Wednesday, October 28, 2015

Health Care After People

There is lots of interesting news about hot health start-ups like Theranos, Amino, and 23andme, any of which deserves a post (and may yet get one), but I find myself thinking about battleships...and robots.  

I've had in mind a post comparing hospitals to battleships.  Battleships were once the crown jewel of navies, massive and full of firepower, but which now are at best only museum pieces.  A conventional wisdom is that battleships grew obsolete due to higher tech innovations like aircraft carriers and guided missiles.  I recently read an analysis that brought up another factor that led to their demise: labor costs.  They're just incredibly expensive to staff.

Just like hospitals, or nursing homes.  

Consider the results of a new study on health care spending.  It retrospectively looked at spending for Medicare beneficiaries who died between 2005 and 2010.  The most expensive cohort?  Patients with dementia.  Not heart disease, not cancer, not other conditions, but dementia.  And not by a little; they spent more than 50% higher than the other cohorts, averaging some $287,000.  

It gets worse.  Medicare spending was actually fairly similar across all cohorts, but out-of-pocket spending was much higher for the dementia patients, leading to the higher overall spending.  They're not racking up huge bills getting invasive surgeries or expensive chemotherapy.  They're not taking advantage of all these slick new machines in these beautiful new hospital additions.  Instead, they're spending time -- lots of time -- getting care in nursing homes or at home.  

If they're lucky, they may qualify for Medicaid, which may help pick up some of these costs for custodial care, as it is not typically covered by Medicare.  Of course, that's a strange kind of lucky, because it means they've spent virtually all their assets in order to qualify.     

Well, at least they get the care they need, right?  Unfortunately, many people with dementia, or with other long term disabilities, spend too much time waiting for care.  Not so much medical care as help with things most of us take for granted -- getting in and out of bed, going to the bathroom, taking a shower, even eating.  Go into a nursing home or assisted living facility and it won't take too long to find residents who are waiting -- knowingly or not -- for assistance with those kinds of tasks.  

It doesn't help that there is already a labor shortage for the kind of workers who provide such care, whether in institutions or at home, and that shortage is predicted to grow.  The field already has an older workforce, it is a very demanding job, and the pay is low.  No wonder turnover in nursing homes averages over 50%.  Last year The Wall Street Journal estimated that the need for health care aides will increase by 48% from 2010 to 2020.  And 2020 is nowhere near the peak of the baby boomers aging, so the need for these workers will keep growing.  It's a recipe for disaster.

Enter the robots.

There are already robots in health care.  Robotic surgery, delivery robots, robotic prescription dispensing systems, even therapeutic robots used in lieu of pet therapy  But we've just scratched the surface, because we still think of care as being something that is delivered by a person.

People like to talk about the importance of the human touch, but when it comes to something like getting out of bed when I want to, I think I'd rather have immediate service from a robot than an indeterminate wait for help from an aide.  And there are some more unpleasant tasks -- like assistance with going to the bathroom -- where I'd prefer not to have to ask another person to help me at all.  Sometimes impersonal is better (just be gentle, please).

A 2012 Georgia Institute of Technology survey found that even the current generation of seniors was surprisingly open to having robots help them with household tasks, although they tended to still prefer humans for personal care.  The respondents were healthy and independent, and I wonder how much more open they'd be to robotic help for personal care as well if they'd had more experience with receiving such care from health aides.  

I also wonder how their children might have responded, if it came to a decision about using robot aides for their parents versus putting them in a nursing home, paying for home care, or providing it themselves.  

A follow-up survey of healthcare workers found them also receptive to assistance from robotic helpers -- even preferring them to humans for some tasks, like transferring, medication reminders, or taking vitals.  As one of the lead researchers said: "In fact, the professional caregivers we interviewed viewed robots as a way to improve their jobs and the care they’re able to give patients."

The robots are ready, or nearly so.  I've previously written about Toyota's Partner Robot Family.  Toyota announced in July that they were putting the home helper robot R&D in "high gear," specifically citing the goal of assisting independent living for the elderly and disabled.   Japan is also the home of Robear, which is billed as an experimental nursing-care robot.  Robear can already assist with transfers, and the leader of its development team said: "We really hope that this robot will lead to advances in nursing care, relieving the burden on care-givers today."

Japan is a natural locus for these efforts, as it has both expertise in manufacturing -- which has already been revolutionized by robots -- and has one of the oldest and most rapidly aging populations.  When the care shortage hits, it is going to hit first in Japan.

We really don't have a lot of options.  We can come up with cures that prevent people from getting conditions that rob them of their independence.  We can throw more people at the problem, if we can find the money -- or the people.  Or we can use technology to help, and that probably means some kind of robots.  

The first two options might be nice, but I think we better be getting the robots ready.  

I may not live long enough to see artificial intelligence serving directly as a clinician, as I've previously written about, sorry to say.  But a personal care robot to help us to stay independent, or at least less dependent on health aides?  That's something that we should be able to do sooner rather than later.

OK, iRobot -- maybe spend more time on this and less time on building a better Roomba.

1 comment:

  1. More coverage of this trend: