How can social robotics improve life in nursing homes?

According to Insee forecasts, the proportion of the French population aged 65 or over could reach, or even exceed, 30% by 2070, compared with around 20% today and 13% in 1970. This demographic transition, accompanied by an increase in the number of people losing their autonomy, inevitably leads to a rise in demand for EHPAD accommodation. However, these establishments are suffering from recruitment difficulties, due in particular to a lack of attractiveness for the professions of the elderly and a sometimes poor image, particularly at the time of the covid health crisis.

In this context, Clariane (formerly Korian), a company specializing in care, health and hospitality for the frail, wanted to find out if and how technology could help the nursing staff in its establishments. More specifically, it was interested in social robots - capable of communicating and interacting with humans - and their potential benefits for both the daily lives of EHPAD residents and the quality of working life for its teams.

The ecology of aging in nursing homes

This research took the form of a CIFRE thesis conducted by Nawelle Zaidi from 2020 to 2024 - at the height of the pandemic. The doctoral student's work involved Clariane, the Projekt innovation laboratory at the University of Nîmes and Strate École de Design, as part of the Robotics by Design Lab, an initiative supported by the Carnot TSN institute. "On the research side, our questions were broader," adds Nawelle Zaidi, now a post-doctoral researcher in design at Strate École de Design. " We wanted to study the EHPAD environment as a whole, and understand the potential impact of integrating social robots into this ecosystem. What new relationships could be established? How might the roles of everyone involved, especially the nursing staff, evolve? What uses would be desirable or undesirable? "

The thesis began with an observation of daily life in EHPAD, without a robot. The aim was to gain a better understanding of the ecosystem in order to model it in the form of an ecology - in the sense of the study of relationships between individuals and their environment - of aging within these establishments. " The aim is to consider all the human components - residents, families, staff - as well as the products - objects, technologies, furniture, etc. - and the environment in which they live, and to analyze their interactions," explains Nawelle Zaidi. This preliminary work is essential before analyzing the changes brought about by the addition of social robots.

The many obstacles to the adoption of robots in nursing homes

The research team has integrated six different robots, developed by several players in the robotics market, at seven different sites. Each of these robots more or less fulfilled five pre-identified uses: information, entertainment and social life, care and mobility assistance, personal safety and assistance to care staff. The aim was to understand how the ecology of aging in EHPAD was affected by the arrival of such a tool, and to observe the uses that individuals projected onto these social robots.

These experiments have confirmed the finding of limited adoption of robotic assistants, already documented in the scientific literature and explained by several factors. Firstly, the solutions employed are generic: they have not been produced for specific use in EHPAD, making them difficult to adapt. What's more, they come up against technical difficulties, such as restricted connectivity within the facility or the need to evolve within a changing environment.

However, the greatest hurdle certainly lies in their acceptability. " The imaginary world associated with robots, particularly in science fiction, often conjures up a negative image of the robot, perceived as cold, inhuman and even potentially dangerous," stresses Nawelle Zaidi. " And yet, caring for people conveys diametrically opposed values: building a relationship with the individual, a human approach, emotions... Similarly, for nursing staff, robots can be perceived as a threat likely to replace them ". In addition to these considerations, there are ethical questions, especially when dealing with fragile populations. Indeed, social robots can foster an emotional bond with their users, which can be confusing for people with cognitive disorders. So, should we let them believe in this erroneous projection, or remind them of its fictitious nature, in the name of truth?

Participatory and speculative design

To improve the adoption of robots, the researcher organized codesign workshops. The idea was to involve various stakeholders to understand how robotic products could better integrate into the ecology of aging in EHPAD. " We then quickly noticed that participants' imaginations seemed skewed," says Nawelle Zaidi. " The uses they envisaged were limited to those generally found in science fiction, or to those conveyed by the robots presented and promoted by their manufacturers. What's more, EHPAD users always positioned robots in competition with existing elements - products or members of staff - rather than finding totally new uses for them. "

To open up the field of possibilities, the research team turned to a speculative design methodology. " The aim of this approach is to break down barriers and encourage participants' creativity," explains the researcher. " It 's no longer just a question of imagining how current robots can meet present needs, but also of envisioning the possible futures of robotics, going beyond probable futures to provoke discussion and debate. In short, the approach is closer to science fiction, but based less on written narratives than on design proposals, like tangible prototypes enabling immersive experiences. " This method was first applied in the form of participatory workshops involving a wide variety of people to enrich exchanges: EHPAD residents, families, care staff, Clariane head office employees, and design students.

The proposals gathered were then reworked to integrate them into an original format: a fictional documentary, featuring diegetic objects (i.e. belonging specifically to the fictional world they help to characterize) such as a non-humanoid robot prototype, the front page of a robotics journal, or a government website promoting the use of these robots. " We interviewed various stakeholders, asking them to project themselves into an imagined future based on the ideas gathered during the workshops," describes Nawelle Zaidi. " Thus, EHPAD residents, families, care staff and members of Clariane's digital innovation team were invited to recount their daily lives in this fictional environment, populated by robots potentially capable of doing everything. " The screening was therefore an opportunity to imagine the influence that such an imaginary context could have on the ecology of aging in EHPAD, while at the same time drawing on testimonials rooted in the current reality of these establishments.

Breaking out of a technocentric vision

This unusual approach was welcomed by participants because of its playfulness, encouraging them to unleash their imaginations. In this sense, Nawelle Zaidi's thesis confirmed the value of adopting new design methodologies for innovation. " The next step would be to show the fictional documentary to other audiences, such as decision-makers at Clariane or robotics manufacturers," adds the researcher. " We might even not immediately indicate that it's fiction, in order to provoke more debate and push thinking about the design of devices that are truly adapted to the field. "

The work undertaken has also highlighted the vital importance of a participative approach in the design of technological products for nursing homes. Indeed, it seems essential to involve all stakeholders - residents, care staff and families - well before considering the use of any technology. " You can't just parachute a robot into a nursing home, adapt the way it works and expect to solve all the problems that way," insists Nawelle Zaidi. " You first have to understand the ecology you're addressing - in this case, that of ageing in EHPAD - before devising the most appropriate solutions, which don't necessarily correspond to those already developed. So it's not just a question of gathering the needs of the individuals concerned, but also of co-constructing with them. Only then will we be able to develop products that really help people to age better, and that are more - but probably not totally - acceptable.