Perceptions of Humanoid Robots in Caregiving: A Study of Skilled

Nursing Home and Long Term Care Administrators

Rana Imtiaz

and Arshia Khan

Kentucky College of Osteopathic Medicine, Pikeville, Kentucky, U.S.A.

University of Minnesota Duluth, Department of Computer Science, Duluth, MN, U.S.A.

Keywords: Humanoid Robots in Nursing Homes, Perspectives of Nursing Home Administrators, Dementia Care, Nursing

Home Residents, Humanoid Robots Caring for Elders.

Abstract: As the aging population increases and the shortage of healthcare workers increases, the need to examine other

means for caring for the aging population increases. One such means is the use of humanoid robots to care

for social, emotional, and physical wellbeing of the people above 65. Understanding skilled and long term

care nursing home administrators' perspectives on humanoid robots in caregiving is crucial as their insights

shape the implementation of robots and their potential impact on resident well-being and quality of life. This

authors surveyed two hundred and sixty nine nursing homes executives to understand their perspectives on

the use of humanoid robots in their nursing home facilities. The data was coded and results revealed that the

executives were keen on exploring other avenues for care such as robotics that would enhance their nursing

homes abilities to care for their residents. Qualitative analysis reveals diverse perspectives on integrating

humanoid robots in nursing homes. While acknowledging benefits like improved engagement and staff

support, concerns persist about costs, impacts on human interaction, and doubts about robot effectiveness.

This highlights complex barriers—financial, technical, and human—and emphasizes the need for strategic

implementation. It underscores the importance of thorough training, role clarity, and showcasing technology

benefits to ensure efficiency and satisfaction among staff and residents.

1 INTRODUCTION

The integration of technology, particularly humanoid

robots, within caregiving settings has sparked

considerable interest and debate in recent years.

Among these environments, skilled and long term

care nursing homes stand at the forefront of exploring

innovative solutions to address the growing

complexities of patient care, especially for

individuals with neurodegenerative conditions like

dementia and Alzheimer's disease. This paper delves

into the perceptions of skilled and long term care

nursing home administrators regarding the

incorporation of humanoid robots in caregiving.

Understanding their viewpoints and insights is crucial

in assessing the feasibility, challenges, and potential

benefits of integrating this technology within such

critical care settings. This study aims to unravel the

nuanced perspectives, concerns, and expectations of

these administrators, shedding light on the

https://orcid.org/0000-0001-8779-9617

implications of humanoid robots in transforming and

augmenting the landscape of caregiving in skilled and

long term care nursing facilities.

Understanding the perspectives of skilled and

long term care nursing home administrators regarding

humanoid robots in caregiving is paramount due to

their pivotal role in shaping and implementing care

strategies. Administrators hold comprehensive

insights into the operational, logistical, and ethical

considerations within these facilities. Their

perspectives directly impact the adoption and

utilization of technological innovations like

humanoid robots, which have the potential to

significantly impact resident care. By comprehending

administrators' viewpoints, we gain crucial insights

into the feasibility, challenges, and potential benefits

of integrating this technology into caregiving

practices, ultimately aiming to enhance the well-

being and quality of life for the residents under their

care.

Imtiaz, R. and Khan, A.

Perceptions of Humanoid Robots in Caregiving: A Study of Skilled Nursing Home and Long Term Care Administrators.

DOI: 10.5220/0012465400003657

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 17th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2024) - Volume 2, pages 731-737

ISBN: 978-989-758-688-0; ISSN: 2184-4305

731

2 BACKGROUND

The integration of technology, notably humanoid

robots, in caregiving environments has gained

traction as a promising solution in the context of the

healthcare workforce shortage. Robotics in

healthcare, particularly in skilled and long term care

nursing homes, has attracted significant interest

owing to its capacity to alleviate the strain on

caregivers grappling with numerous challenges,

notably in caring for individuals with intricate health

requirements like dementia and Alzheimer's disease.

Several studies have highlighted the multifaceted

roles that humanoid robots can play in caregiving.

Notably, these robots have been envisioned as

companions for residents, assisting with daily

activities, providing cognitive stimulation, and

monitoring health parameters. Studies conducted by

Khan (2022, 2022, 2023, 2023) showcased that

humanoid robots, through personalized interaction

and assistance, significantly improved the quality of

life for residents in nursing homes, fostering

emotional well-being and reducing feelings of

loneliness and isolation.

However, while the potential benefits of

humanoid robots in caregiving are evident, concerns

and challenges have also been identified. Ethical

considerations surrounding privacy, autonomy, and

the ethical implications of human-robot interactions

remain pivotal concerns. Research by Van et.

Al(2020) underscored the importance of addressing

these ethical dilemmas to ensure the responsible and

ethical deployment of humanoid robots in caregiving

environments.

Moreover, the attitudes and perceptions of key

stakeholders, particularly skilled and long term care

nursing home administrators, are critical in shaping

the successful implementation of humanoid robots in

caregiving. Understanding their perspectives

regarding the feasibility, acceptance, and challenges

associated with integrating this technology into daily

caregiving practices is fundamental. A study by Chen

et al (2020) elucidated that health professionals

perceived humanoid robots as potential tools for

augmenting staff efficiency and supplementing care

services, yet concerns regarding cost, staff training,

and patient acceptance were prevalent.

The literature emphasizes the necessity of

exploring and comprehending the viewpoints of

skilled and long term care nursing home

administrators in embracing humanoid robots within

caregiving contexts. This paper seeks to contribute to

this growing body of research by delving into the

perceptions, attitudes, and expectations of

administrators regarding the role and implications of

humanoid robots in skilled and long term care nursing

homes, thereby providing valuable insights for future

implementation strategies and policy development

(Bemelmans et al., 2012).

3 METHODS

3.1 Data Analysis

Two hundred and sixty nine (N=269) skilled and long

term care nursing home executive administrators

from various regions of the United States were

surveyed. The survey comprised of five questions-1a)

Would this be useful in your nursing home?, 1b) Why

or why not?; 2a) Would this enhance your nursing

home’s care-giving abilities?, 2b) Why or why not?;

3) What are the structural barriers to employing

robots at your nursing home that would concern you?;

4) What are the structural supports?; 5) What would

enhance your employees’ utilization of the proposed

technology? The data gathered was coded by the

authors to find several emerging themes.

3.2 Results

The qualitative data collected from administrators

uncovered numerous recurring themes. Each

question's data underwent coding and is summarized

subsequently.

3.2.1 Perceptions of Usefulness of Humanoid

Robots

The results indicate a varied spectrum of responses

regarding the usefulness of humanoid robots in

nursing homes. The majority (88.7%) of respondents

found them very useful or useful, with a smaller yet

notable portion (21.3%) considering them not as

useful or even not useful at all for their nursing home

setting. Overall, a substantial proportion of

participants expressed a positive perception of the

potential utility of humanoid robots in their

caregiving environment.

3.2.2 Qualitative Data on the Usefulness of

Humanoid Robots

After analysing the perceptions of nursing home

administrators regarding the usefulness of humanoid

robots in nursing homes, several recurring themes

emerged:

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Enhancing Resident Engagement and Joy:

● Offer more attention to residents.

● Engage and entertain residents, particularly

those with dementia, through activities and

physical interaction.

● Provide companionship, interaction, and

activities to reduce loneliness.

● Increase resident engagement with

technology-based activities.

Assistance and Support for Staff:

● Assist staff with routine tasks, aiding in

patient care and monitoring when

caregivers are busy.

● Provide additional support to staff,

particularly in activities, memory care, and

dealing with behavioural challenges.

● Help in tasks that improve the quality of

care provided to residents.

Concerns and Limitations:

● Fear of eliminating or reducing human

contact.

● Concerns about cost-effectiveness and the

initial novelty wearing off.

● Worries about how residents, especially

those with advanced dementia, might react

or if they would understand the technology.

Potential Benefits for Residents and

Operations:

● Improve resident outcomes and medication

management.

● Assist in providing emotional and physical

support to residents.

● Augment current staff processes and help

alleviate staffing shortages.

Safety and Practical Applications:

● Use in various areas like activities, meal

delivery, cleaning, and assisting with

ADLs.

● Support for residents, especially those in

memory care units, to improve their daily

activities and quality of life.

● Concerns about potential hazards, fall

risks, and monitoring of the robot's

activities.

Technology Advancement and Future Use:

● Viewed as the future of care, where

technology will play a pivotal role in

addressing challenges related to an aging

population and workforce shortages.

● Acknowledgment of the potential

advancements in technology to cater to

specific needs and tasks over time.

Mixed Reactions and Uncertainty:

● Mixed feelings about the level of readiness

for robotic integration and uncertainty

about the overall benefits versus potential

downsides.

Assisting Residents with Dementia:

● Offer proactive care and engagement,

especially for residents with advanced

dementia.

● Assist with behaviours and activities

specific to memory care units.

These themes showcase a wide range of

perspectives, highlighting the potential benefits of

humanoid robots in enhancing resident engagement

and support for staff, while also emphasizing

concerns about cost, resident reactions, and the

impact on human interaction.

3.2.3 Enhancing Care Giving Abilities of the

Nursing Homes

With regards to the humanoid robots ability to

enhance the care giving abilities of their nursing

homes, 88.3% believed that the robots would enhance

their nursing homes care giving abilities while 11.3%

believed the robots would not advance their nursing

homes caregiving abilities.

3.2.4 Qualitative Data on Enhancing Care

Giving Abilities of the Nursing Homes

From the data on nursing home administrators'

perceptions of humanoid robots in enhancing

caregiving abilities, several themes emerge:

Workload Relief: Administrators anticipate that

humanoid robots could ease staff workload by

assisting with routine tasks, freeing up time for

nurses to focus on more critical aspects of care, and

potentially reducing burnout among caregivers.

Resident Engagement: There's a strong

expectation that these robots could significantly

engage residents through activities, interactions,

and entertainment, potentially enhancing their

quality of life and reducing feelings of loneliness or

boredom.

Learning and Personalization: Anticipation

exists that the robots could learn resident patterns,

collect vital information, and possibly personalize

care strategies, leading to better understanding and

delivery of individualized care.

Concerns about Limitations: Despite the

potential benefits, reservations persist about the

robots' limitations, including doubts about their

ability to replace human interactions, concerns

about their cost-effectiveness, and skepticism about

Perceptions of Humanoid Robots in Caregiving: A Study of Skilled Nursing Home and Long Term Care Administrators

733

their capabilities in addressing complex caregiving

tasks or emotions.

Staffing Shortages: The theme of staffing

shortages is prevalent, with the hope that robots

could fill gaps, assist with tasks, and augment the

capabilities of a limited staff force.

Technology Readiness: Some express

reservations about the readiness and advancement

of the technology, suggesting that the current state

might not be advanced enough to meet practical

caregiving needs.

Potential Impact on Care: Administrators are

hopeful about the potential positive impact of

robots on caregiving capabilities, envisioning

enhanced efficiency, proactive care, and better

resident monitoring. However, there's uncertainty

about their effectiveness in certain caregiving

situations or with certain resident populations.

These themes collectively represent a spectrum of

expectations, concerns, and hopes regarding the

incorporation of humanoid robots in nursing home

caregiving, highlighting both potential benefits and

reservations among administrators.

3.2.5 Structural Barriers to Employing

Robots

The identified themes underscore the complex

obstacles that nursing home administrators anticipate

while integrating humanoid robots into their facilities.

These encompass financial, technological,

environmental, human-related factors, and specific

technical issues. Upon analyzing the nursing home

administrators' perceptions about the structural

barriers in adopting humanoid robots, several

recurring themes emerged:

Financial Concerns:

● Costs: Major concerns related to the initial cost of

acquisition, ongoing maintenance expenses, and

the overall financial implications.

● Budget Constraints: Financial limitations within

the facility's budget allocation for such technology.

● Funding Challenges: Difficulty in securing funding

or financing for the purchase and maintenance of

robots.

Technological Challenges:

● Operational Issues: Concerns regarding

malfunctions, technological barriers, and the need

for regular maintenance.

● Internet Connectivity: Issues related to bandwidth,

Wi-Fi availability, and reliance on technology

infrastructure.

● Regulatory Compliance: Challenges ensuring

compliance with HIPAA regulations and privacy

concerns.

Physical Environment and Infrastructure:

● Building Structure: Challenges associated with the

physical layout of the facility, including multi-level

centers, elevators, stairs, and navigational

obstacles.

● Safety Hazards: Concerns about potential tripping

hazards, falling risks, and risks associated with

combative residents interacting with the robots.

● Doors and Access: Limitations concerning door

access for locked doors and the robot's ability to

navigate closed doors.

Staff and Resident Factors:

● Training and Adaptation: Staff concerns about

understanding and operating the technology,

resistance to change, and worries about job

displacement.

● Resident Acceptance: Fear, anxiety, or resistance

among residents towards the technology, especially

among those with cognitive impairments or

paranoia.

● Lack of Buy-in: Challenges in getting staff or

residents to accept and utilize the robots due to

skepticism or perceived loss of human connection.

Miscellaneous Concerns:

● Storage and Maintenance: Worries about where

and how to store the robots when not in use and

concerns regarding the durability of the robots.

● Perception and Beliefs: Residents' beliefs regarding

government surveillance, fear, or paranoia related

to technology spying on them.

● Specific Technical Issues: Concerns related to the

robot's capabilities, such as navigational

difficulties, small size, or potential for malfunction.

These themes highlight the multifaceted

challenges nursing home administrators foresee in

integrating humanoid robots into their facilities,

encompassing financial, technological,

environmental, human factors, and specific technical

concerns.

3.2.6 Existing Structural Supports that Can

Mobilize the Use of Humanoid Robots

in Nursing Homes

The themes that emerged suggest a varied perspective

among administrators, highlighting both enthusiasm

and apprehension regarding the structural supports

for implementing humanoid robots in nursing homes.

There's recognition of the benefits they could bring

but also acknowledgment of challenges, particularly

related to cost and regulatory hurdles.

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Corporate & Technological Infrastructure:

● Emphasis on good corporate support and the

presence of an innovative mindset towards

technology.

● Existing use of technology and Wi-Fi

availability are noted as beneficial supports.

Physical Environment & Facilities:

● Favorable mentions of single-level facilities,

wide hallways, and flat open floors conducive

to robot navigation.

Staff Engagement & Support:

● Interest and support from staff members for the

implementation of robots in various aspects of

care.

Quality of Life Enhancement:

● Belief that robots can enhance activities and

engagement, potentially improving the

residents' quality of life.

Financial & Regulatory Concerns:

● Concerns over affordability and potential

legislative challenges in deploying and

maintaining robots.

Functional Capabilities & Use Cases:

● Recognition of the potential of robots in

assisting with daily activities, dietary serving,

and providing additional support to residents.

3.2.5 Needs to Enhance the Nursing Home

Employees’ Utilization of Humanoid

Robots:

The data suggests that training and familiarization

play a pivotal role in encouraging staff acceptance

and utilization of robots in nursing homes. Enhanced

work dynamics, efficiency gains, and the reduction of

routine tasks through technology are identified as

major benefits.

Moreover, staff reassurance about job security,

showcasing the integration of robots into daily

activities, and demonstrating positive outcomes

contribute to a favorable reception. Financial

considerations, especially demonstrating cost-

effectiveness, are crucial factors influencing

acceptance.

Improving resident engagement and care,

receiving support from leadership, and understanding

the functional features and benefits of robotics also

feature prominently. Overall, the themes highlight the

need for comprehensive training, institutional

support, and a clear demonstration of the benefits to

successfully integrate robots into the caregiving

environment of nursing homes. The themes found in

the last question are as follows:

1) Training and Education

Need for Comprehensive Training Programs:

● Hands-on, immersive training sessions to

ensure staff adaptability and competence in

using humanoid robots.

● Structured onboarding programs for

seamless adoption and continuous

education on robot capabilities.

Need for Educational Support and

Reassurance:

● Need for continuous education and

reassurance that humanoid robots are

meant to enhance, not replace, job roles.

● Demonstrations, tutorials, and

familiarization with the technology to build

confidence and alleviate concerns.

Need for Leadership and Institutional Support:

● Encouragement for enthusiastic leadership

support and buy-in for integrating robots

into daily activities.

● Desire for ongoing financial support and

resource availability for effective

implementation.

2) Efficiency and Work Dynamics

Need for Workflow Enhancement and Task

Allocation:

● Expectation for robots to handle routine

tasks, allowing staff to focus on more

critical aspects of care.

● Desire for technology to simplify activities,

reduce workload, and streamline daily

operations.

Need for Resident Engagement and Care

Improvement:

● Aspiration for robots to enhance resident

engagement, care quality, and satisfaction

within the nursing home.

● Anticipated positive impact on resident

behavior and increased trust due to

effective robot interaction.

Need for Technical Features and Usability:

● Emphasis on user-friendly, self-directed

robots compatible with existing software

and electronic medical records (EMR).

● Training to ensure staff comfort and ease in

using robots, ultimately increasing staff

satisfaction and job performance.

3) Financial Considerations and Viability

Need for Cost-Effectiveness and Return on

Investment (ROI):

● The need for proving cost reduction,

affordability, and demonstrating the finan-

cial feasibility of robot implementation.

Perceptions of Humanoid Robots in Caregiving: A Study of Skilled Nursing Home and Long Term Care Administrators

735

● Demonstrated evidence of decreased costs,

increased efficiency, and positive

outcomes to justify investment.

Need for Positive Impacts and Benefits:

● Emphasizing the benefits of using robotics

to increase resident engagement, reduce

workload, and facilitate hands-on care.

● Identifying potential positive impacts on

staff satisfaction, leading to enhanced

resident-staff interaction and care delivery.

4 DISCUSSION

Qualitative data reveals consistent optimism about

humanoid robots in nursing homes, acknowledging

their potential to enhance engagement, aid staff, and

improve residents' lives. However, concerns linger

around costs, the potential to replace human

interaction, and doubts about their full effectiveness

in caregiving. While administrators foresee workload

relief and improved resident engagement,

reservations exist about financial barriers, technical

challenges, and acceptance by staff and residents.

Despite recognizing their capabilities and supportive

infrastructure, worries persist about affordability and

regulatory barriers. Overall, these themes highlight

the necessity for thorough training, role clarification,

technology promotion, and effective integration to

ensure nursing home efficiency and satisfaction.

Usefulness: Analyzing the qualitative data on

administrators' perceptions of the usefulness of

humanoid robots in nursing homes reveals diverse

perspectives. Many administrators see potential in

robots for enhancing resident engagement,

entertainment, and physical activity, especially for

dementia residents. They highlight the robots'

potential to monitor falls, check on patients when

aides are busy, and improve patient care, while others

emphasize the robots' ability to augment human touch

and provide companionship. Concerns include

limitations in tasks, fear of resident misunderstanding

or breakage, and doubts about cost-effectiveness.

Some express skepticism about replacing human care

with robotics, emphasizing the need for human

interaction and concern over the potential fear or

confusion in advanced dementia patients. Overall,

there's recognition of the robots' potential to

supplement staff, engage residents, and improve the

quality of life in nursing homes, but reservations

persist regarding cost, human-like interaction, and the

ability to replace human care entirely.

Enhancing the Caregiving Abilities of Nursing

Homes: Analyzing the qualitative data on nursing

home administrators' perceptions of humanoid robots'

abilities to enhance caregiving reveals diverse

viewpoints. Administrators anticipate that these

robots could ease staff workload, free up time for

nurses, and engage residents more effectively. They

envision the robots learning patterns about residents,

assisting with non-human care-related tasks, and

leading activities while staff provides individualized

help. Many administrators believe these robots could

collect vital information, improve staff satisfaction,

and entertain both staff and residents. However,

concerns about staffing shortages, cost-effectiveness,

and limitations in the robot's capabilities remain

prominent. Some express doubts about the robots'

ability to replace human interaction or effectively

handle certain tasks, particularly in the absence of

advanced technology. Overall, there's recognition of

potential benefits in augmenting staff, engaging

residents, and improving efficiency, yet reservations

persist regarding the robots' cost, capability, and

potential impact on human interactions in caregiving.

Structural Barriers: Nursing home administrators

express varied apprehensions regarding the

implementation of humanoid robots. Chief among

their concerns are financial barriers, encompassing

high costs, budget constraints, and uncertainties

around funding. Technical challenges, such as

malfunctions, internet connectivity issues, and

compliance with regulations, also pose significant

hurdles. The physical environment presents its own

obstacles, including building structures, safety

considerations, and access through doors.

Administrator concerns extend to staff and resident

factors, involving training needs, resistance to

change, and uncertainties about resident acceptance.

Miscellaneous worries, like storage, beliefs regarding

surveillance, and specific technical glitches, further

compound the complexities of integrating robots into

nursing home settings. These multifaceted challenges

underscore the intricate nature of robot assimilation,

involving financial, technical, environmental, human,

and operational considerations.

Structural Support: The perceptions among nursing

home administrators highlight the pivotal role of

corporate backing and technological infrastructure,

emphasizing robust support from corporate entities

and an open-minded approach toward innovative

technology. They appreciate the benefits derived

from existing technology and Wi-Fi availability. The

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physical environment, characterized by single-level

facilities, wide hallways, and spacious open floors, is

seen as conducive to integrating robot navigation

seamlessly. Staff members express keen interest and

support for implementing robots in various care

aspects, foreseeing the potential for these machines to

enhance activities and engagement, ultimately

improving residents' quality of life. However,

concerns linger regarding the financial feasibility and

potential legislative challenges in deploying and

sustaining these robotic systems. Administrators

recognize the functional capabilities of robots,

foreseeing their assistance in daily activities, dietary

serving, and providing additional support to residents,

revealing an optimistic outlook despite some

prevailing apprehensions.

Needs of Technological Skills to Enhance the

Utilization of the Robots in Nursing Homes: These

themes collectively emphasize the significance of

providing comprehensive training, reassurance about

job roles, showcasing the benefits of technology, and

integrating robotics effectively into the nursing home

environment to enhance efficiency, improve care, and

ensure staff and resident satisfaction.

5 CONCLUSION

From the qualitative data, several overarching themes

emerge regarding the use of humanoid robots in

nursing homes. There's a consistent recognition of the

potential benefits these robots offer, such as

enhancing resident engagement, supplementing staff,

and improving the quality of life. However, various

concerns persist, primarily revolving around cost, the

potential to replace human interaction, and doubts

about the complete effectiveness of robots in

caregiving. Skilled and long term care nursing home

administrators anticipate these robots easing staff

workload, engaging residents, and collecting vital

information but express reservations about financial

barriers, technical challenges, and staff and resident

acceptance. Despite acknowledging the robots'

functional capabilities and the supportive corporate

and technological infrastructure, apprehensions about

affordability and legislative hurdles prevail. Overall,

the common themes underline the need for

comprehensive training, reassurance about job roles,

showcasing technology benefits, and integrating

robotics effectively to enhance efficiency and ensure

staff and resident satisfaction in nursing homes.

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