old people and their families need most these days: a home that allows them to maintain the feeling of autonomy while also offering genuine sources of social connection and access to services and amenities. Places like these do exist, and they’re not nursing homes. They’re called assisted living facilities—or, alternatively, independent living facilities, a telling conceptual distinction for a place without a difference—and roughly one million elderly Americans live in them today.
Typically, assisted living facilities are located in large apartment buildings that carve out spaces for communal activities: a dining room for shared meals, a gymnasium, classrooms, or a garden. They also tend to have large support staffs, from cooks to cleaners, security guards to home care assistants. About one-third of assisted living residents occupy smaller places, including houses, that have fewer than sixteen tenants. They may not offer all the amenities of larger facilities, but these homes can offer more personal services, and they lack the institutional feel that can be off-putting to people who are fighting to retain their dignity as they age.
Whether large or small, high-quality assisted living facilities share at least one characteristic: They are prohibitively expensive for all but the most affluent individuals and families. A report published by the trade publication Assisted Living Executive estimates the monthly rent for a typical room at about $3,500, or $42,600 per year. In one recent post on the New York Times blog The New Old Age, Paula Span explains that, at $4,000 a month, a small residential home in New Jersey is a bargain compared to a neighboring facility with ninety-eight beds and fees starting at about $65,000 per year. (Residents pay more for services like home care or medication reminders.)10 In another post, the reporter Jane Gross recounts her own family’s expenses for the nine years that her mother (who, it should be noted, held an expensive long-term insurance policy) spent in two assisted living facilities and one nursing home: “All in all, I figure the years from 1994 to 2003, when my mother died, cost our family $500,000, easy, even without accounting for her lesser expenses or, more important, the emotional and physical wear and tear of so many moves on an old lady.”11
The wear and tear related to moving could be avoided, Gross writes, if families encouraged their elderly relatives to move into a special kind of assisted living facility: a continuing care retirement community, which can accommodate residents no matter how much special care they need when they lose the capacity for domestic independence or approach the end of life. The catch, however, is that these facilities demand a large up-front payment; the one Gross visited, in Tarrytown, New York, asked for about a $200,000 payment against which future costs would be deducted, just to get in the door. Those rich enough to afford this may well benefit in the long run. Then again, they may not, since there’s no refund if the resident dies soon after moving in, as many inevitably do. It’s “a dilemma many can only wish for,” Gross acknowledges. But that doesn’t make it any less difficult for the families that are affluent enough to consider a continuing care facility.12
For the past dozen years my own family has experienced the stress of this fortune. Until her death in 2011, my grandmother Esther had always been humorous, mischievous, and full of life. As a child during prohibition, she learned to make bathtub gin; as a young mother, she was the president of the local school parents’ association and the synagogue women’s auxiliary, and she also threw enormous, occasionally raucous parties where she taught her friends to dance; as a grandmother, she taught me how to hit a baseball and drive with my left hand so I could put my right arm around a date. But for the last twenty-five years of her life, she spent much of her energy in a daily battle with Parkinson’s disease, and the fight became more difficult after her second husband, Irv, died in 1997.
For most of their marriage, Esther and Irv lived in small rental apartments in Los Angeles; among the countless ways that Irv helped her, driving her around town was particularly important, because their city, like so many others, demands mobility, and she could no longer drive. When he died, quite unexpectedly, the quality of Esther’s life in Southern California diminished immediately. She had a few friends in the area, but they too were beginning to suffer from various illnesses and the deaths of their husbands, and it was hard for them to visit. Her three children lived elsewhere: my mother in Chicago, my aunt in Milwaukee, and my uncle in Silicon Valley. After a few scary mishaps, including one where she tried driving a golf cart and accidentally crashed it into the local senior center, we decided she would be better off coming back to Chicago, where she had been born nearly eighty years before.
My grandmother didn’t own a home and had little savings, but her children had been successful and they agreed to share the costs of a luxury assisted living facility on the lakefront. It’s a gorgeous high-rise building, with a sweeping, glass-enclosed atrium on the ground floor; an open, sun-drenched dining room; generously sized apartments, many with water views; and a kind, attentive staff. It’s expensive: about $50,000 per year for a one-bedroom apartment with two meals a day and access to the building’s services and amenities, and more for those, like my grandmother, who need additional care. But when it’s your own parent, who has given so much of her life to you and the family, it’s hard, if not inconceivable, to give back anything but the best.
Esther’s first years in the Breakers went smoothly. Of course, she missed her deceased husband and her life in California. But as a spritely newcomer, she had little trouble making friends and joining in various activities at the complex. She was witty and engaging, and within days she was getting invitations to dine with her new neighbors. She had always been a good bridge player, and once she made that known a small group of women let her into their game. The facility, which is located on the far north side of Chicago, offered shuttle service to the downtown shopping district, and although she didn’t have much to spend, she’d often go just to be social. Moreover, she was close to family—daughters, grandchildren, cousins—as well as old friends, and visits with them made her feel like she was back home.
Things got complicated as her disease progressed, however. Although Esther retained her mental acuity, her Parkinson’s made it difficult for her to walk, speak clearly, and control her hands. Most of her neighbors were sympathetic, and helpful. But as her body failed, she was forced to acknowledge a brutality in the culture of assisted living complexes that she hadn’t previously registered: They are organized around a social hierarchy, with the healthiest and most independent at the top and the sick and frail at the bottom, stigmatized and marginalized, lest their company remind others how vulnerable they really are.13
In her telling, my grandmother’s stories sounded like dispatches from the front lines of junior high school, not a retirement community. Women who had always included her in their social outings began plannin
g them without her. When she confronted them, they’d usually be evasive, but sometimes they could be nasty, too. Friends who once held a place for her at the dining table allowed others to fill her seat. The greatest insult came from her bridge group, whose members decided that her problems communicating made her an impossible partner and barred her from their game. Suddenly she was an outcast, forced to find a new set of friends.
There was no shortage of possibilities, since assisted living facilities are full of people who, like Esther, are physically compromised but intent on preserving their dignity and maintaining their social lives. Remarkably, she quickly found her way into another small community, and repaired a few of her older friendships, too. Yet her enthusiasm for the assisted living facility diminished. She complained more: about the food, the staff, and other residents. She began reporting the times when paramedics would arrive to assist a neighbor, and told us about all the friends who would fail to show up for breakfast one day and turn out to be dead.
By the time she reached her late eighties, my grandmother’s disease had rendered her incapable of living independently, even with the extraordinary support that her building offered, so her children hired someone to move into her apartment. Five years later, Esther was turning ninety-two, and on her birthday, July 4, my mother hired a small bus to bring about fifteen of her neighboring friends to her home for a party. Nothing was easy for my grandmother in those days. She was weak, occasionally depressed, and sometimes disoriented. She was spending ever more time in her apartment, and she said that on some days the effort to go downstairs for dinner demanded more than she could give. Her children faced a different kind of struggle. Her care costs reached more than $80,000 per year by the end of her life, and they’d spent a fortune to help her get through the last decade—a fact that made her feel embarrassed, and perhaps a little proud as well. But that day there was still a lot to celebrate. After all, there she was, still spirited in her nineties, surrounded by family and embraced by friends who lived only steps away. Sitting beside her at our Independence Day ritual, I found myself asking how more of us could wind up this way.
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