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Tender Loving Computers: Caregivers of the Future?
By Beverly Goldberg, The Century Foundation
September
12, 2007
The current shortage of nurses and other caregivers for the elderly, already severe, is bound to increase dramatically as the baby boomers age. While a few states have put in place programs designed to alleviate the severity of the coming shortage, such as educational loans to those interested in nursing careers, they are far from enough to end it. Moreover, the restrictions on immigration, particularly on the number of visas for less-skilled workers, the primary source of health care aides for both nursing homes and home health care, will exacerbate the problem of finding people willing to do this kind of work. Unless policies aimed at resolving these shortages are put in place, in the future, tender loving care from warm-hearted human beings may, of necessity, be replaced by tender loving computers—sophisticated electronic monitoring devices and other aids being developed both to make possible longer independent living and to supplement the staffing of nursing homes.
Among the devices that are currently available or in development are the simple and relatively inexpensive Life Alert (“you can live alone without ever being alone”) and Lifeline pendants that allow someone living alone to push a button to summon emergency services. The next level in terms of both expense and protection are devices such as GrandCare’s black box that communicates wirelessly with various sensors installed around the home (for example, motion, temperature, and light sensors, as well as a blood pressure cuff) and transmits the collected information to a secure Web site where a relative or friend can check on the results; it also offers a private television channel for communication between the caregiver and patient. At the top end are services provided by companies such as Dovetail Health, which provide nurses who monitor the health readings collected by the participants and then call or visit if they detect a problem.
None of these systems, however, is covered by Medicare or Medicaid, and only a few long-term care policies will pay for their use—and the more advanced systems are expensive. At the top end, for example, Dovetail costs about $9,000 a year. However, that is not much when compared to the costs of assisted living, about $34,860 a year according to the 2005 MetLife Market Survey of Assisted Living Costs—provided the family has adequate means to pay for it. Moreover, for the public, the savings could be enormous because these devices could postpone entry into nursing homes, whose services usually are paid for by Medicare and Medicaid. In fact, the Center for Community Economic Development at the University of Wisconsin-Extension reports that while such facilities “serve only about 5 percent of the elderly at any one point in time, they consume the largest proportion of public dollars spent on the elderly.”
While financial considerations and the worsening shortage of health care workers may make adoption of these new technologies almost inevitable, a number of questions about their use remain. Some fear the elderly will not be comfortable with the technology, but the devices are extremely user-friendly (the black boxes look like cable television devices), and the baby boomers, unlike current seniors, are used to technology in the workplace and in their homes. For example, according to a Pew Foundation report, while only 22 percent of those 65 and older used the Internet in 2004, 58 percent of those aged 50 to 64 (the boomers) did, and those numbers have grown each year.
Another objection is that these devices are an invasion of privacy, but if the alternative is living in a facility, there is little real difference. Many assisted living facilities and nursing homes have such a shortage of attendants to check on residents that similar sensors are already in use, and more facilities are planning to turn to them.
The most valid objection is that such devices do nothing to overcome the isolation that so many of the elderly experience. Japan, facing an even more severe aging problem than the United States, has been working to solve that issue with products that provide substitutes for human companionship. Among the “solutions” offered are robotic dolls and a robotic baby seal that supposedly calms and comforts nursing-home patients much as a pet would.
While this kind of care may make us shudder, unless we solve the problem of the coming shortage of caregivers—by implementing an array of education and pay incentives for workers, reforms of the health care system, and new immigration policies—it may well be what we have to accept.
Beverly Goldberg, a Senior Fellow at The Century Foundation, is the author of Age Works: What Corporate America Must Do to Survive the Graying of the Workforce.
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