The problem is already there, and it’s only getting bigger: there are more and more old and sick people in Germany who need care. But people who want to care less and less. And the gap will widen so wide in the coming years, as the Boomer generation celebrates its 80th birthday, that hundreds of thousands of caregivers are feared to be in short supply. In an industrialized country, technical support systems right down to human-like robots appear to be a possible way out: if there are no longer enough helping hands, robotic arms or other technical solutions could perhaps lend a hand. How likely it is that the caregivers will be relieved and cared for with the help of machines in the future and which technical aids can already contribute today was the subject of a SZ health forum.
Right from the start, the participating experts promoted one vision to science fiction: they all thought it was unrealistic that one day, in the not too distant future, a robot could replace the 24-hour nurse. “I don’t want to speculate about what will be in 100 years,” said Daniel Flemming, Professor of Computer Science and Information Technology in Nursing and Social Work at the Catholic University of Applied Sciences in Munich. “But in the coming decades, it will not be possible to replace a nurse with a robot. Caring for a person is so individual, so much empathy is also required, it cannot be replaced.”
Flemming pointed out how the idea of the robot as a care worker developed: “It didn’t come from care, but from industry,” he said. Robots were developed for industrial production, and there, for example in automobile production, they have worked extremely well for decades. “But it is an enormous challenge to bring this technology to people.”
Nevertheless, according to the experts at the SZ Health Forum, mechanical systems can make a contribution to caring for people in need. “Individual actions can definitely be done by technical support systems,” said Uli Fischer, head of the staff unit for clinical nursing research and quality management at the Ludwig Maximilian University of Munich (LMU). This includes, for example, turning patients in bed, which is very exhausting for the nursing staff, holding patients while they are being moved, or the contactless measurement of vital data such as pulse or body temperature, including automated entry in the patient file. “All of this can relieve the nursing staff,” says Fischer. If the nursing staff get more time for the human part of the care, then the technology is a gain – for the nursing staff as well as for the people in need of care.
“People aren’t just car parts”
Fischer has already tested various robot-supported systems as part of studies at the LMU Clinic – and with great success, even if it was quite complicated to implement at the beginning. “An industrial hall is designed so that things are always in the same place with millimeter precision and always go through the same processes,” said Fischer. “These are definitely not clinics. And people aren’t car parts either, everyone is different.”
But despite all the hurdles, the studies were successful. For example, a robotic system was tested that was intended to help mobilize unconscious patients in bed immediately after a lung transplant. “This is extremely valuable for the healing process,” said Fischer, “mobilization ensures good ventilation of the new lung.” Normally, however, two to four nurses need four hours to get such a critically ill patient with the many hoses and cables hanging from him up in bed and bring him into a sitting position. If technology helped, one or two nurses would suffice. At the end of the study, everyone involved was satisfied – the nurses, the relatives, the physiotherapists. “You could really use the system on the ward,” says Fischer.
But despite some successes – nationally and internationally – hardly any robotic systems are used in everyday clinical practice. In the end, money is a factor. “In the end, it boils down to a commercial analysis,” said Fischer. “How much does the robot cost, what does the necessary associated technology cost, how often is it ready for use and how much working time does it really replace?” This is also so difficult to calculate because the technology does not replace an entire nurse, but only a part of the nursing work.
Even less complex technology has hardly made it into everyday clinical practice – despite initial successes in studies. For example, Fischer’s team sent robots down the hospital corridors as butlers to provide drinks and other services to patients who had been in the hospital for a while because of cancer. That also worked well, said Fischer. But while robot butlers in hotels or at airports have been selling toothbrushes to travelers for years or serving cold drinks as soon as they pull out their credit cards, the demands in the clinic are considerably more complex.
In home care there are fewer regulatory hurdles, but more technical ones
It would also be conceivable to use the technology in home care, said Fischer. After all, there are not as many regulatory and insurance law hurdles there as in hospitals – but there may be more technical ones, because apartments, unlike hospital corridors, are often not suitable for robots.
The main problem at the moment is the will and the costs of implementation – and not only in Germany. “Japan is often cited as a role model – as if care robotics were already commonplace there,” said Flemming. “There may be more studies, but in terms of application in clinical or home life, Japan is no further than here.”
But there are enough systems. Chat robots that communicate with people, even remembering what was said and said last time; robots that can take over the night watch; automated care carts that deliver bandages to the caregiver and refill themselves in the storeroom; Robot cuddly toys so that people can have something to pet.
There are also plenty of other ideas for the future, said Thomas Wittenberg, computer scientist at the Fraunhofer Institute for Integrated Circuits in Erlangen. He reported on the possibilities that emotion research can open up for medicine. With the help of cameras and sensors based on facial movements, pain could be recorded and automatically documented and evaluated. One day it may also be possible to record the progression of diseases such as Parkinson’s.
Various technologies could undoubtedly be of great benefit to nurses and those to be cared for, said Constanze Giese, professor of ethics and anthropology in nursing at the Catholic Foundation University in Munich. However, any technique must be used with care. If technology does not complement care but replaces it, people in need of care could lose their last human contact.
However, some technology could already be used by people in home care today – even beyond household helpers such as vacuum cleaner robots. The emergency call button, which when triggered alerts an emergency service, has been established for a long time. Meanwhile, there are also automated emergency call systems that are getting smarter with the help of “Ambient Assisted Living”, reported Daniel Flemming. Such systems use installed cameras and automatically record when a person is lying on the ground – the person concerned no longer has to actively initiate the emergency call. In addition, smart home technologies can ensure that the stove switches off automatically if you forget to put the pot of potatoes on the stove again. Communicating mirrors can remind you to take your medication. Smartphone apps regularly remind people to drink.
But it is also important that people acquire new digital skills when they are old and maintain the skills they have already acquired, said Uli Fischer: “You shouldn’t push this technology away and think, I don’t want anything to do with it.” The possibilities of digitization are extremely helpful, especially for people who are losing mobility. Online banking and supermarket apps are also given independence if you can no longer walk longer distances. “You don’t have to go along with everything,” said Fischer, “but you should also realize that new technologies mean a real chance for a long self-determined life at home.”