There is an innovation gap in caregiving

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Longevity achieves the triumph of over a century of public health, and nutritional victories have led to a growing population of seniors in the United States and many other countries. Meanwhile, the aging of the sizable baby boom generation and the decline in fertility rates mean that the elderly population is growing not only in absolute terms but also relative to the young. In 2020, there were approximately 56.1 million people aged 65 and over in the United States, 17% of the population. In 2034, there will be more Americans aged 65 and more than children. These demographic shifts will lead to a decline in what is known as the caregiver support ratio – the number of adults between the ages of 45 and 64 who are available to provide care to those over 80. Between 1990 and 2010, the caregiver support ratio was around 7 caregivers per recipient of care, but by 2030 the ratio is estimated to drop to 4 to 1, reaching 3 to 1 by 2050.

One of the main questions about assisting aging countries is whether technological innovation can help fill the demographic deficit. It is a concern not only for professional caregivers, but also for the 42 million-plus Americans who provide informal care to family members and loved ones.

The technology has been touted as a potential, albeit partial, solution to the caregiving crisis, but what has not been clear is which areas of life for caregivers and clients will be most affected. Experts from academia and industry expect technological advances in healthcare over the next 10 years to focus on extended applications of existing technologies, such as smart home and wearable technologies. They project that the greatest impacts of technological innovation will be on relatively low-contact activities, such as social engagement, drug management and transportation. They expect the technology to have limited impact on more complex, high-contact tasks, such as feeding, dressing, and bathing.

It seems that caregiving faces an innovation gap. While there is plenty of inventive energy pouring into some care needs, care’s core tasks – those that require the most intense and even laborious attention – appear to be the last in line for tech help.

Part of the reason technology has been so unevenly applied to caregiving is that the simplest technological challenges tend to be solved first. It is far beyond the current state of the art technology, for example, that a robot safely helps an assisted person with the toilet or with dressing. But a more subtle cause may be that caregivers’ needs are poorly understood. The vast majority of caregiving takes place in private homes, is experienced only on an individual basis, and is also in a state of constant flux as needs evolve and caregiving work changes accordingly. As a result, while caregiving is an extremely common activity, it is also remarkably opaque.

Perhaps the simplest way to shed light on such private, yet almost universal experiences is to simply ask people for information. For example, the MIT AgeLab CareHive is based on a multigenerational caregiver panel that includes over 1,400 current and former caregivers who can talk about a variety of underestimated concerns and requests. Caregivers have reported concerns about the reliability of some technologies, such as various engagement or communication tools, which are not designed with clients in mind or lack the flexibility to adapt to different care situations. Caregivers avoid technology because it doesn’t seem to work, one caregiver commented. Technology vendors often seem to have a solution, but only for things that aren’t the problem.

The innovation gap facing the care-intensive society of tomorrow has its roots in a different kind of gap: an information gap. Providing care is not only necessary for a decent quality of life and a functioning society; it is also, and always has been, a cornerstone of human experience. Well, don’t do us a favor by ignoring or turning a blind eye to caregivers. Quite the opposite: To reimagine an innovative future of care, developers, policymakers and researchers must first understand the requirements of those who provide and receive it. This is an essential question. After all, many of us will find ourselves occupying one or both of these categories in the years to come.

Lisa DAmbrosio is a researcher at MIT AgeLab.

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