Inside Japan’s long experiment in automating elderly care

Japan has been developing robots to care for the elderly for more than two decades, and public and private investment accelerated significantly in the 2010s. By 2018, the national government alone had spent well over $300 million to fund research and development of such devices. At first glance, the reason for the race to robotize care may seem obvious. Almost every newspaper article, presentation, or academic paper on the subject is preceded by a series of anxiety-inducing facts and figures about Japan’s aging population: the birth rate is below replacement, the population has begun to shrink, and although in 2000, about four working-age adults for every person over the age of 65, by 2050 these two groups will be close to parity. The number of elderly people in need of care is growing rapidly, as are the costs of caring for them. At the same time, the already severe shortage of care workers is expected to worsen significantly over the next decade. No doubt many people in Japan see robots as a way to fill these missing workers without paying higher wages or facing tough questions about importing cheap immigrant labor, which successive conservative Japanese governments have tried to curtail.

Nursing robots come in different shapes and sizes. Some are for physical care, including machines that can help lift older people if they can’t get up on their own; help with movement and exercise; monitor their physical activity and detect falls; feed them; and help them bathe or use the toilet. Others aim to engage older people socially and emotionally to manage, reduce and even prevent cognitive decline; they could also provide companionship and therapy for lonely older people, make it easier to care for people with dementia-related conditions, and reduce the number of caregivers needed for day-to-day care. These robots are usually expensive to buy or rent, and so far most have been marketed toward residential care facilities.

A growing body of evidence reveals that robots are ultimately creating more job for caregivers.

In Japan, robots are often assumed to be a natural solution to the “problem” of caring for the elderly. The country has great expertise in industrial robotics and has led the world in humanoid robot research for decades. At the same time, many Japanese seem to – at least on the surface – welcome the idea of ​​interacting with robots in their daily lives. Commentators often point to alleged religious and cultural explanations for this apparent preference—specifically, an animistic worldview that encourages people to see robots as having some kind of spirit of their own, and the enormous popularity of robot characters in manga and animation. Robotics companies and supportive policymakers have promoted the idea that care robots will relieve human care workers and become a major new export industry for Japanese manufacturers. The title of not one but two books (published in 2006 and 2011 by Nakayama Shin and Kishi Nobuhito, respectively) sums up this belief: Robots will save Japan.

Robear is ready to lift a person during a press demonstration.
Japan is a pioneer in the automation of care. Notable devices include this prototype lifting robot, Robear.

The reality is, of course, more complex, and the popularity of robots among the Japanese largely depends on decades of relentless promotion by the state, media and industry. Embracing the idea of ​​robots is one thing; being willing to interact with them in real life is quite another. Moreover, their actual abilities fall far short of the expectations shaped by their emphasized image. The somewhat inconvenient truth for robot enthusiasts is that despite the publicity, government support and subsidies—and the actual technological achievements of engineers and programmers—robots are not actually present in any important aspect of most people’s daily lives in Japan, including caregiving.

A large national survey of over 9,000 elderly care facilities in Japan found that in 2019, only about 10% reported introducing any kind of care robot, while a 2021 study found that of a sample of 444 people who provided home care, only 2% had experience with a care robot. There is some evidence to suggest that once robots are purchased, they are often used for only a short time before being locked away in the closet.

My research has focused on this disconnect between the promise of care robots and their actual introduction and use. Since 2016, I have spent over 18 months doing ethnographic fieldwork in Japan, including time spent in a nursing home testing three of them: Hug, a lifting robot; Paro, the robotic seal; and Pepper, a humanoid robot. The hug was to prevent caregivers from having to lift residents by hand, Paro to offer a robotic form of animal therapy (while also acting as a distraction aid for some people with dementia who constantly required staff during the day), and Pepper to lead recreational exercises to the staff was freed for other duties.

Satsuko Yatsuzaka, 84, holds a therapy robot named Paro at Suisyoen Nursing Home.
Paro, a fuzzy animatronic seal, is intended for a robotic form of animal therapy.


But problems quickly became apparent. Staff stopped using Hug after just a few days, saying it was cumbersome and time-consuming to drive from room to room – which cut into the time they had to interact with residents. And only a small number of them could be lifted comfortably by the machine.

Paro is better received by staff and residents. Shaped like a fluffy, soft toy seal, it can make sounds, move its head and wag its tail when users pet and talk to it. At first, the workers were quite happy with the robot. However, difficulties soon arose. One resident kept trying to “skin” Paro by removing the outer layer of synthetic fur, while another developed a very close attachment, refusing to eat meals or go to bed without him by her side. Staff eventually had to keep a close eye on Parr’s interactions with residents, and this did not seem to reduce the repetitive behavior patterns of those with severe dementia.

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