Grandma's little helpers?

Home nursing care is exhausting, often poorly paid work even as the demand for skilled workers is rising, particularly in industrialized countries. Could robots avert the impending nursing crisis? A visit to a group home for people suffering from dementia in Kiel, Germany—with their care robot Emma. 

Text Christoph Wöhrle  Photos Heinrich Holtgreve

Emma shifts rhythmically as her loudspeaker plays a song by Freddy Quinn, a pop star in the German-speaking world in the late 50s and early 60s. For a moment, forgetting becomes remembering. The dementia is suddenly far, far away and the days of youth return for a brief sojourn. Gertrud M. rocks back and forth on her chair, quietly singing along. With a happy face, she strokes the cane propped against her armrest, as if it were a beloved pet.

Other residents of the group home pat Emma’s plastic robot head while she provides their entertainment—which is why Emma is there in the first place. She’s been coming here for the past eighteen months with Hannes Eilers, a laboratory engineer from Kiel University of Applied Sciences, who programmed her. “It’s hugely motivating when you see the people here smiling and singing because of Emma,” Eilers says.

Demographic changes are creating a nursing crisis in many countries. In Germany, for example, there are currently more than 5.5 million people aged 80 and older, a figure that is expected to double by 2050. However, the country is already suffering from a nursing shortage. According to the German Economic Institute in Cologne, more than 22,000 jobs per month, on average, remained unfilled in 2017. At the moment there are only 22 unemployed skilled workers for every 100 open gerontological nursing jobs. The demand for skilled nurses in elder care is expected to rise by another 150,000 positions by 2035. Some researchers hope that robots will be able to bridge this gap in the near future, thereby helping to solve the problem in part. Human or machine? Many consider this a crucial question—one with major ethical implications.

Emma Learns Over Time

In Kiel, the residents are sitting on chairs placed in a circle facing inward—Emma is at its center, inviting them to dance. “Of course I can dance,” Emma says. “Pick something you’d like on my screen.” The old women stand up to the opening tones of the Snow Waltz, find a dance partner—whether nurse or fellow resident—and dance and bob in the rhythm of the three-quarters time. The robot politely thanks them after the dance has ended. Gertrud, a resident here, enjoys the diversion: “I like it when Emma comes by. It brings us joy.”

Emma’s real name is Pepper. The Japanese company SoftBank manufactures the robot: priced at around 17,000 euros, plus costs for the software and maintenance. “Emma’s total costs for customers can run between thirty and forty thousand euros,” Eilers says. The robot didn’t have to be subjected to any additional safety tests because it’s already been approved for use as an electronic device.

Eilers and his computer science students are Emma’s teachers. They write the software and develop the robot’s skills. Over time, the robot’s artificial intelligence allows it to begin learning on its own. For instance, Emma has learned to read facial expressions, assign emotions to them and react accordingly. A conceivable future for home nursing care has begun in Kiel, with this plastic figure full of computer chips and a hard drive instead of a heart.

“Not all of the employees were immediately ­impressed”

Eilers isn’t the only one setting great hopes on robots. Scientists at the University of Siegen are also researching potential applications for Pepper and regularly bring it to a retirement home, where it routinely leads Tai-Chi exercises. Up in the north of Germany, Eilers brings Emma to a variety of social institutions to demonstrate the capabilities of the 120-centimeter-tall robot with a tablet hanging from its neck. Eilers discusses in advance with the nurses and residents what exactly it is that Emma should do. Which songs, which games—it is all worked out in long discussions beforehand. Emma and Eilers learn more with every visit. Early on, for instance, the residents in Kiel were bothered by the fact that Emma was too lightly dressed as she rolled through their shared apartment. Since then, Emma wears a scarf in addition to the tablet.

Ingrid Fritsch at the Diakonie Altholstein, a Protestant social welfare organization, runs the group home in Kiel. “Not all of the employees were immediately impressed with Emma,” she reports. But they have since come to see Emma as welcome support. The nurses are able to complete other tasks while Emma is entertaining the residents. “Looking at it this way, you could definitely say it relieves some of the stress,” Fritsch says.

In the apartment in Kiel, in the meantime, Emma has the residents involved playing a game. The goal is to identify animated rabbits on the tablet’s display and quickly “capture” them by pressing on them, and Gertrud plays it every week. “She’s getting better and better,” the nurses say. The rabbits appear faster and faster on the screen, yet almost none escape her. “Well done,” Emma says, “you’ve captured 226 rabbits.” Experts say that even this simple rabbit game can actually strengthen dementia patients’ self-confidence and promote their cognitive abilities as well as their ability to focus. “Our concept for Emma works particularly well for people with dementia,” Eilers explains, “because they have no reservations at all about the technology.” Yet he doesn’t think that Emma will ever be able to completely replace people in nursing care.

A Huge Market Beckons

In fact, care robots quickly reach their limits. They have mastered mostly what we would call a person’s soft skills: politeness, entertainment, pre-programmed dialogues and games. Truly autonomous tasks overwhelm them. Eilers admits, “Robots have only been used to a very limited extent so far.” However, researchers around the world are working to change this. After all, a huge market beckons. In Japan, robots are already distributing medications in hospitals. The Helpmate transport robot or the Care-O-bot 4 from the Fraunhofer Institute for Manufacturing Engineering and Automation can be used to fetch objects or to remind people to take their medications. Even if many robots have only just reached the prototype phase, they already make fewer mistakes than people do.

Hans-Joachim Böhme, professor of artificial intelligence at the Dresden University of Applied Sciences, is developing his own care robots and makes a rough distinction between two types of robots. One type is suitable for jobs such as night watchman, while the other type can support therapeutic concepts. The first group of robots could for instance help compensate for understaffing on night shifts and reliably monitor patients. Robots in the second group could provide therapists with long-term support.

Böhme uses MAKS Therapy, developed by Prof. Elmar Gräßel at Erlangen University Hospital, in order to advance it in collaboration with additional partners and to expand the field of robot assistance. His robots are methodical, practical, cognitive and social in dealing with dementia patients. The robot accompanies therapists six times a week to have the patients perform tasks, to train them, to stimulate them and, as Böhme says, to help them achieve real empowerment. This is why he firmly believes that robots can do much more than just entertain.

Yet it could take years before the visions of therapy robots or tireless night-watch robots become reality. Jens Kahl, a social worker in Kiel, says, “I’m certain that Emma will never be able to replace us.” He’s currently preparing lunch—they’re serving meatloaf, carrots and boiled potatoes today. While he does this, the residents are playing Memory with Emma. “Do you see a cat?” the robot asks. Gertrud unerringly presses the animal that is visible on the screen. “Correct! You’re very clever!” Emma says. It’s a strange scene, but Gertrud smiles, happy about the praise.

In Japan, Pepper-type robots have long been a part of everyday life. They greet people in hotel lobbies, advise consumers in shops or fetch drinks in bars. They are also used to a greater extent in retirement homes—like Germany, Japan is struggling with the demographic trend of an aging population. However the focus in this Asian country is on technology’s benefits, and the state gives generous amounts of money to universities for research.

More than Just a Money Saver

At Toyohashi University of Technology, scientists are researching the automation of working processes. They’re working on robots to help people walk or to lift and transfer patients from one bed to another. Yet the robots have a very difficult time lifting and turning a person—no prototype for this has yet reached the level of mass production. Another project is the chest-high Terapio robot, which is designed to automatically display a patient’s medical file when a doctor takes it along on her medical rounds. Terapio speaks with the patients and displays the results of the electrocardiogram, urine and blood samples beforehand. The robot can also record the conversation between the doctor and patient. Terapio, however, is still purely a research project.

In Europe this topic is also picking up speed. In the “Am Schärme” retirement home in Sarnen, Switzerland, the residents have become very well acquainted with robots by now. Pepper was there, as was the robot seal Paro, which looks like a child’s soft toy and interacts with the residents. Paro can squeak, express contentment and patiently accept cuddles.

Here, questions about the ethics of it all are being asked. The French researcher Jérôme Monceaux is founder and CEO of, which makes artificial animals. He helped co-develop the Pepper generation and is convinced that a robot must be able to do more than just “save money and increase profits.” This is why Monceaux wishes to create a completely new type of artificial intelligence. His new robots will be more emotional and more natural than today’s models. “The interaction between people and machines must serve human relationships,” he says. In other words, the technology must adapt to people and not the other way around.

In Kiel, Emma is playing a last song, this one from a local duo called Klaus and Klaus who were popular back in the day. “On the North Sea coast on the flat German shore, the fish are in the water and seldom in the store.” The residents clap and sing along even louder than they did to Freddy Quinn. Then, with hands on the shoulders of the person in front of them, they form a conga line that dances through the dining room, past the kitchen and then back to the living room. It’s a little bit of zest for life that Emma triggers with the song. As the music from the robot finally comes to an end, the apartment residents sink back into their chairs. They look very happy.