The Care Economy in 2030

Weekly Article
Shutterstock / Willyam Bradberry
July 27, 2017

Claudine lives alone, in a small but comfortably furnished house. Her companion, Ben, prepares and serves her meals, with a glass of wine, and ensures that she takes her medications as prescribed. Before she sleeps she looks at the picture on her bedstand, of her husband and her smiling younger self. The next morning, we hear Ben asking, “Claudine, would you like to get up now?” She does not respond; he repeats himself three or four times. We think she has died in her sleep, but then the next frame shows her at breakfast, eating a last spoonful of yogurt before he clears her plate. He tells her that because she was unresponsive earlier, he has notified the doctor. She apologizes, saying, “I just needed that moment this morning… ”

Before she can finish he asks her if she would like to watch TV. When she does not respond he asks if she would like to dance, and slowly extends his hand. She takes it; the closing frame shows her wrapped in his embrace, eyes closed but with a sad expression, slow dancing in the living room as the music plays: “Take me walking in the morning dew, my love … You can’t go walking in the morning dew, today.”

Ben is a robot. Indeed, B.E.N. stands for “bionically engineered nursing.”

Does Claudine really live alone?

In a world in which “virtual reality” is now being called “mixed reality” and our progeny can be expected to have various devices implanted in their brains, the question of what is human will become more and more central and harder and harder to answer. But the first message to take away from this short but powerful video of Claudine and Ben is that the future of care is big business. The final two frames say: “Today, companion robots are being introduced to assist lonely people. At Society Saint-Vincent-de-Paul, we think that only human beings can help in fighting loneliness. We recruit volunteers.”

Society Saint-Vincent-de-Paul is a French religious organization. The French, and indeed all the Europeans, are facing the conundrum of aging and shrinking societies, without enough young people to take care of the old. Japan faces this problem even more acutely and is a pioneer in developing robots for elder care. The demand is evident and growing, which means that markets should hasten to increase supply.

But will that supply be human or automated? And how much does it really matter? China is making a big bet on “care bots,” with plans to turn “service robots” into a $4 billion industry by 2020, a large slice of which will be for elder care. Some are already being tested, with pictures of elderly Chinese interacting with a cute white robot with a pink headpiece that resembles a living anime character.

Yet is that really how many of us want to grow old? It is emphatically not what I want. In his deservedly bestselling book On Mortality, Atul Gawande points out that the adult children of an elderly parent are often most concerned about safety, nutrition, and longevity, while the person who is being cared for is much more concerned about quality of day-to-day life. I know right now that I should eat better, but if I want to blow my diet and eat a cookie, that’s my prerogative as an adult. And make that cookie a glass of champagne, and that’s what makes life worth living! The last time someone told me what time to go to bed was early teenagerdom; taking risks and breaking rules is part of the definition of adulthood. What most of us want, at least in Gawande’s experience, is “our best day”: the ability to do the things that matter most to us within the compass of our abilities and the length of days we have left.

So. Who or what will be able to give us “our best day”? In my view, it is most likely a combination of humans and robots. Many of our fears about aging involve the loss of personal privacy and the indignities that follow; I would assume many people would want a robot to help with bathing and toileting any day. Moreover, I can imagine an entire industry built around customizing care by feeding information about an elderly person’s life—a virtual scrapbook of her parents, siblings, spouse, kids, friends, house, neighbors, work, colleagues, vacations, hobbies—to create as close a facsimile as possible of growing old the way the elderly do in the small Italian town where my family vacations, surrounded by people they know and who know them. Indeed, MemoryWell, a new company, is pioneering “person-centered care” by hiring journalists to write the life stories of patients with dementia to help their caregivers know who they are.

The robot’s artificial intelligence can keep track of all that information, just as it can keep track of streams of health data and the latest games and exercises for geriatric wellbeing. That should free up a human caregiver to provide real companionship, the connection to other human beings that is such a large part of what it means to be human in the first place. We connect to others, if we are psychologically healthy, not simply to have our lives reflected back to us, but to learn about their lives, take joy in their successes, and grieve with their losses. Those human caregivers of the future who can give us our best day will benefit from education in psychology, neuroscience, and geriatrics. Equally important, however, will be their capacity to tap into their own humanity and share at least a little of it with us.

The more intertwined human and robotic care becomes, the better, and better-paid, care jobs will be—from education to health and life care to advising, mentoring, and coaching of all kinds. When we hear “coach,” we think sports and we typically think men and tough women: people who engage in the character-building, teamwork-teaching, hard-driving, tough-love activity of investing in the performance of others. Navigator—a term increasingly used to describe the people who help others find their way through complex governmental, educational, and employment systems—dates back to men with charts on ships. And Mentor was the wise tutor and adviser to Telemachus, son of Odysseus, in an age of heroes. Defining care as “investing in others” makes the contours of the future care economy both broader and more appealing to men, which will be good both for men and for the quality and pay of the jobs in question.

With these opening thoughts, I am delighted to introduce a package of stories that New America has curated for this edition of the Weekly on “The Care Economy in 2030.” A talented group of writers investigate issues we can expect to grapple with in the near future, such as how automation, diminishing dynamism, and other future of work trends will impact the care industry and the way we measure and value both paid and unpaid care work. Looking ahead, the care economy will be an important source of jobs, revenue, and both economic and human growth. How well we invest in the next generation will determine our national security and competitiveness in a global economy. How well we nurture human intelligence and integrate it with artificial intelligence will determine our productivity. And how well we care for the vulnerable and less abled among us, at every age, will determine how many of us will have our best day.

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Family-Supportive Social Policy