What robots can and cannot do for the elderly and isolated
It was good to love again, in this big empty house. Virginia Kellner had the cat last November, around her ninetieth birthday, and now he’s always nearby. It keeps her company as she moves, bent over her walker, from the sofa to the bathroom and back again. The walker has a pair of orange scissors hanging from the handlebars, to open the mail. Virginia loves the animal’s green eyes. She likes it to be there in the morning when she wakes up. Sometimes on the days when she’s feeling sad, she will sit in her plush chair and lay the cat on her soft belly and let him do his thing. Touch his nose. Stretch. Vibrate. Virginia knows the cat is programmed to move this way; there’s an engine somewhere that controls things. Yet she can almost forget. “It makes you feel like it’s real,” Virginia told me the first time we spoke. “I mean, mentally, I know it’s not. But… oh, it mewed again!
She named the cat Jennie, for one of the nice ladies who work at the local Department of Aging in Cattaraugus County, a rural area in upstate New York on the border with Pennsylvania. It was Jennie (the person) who told her that the county offered house robots to elderly people like her. Did she want one? She could have a dog or a cat. A driver from Meals on Wheels brought Virginia the pet, along with her daily lunch. He couldn’t wait to show it to her that he opened the box himself, instead of letting Virginia do it. The Joy for All companion was orange with a white chest and tapered mustache. No one mentioned it was part of a statewide loneliness response.
One Thursday this spring, Jennie (the cat) sat on the dining room table, by Virginia and her stepdaughter Rose, who is being funded by Medicaid to act as Virginia’s caregiver for nine hours by week. Virginia was holding a donut very carefully, her thumb pressed into the glaze. Her white hair, which she used to do before it got too thin to hold a curl, was removed from her face. Decades ago, Virginia and her husband Joe, who ran a nearby campground, had entertained themselves at this table. But everyone who attended their parties was either dead or “mentally gone.”
John Cheever wrote that he could taste his loneliness. Other people have compared theirs to hunger. Virginia said her loneliness came and went and felt a bit like sadness. And like having no one to call. “Well, I do. I have a family, but I don’t want to disturb them,” she said to me. “They say, ‘Oh, you don’t bother!’ But you know you don’t wanna to be a problem. Her daughter was in Florida. Her oldest son sometimes came with food, but he spoke so softly that Virginia couldn’t always hear him, and then she felt bad for being irritated.
Other times, loneliness felt like a great life falling on itself. It had been years since Virginia could drive anywhere, and even the house seemed to have shrunk. “The kids won’t let me go to the basement,” she said. “They won’t let me go upstairs. They are afraid that I will fall. Sometimes she fell. Once, while waiting in the field to be rescued, she was very cold because she was not wearing stockings.
At the table, Virginia pulled the cat’s tail. He let out a small meow: one of over thirty sounds and gestures – closing eyes, opening mouth, rotating head – that Joy for All cats are designed to produce. A spoonful of jelly fell from Virginia’s donut onto her turquoise dress. She laughed and looked at Jennie, “I can’t believe it meant that much to me.
When the coronavirus arrived in Cattaraugus County last spring, Allison Ayers Hendy, a fifty-year-old worker in the Department of Aging, suddenly found herself separated from hundreds of clients. His routine home visits had been replaced by “comfort over the phone” tapes. His days on the road, driving between mundane towns to see old people in their dilapidated farms, were over. Some of Hendy’s customers have told him that they have no way of getting food or that they are too afraid to try. When the ministry began producing packaged meals to send to senior residents – king turkey, chicken cordon bleu – Hendy volunteered to help distribute them. Meal deliveries, at least, allowed him to keep an eye on people.
Hendy paid special attention to clients who lived alone. There was a lot. Seniors are more likely to live alone in the United States than in most other places in the world. Almost thirty percent of Americans over the age of sixty-five live alone, most of them women. And Hendy had reason to be concerned about how they would behave in quarantine. In a heatwave in Chicago in 1995, when temperatures reached 106 degrees, more than seven hundred people died, most of them over sixty-five. During the SARS in Hong Kong in 2003, health officials reported a surge in suicides among the imprisoned elderly. Some left notes saying they feared becoming a burden on their families. Some said they felt isolated.
Hendy and his colleagues were sometimes disturbed by what they saw. There was a man who was basically stuck on the second floor of his house because he had no one to help him down the stairs. There was a woman surrounded by bags of used adult diapers because her son did not visit her and she was too unstable to take out the trash on her own. The delivery drivers found people living without heat, fallen to the ground or dead. More often than not, people seemed very lonely. Meal recipients wanted to talk longer; they invited the drivers to linger.
In 2017, Surgeon General Vivek Murthy declared loneliness an “epidemic” among Americans of all ages. This warning was in part inspired by new medical research that has revealed the damage social isolation and loneliness can inflict on a body. The two conditions are often linked, but they are not the same: isolation is an objective state (not having much contact with the world); loneliness is subjective (the feeling that the contact you have is not enough). Both are thought to cause an increased inflammatory response, which can increase a person’s risk for a wide range of conditions, including dementia, depression, high blood pressure, and stroke. Older people are more sensitive to loneliness; Forty-three percent of Americans over sixty identify as loners. Their individual suffering is often described by medical researchers as particularly perilous, and their collective suffering is seen as a particularly terrible societal failure.
It is a costly failure. Research from AARP and Stanford University has found that social isolation adds nearly $ 7 billion a year to the total cost of Medicare, in part because people who are isolated come to the hospital. hospital sicker and stay longer. Last year, the National Academies of Science, Engineering and Medicine advised healthcare providers to periodically start screening elderly patients for loneliness, although doctors have not been given clear instructions. on how to move forward after being diagnosed with loneliness. Several recent meta-studies have shown that common interventions, such as formal twinning programs, are often ineffective.
So what should a well-meaning social worker do? In 2018, the New York State Office for the Aging started a pilot project, distributing Joy for All robots to sixty residents of the state, then tracking them over time. The researchers used a six-point loneliness scale, which asks respondents to accept or disagree with statements such as “I feel a general feeling of emptiness.” They found that seventy percent of participants felt less lonely after one year. Pets weren’t as sophisticated as other social robots designed for the so-called money market or loneliness economy, but they were cheaper, at around a hundred dollars each.
In April 2020, weeks after New York’s departments of aging closed their adult day programs and joint catering sites, the state placed a bulk order for more than a thousand cats and robot dogs. The pets went quickly and the case officers started asking for more, “Can I have five cats?” A few clients with cognitive impairments were confused by the machines. One of them called his local department, distraught, to tell him that his kitty was not eating. But, more often than not, people loved pets so much that the batteries ran out. The officers in charge of the case joked that their clients had loved them to death.
Hendy loved robots because they were something tangible that she could give. When clients were alone, she could apply for a grant to pay for their participation in a social program – but sometimes they had no way of getting to the community center. Hendy put people in touch with caregivers when she could, but caregivers were scarce; Cattaraugus, like everywhere else, needs it. And anyway, a lot of people couldn’t afford it. Many of Hendy’s clients fall into a kind of service dead zone: they’re a little too rich to be on Medicaid, which covers home assistance for low-income recipients, but not rich enough to pay for private assistance. All they have is Medicare, which doesn’t cover long-term care, even when someone needs help with bathing, eating, or using the bathroom. People tend to fend for themselves until they either fall and break their hip, or may have an infected pressure sore; then they find themselves in a hospital, and finally in a retirement home. There they spend thousands of dollars a month, until their savings are depleted, in which case they are ultimately eligible for Medicaid and can live their days in a taxpayer-subsidized bed assisted by a caregiver.