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Robotics Part 3
A world where we work, learn, play, relax, and eat with robots every day

How Will Robotics Change Nursing Care in 2030/2040?

Yumi Shirai, Future Vision Center 6 April 2020

Aging Population and Shortage of Care Workers

Japan is set to face an acute decline in population. The percentage of elderly people among the total population, especially those over age 75, is increasing year by year. As of FY 2018, the number of elderly residents eligible for nursing care and assistance services was 6.44 million as of FY 2018, 2.95 times that of FY 2000 (Figure 1).

Figure 1

Change in Number of Elderly Eligible for Nursing Care & Assistance Services

Note 1) Excludes City of Rikuzentakata, Otsuchi Town, Onagawa Town, Koori Town, Hirono Town, Naraha Town, Tomioka Town, Village of Kawauchi, Okuma Town, Futaba Town, and Namie Town

Note 2) Excludes Naraha Town, Tomioka Town, and Okuma Town

Source: Ministry of Health, Labour and Welfare (2019) “Circumstances Surrounding the Nursing Care Insurance System”
https://www.mhlw.go.jp/content/12601000/000482328.pdf
(Accessed: February 27, 2020)

On the other hand, the demand for care workers is forecast to reach 2.45 million at the end of FY 2025 (Figure 2), resulting in a shortage of about 550,000 with respect to the FY 2016 figures on care workers: 1.9 million. To meet this demand, the country must secure care workers at a pace of 60,000 new workers a year.

Figure 2

Demand for Care Workers

Note 1) Demand forecasts (approx. 2.16 million and 2.45 million people) are aggregated values estimated by local governments based on the estimated volume of services (including general businesses) identified by municipalities in the Insured Long-Term Care Service Plan: Phase Seven.

Note 2) The approximately 1.9 million people of FY 2016 shown above is the sum of care workers at comprehensive caregiving organizations that provided services corresponding to the former “care prevention, home care, etc.” category (estimated at approx. 66,000) and care workers (corrected based on response rate, etc.) in the survey on nursing care service facilities & establishments.

Source: Ministry of Health, Labour and Welfare “Efforts to Secure Care Workers”
https://www.mhlw.go.jp/stf/newpage_02977.html
(Accessed: February 27, 2020)

Securing the necessary amount of care workers requires the following: improving caregivers’ benefits; enhancing recruitment and training of staff; and utilizing robot technologies at care sites. To increase the amount time that caregivers can dedicate directly to caregiving, it is essential to implement robots that reduce the burden of nursing care work and ICT that improves the efficiency of administrative work such as the creation and storage of nursing care records.

Trends in Nursing Care Robots

The Ministry of Economy, Trade and Industry is promoting the development of robotic caregiving equipment for thirteen items in six priority areas (Figure 3).

Figure 3

Priority Areas for Robotic Caregiving Equipment (revised in October 2017)

Source: Project to Promote the Development and Introduction of Robotic Devices for Nursing Care “The Priority Areas to Which Robot Technology is to be Introduced in Nursing Care of the Elderly”
http://robotcare.jp/en/priority/index.php?lang=en&PHPSESSID=9528ongqavndk7likmoe49nqh6
(Accessed: March 10, 2019)

In response to national policy, caregiving robots have been developed and sold mainly by small and medium-sized companies throughout Japan. In particular, a number of trials have already been conducted to introduce robots in five areas: transfer aids, mobility aids, toileting aids, monitoring systems, and bathing aids (Figure 4).

Unfortunately, the overall use of robots at nursing homes has not made much progress. Reasons include the equipment’s poor operability (e.g., equipment is heavy and large, difficult to operate, usage is limited, users are limited) and high installation costs, with both of these factors diverging from the needs of medical sites. Furthermore, there is generally a strong societal impression that caregiving should be provided by humans. This aversion toward caregiving robots hinders their active introduction.

Figure 4

Example of Caregiving Robot

Transfer Aid Robots

The Resyone Plus developed by Panasonic AGE Free Services is a bed where half of the bed can transform into an electric wheelchair.

Source: Panasonic AGE-FREE Services Co., Ltd.

Transfer Aid Suits

HAL® Lumbar Type Well-Being developed by CYBERDYNE reads bioelectric potential and assists the movement of the lower back.

Source: CYBERDYNE Inc.

Urination Prediction

DFree developed by Triple W Japan is a device that provides advance notification of urination using ultrasonic waves.

Source: “DFree” Triple W Japan Inc.
https://dfree.biz/beginners.html
(Accessed: February 27, 2020)

Bed Sensors

Nemuri SCAN developed by Paramount Bed displays the sleep state of a subject in real time through a sensor installed under the mattress.

Source: “Nemuri SCAN: System to support watching over patients” Paramount Bed Co., Ltd.
https://www.paramount.co.jp/learn/reductionworkburden/nemuriscan
(Accessed: February 27, 2020)

Therapeutic Robots

Developed by AIST, PARO is a robot with animal therapy effects for elderly persons and people with dementia; PARO is used all over the world.

Source: National Institute of Advanced Industrial Science and Technology (AIST)

Communication Robots

Mitsubishi Research Institute DCS and Japan Third Party have started a joint experiment on communication robot services for children and elderly persons utilizing a cloud-type interactive AI engine and the humanoid robot NAO from SoftBank Robotics.

Source: Mitsubishi Research Institute DCS Co., Ltd.

Public finance for social security faces a tight situation. Focus will shift from the current institutional care to a balanced social system that is based on both institutional and home care. The goal of this system is to prevent conditions requiring long-term care in the first place or aggravation of conditions. It is imperative to understand the particular health condition, behavior, and psychological symptoms of elderly persons from early stages where only moderate nursing care is required, in order to not miss small changes, and to take proactive measures before conditions deteriorate.

To make these possible, the burden on the caregiver should be reduced. Caregivers are faced with enormous physical and mental stress ranging from ensuring care recipients’ hygiene to the erratic and at times abusive behavior of dementia patients. If their total work volume can be reduced, caregivers will be better able to catch early signs of patient deterioration and prevent a need for an increased level of care.

In addition to improvements in the efficiency of individual caregiving tasks, it will be essential to hasten the uptake of robots that support independence in daily life and communication as well as sensor systems that collect information which can optimize nursing care.

Robots for Monitoring, Toileting Aid & Medication Aid Expected to Gain Traction by 2030

Around 2030, the use of robots is expected to grow in the area of caregiving first in situations where such use is cost-effective. Robot monitoring systems can be used for long periods of time every day and by people with a wide range of care needs, and such features will greatly reduce the burden on caregivers. To keep the required degree of care at a low level, it is important for elderly persons to use their remaining physical and cognitive abilities as much as possible. The widespread use of robots that can assist exercise and communication in the daily lives of elderly persons should enable these individuals to preserve their remaining abilities.

The need for toileting aids in caregiving is very high. Toileting aid robots have assisted care recipients in urinating by themselves, thus restoring a sense of dignity among patients and dramatically improving the level of care required.

Robots that aid in the administration of medication help prevent people from forgetting or mistaking their medicines and are much sought after in caregiving. Sharing medication information between family members, medical staff, and caregivers helps improve the quality of care.

However, challenges in coping with care recipients’ various physical conditions must be overcome before work support robots can be effectively applied to aid in tasks such as transfer, mobility, and bathing.
Limited operating space is another problem delaying the uptake of robots.

Figure 5

Conceptual Illustration of Home Care in 2030

Source: Mitsubishi Research Institute, Inc.

Figure 6

Conceptual Illustration of Care at Facility in 2030

Source: Mitsubishi Research Institute, Inc.

Life with Robots Commonplace in 2040

By 2040, facilities and homes designed for the effective use of robots will become increasingly common, with user interfaces such as bathtubs, beds, and toilets tailored to the elderly. Robot technologies will also have advanced significantly, and robots supporting activities such as transfer, mobility, and bathing will have become widespread. People will be so comfortable with using robots in their daily life that they will be unconscious of their presence, thus enabling even moderate care recipients to live comfortable and independent lives.

For those with severe care needs, caregiving facilities comprehensively designed with the use of robots in mind will appear. Robots will perform care work directly while care workers can dedicate themselves to attending to residents and providing mental healthcare. In such a society, the perception that caregiving should be done by humans will change, and people may even start to feel more comfortable being cared for by robots.

Figure 7

Conceptual Illustration of Home Care in 2040

Source: Mitsubishi Research Institute, Inc.

Figure 8

Conceptual Illustration of Facility Care Work in 2040

Source: Mitsubishi Research Institute, Inc.

User Needs the Key in the Spread of Caregiving Robots

The key to the widespread use of caregiving robots is the development of reliable technology and increased awareness among caregivers and care recipients. In order to develop and apply caregiving robots that are easy to use, developers and caregiving facilities need to engage in repeated discussion. Although it may be more efficient for humans to carry out caregiving work in the short run, given the increasing burden of caregiving and the serious lack of human resources, the introduction of robots can not only alleviate this situation but also expand future possibilities. For example, if a large amount of data can be collected and analyzed using sensor information, this should lead to improved care services and the discovery of new care and treatment strategies. Some caregiving facilities have also commented that new hires may find working at their facilities more attractive if these places can emphasize a forward-thinking culture embodied by their use of any kind of robot.

However, there is still a lack of consensus at the individual level as to whether one wants to be cared for by a robot. Instead of an emotional argument, consideration must be given for how best to provide comfort and peace of mind to both caregivers and care recipients.

Developers may find the answer by asking questions such as “What would you be OK with a robot doing for you?” and “What requirements would you have for such a situation?” For example, with toileting aids some people may prefer help from robots rather than humans. By clarifying the needs of users, it will be easier for caregiving facilities to begin using robots. Furthermore, once there are tangible prospects for robots’ commercial success, manufacturers will be able to commit to production.

There is no way of being certain what society will be like in ten or twenty years, but what is certain is that all of us will be that much older by that time. It is important to increase awareness that caregiving is a concern for everyone, and that decisions should be made to achieve a desirable future world.

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