WITH many of his friends and family getting on in years, Babbage has had perforce the chance to compare how the elderly are cared for professionally in America, Britain and Japan. In all three, the private facilities he has visited have been broadly similar and their costs much the same. But one thing stands out about the places the old and infirm are cared for in Japan. Whether they be nursing homes, geriatric hospitals or hospices, all seem to suffer a dire shortage of nursing staff. Being an inventive people, though, the Japanese have come up with some nifty solutions. The rest of the ageing world would do well to take note.
Blessed as they are with a healthy diet, plenty of unavoidable exercise and near universal access to cheap medical services, it is no surprise that the Japanese live longer than practically any other nationality. With an average life expectancy of 82 years for women and 79 for men, Japan has more than its share of octogenarians and nonagenarians.
Thanks to a rapid decline in its fertility rate over recent years (now down to 1.3 births per woman), Japan is also ageing faster than any other country. In 1990 only 12% of Japanese were over 65. In 2010, 23% were. By 2025 an estimated 33% of the population will have become senior citizens. No other country has seen so swift a reversal of its demographics.
This speedy change has focused the minds of Japanese health officials. All the more so as it has occurred while the young have migrated faster than ever to big cities in search of better jobs and services, leaving older relatives to fend for themselves in the provinces. Once the rule, inter-generational families—with children, parents and grandparents all living under the same roof—have become a rarity. A lot of long-living, solitary folk thus now find themselves in desperate need of professional care.
The waiting lists are lengthy. The trouble is not building facilities, but finding trained people to do the job. In 2010 the Ministry of Health, Labour and Welfare reckoned Japanese nursing homes and hospitals needed 2m professional carers to look after the country’s 30m elderly and infirm, but managed to attract only 1.3m. By 2025 the ministry expects the country to need 4m such workers.
One way to plug the gap would be to employ foreign nurses. Unfortunately, rather than being welcomed, foreigners seeking to work in Japan are discouraged as a matter of national policy. Japanese immigration authorities issue no more than 50,000 work visas a year—remarkably few for a country of 128m people. These visas go mainly to ex-patriot professionals with job offers from firms in Japan, or to “exotic dancers” seeking work in hostess bars and the like. The result is that, unlike other countries, Japan has few foreign nurses ready and willing to do the caring jobs locals prefer not to do, but which desperately need doing.
As the Japanese see it, the answer is not cheap foreign workers, but lots of cheap Japanese robots. This comes as no surprise. There is a profound belief in Japan that the application of ingenious hardware can be relied upon to solve most problems.
The development of caring robots could certainly reduce the work load on nurses, while enriching the quality of life for elderly patients. Researchers reckon people with impaired motor skills could benefit from robotic help with hygiene, eating meals and picking things up from the floor.
Because of the country’s vast experience with automation for the motor and electronics industries, Japanese researchers have tended to focus on developing nursing robots that can grasp or fetch things. Far less attention has been given to machines capable of performing trickier and more delicate tasks like washing, wiping, shaving or brushing a patient’s teeth. The trouble with anthropomorphic robots capable of such dexterity is that they are invariably complex and expensive—costing $200,000 or more.
They can be heavy, too. Robots can typically lift no more than 10% of their own weight. A nursing robot capable of lifting, say, a full-grown man and putting him in a bath or a wheelchair can weigh as much as a car. The possibility of a one-tonne robot becoming unbalanced and toppling on a patient does not bear thinking about.
Such issues have begun to give Japanese researchers pause for thought. The consensus now is that, rather than building robots capable of doing a nurse’s job, a better approach might be to develop “assistive mechanisms” that help nurses or patients do the chore themselves. With limited functions, such motorised assistants could help the elderly perform their daily activities, while reducing the burden on nursing staff.
A typical example is the Hybrid Assistive Limb manufactured by Cyberdyne, a nine-year-old robotics venture founded by Yoshiyuki Sankai of Tsukuba University. The battery-powered suit functions as an exoskeleton, sensing and amplifying the wearer’s muscle action when he attempts to lift or carry heavy objects. The suit can be used by carers for picking patients up off a bed. Or it can be worn by patients to help them move around and do things for themselves.
Over the past two years, Cyberdyne has delivered 330 motorised suits—costing a modest ¥178,000 ($1,780) apiece—to various hospitals and welfare facilities in Japan. It is the world’s first assistive nursing mechanism to be certified under a draft international safety standard for personal robots.
Health and welfare officials in Tokyo have clearly been impressed. Starting this fiscal year, the government is to provide subsidies covering half to two-thirds of the development cost for firms working on assistive robots with sticker prices of ¥100,000 or less. Officials hope to get a bill through the Diet (the country's parliament) that would modify the national health insurance scheme, so the elderly could hire such aids for little more than the cost of renting a wheel chair.
Apart from a motorised exoskeleton like the Cyberdyne device, the plan envisages three other assistive devices, each costing less than ¥100,000. One is a small, battery-powered trolley that helps the infirm to walk by themselves. The second is a portable, self-cleaning bedside toilet. The third is a monitoring robot capable of tracking and reporting the whereabouts of patients suffering from dementia. The government wants all four to be in production by 2016.
That Cyberdyne can sell its battery-powered exoskeleton for the price it does—even though it is manufactured on a limited scale—suggests Japan’s well-established mechatronics industry should have little difficulty mass producing assistive robots for the price the government has set. Babbage expects Japanese robot-makers to be flooding America and other export markets with cheap, single-purpose caring machines before the decade is out. As far as he and his ageing circle are concerned, they cannot come soon enough.
