Will tech replace nurses?
This spring I took part in a multidisciplinary course at Aalto University focusing on innovating in elderly care. For one week, each of us shadowed a nurse making house calls. This was an eye-opening experience for me, revealing how alone many elderly people are in Finland, as fewer younger people today take care of their parents (1). The Nordic welfare states take care of everyone, which further amplifies this trend in the Nordics.
Studies have found that home care is a more cost-effective way to arrange elderly care, and that the elderly themselves prefer home care to institutional care (2). Digitalization and innovations such as e-health, gathering and monitoring data, sensor systems home automation, robotics, as well as diagnosis, treatment, and retrieving electronic health records at distances, are increasing in elderly care (3, 4, 5, 6).
Gerontechnology addresses the needs of an ageing society through technology and technological devices. It facilitates and replaces human work, but can also jeopardize human contact (4). For many of the home care clients I got to visit the checkup with the nurse was their only human contact that day.
Home care in the Nordic countries is mainly provided within the public sector and the services are free of charge including personal and household care (7). Smartphones are commonly used by doctors, nurses, and care workers to record each visit’s start and finish time, write notes for other care workers and nurses, and facilitate scheduling (7, 8). For instance, in the City of Helsinki, each nurse signs in to the clients by reading a barcode, and makes notes of each visit to a proprietary database.
Even though there have been significant investments to stimulate technology-enhanced services for the home care markets (2), there has also been budgetary pressure to replace humans with technology. The views on technology in elderly care tend to be polarized, either seeing it as the solution to everything or as a source of additional problems (4). Nielsen and Andersen (8) found that “mobile technology usage was heavily supported by technology vendors, consultants and powerful government stakeholders and promoted mainly by managers within adopter organizations […] the health care personal remained split and ambivalent to mobile technology use as it was, of many, perceived as a system of control. “
I’m usually a proponent of everything new and innovative, but after experiencing the yearn for human contact in the elderly I met through home care I do not think that decreasing the time they spend with nurses will improve their lives. Therefore, I loved Lark’s focus on creating a friend for preventing and managing chronic diseases opposed to replacing nurses. Furthermore, the role of care personnel in introducing eHealth solutions to home care has been emphasized by many studies. Melkas et al. (3) found that “it is vital for the care personnel to know the clients well and thus be able to anticipate how they react”. Additionally, assistive devices have to be fully integrated with elderly care service processes (9), and it is important to see the big picture and “analyzing the contextual value for a variety of relevant stakeholders“ (2).
Home care in the US is dominated by private players, and the industry is estimated to be worth $40-50bn (10). The industry has also seen a recent influx of capital, notable startups including Palo Alto-based Home Care Assistance aiming to prevent preventable hospital admissions through sharing data across different stakeholders (1), and using algorithms to handle the logistics, which will allow the business to scale up more easily than traditional care agencies (10).
Investors want to fund scalable solutions, which caused trouble for Hometeam focusing on solving systemic problems in the industry and employing thousands of nurses and care givers. Hometeam CEO Josh Bruno originally played around with the idea of creating an Uber for in-home care, matching clients with caregivers without employing them, but “found out that much of the problem was the job of home health aid itself”. (10)
I believe that investors and decision makers need to see technology as a complement, not as a substitute for human care, and reward solutions that can enhance both aspects, as I believe Lark is doing. There is also plenty of room to innovate in the space of elderly care without any technology. One of my favorite concepts is a pilot program in Finland where young people are offered affordable housing together with seniors in Helsinki, in return for spending a number of hours a week with their elderly neighbors (11).
Sources:
(1) Mack, H. (2016, October 14). What the senior and aging care industry wants from digital health innovators. Mobi Health News. Retrieves at: http://www.mobihealthnews.com/content/what-senior-and-aging-care-industry-wants-digital-health-innovators.
(2) Wallin, A., Harjumaa, M., Pussinen, P., & Isomursu, M. (2015). Challenges of new service development: Case video-supported home care service. Service Science, 7(2), 100-118.
(3) Melkas, H., Hennala, L., Pekkarinen, S., & Kyrki, V. (2016, September). Human Impact Assessment of Robot Implementation in Finnish Elderly Care. In International Conference on Serviceology, Tokyo, Japan (pp. 6-8).
(4) Pekkarinen, S., & Melkas, H. (2017). Digitalisation in Health Care and Elderly Care Services: From Potholes to Innovation Opportunities. International Journal of Information Systems and Social Change (IJISSC), 8(1), 24-45.
(5) Lindberg, B., Nilsson, C., Zotterman, D., Söderberg, S., & Skär, L. (2013). Using information and communication technology in home care for communication between patients, family members, and healthcare professionals: a systematic review. International journal of telemedicine and applications, 2013.
(6) Bolt, T., & Kano, S. (2007). Network technologies and messaging for the community-based care of the elderly. International journal of healthcare technology and management, 8(3-4), 175-195.
(7) Nielsen, J., Mathiassen, L., & Newell, S. (2014). Theorization and translation in information technology institutionalization: evidence from Danish home care. MIS Quarterly, 38(1), 165-186.
(8) Nielsen, J. A., & Andersen, K. N. (2012). The Reinforcement Hypothesis Revisited: Mobile Technology and Management Control in Home Care.
(9) Melkas, H. (2013). Innovative assistive technology in Finnish public elderly-care services: A focus on productivity. Work, 46(1), 77-91.
(10) Crow, W. (2017, January 24). Tech start-ups try to fix ailing US elderly care sector. Financial Times. Retrieved at: https://www.ft.com/content/f026e228-e1a5-11e6-8405-9e5580d6e5fb.
(11) Aged Care Guide. Youths living with the elderly – a Finnish example. Retrieved at: https://www.agedcareguide.com.au/talking-aged-care/youths-living-with-the-elderly-a-finnish-example.
6 comments on “Will tech replace nurses?”
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Thank you for this unique and informative blog post, Ghita.
In 2015 ~35% of people over 65 and ~50% of people between 50 and 64 years old reported that they are using social media. That percentage had tripled in only 5 years. The elderly can embrace technology, and as you mention, if the effort promises companionship they might use it even more.
The risk of the Lark concept is that that the app will make people increasingly anti-social and lead to both physical and mental issues. However, after some research, I am onboard with its intended used and possible efficacy on elderly people. The elderly do not get enough social interaction so Lark will likely provide that. However, I am still concerned about younger people with chronic disease using Lark. I read a number of studies indicating that the higher percentage of social media consumption, the more antisocial the person becomes. The comparison factor on social media is detrimental for mental well being but even if there were no comparison, social media takes away time the person could be spending with people. Unless the app encourages the person to get out there and not spend much time in the immersive environment, I see a risk.
References:
http://www.businessinsider.com/social-media-usage-among-people-over-65-has-tripled-2015-11
https://www.psychologytoday.com/blog/nurturing-self-compassion/201703/mental-health-and-the-effects-social-media
https://www.forbes.com/sites/alicegwalton/2017/06/30/a-run-down-of-social-medias-effects-on-our-mental-health/#754417c12e5a
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Great post. I think this is very relevant as AI is making further inroads into the medical field. There seems to be a widespread fear (in most industries that AI is incorporated into) that AI will replace all the professionals. Unfortunately to some degree and in some cases this is true, but at the pace of adoption it seems clear that our society values the services and price points offered by AI too much to prevent this fully.
In the meantime with certain professions such as doctors or nurses it seems likely that AI will not replace everyone (the way it might on an assembly line) but it can definitely be used to make one professional more effective, possibly leading to a need for less professionals overall. Doctors and nurses are a good example of this, AI is currently being proposed mostly as a complement in the medical field not a replacement. The promises range from faster more accurate diagnoses to simply reducing wait time and organizing records. With these aids one doctor could manage as many patients as ten doctors do currently.
https://www.forbes.com/sites/jenniferhicks/2017/05/16/see-how-artificial-intelligence-can-improve-medical-diagnosis-and-healthcare/#1f488f186223
http://medicalfuturist.com/10-things-how-artificial-intelligence-could-make-me-a-better-doctor/
We have seen that if it is possible to do something cheaply with fewer employees and also more efficiently that approach usually wins out in the market. However I do echo your concerns about human interaction. It seems we are constantly finding out more about our brains, and how our brains affect our physical health. While I think the lark app is great for times when a professional is not available I think we need to be careful to phase out too much of our social interactions before we fully understand the physcological and physical implications of the isolation that can result.
https://www.psychologytoday.com/articles/200307/the-dangers-loneliness
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Great insights! I find the home care of elderly to be a special case, because very few of the deicisionmakers (or people in general) has good insight into what their work and days look like. In a hospital setting it is easier to identify specific instances to improve, but what I learnt from shadowing the home care nurse, was that each client is very unique. For some she administered medicines, for one client she filled out a form for financial aid, and she took a third out for a short walk. I think we are still very far from AI providing this type of support to the elderly.
Love the angle. Elder care has become more and more important issue across the globe, in Asia, like China, Japan, Korea but also in the developed countries in Europe, and of course, U.S. where the aging society problem is substantial and young children are moving away to work in the Metropolitans and less present at home.
One interesting dilemma in elder care is the need for technology to decrease cost, versus the difficulty for elder people to use/adapt to new technology together with their need for the human companion to tackle loneliness.
So the key to success in this field should then include a combination of the three components mentioned above in order to tackle the problem elegantly. Opportunities may also lie in the potential support provided by the government.
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Thank you for an interesting comment. In Finland it is in fact the government (and not for instance children) that has the responsibility for elderly care, which means that they are also making decisions related to budget allocation and new investments into technology. Whereas I think its great that there is a system making sure that everyone needing help and health care gets it, I am worried about the Finnish government’s eagerness to digitalize elderly care, while forgetting the importance of human contact.
Thank you for an insightful blog post!
The topic is quite personal to me as a few years back my beloved grandmother was in this situation. She had both family and home care looking after her taking care of daily routine tasks and helping out. She liked the home care nurses which were often friendly and helpful. We had many precious moments together visiting her and talking about old memories. The thing that I vividly recall from these visits was the smile on her face while talking, holding hands and sometimes just being silent.
These magical moments will be very hard to replicate with machines for a long time. Some companies such as https://www.jibo.com/ from MIT Media Lab are paving way for more natural human-computer interactions. Other startups such as https://www.joinhonor.com/ have made the process of accessing home care easier. From all the innovations out there, concepts such as youths living with the elderly that is piloted in Finland are in the very essence of what meaningful human interaction is all about. I support strongly these types of low-tech solutions that have a great design epiphany behind them.