News on Aging

The Future of the Robot-led Nursing Care

Toru Saito, Manager for Senior Projects at Dentsu September 6, 2017 (Wed.) 7:00

PALRO greets people at the adult day care facility (photo: author)

The landscape of the adult day care facility with care robots

”PALRO, do the exercise for shoulders.”
”Ok, exercise for shoulders. Let’s do it together!”
”This exercise makes your shoulders easy and relaxed. Let’s take a deep breath before starting the exercise.”

This is the scene in the mornings at the adult day care facility near the Hongodai Station in Yokohama. The elderly people who gathered at the studio start exercising together following the directions from PALRO, the communication robot. This adult day care facility is managed by ARFIT and their focus is functional training. They utilize PALRO which was developed by Fujisoft Inc. as a robot instructor since they opened this facility a year ago.

PALRO is the first one at the front entrance to greet the people who were approved to receive long-term care and support with government insurance. With the help of the face recognition system, PALRO greets the people that he recognizes by name in a friendly manner.

The rehabilitation program for function recovery lasts for 3 hours and the first exercise part is led by PALRO. It lasts for 5 minutes and 10 different types of exercise such as warming up shoulders and the lower back are installed in the program and different exercises are used each week or month. After the initial exercise, people keep working on other programs such as muscle training as well as taking breaks before PALRO leads the final “mouth exercise” which aims at improving palate function. PALRO’s job is finally over after he says goodbye to the people at the entrance again. PALRO plays a key role in the exercise program.

“The effect of using PALRO as a mascot is enormous. People such as geriatric care managers immediately remember us saying ‘Oh, that is the facility with that robot!’. However, it took a while for the people get used to PALRO. Initially they were intimidated by him but the staff tried many different ways to utilize him and now he blends in the program so well.” says Hiroshi Takeuchi, the CEO of INSEAC who manages ARFIT. Since this adult care facility is focused on functional recovery, it means the need of care is relatively low. Therefore, it gave me the impression that PALRO’s potential roles are limited, but I can clearly see that PALRO creates an impression among the people.

Users exercise together with PALRO (photograph: author)

Classification of care robots

Currently care robots are developed by various companies and they can be categorized roughly as below. (Partly added by reference to the care robots portal site by AMED, the Japan Agency for Medical Research and Development).

- Transfer assistance: power assistance for caregivers, using robot technology
- Mobility support: indoor and outdoor walking support
- Toilet support: using robot technology for disposal of excrement
- Dementia monitoring: monitoring and fall detection with sensors and external communication function
- Bathing support: bathing assistance with robots
- Communication support: communication support with care recipients by robots

Nursing care workers do a lot of physical work. The high-need of patients requires assistance by caregivers for everything such as transferring from bed to wheelchairs, bathing, going to dining hall and so on. It is said that many people are forced to leave aid jobs because they hurt their lower backs by doing such assisting work. Developing new robots for transfer assistance, mobility support, toilet support and bathing support is aimed at reducing workload for such aid workers. Therefore, when we talk about robots here, it may not be necessarily human shaped ones but more likely it is equipment or devices to assist such work. For instance, “robot suits” and “muscle suits” are devices that you wear to reduce the weight to your lower back when transferring patients. “Rise assisting bed” makes it easier to move a patient from a bed to a wheelchair. A “mobile flushing toilet” can be used in the bedroom without causing any odor.

On another front, we are going to introduce you another type of robot that is expected to help communication with the people who require care.

There are various types of communication support robots such as animal type, baby type or robot type. No matter which type it is, the focus is to improve the QOL of those who need care through communication with robots. PALRO has been adopted in about 900 nursing care facilities all over Japan since its debut and you can say that he is the leader in this field. We interviewed Mr. Toshiyuki Takaha, the Director, Office of Field Sales, PALRO Division at Fujisoft Inc. about the background of the development and the characteristics.

Background of the development of PALRO

Since Fujisoft Inc. has been the main sponsor of the Robot Sumo Tournament since 1990, they have a wide network with many professors in the robotics engineering field. There was a high demand from those professors for developing a versatile programmable robot, so they decided to develop robots and finally released one for academic use in March 2010. Because the robot was used at 190 universities and research institutes, they were able to collect a lot of useful data.

Later, they looked into the possibilities of developing this as a business and because PALRO was popular at the elderly care facilities when they loaned it to them, they developed PALRO for nursing care facilities to “improve the QOL of the elderly” and “reduce the burden on caregivers” and finally released it in June, 2012. Mr. Takaha says that during its development, it was a big challenge to adjust PALRO as a communication robot for the nursing care facilities.

The Yokohama Community Care Plaza helped them to modify PALRO. You need some techniques to be a good communication companion for elderly people. You have to adjust the speed of conversations, timing, how to pause and so on. Also, how to carry conversations with people with dementia or how to respond to the people with a hard time hearing…these are a few of the important things that you need to keep it in mind when adjusting/modifying a communication robot. “For instance, if PALRO asks a name to an elderly person many times when the person mumbles and is hard to hear, PALRO should not ask many times to repeat the name. Otherwise, the person may lose confidence because they think that their way of speaking is not good enough. In that case, PALRO should respond “I’m sorry, my listening ability is not good enough” so that you can continue the conversation smoothly. (by Mr. Takaha)

Currently PALRO has such functions as emcee for recreation, instructor for exercise classes or conversation companion. Mr. Takaha says that the main purpose and challenge for PALRO as a communication robot at elderly care facilities is to think how the recreation should be with some sort of entertainment as well as to improve QOL, physical and recognition functions.

Can robots save the nursing care sector?

It is expected that there will be a significant personnel shortage for nursing care in the near future so taking some kind of measure is a pressing agenda. In the report the “Committee on providing nursing care service in line with nursing care demand in the future” by the Ministry of Economy, Trade and Industry, it is anticipated that caregivers will fall short of demand by more than 680,000 by 2035 when the baby boomers will be 85 years old or older.

Some say that caregivers are already in a shortage. According to the survey by the Ministry of Health, Labor and Welfare, the number of people with the need for long-term care waiting for admission to special nursing homes for the elderly is up to 360,000. It looks like there are quite a few of those nursing homes that are currently not accepting their maximum capacity due to the shortage of workers.

In order to improve such a worker shortage, nursing care robots are expected to be a great tool to tackle the issue. Both the Ministry of Economy, Trade and Industry and the Ministry of Health, Labor and Welfare are strongly supporting the idea to make use of robotic technologies for nursing care. The “Five-year Plan for Developing Nursing Care Robots” was included in the “Japan Revitalization Strategy” which was approved by the Cabinet in 2013. Later, the strategy was revised as the “Growth Strategy 2017” and even in the new strategy, items such as “We will newly cultivate and assign project coordinators who can truly pick up the on-site needs, turn them into development seeds and lead the projects“ and “the government support in the evaluation and test data acquisition for advancing coordination between ISO13482, which is the standard concerning the safety of the day-to-day living support robots and the overseas systems, so as to smoothly develop an overseas robot nursing equipment market“ are included as measures to advance the development of nursing care robots effectively.

As you can tell from Mr. Takaha’s comments regarding the challenges during development, it looks like there is still a large gap between “development side” (engineers) and “user side” (facility management and users). The reason why the use of robots within a facility is not as active as expected while the development is strongly encouraged is not only due to its price but also the development is not good enough yet for users. In order to tackle and solve the challenges of the first super-aged society in the world, AI and robots must be able to play a big role. We are only at the beginning of this journey, but we sure have high expectations for the future development.

Interview Cooperation

INSEAC: Functional training focused adult day care facility 「ARFIT」

Fujisoft Inc.: Communication Robot「PALRO」

Toru Saito, Manager for Senior Projects at Dentsu

Born in 1958. His specialty is “super-aged” society and future predictions. He has worked for Seibu Department Stores, Distribution Industry Research Institute (currently Saison Research Institute) and Parco Co., Ltd. before joining Dentsu Inc. and becoming a manager for Senior Projects. He is a social worker and also serves as a board member for the Kichijoji Grand Design Revision Committee. His publications include “Social History of Shopping Malls” (Sairyusha), “Marketing for Super-Aged Society” (Diamond Inc.), “The reason why Kichijoji became ‘the most popular town people want to live in now’ “(Bunshin Publishing) and “Introduction to Developmental Science” (Coauthor, University of Tokyo Press).

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