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Robots for caregiving -- pick up the pace or give it up

Patience, patience, when it comes to robots and elder care.  When it comes to robots to assist with caregiving and the elderly, we want to believe. It was just 2 years ago that Gecko Systems issued a press release saying that they expected "Medicare/Medicaid Payments to Increase Personal Robot Demand." Makers of the CareBot, the company announced its dealer program in June 2010 -- but it is unclear whether the company has moved into commercial release. It was just 3 years ago that the uBOT-5 (UMass Amherst) was offered up as having the potential to provide elder care for aging baby boomers.

Sounds good -- maybe stymied. On the (positive?) side, iRobot's Colin Angle announced that iRobot would make robots to assist the elderly and would tap the interest of the "American government which could provide the financial aid to develop these domestic robots." Hmmm, not so likely these days, with this US senator publicly criticizing NSF investment in robots, particularly irksome to the senator was the towel-folding research experiment. The 'foul' cry of the researcher is certainly the priceless part: "Towel folding is just a first, small step towards a new generation of robotic devices that could, for example, significantly increase the independence of elderly and sick people."

Other causes for, uh, robotic eldercare optimism. The Japanese, way ahead at experimentation and conversion to product, have produced Paro, the baby seal-bot for pet-free companionship that will help elderly Japanese be less lonely -- at $6000 in the US, it's out and presumably somewhere in the US today. Then there was HAL, the 'exoskeleton' to help nursing assistants lift residents (also Japanese developed, also estimated at $6000).  And now, a Japanese Caretaker Robot that kneels to lift people off the floor, priced at $78K (that's right!) to save nursing aide labor. But as one nursing home worker noted on LinkedIn, this lifting cannot be done unsupervised -- because of course, the robot cannot observe and communicate the condition of the person on the floor -- so no labor savings there, yet; more research required, and its just as well, availability is predicted to be around 2015.

The trouble with robots and eldercare -- people are required. So with the Caretaker Robot announcement, let's mark the reality of where we are today. Elder care robotic technology innovation and research is failing the elder caregiving industry. Whether in Japan (where the aging population and scarcity of caregiver workers is already frightening) or in the US, where longevity expectations are up, up, up -- and the workload of caregiving is up enough to confirm that the fastest growing job category in the US among all careers is personal care aide, best salary prediction, around $20K. So where does a robot fit into the personal care aide scenario, when that job represents employment to hundreds of thousands in a slumped economy?  More to the social point, a person can hug and be hugged, smile, and engage with a lonely older person. Through a web camera and Skype, more than one person can be engaged in conversation and monitored for changes in health status, demonstrated in numerous examples at relatively tiny price points. 

Rethink robot role in elder care.  Before someone says that this blog post is anti-technology, hold on. Scientists and engineers would say that you can't have a really useful robot until experiments, trials, pilot projects, redesign, and rethink phases have all been (sequentially) completed. Certainly true, but you can halt release of press packets and video interviews until the usefulness is up and the price point is down. Unfortunately, isn't that precisely the point -- to obtain more funding for more research in still-not-useful projects, publicity is required and the press just eats it up. In the meantime, to those smart folk in Japanese and US research organizations, how about slicing off just a few NSF dollars for projects that are focused on making the jobs of CNAs better and less back-breaking today? How about as an interim approach, introducing a few clever technologies that pump up the socialization for older adults well beyond pathetic Paro parity. Efficiency in meal packaging and delivery, effectiveness for staff during shift turnover, more social connectivity for seniors at home or in senior housing -- those might be a good start.  And to the NSF -- for every $1 invested in robotic research, how about 10 cents toward making the lives of older adults better right now?

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As a member of the robotics community, and one focused on addressing the caregiving challenges, I partially agree with you. There has been a lot said and demoed about the potential of robots in the caregiving role, but little in the way of actual delivery of anything into the marketplace. Most of what have been shown are great demonstrations of technology, but often too expensive or premature to be useful or practical.

I believe this is due to the fact that many in the community are too focused on technology like walking or manipulation and not enough on defining a solid value proposition that addresses real user needs at a price they can afford. The second issue is that few pay enough attention to a practical and usable user experience. For example, you can see demonstrations of the Honda Asimo, Toyota's Partner Robots, or even the Willow Garage PR2, but don't ask the price of these if these companies were actually to try to sell them. Most of them are in the hundreds of thousands of dollars. They also allude to potential tasks, but never really show the robots able to do multiple tasks with a real user. Further they also play on your imagination on how you will interact with these robots, implying you will just be able to talk to them. It all is exciting to watch, but it builds up expectations for technology that may demo well and shows the future potential, but even as optimistic as I am, would not foresee this being delivered for at least the next 15-20 years, when we will be well into our challenges with regards to caregiving crisis.

Even for my own business, I had hoped to find many potential partners on the hardware side, so I could focus on the software side. However, I find that most robot hardware companies are too focused on dazzling us with technology than solving real needs and totally neglecting how users will interact. I like to call this the "build it and they (i.e. the users) will come.

But that is not very realistic thinking and is not proven out by the history of the PC, or even the more recent success of Apple with the iPhone and iPad products. For example, consider that Apple came in late in both areas and yet they have taken the industry by storm. But why should the iPhone have succeeded since it really didn't initially offer any more functionality than existing smartphones in the market and actually offered poorer service because of its carrier partner. Similarly, if one thinks of the limitations you have with doing things like creating documents or spreadsheets, the iPad should not have had any impact on the PC market, being technically inferior to even a netbook. But the difference here in both cases was that Apple polished what Jobs likes to call a "magical" user experience.

All that said, I must defend my fellow industry players on one point. Defining a value proposition and a successful user interface is not easy. Even with the PC industry it took several years before applications and interfaces evolved that made it rational to buy one.

Doing that for a caregiving robot requires that and possibly more. But the industry first needs to step by from the multi-armed wonders with expensive laser sensors or android-like clones and figure out how to construct a robot that could sell to users at a reasonable price. But more importantly it needs to match technical capability with applications that can solve real user needs. And finally, it needs to design interfaces that are realistic. Most robot vendors leave you with the expectation that users will just converse with their robot and it will understand them. Don't you believe it. The best examples of speech interfaces still fail 20-30% of the time. Even non-seniors find existing speech interfaces limiting and frustrating. After all if your keyboard or mouse failed 20% of the time you would throw it out. Interfaces must work reliably and tuned to how users can operate, or in the latest Steve Jobs parlance, "just work".

So in some ways the industry is sometimes its worst enemy by demoing platforms that create the unrealistic expectations that help perpetuate the illusions already created by sci-fi material. They tend to get so carried away with their technology they forget the key factors in terms of delivering something useful and easy to use.

Finally, I will have to disagree that with the current failure to deliver, we should consider putting the money elsewhere where it can be used for more immediate solutions. While it is true that a lot of investment worldwide has not produced the needed results, I believe that is because governments funding such research have not set the right goals. Look at what DARPA got with a $1M prize for an autonomous car. It brought out the hobbyists and professionals working not only to create a single solution but many that I believe will pay off in the future in giving us safer cars and perhaps extend the time as we age to use our cars. Maybe its time to have a prize for creating an affordable and user caregiving robot.

In any case, patience is needed. Everyday the component technologies are getting better and if the industry can recognize the importance of defining compelling applications than fancy demos and create a user interface that like GUI make the technology usable, this technology will play an important role in addressing caregiving needs. But you are right that we aren't there yet, and better focus is needed on the factors that count.

Tandy Trower

Hoaloaha is Hawaiian for caring companion


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