In last week’s Connelly Law Senior Issues’ blog, we discussed the growing need for home health aides and other health care professionals to provide services to an aging America. This problem is not unique to this country -- it is, in fact, a problem facing many societies around the world.
Here in the United States, the Census Bureau estimates that 15 percent of Americans – nearly one in six of us – were aged 65 or older in 2016, up from 12 percent in 2000. Demographers anticipate that by 2060 almost one in four will be in that age group. That means there will be some 48 million more elderly people in the U.S. just four decades from now.
Adding to this, the National Center for Health Statistics released a report shortly after we published our last blog that stated American births fell to a record low for the second straight year, extending a deep decline that began in 2008. In 2017, the fertility rate was 60.2 births per 1000 women, down 3 percent from 2016.
Why is this important?
Because birth rates are an important measure of a society’s demographic balance. If rates are too high, resources like education and housing are strained, and yet if they are too low, a country will face challenges replacing its workforce and supporting its seniors.
In America, that means the less people in the workforce, the less money the government collects in social security and medicare taxes that supports a growing senior population. It also means less employees to work with the elderly who are living longer and in need of services.
Last week, we discussed the current shortage of those to work with our seniors and the tremendous shortfalls expected in just a few years due to the baby boomer population. To address the worker shortage, developed countries are looking towards technology, specifically robots, as the answer to providing care to our seniors. But before we rejoice, there are some serious concerns about using robots.
Before we get into this, let’s take a look at this new technology.
Most of us who work with seniors are aware of the new innovations in the home that have allowed seniors to continue living on their own. Devices hooked to phone lines that monitor pacemakers, defibrillators and other medical hardware help to keep them from moving into long term care facilities. But, it’s not just medical issues that seniors living independently need, it’s also help with everyday chores like cooking, light housework and managing finances.
Currently, relatives are often not close enough to help with this work and evidence is beginning to show that when relatives do this work, it is neither healthy nor sustainable for either party. This has led to the explosive growth of professional home health care services. These businesses, however, struggle to keep their positions full and their employees properly trained as the need far outstrips the supply and the workforce shortage only projected to get worse.
Without people to man these positions and costs of care skyrocketing, healthcare
providers are looking at robots to help supply these services. It makes good business sense -- they are a one time investment with some upkeep, don’t call out sick or quit, and provide consistent care without the emotions of a human provider.
In the past, the majority of providers and consumers had strong negative feelings about robotics being involved in the care of humans, but the attitudes are changing. Recent surveys of professionals and families in need of health aides for aging parents indicate an acceptance of robot help in providing care. In Europe, the prototype testing is currently underway with six elderly people across the continent being provided with a new electronic helper – the GiraffPlus robot.
This machine is designed to help elderly people who want to stay at home remain independent past the point they’d usually be unable to live alone due to physical or cognitive difficulties. Motion sensors track if someone is in a certain room while pressure sensors under beds and sofas can tell if someone is sitting down. There are also sensors that are activated when certain appliances are plugged in and sensors that monitor when doors and windows are open or closed. The sensors can measure room temperature and humidity, turning on heat or cooling systems.
This robot has other uses as well, it can be fitted to measure weight, blood pressure, sugar levels and monitor the night movements of the senior. The machine also allows “virtual visits” from friends, family and healthcare professionals by using a screen fitted to it.
Some of the problems they are finding with the robot is its inability to discern the idiosyncrasies of each individual user. It can also be unplugged by the user or have food or drink spilled on it causing the sensors to malfunction. But its inventors see this as a surmountable problem that can be corrected simply and quickly. In short, the elder care industry sees the use of robots as something that will happen.
Although we mentioned that surveys show some acceptance of using robot technology, many others in healthcare have a major concern – “warm hands versus cold hands”.
These concerns are not to be taken lightly. In many cases, daily caregiver visits are the only human contact some elders have with other human beings. Lacking the human touch, they say, will not only further isolate seniors but lead to a rapid decline in health.
Those in favor of robots calls this fear ludicrous, stating that those healthcare professionals who cite these concerns are “insecure and afraid of new technology.” Do they have a point? Are healthcare professionals insecure about new technology or is human touch a real and necessary component of senior care? Let's explore this.
The Need for Human Touch
In the early 1900s, the United States was populated with thousands of orphanages where unwanted babies were dropped. These institutions were sanitary, warm and provided appropriate food to these children and yet nearly all infants placed there died before they were seven months old. Doctors noted that these children were not sick and many ate normally, but they just seemed to “waste away”, a condition they called “marasmus”.
At the same time, a pediatrician named Luther Emmett Holt spewed forth a revolutionary idea in child care – keep away from your baby. He blamed parents for “spoiling” their children through cuddling and holding them too much. According to Holt, a good parent needed to take a “hands off” approach to parenting. New parents across the nation heeded the good doctor’s approach. Within a few years, pediatricians began to notice a dramatic rise in infant deaths – among normally healthy babies.
It soon became apparent that these children died from a condition commonly called
“failure to thrive” – they were simply not getting enough human touch. Studies conducted at the time from devotees of Holt and on babies who died in orphanages found that touch deprived babies were half the size of normal children.
When Holt’s methods were dismissed and children were removed from institutions and placed into environments where they received physical nurturing, the “marasmus” reversed. They finally gained weight and began to thrive. Bottom line, touch is vital for the survival in the very young – and the very old.
Don Drake, a presenter for Connelly Law Offices, Ltd.’s Community Education Series, explains why human touch is important for seniors.
“When exposed as children to a world full of new experiences, we rely on the touch of a nurturing caregiver to provide a sense of safety. This touch helps us form patterns of consistency during vulnerable times and allows us feel how valued we are by those around us. As we grow, the need for touch does not disappear and we continue to benefit from such human to human contact. As we age, this becomes even more important as we rely on those around us to once again provide us with a sense of safety and nurturance.”
Research seems to back this up. In a study conducted by the University of Miami’s Touch Research Institute, they found that touch can:
Lower blood glucose levels
Slow the heart rate
Lower blood pressure
Improve pulmonary function
Improve the immune system
Enhance alertness and performance
Other studies show:
Hugs elevate mood, reduce stress and may prevent Parkinson’s
Eye contact and a pat on the back from a health care professional may increase the survival rate of patients with complex conditions
Therapeutic touch clams people with dementia
Touching makes you appear more trustworthy
A light touch makes people more agreeable when you request something from them
Attorney Connelly, who acts as a guardian for many clients, speaks about his own feelings about the importance of touch.
“I visit our wards on a regular basis and it is often an emotional experience for both of us. When I walk in and hold out my hand for a handshake, they will grab my hand and hold onto it tightly, looking me in the eye and often tearing up. I can feel their loneliness and the gratitude they have for someone caring about them. It amazes me how such a small gesture can have a really profound effect -- not just on the senior but on me as well.”
Researchers in the United States reviewed 218 studies involving health effects of social isolation and loneliness on nearly four million older adults. What they found was astounding.
Lonely people had a 50 percent increase of early death compared to those who had a more active life and regular contact with others. In Europe, similar studies have comparable results.
The Telegraph, a British newspaper, reports that Britain is the “loneliness capital” of Europe, citing that its citizens are less likely to know their neighbors or have any strong friendships. The United Kingdom’s Local Government Association was so concerned about these results that they petitioned the government to treat loneliness as a major health issue. Following up on this report, the non-profit agency, Age UK, issued a press release calling this issue a blight on the lives of more than one million elderly people.
In another recent study, concerns were raised about the new reality of seniors staying in their homes. When connected with others and having an active social life, they seem to thrive. But for those without such supports, it is a recipe for depression and chronic illness. So although we may want to keep our seniors home the lack of human interaction may lead to more problems and even higher costs on the health care system through increased physical and mental illness. In these cases, robots may not be able to meet the needs.
At a Boston Hospital, a treatment program directed by Drake dealt with multiple patients diagnosed with AIDS dementia. This type of dementia is caused by HIV itself and not by the opportunistic infections that commonly occur during the course of the disease. Although it is still not exactly known how the virus damages brain cells, it presents with symptoms similar to other dementias.
Drake recalls one patient, we’ll call her Wanda, who had spent months in a hospital after being found close to death on the streets of Mattapan. Once a bookkeeper who operated her own tax preparation service, she became involved with a man who was an active intravenous drug user and carried HIV. Once she found out she had contracted the virus, her life spun out of control sending her into a depression and a life of heroin addiction. Her HIV had advanced to an AIDS diagnosis and eventually, dementia.
“The program Wanda was transferred to had a mental health and addiction counseling component specializing in those with HIV/AIDS. Upon admission, she was totally disengaged, wearing diapers, had a feeding tube and had extremely poor hygiene. What we put into place was a morning greeting for her along with a handshake and a mentor who would help her with fixing her hair, applying make-up and doing her nails”, Drake said.
“The most positive part of this very modest touch was an increase in socialization. She bonded with the counselors, often talking about her early life and not always connecting her stories, but it was an enjoyable time for her. She began to joke and laugh. She started to feel comfortable sharing her sadness – about her loss of independence, her children, and control over her life. She began to show an enthusiasm for life once again.”
Wanda was referred on an outpatient basis to a program in Boston called the Boston Living Center, which provided services to HIV/AIDS patients including therapeutic massage.
“Once she was able to leave the hospital and became involved with the Living Center, things changed even more for her. She no longer needed to wear protective undergarments, the feeding tube was removed and her personality once again emerged. Although her dementia persisted, she showed a considerable insight and awareness of her situation. Touch and socialization was indeed the best medicine for Wanda," said Drake.
This story is backed up by a similar program in place at the Methodist Home in
According to the results of a six-month pilot program on massage therapy for Alzheimer's patients, correlations were found between gentle touch and the easing of anxiety and angry acting out in Alzheimer's patients.
The study stated that back rubs were helpful for those confined to wheelchairs, those experiencing chronic pain and those exhibiting irritability or even anger. Foot massage proved helpful for those exhibiting hyperactive behavior or restlessness and “wandering” behaviors. Hand massage or face stroking seemed to calm those exhibiting anxiety, worry, sadness and fearfulness. Massaging the temples, scalp and forehead helped relieve headaches and tension. Shoulder and neck massage seemed useful in alleviating tiredness, irritability or mild upset.
Since the inability to communicate normally with language increases anxiety and frustration for people living with dementia, utilizing touch as a form of nonverbal communication and a therapeutic modality, such as massage, for inducing relaxation proved successful.
In one study, people with AD who received hand massages and were spoken to in a calming manner had a reduction in pulse rate and in inappropriate acting out. Health-care professionals have speculated that massage may be beneficial in dementia care, not only because it is relaxing, but because it provides a form of social interaction often missing for them.
It remains to be seen if robots can provide the type of interactions seniors rely on from human caretakers. Can a robot companion provide soothing touch, understand the concerns of someone with dementia, or exhibit empathy spontaneously?
There are also other concerns about robotic care for seniors.
“There exists multiple ethical concerns associated with the use of robots in senior care besides the reduction in human touch,” Drake said. “These include issues of loss of privacy, loss of personal choice and liberty, feelings of objectification and loss of control, and of course, possibilities of outsiders hacking into these control systems and gaining access to patient records or financial information."
Attorney Connelly cautions that using robots to provide services must be balanced with the individual's need for human caregivers.
“My question is, how far are we willing to go just to meet numbers. Yes, we want to provide a better quality of life for our seniors by delivering the services they need and using robots can do this, but if human touch and social interactions are lacking, is this the quality of life we want for our loved ones and ultimately for ourselves?”
Although we have not yet reached a point where robot care has become a reality, it may be less than a decade away. We need to approach this by balancing the care benefits against the ethical costs. But one thing for sure, the choices we make today for our elderly will be the reality we will be living with tomorrow when we need care. Just how comfortable will we be when a cold plastic machine stands over us flashing an electronic smile and wishing us a good morning?
Attorney Connelly practices in the area of elder law. This area of law involves Medicaid planning and asset protection advice for those individuals entering nursing homes, planning for the possibility of disability through the use of powers of attorney for the both health care and finances, guardianship, estate planning, probate and estate administration, preparation of wills, living trusts and special or supplemental needs trusts. He represents clients primarily in the states of Rhode Island, Connecticut and the Commonwealth of Massachusetts. He was certified as an Elder Law Attorney (CELA) by the National Elder Law Foundation (NELF) in 2008. Attorney Connelly is licensed to practice before the Rhode Island, Massachusetts, Connecticut, and Federal Bars.