The current long-term care system is ill-suited to meeting what this marketplace wants.
Seventy million baby boomers are moving past or toward the age of 65 years. Another 65 million Gen Xers are following them. A pandemic showed in unflattering detail the many things wrong with institutional long-term care. Generations are used to getting their own way, consumers to the core, and many have large amounts of wealth. Generations live longer by taking better care of themselves, benefiting from the triumphs of modern medicine and retiring earlier.
Long-term care in the United States is on the verge of profound change. The marketplace will demand it. More people than ever want to age in place. They want to stay in their homes longer, and if they cannot do that, they want to live independently in adult living communities or assisted living facilities near their children. As a result, increasing numbers of older individuals end up living alone. But the current long-term care system is ill-suited to meeting what this marketplace wants. If the major innovations are going to comprise building a few more adult housing units, sprucing up traditional nursing homes and trying to increase the number of home health aides, they will not be enough to satisfy this evolving level of demand.
That brings us to artificial intelligence (AI). Of course, there is no manufacturing or service sector on earth right now that isn’t being talked about as a potential target for AI innovation. But what do we mean by AI and long-term care?
Let’s assume many older adults will want to live at home for as long as possible. There are AI innovations already developed or under development that can help them do that. These include AI-assisted devices to monitor people’s movements around their house, wearable and implantable devices to track health status and mood, and conversational AI systems such as Amazon Alexa that provide real-time medical advice, connect individuals with their doctors and help care for patients in the home. At present, these innovations have to contend with insufficient consumer demand, the existing limited scalability and capabilities of the technology, and the higher price points required to maximize full device functionality. But these constraints are temporary. In the near future, this AI-supported home technology will facilitate many people’s abilities to live independent lives for as long as possible. I personally experienced the benefits of what a single indoor room camera, not even an AI piece of technology, combined with good home health aides and diligent children watching through that camera could do for letting my mother-in-law remain in her home well past when someone with her ailments would have done so two decades ago.
The next wave of AI technology carries with it additional promise. Imagine AI-enabled avatars in the form of caregivers and family members who can be placed in the home with an older adult, keeping them company around the clock and helping them navigate their day. They could give advice, carry on conversations, relive memories and provide emotional support. Robots could assist older adults with the activities of daily living. Smart homes could maximize safety by overseeing the usage of appliances, climate control and home security.
There will still be an important role for trained personnel who can visit the older adult’s home, check to ensure the technology is doing what it is supposed to do, fill in the gaps that the technology leaves and provide real human interaction. But the need for such personnel will vary greatly depending on how much AI is embedded in the older adult’s home.
Negative byproducts may emerge with the infiltration of AI into long-term care. Health disparities may grow worse. Some older adults will not have the means to acquire the technology, and the technology itself may amplify existing biases toward specific groups of individuals. Those not able to access AI technology will have few options but to leave their homes sooner, go into a nursing home environment, or remain at home independently but experience states such as loneliness, fear and anxiety to a greater degree. There will be AI technology sold to older adults that they do not need as the marketplace is hyped relentlessly and profit is sought. Questions will be raised about whether the technology in question accomplishes what it is supposed to do. Some AI technology will deliver great value. Other AI technology may not deliver much value at all.
But meeting the preferences of older adults and addressing the already significant staffing and bed shortages in nursing homes demands the integration of AI into long-term care. Although we cannot predict what this future will look like exactly, we must accept that it is coming to us soon. Like everything in health care, it will not be a perfect future by any means. But it also could help transform long-term care into something that is more empathetic, responsive, patient-centric and effective.
Timothy Hoff, Ph.D., is professor of management, healthcare systems and health policy at Northeastern University in Boston, Massachusetts, and visiting associate fellow at Green Templeton College at the University of Oxford in the United Kingdom. He is the author of the book “Searching for the Family Doctor: Primary Care on the Brink” (Johns Hopkins University Press, 2022).