What robots can and can't do for the old and lonely

It felt good to love again, in that big empty house. Virginia Kellner got the cat last November, around her ninety-second birthday, and now it’s always nearby. It keeps her company as she moves, bent over her walker, from the couch to the bathroom and back again. The walker has a pair of orange scissors hanging from the handlebar, for opening mail. Virginia likes the pet’s green eyes. She likes that it’s there in the morning, when she wakes up. Sometimes, on days when she feels sad, she sits in her soft armchair and rests the cat on her soft stomach and just lets it do its thing. Nuzzle. Stretch. Vibrate. Virginia knows that the cat is programmed to move this way; there is a motor somewhere, controlling things. Still, she can almost forget. “It makes you feel like it’s real,” Virginia told me, the first time we spoke. “I mean, mentally, I know it’s not. But—oh, it meowed again!”

She named the cat Jennie, for one of the nice ladies who work at the local Department of the Aging in Cattaraugus County, a rural area in upstate New York, bordering Pennsylvania. It was Jennie (the person) who told her that the county was giving robot pets to old people like her. Did she want one? She could have a dog or a cat. A Meals on Wheels driver brought Virginia the pet, along with her daily lunch delivery. He was so eager to show it to her that he opened the box himself, instead of letting Virginia do it. The Joy for All Companion pet was orange with a white chest and tapered whiskers. Nobody mentioned that it was part of a statewide loneliness intervention.

On a Thursday this spring, Jennie (the cat) sat on the dining-room table, by Virginia and her daughter-in-law Rose, who is subsidized by Medicaid to act as Virginia’s caregiver for nine hours each week. Virginia was holding a doughnut very carefully, her thumb pressed into the glaze. Her white hair, which she used to perm before it got too thin to hold a curl, was brushed away from her face. Decades ago, Virginia and her husband, Joe, who ran a nearby campground, had entertained at this table. But everyone who used to attend their parties was either dead or “mentally gone.”

John Cheever wrote that he could taste his loneliness. Other people have likened theirs to hunger. Virginia said that her loneliness came and went and felt sort of like sadness. And like not having anyone to call. “Well, I do. I have a family, but I don’t want to bother them,” she told me. “They say, ‘Oh, you aren’t bothering!’ But, you know, you don’t want to be a bother.” Her daughter was in Florida. Her older son came by with food sometimes, but he spoke so quietly that Virginia couldn’t always hear him, and then she felt bad for being irritating.

Other times, loneliness felt like a big life falling in on itself. It had been years since Virginia could drive anywhere, and even the house seemed to have shrunk. “The kids won’t let me go in the basement,” she said. “They won’t let me go upstairs. They’re afraid I’ll fall.” She did fall sometimes. Once, as she waited on the ground to be rescued, she grew very cold, because she wasn’t wearing stockings.

At the table, Virginia pulled the cat’s tail. It let out a tinny meow: one of more than thirty sounds and gestures—eye closing, mouth opening, head turning—that the Joy for All cats are designed to make. A dollop of jelly fell from Virginia’s doughnut onto her turquoise dress. She laughed and looked over at Jennie: “I can’t believe that this has meant as much as it has to me.”

When the coronavirus arrived in Cattaraugus County, last spring, Allison Ayers Hendy, a fifty-year-old caseworker at the Department of the Aging, found herself suddenly separated from hundreds of clients. Her routine home visits had been swapped for “telephone reassurance” check-ins. Her days on the road, driving between unremarkable towns to see old people in their decaying farmhouses, were over. Some of Hendy’s clients told her that they had no way of getting food, or were too afraid to try. When the department started producing packaged meals to send to elderly residents—turkey à la king, chicken cordon bleu—Hendy volunteered to help distribute them. The meal deliveries, at least, let her keep an eye on people.

Hendy paid special attention to clients who lived alone. There were lots of them. Older people are more likely to live alone in the United States than in most other places in the world. Nearly thirty per cent of Americans over sixty-five live by themselves, most of them women. And Hendy had reason to worry about how they would fare in quarantine. During a 1995 Chicago heat wave, when temperatures reached a hundred and six degrees, more than seven hundred people died, most of them over sixty-five. During the SARS outbreak in Hong Kong, in 2003, health authorities reported a spike in suicides among the locked-down elderly. Some left notes saying that they feared becoming a burden to their family. Some said that they felt isolated.

Hendy and her co-workers were sometimes disturbed by what they saw. There was a man who was basically stuck on the second floor of his house because he had nobody to help him climb down the stairs. There was a woman surrounded by bags of used adult diapers, because her son wasn’t visiting and she was too unsteady to take the trash out herself. Delivery drivers found people living without heat, or fallen on the ground, or dead. More often, people just seemed very lonely. Meal recipients wanted to talk for longer; they invited the drivers to linger.

In 2017, the Surgeon General, Vivek Murthy, declared loneliness an “epidemic” among Americans of all ages. This warning was partly inspired by new medical research that has revealed the damage that social isolation and loneliness can inflict on a body. The two conditions are often linked, but they are not the same: isolation is an objective state (not having much contact with the world); loneliness is a subjective one (feeling that the contact you have is not enough). Both are thought to prompt a heightened inflammatory response, which can increase a person’s risk for a vast range of pathologies, including dementia, depression, high blood pressure, and stroke. Older people are more susceptible to loneliness; forty-three per cent of Americans over sixty identify as lonely. Their individual suffering is often described by medical researchers as especially perilous, and their collective suffering is seen as an especially awful societal failing.

It’s an expensive failure. Research from the A.A.R.P. and Stanford University has found that social isolation adds nearly seven billion dollars a year to the total cost of Medicare, in part because isolated people show up to the hospital sicker and stay longer. Last year, the National Academies of Sciences, Engineering, and Medicine advised health-care providers to start periodically screening older patients for loneliness, though physicians were given no clear instructions on how to move forward once loneliness had been diagnosed. Several recent meta-studies have found that common interventions, like formal buddy programs, are often ineffective.

So what’s a well-meaning social worker to do? In 2018, New York State’s Office for the Aging launched a pilot project, distributing Joy for All robots to sixty state residents and then tracking them over time. Researchers used a six-point loneliness scale, which asks respondents to agree or disagree with statements like “I experience a general sense of emptiness.” They concluded that seventy per cent of participants felt less lonely after one year. The pets were not as sophisticated as other social robots being designed for the so-called silver market or loneliness economy, but they were cheaper, at about a hundred dollars apiece.

In April, 2020, a few weeks after New York aging departments shut down their adult day programs and communal dining sites, the state placed a bulk order for more than a thousand robot cats and dogs. The pets went quickly, and caseworkers started asking for more: “Can I get five cats?” A few clients with cognitive impairments were disoriented by the machines. One called her local department, distraught, to say that her kitty wasn’t eating. But, more commonly, people liked the pets so much that the batteries ran out. Caseworkers joked that their clients had loved them to death.

Hendy liked the robots because they were something tangible that she could give. When clients were lonely, she might apply for grant funding to pay for them to attend a social program—but sometimes they had no way of getting to the community center. Hendy connected people with caregivers when she could, but caregivers were scarce; Cattaraugus, like everywhere else, has a shortage of them. And many people couldn’t afford one anyway. A lot of Hendy’s clients fall into a kind of service dead zone: they are a little too wealthy to be on Medicaid, which covers some at-home help for low-income recipients, but not wealthy enough to pay for private aides. All they have is Medicare, which does not cover long-term caregiving, even when someone needs help bathing or eating or using the bathroom. People tend to make do until they fall and break a hip, or maybe get an infected bedsore; then they end up in a hospital, and eventually in a nursing home. There they spend thousands of dollars a month, until their savings are depleted, at which point they finally qualify for Medicaid and can live out their days in a taxpayer-subsidized, caregiver-attended bed.

from Hacker News https://ift.tt/3yAIKqr