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LONDON: The future of nursing homes may depend on augmenting staff shortages with intelligent robots.

Arshia Khan asked a group of older adults in Minnesota what they would like in a nursing home, and their answer surprised her. They wanted standup comedy, but not just any comedy: They wanted off-color jokes.

Dr. Khan, a professor of computer science at the University of Minnesota Duluth, programs robots to work in nursing homes.

On a March afternoon in her lab, surrounded by a dozen robots of different sizes and designs, Dr. Khan asked one to show off its stuff. The robot, a four-foot-tall white plastic figure named Pepper, with a tablet screen in its chest, blinked its eyes and wiggled its hips.

“So, which one of you requested the dirty jokes?” Pepper asked, in a computer voice.

There followed a risqué joke about the robot’s relationship with its charging plug, and another about an unhappy date with a Tesla (too conceited). After each, the robot giggled. “I went on a date with a Roomba last week,” the robot said, gesticulating with its arms. Pause. “It totally sucked.”

Later this year, pending approval from the university’s institutional review board, 16 of Dr. Khan’s robots will go to eight nursing homes around the state — though without the off-color jokes.

The robot program in Duluth is just one of several newly energized efforts to use robots and other technology to solve some of the problems in nursing homes and assisted living facilities — or to help people stay out of them. The trend began before the pandemic, but COVID-19 gave it new urgency.

Since the start of the pandemic, more than 200,000 residents or workers at long-term care facilities have died of the coronavirus, and those who survived had to cope with extended isolation from their families.

This has left an existential problem for facilities for older adults: People don’t want to live there, don’t want to work there, and don’t want to place their parents there. Since 2020, more than 300 nursing homes have closed, said Mark Parkinson, president of the American Health Care Association, a trade group that represents 14,000 nursing homes and assisted living facilities. More than 400,000 workers at long-term care facilities have left the profession, according to the U.S. Bureau of Labor Statistics.

Nursing homes are seeking more money from the federal and state government. But in the meantime, some operators are looking to robots to help fill a critical gap.

New waves of technology and services have already arrived in homes, boosted by a pandemic that dissuades human contact that could be deadly. There are touchless delivery of meals or groceries, video doctor visits, smart speakers, home monitoring devices and even smart toilets.

“Virtual assisted living is already here,” said Joseph F. Coughlin, who runs the AgeLab at the Massachusetts Institute of Technology. “Robots are going to play a major role in reminding us to take our medications, keeping us socially engaged, helping us if we fall and can’t get up, navigating getting food delivered to the home. Toilets will give you a checkup a day and tell you if you’re not taking your pills or getting nutrition. Pretty soon your toilet will be talking about you.”

He pointed to new products and services at Best Buy and Amazon to make highly sophisticated health care monitoring devices accessible to people who may not be tech wizards. For $20 to $30 a month, Best Buy offers senior-friendly mobile phones that detect falls, tie in with hospital systems, access electronic medical records and provide one-touch connection with the company’s 1,400-member call center, which can contact doctors, order a car from Lyft and alert the owner’s caregivers. Last year the center took 9 million calls from 1 million users, said Deborah Di Sanzo, president of Best Buy Health.

In Japan, which has the world’s oldest population, robots have long been used in long-term care, including robotic exoskeletons that enable caregivers to lift frail elders. In the United States the progress has been slower.

An early arrival was the robot Stevie, designed at Trinity College Dublin in Ireland, which began a two-year trial in 2018 at Knollwood Life Plan Community in Washington, D.C.
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Stevie told jokes, played bingo, led karaoke and used stories and music for reminiscence therapy. To help with infection control, it could go into rooms carrying ultraviolet lights that killed germs on surfaces.

Residents loved it, said James Michels, vice president of development at Knollwood. Some staff members feared it was meant to replace them.

“Residents felt they were a part of something new,” Mr. Michels said. “Caregivers needed to understand that it was meant to be a research tool for them, not a replacement.

Stevie made the cover of Time magazine, but the facility’s grant ran out just before the pandemic, and the robot has not returned. Such are the promises and present realities of robot care.

Dr. Khan and her team in Duluth — which includes ethicists, cardiologists, urologists, psychologists, philosophers, nurses and graduate students — hope to pick up where Stevie left off.

“The pandemic has given us a jump start and opened up our minds to using technology more than we used to,” Dr. Khan said. “Before the pandemic, people weren’t as accepting of robotics. When I started applying for grants, the reviewers were saying things like, ‘She’s going to unleash her robots on these poor, vulnerable people.’”

With $2 million from the Minnesota Department of Human Services, Dr. Khan plans to place two robots in each of eight nursing homes operated by Monarch Healthcare Management, a for-profit company that has about 40 homes around the state. One robot, a two-foot-tall model called NAO, priced at about $12,500, will lead classes in yoga, tai chi and strength training. The larger robot, Pepper, which costs about $32,000, will socialize, tell jokes and play games with residents.

In her basement lab, Dr. Khan asked a Pepper robot to launch its program for reminiscence therapy.

“Hi, I’m Pepper,” the robot said. “I hope you are having a wonderful day. Would you like to relive some of your memories from the past?”

“Yes.”

From a selection of topics, Dr. Khan chose “Wedding.”

“Great,” the robot said. “Remember the day you got married? It’s been 52 yrs. That’s a really long time. So much must’ve happened since then. Do you remember, it was the summer of 1970 and the weather was great. The ceremony was beautiful, and the food, it was amazing.”

On a screen mounted on its chest, the robot showed images from a generic wedding, loaded for demonstration purposes. (Later, the images and music, along with the text, will come from residents’ actual lives.)

Alexis Elder, a philosophy professor and ethicist who works with Dr. Khan, said the use of robots in nursing homes raises a range of ethical issues. Who should get access to the robots’ extensive monitoring data — only the residents and doctors, or should their families also have it? And will the robots ultimately diminish human-to-human contact, an essential part of care?

The robots also carry associations of gender and ethnicity, Dr. Elder said. “Most robots are white-presenting, and their speech patterns and vocal ranges are playing to some stereotypes on racial dimensions. I think this is going to be an interesting challenge, and really important to make progress in that area.”

On gender, she said, if the robots present as female and subservient, will residents then become more belligerent with female workers?

Even in Dr. Khan’s lab on this March day, a techno-future where robots serve many human needs seemed tantalizing, but still far away. Robots suddenly started talking unprompted, or crashed in mid-program. They seemed remarkably human one minute, maintaining eye contact and leaning into conversation, but in the next they spoke over any attempts to go off-script, lacking the functional agility of Apple’s Siri or Amazon’s Alexa. When one of the small robots fell demonstrating yoga poses, sometimes it could right itself, sometimes not.

On the plus side, unlike human workers, robots never get in a bad mood or tire of having to repeat themselves.

For Monarch, the robots’ limitations are not the point. Like other nursing home systems, Monarch has been struggling with severe labor shortages since the pandemic. Marc Halpern, the chief executive of Monarch, said the company “1,000 percent” did not intend to replace workers with robots. “But if these robots can help us fill in gaps to help meet the needs of the residents, that’s what we’re looking for.”

At RiverWoods Durham, a continuing care community in Durham, New Hampshire, a canister-shaped robot called Servi, from Bear Robotics in Silicon Valley, carries food from the kitchen to the dining area, and buses dishes from the tables back to the kitchen. The residents named it Rosie, after the robot on “The Jetsons.”

Kim Gaskell, the executive director, said she hoped the robot could someday reduce staffing needs by one worker per shift. But mainly, she said, the residents like it. “Now when grandchildren are visiting, they say, ‘Look, we have a robot,’” she said.

Residents at Covenant Living of Cromwell, in Cromwell, Conn., were getting their first look at Servi in late March. They called theirs Rover. It has two trays for carrying dishes, and sensors to keep it from bumping into people. When a reporter stepped into its path, it stopped and found a different route.

At a table in the dining room, Janet and Bill Carlson, both in their 80s, watched the empty robot glide around the room. “I think he’s kind of cute,” Ms. Carlson said. The other night at dinner, she said, the robot kept walking behind her husband and saying thank you. “And Bill kept saying, ‘You’re welcome.’ I said, ‘Bill, I don’t think we have to answer.’”

“It’s fun for me to say that we have a robot in our dining room,” she said.

At Inspir Carnegie Hill, a high end assisted living building on Manhattan’s Upper East Side, where 400-square-foot studios start at $13,000 a month — including meals — every room has a smart speaker to communicate with the front desk or control the heat and lights, and every floor has a robot that monitors the hall and can facilitate video calls to the concierge or the in-house nurse if a resident needs medical care or help with his or her apartment, said Brian Geyser, the chief clinical officer.

On a rainy morning in April, Susan Kraus, 81, a new arrival at Inspir, was having her first encounter with the robot, an Israeli model named Temi that works like an iPad on a rolling platform. “I’m game, absolutely,” Ms. Kraus said, heading into an elevator with Temi.

During the pandemic lockdown, Temi entertained residents in the hallways by playing music and dancing, and enabled video calls with residents’ families, so human workers had less contact with residents, and less chance of infection.

On Ms. Kraus’s trial run things did not start well. At the 17th-floor restaurant and lounge, where the robot was supposed to conduct a tour, it took several tries from Mr. Geyser and a representative from the distributor to get it to start up. When it finally responded to Ms. Kraus, she asked it to call the concierge.

“It says, ‘Unable to download,’” she said, looking at the screen.

Mr. Geyser said the building was still in the testing phase for some functions, clearing out the glitches. “You can see it’s all there, we just have to work on the coding and algorithms,” he said. But he added that the shortage of workers would make robots essential in the coming years. “We just don’t have enough caregivers in the country, so we have to be able to leverage robots as we move into the future.”

Perhaps someday the technology will be ready to do the work of human caregivers, but not yet.

Before leaving, I asked Temi to tell a story, as one might a smart speaker.

Temi responded: “Calling the nurse.”