▲ Current elderly care services face issues such as “only children not being able to care, difficult to find reliable caregivers, shortage of professional nurses, and high turnover among nursing staff.” Experts believe that using elderly care robots to replace human labor in smart elderly care is an inevitable choice to solve this problem. (Visual China / Photo)
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A feeding robot for disabled elderly can indeed free hands when used correctly by normal people, but it struggles to recognize users who are bedridden and cannot adjust their neck angle, often leading to situations where it “cannot find the mouth.”
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After testing a portable smart bathing machine, Cheng Chuantao asked a severely disabled elderly person to express their feelings by blinking, with a full score of five stars. The elderly person blinked four times, leaving one star unaccounted for. Cheng Chuantao asked and answered himself—probably it was not as comfortable as a shower.
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“The end of smart elderly care is not to let machines replace humans, nor to completely hand over elderly care to robots. Human participation is still needed for irreplaceable humanistic care services like palliative care.”
What do elderly people care about the most?
70-year-old Zhao Lun feels it is eating, seeing a doctor, and emergency rescue; Zhang Xia, who lives alone and is not elderly, pulls the emergency call rope to her pillow every night before bed, fearing that she might “suddenly have an accident”; 80-year-old Zhang Songxue fell on the balcony of her apartment and was afraid that if she froze overnight, “she would just be gone,” so she gritted her teeth and moved herself back inside, pulling the emergency call device hard.
A statement released by the National Health Commission and other authoritative departments shows that falls are the leading cause of injury-related deaths among people aged 65 and older in China. The older the age, the higher the risk of falling and being injured or dying from falls.
Clearly, compared to the 2024 New Year’s movie “If You Are the One 3”, where Ge You plays a 70-year-old empty-nester who falls in love with an AI robot, the real dilemma for the elderly is not romance but how long it takes for someone to notice if they fall.
This is closely related to the current issues facing elderly care services such as “only children not being able to care, difficult to find reliable caregivers, shortage of professional nurses, and high turnover among nursing staff.” Zhang Sifeng, an executive director of the China Society for Social Security Studies and a professor at Xi’an Jiaotong University, told Southern Weekend reporters that using elderly care robots to replace human labor in smart elderly care is an inevitable choice to solve this problem.
The General Office of the State Council has just released the “Opinions on Developing the Silver Economy to Improve the Well-being of the Elderly” (hereinafter referred to as “Opinions”), responding to this call. The “Opinions” emphasize the creation of a new model for smart health elderly care, promoting the integration of new generation information technology, mobile terminals, wearable devices, service robots, and other smart devices in home, community, and institutional elderly care scenarios, and promoting the application of smart nursing robots and other smart devices.
However, Southern Weekend reporters found during research in elderly care institutions in Beijing and Henan that the smart elderly care model being promoted in domestic elderly communities and institutions faces many obstacles in reality, such as “not smart enough, expensive, neglecting the needs of disabled elderly,” etc.
From Emergency Call Systems to Electronic “Fences”
After turning sixty, Zhao Lun and his wife decided to spend their twilight years in a centralized home care community.
Four years ago, the couple moved into the Beijing Shuangqiao Gonghe Home, which is the first pilot project in China for shared property elderly care, where buyers own 95% of the property rights of the elderly care room, and each room must have at least one resident over 60 years old, paying a service fee of 3000 yuan per month, with Lecheng Group providing services as the elderly care operator.
Initially, a 24-hour emergency call alarm system was installed in the elderly apartments and community public service spaces, triggered by buttons and pull ropes connected to the community control room. However, Lu Shuo, the director of Shuangqiao Gonghe Home, found that there were still elderly people who felt unwell while walking outside or fell at home alone and could not reach the wall-mounted call device.
In 2023, Shuangqiao Gonghe Home introduced wireless positioning chest cards and integrated community meal cards and access cards for the elderly to carry conveniently.
Zhao Lun shows his wireless positioning chest card. (Xi Lijie / Photo)
Based on wireless positioning, the community set electronic “fences” for elderly people living alone and those with a risk of wandering. If an elderly person living alone does not leave their room for over a day, staff will receive a notification on their mobile platform and proactively contact the elderly to confirm their health status; if a person with dementia approaches the community entrance, an alarm for “exceeding the fence range” will trigger, and they will be advised and stopped immediately to avoid wandering outside.
These practices at Shuangqiao Gonghe Home are basically in line with the current situation of smart elderly care services in the country. Currently, there are three types of smart elderly care services in the country: the first type provides elderly health data, remote emergency medical rescue information, remote medical monitoring services, and activity trajectory analysis; the second type allows elderly people to select various life service items through smart devices; the third type enriches the spiritual and cultural lives of the elderly through voice mutual assistance functions and interactive information exchange.
“These services mainly rely on smart wearables, remote monitoring, and other information devices and technologies, focusing on detection, alarm, reminders, and information transmission, targeting healthy elderly people living alone or in institutions and semi-self-sufficient elderly people, extending the functions of traditional elderly care services,” said Zhang Sifeng.
For healthy Zhao Lun, the most common smart service is the community-built smart information platform, which allows him to book repairs, haircuts, foot massages, home cleaning, and medical accompaniment through a mobile app. The community also holds weekly smartphone classes specifically to teach the elderly how to use this system.
The traditional repair reporting system requires taking photos and writing text to record repair requests, which is not friendly for elderly people who need to write on a smartphone. On this platform, Zhao Lun only needs to click the video recording button to record a video while verbally expressing his request.
“Caring for your own parents is different from caring for others’ parents”
Compared to serving the elderly, Qi Yinglin, assistant general manager of Lecheng Group’s health and wellness department, admits that the artificial intelligence and IoT devices at Shuangqiao Gonghe Home are more about liberating community staff and alleviating the human resource challenges in elderly care.
“The new disabled elderly Mr. Wu weighs 180 pounds, and I can’t move him to the toilet at all; my back is killing me. I really can’t do this job anymore.” To introduce the newly purchased electric transfer machine in the facility, Cheng Chuantao filmed a short video where the caregiver Zhou Jing asks the director for resignation.
After using the electric transfer machine, Zhou Jing helps Mr. Wu sit upright from the bed, attaches the transfer machine under him, and moves him out of bed like pushing a wheelchair, solving the elderly person’s mobility problem. In the end, Zhou Jing smiles and tells the director that she “will not resign.”
Setting aside this Spring Festival Gala skit-style conclusion, Zhou Jing’s “resignation” scenario is actually a true reflection of the high turnover rate among elderly care workers.
福满堂 houses nearly three hundred elderly residents, with an average age of over eighty, half of whom have lost self-care ability. Caregivers who choose to care for disabled elderly people in the full-care area earn a monthly salary up to 1600 yuan more than those in the self-care area.
The applicants are mostly rural women in their fifties, claiming to have cared for their parents and are not afraid of dirt or hardship. However, Cheng Chuantao finds that only about three out of ten can remain after they start working independently.
Looking after, feeding, bathing, moving, and handling excrement… Associate Professor Zhang Zehui from Xi’an Jiaotong University’s School of Public Policy and Management found in his research that traditional elderly care services are a typical labor-intensive industry. In institutions, an average caregiver needs to look after 5-6 elderly patients, working shifts day and night, with work that is “dirty, tiring, and dangerous.”
In an elderly apartment in Shaanxi, an 81-year-old disabled person told Zhang Sifeng that apart from getting up, eating, and sleeping, caregivers hardly come during other times. Sometimes when they press the bedside call button, caregivers cannot arrive in time. “Once, the caregivers pushed us outside to bask in the sun, but suddenly it rained, and they were short-staffed, so several of us old men got soaked.”
A bigger problem is that the elderly care industry still has very few highly educated young professionals. In 2023, a study published in the Journal of Nursing showed that medical and nursing professionals in integrated medical care institutions only account for 12.2%, with graduate degrees at 0.23%, undergraduate degrees at 6.95%, and only 70% with primary or secondary school education.
“Completely disabled elderly people often suffer from incontinence, and many cannot overcome psychological barriers. Moreover, one often overlooks the fact that caring for one’s own parents is different from caring for others’ parents,” said Cheng Chuantao.
Feeding robots often “cannot find the mouth”
Cheng Chuantao introduced a video of the electric transfer machine, where experienced netizens continuously raised questions in the comments: “What if it is also very difficult to help the elderly sit up?” “How to take off the elderly’s pants while sitting in the transfer machine?”
At Henan Shangqiu Fumantang Nursing Center, caregivers use electric transfer machines to move disabled elderly people. (Photo provided by interviewee)
These questions imply a reality: the current smart products “have not yet achieved true intelligence or wisdom.” Mechanical repetitive tasks like turning over, feeding, and moving cannot be accurately completed by machines, preventing caregivers from focusing their energy on higher-level, more precise care.
Along with the electric transfer machine, Fumantang also purchased a feeding robot for disabled elderly people. During testing, Cheng Chuantao found that while the machine can indeed free hands when used correctly by normal people, it struggles to recognize users who are bedridden and cannot adjust their neck angle, often leading to situations where it “cannot find the mouth.”
The complexity of smart elderly care lies in the vast differences among elderly individuals. Even for feeding, at the Lecheng elderly care institution under Lecheng, some elderly people have poor dentition and eat slowly; some have shaky hands but can eat without issue; some are at risk of choking and need careful supervision; and some demented elderly people, like children, cannot sit still to eat and prefer to wander around. Even with a uniform feeding robot, only two or three elderly people may manage to get fed by the machine.
Existing smart devices also struggle to match the complex elderly care scenarios. Qi Yinglin gave an example to Southern Weekend reporters: if there is a spill on the floor, it poses a significant risk of falling for the elderly, but a sweeping robot can only clean along a predetermined route and cannot promptly and accurately clean up the spill.
Even so, the institutions where Qi Yinglin and Cheng Chuantao work are already at the forefront of smart elderly care. Since 2017, Zhang Sifeng’s team has visited over 40 elderly care institutions in 10 cities across three provinces, and hardly any practical applications of highly intelligent elderly care robots have been observed, with institutions setting up smart beds and other aids not exceeding 10% of the total surveyed.
Yang Zhihao, product director of Fourier Intelligent Technology Co., Ltd., told Southern Weekend reporters that the elderly care industry cannot often be clearly distinguished as an independent industry. Fourier focuses on the application of robot technology in the field of smart rehabilitation, with most products suitable for both young and elderly people. During the early research and development stages, the needs of the elderly population are considered, but they do not specifically launch an “elderly version.”
The Ministry of Industry and Information Technology and other departments issued the “Action Plan for the Development of the Smart Health Elderly Care Industry (2021-2025)” which proposes to focus on enhancing the supply capacity of smart products and developing five major categories of products: health management, elderly care monitoring, rehabilitation aids, digital traditional Chinese medicine products, and home service robots.
Zhang Sifeng believes that the importance of developing highly intelligent elderly care robots is no less than that of developing self-driving cars. Currently, the limitations of smart elderly care products still rely on human services and cannot fundamentally reduce the use of human labor.
Some smart products not only fail to alleviate the burden but also increase the workload of caregivers. Fumantang has a walking robot that can help paralyzed elderly people “stand” again, but the elderly still need caregiver assistance when using it. Consequently, the 20,000 yuan walking robot is left in the building, where family members can use it for free while watching over, but if caregiver assistance is needed, an additional fee is required.
“Disconnected from social reality”
During the free trial, the walking robot was popular at Fumantang, with elderly people with mobility issues eager to use it for rehabilitation exercises. In stark contrast, after a fee was introduced, hardly any elderly people were willing to pay for it.
An intelligent cane that can recognize when an elderly person has fallen, and can also communicate and locate, costs nearly 1,000 yuan, but it is also unsold at Fumantang. Cheng Chuantao has also looked into smart mattresses that can monitor the elderly’s heart rate, temperature, and nighttime movements, and a smart watch, but ultimately did not introduce them, “as these costs would ultimately be passed on to the elderly, but elderly people in third- and fourth-tier cities do not have the purchasing power for smart products.”
Even if some intelligent elderly care facilities are installed in the community, it is difficult to provide follow-up services like centralized elderly care communities.
Qi Yinglin believes that in ordinary communities, decentralized home care increases the difficulty of deploying smart devices. Even if emergency call devices are installed, they are responded to by community workers rather than doctors or nurses, making it difficult to provide timely assistance to the elderly. Only when the demand is relatively concentrated can it be possible to organize substantial resources to serve the elderly, “what the elderly want is not that (intelligent) thing, but the follow-up professional services provided by people.”
The elderly care model at Shuangqiao Gonghe Home is called “service-providing elderly housing” in Japan. However, whether in Japan or China, this model is far from mainstream, as more elderly people choose to age at home. The National Health Commission’s Department of Aging Health previously summarized China’s elderly care model as the “9073” pattern, where 90% of the elderly live at home, 7% rely on community support for elderly care, and 3% live in institutional elderly care.
Zhang Sifeng bluntly stated that like most smart elderly care products, the centralized elderly care model is currently difficult to promote because it does not match the payment capacity and elderly care concepts of the elderly, “disconnected from social reality.”
At Fumantang Nursing Center, it is rare to see local elderly people under 80 years old. Most elderly people Cheng Chuantao interacts with are over 70 and still need to cook and care for grandchildren at home. Some elderly people approach Cheng Chuantao wanting to enter the nursing home, but their children disagree, “saying it is to honor the elderly, but the elderly know that they do not want to lose a free nanny.”
The overlooked needs of disabled elderly
In addition to concepts and payment capacity, another often overlooked issue is that many elderly people can only passively accept services when it comes to smart elderly care. Are they satisfied? This question often goes unanswered accurately.
Holding a portable smart bathing machine, Cheng Chuantao took fifteen minutes to wash a severely bedridden elderly person using this device based on nebulized nano water droplet technology, which allows bathing in bed without wetting the bedding.
Severely disabled elderly people often have unclear consciousness and speech. After the trial, Cheng Chuantao asked the elderly person to express their feelings by blinking, with a full score of five stars. The elderly person blinked four times, leaving one star unaccounted for. Cheng Chuantao asked and answered himself—probably it was not as comfortable as a shower.
The service objects of smart elderly care include a special group of disabled elderly people, whose daily living, medical care, and nursing must rely on others’ help and care. The industry often uses the phrase “one person disabled, the whole family is unbalanced” to describe the huge impact that disabled elderly people have on their families. However, on a social level, disabled elderly people often remain invisible.
In Shenzhen, a technology company focused on disabled individuals’ smart care, assistant to the chairman Cai Yitong told Southern Weekend reporters that currently, a major difficulty in product promotion is the low exposure, and the care for disabled groups cannot receive widespread attention; the new concept of “smart care” has not yet formed an industry. “As a technology targeting disabled elderly individuals, the founding team members all have experiences caring for disabled people, leading to the discovery of the gap in smart care products and companies for this group in China.”
Intelligent nursing robots for handling the excrement of disabled elderly individuals. (Photo provided by interviewee)
Also overlooked are the elderly care needs of disabled elderly people. “The primary need for disabled and demented elderly people is health care, while also focusing on spiritual comfort and improvement of mental states.” During the research process, Zhang Zehui found that due to limited mobility, disabled and demented elderly people lack communication and social interaction for a long time, resulting in a higher demand for spiritual comfort compared to ordinary elderly people.
Cheng Chuantao believes that under the “9073” model, the 7% community elderly care primarily addresses the needs of self-sufficient elderly individuals, while the 3% of elderly care institutions must directly face the urgent needs of disabled elderly individuals.
Based on health status (self-sufficient – semi-disabled – disabled) and income level (low income – middle income – high income), Zhang Sifeng classifies elderly individuals into nine types, proposing that semi-disabled and disabled elderly people are key targets for elderly care services, and middle to low-income semi-disabled and disabled elderly individuals should be the focus of government support and social attention. “The future development direction of the smart elderly care industry should concentrate resources on disabled elderly individuals, develop highly intelligent elderly care robots on the supply side, and enhance the payment capacity of the elderly on the demand side, working on both high-tech and popularization fronts.”
The essence of elderly care is money and health; having either can solve most elderly care issues. Elderly individuals with neither money nor health present the most challenging problems for elderly care,” said Cheng Chuantao.
Cai Yitong stated that from the supply perspective, developing integrated smart robots cannot be achieved overnight. It requires transitioning from initial hardware devices to a combination of hardware and software, and finally forming a big data platform to deeply understand the differentiated needs of disabled elderly individuals. “We plan to develop a one-stop intelligent care cabin in the next three to five years to meet the six nursing needs of disabled elderly individuals, such as convenience, bathing, eating, getting in and out of bed, moving, and dressing.”
In the movie “Robot & Frank,” Frank, who has Alzheimer’s, becomes friends with a robot. At Shuangqiao Gonghe Home, there are demented elderly individuals who no longer recognize their children but treat the caregivers they see every day as their own sons, and there are demented elderly individuals who call out for the caregivers’ names before passing away, hoping to see them once more. “The end of smart elderly care is not to let machines replace humans, nor to completely hand over elderly care to robots. Human participation is still needed for irreplaceable humanistic care services like palliative care,” said Zhang Sifeng.
(The names Zhang Song and Zhang Xia are pseudonyms)
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