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Abstract
This article explores the attempted introduction of a lifting robot called “Hug” into an elderly care home in Japan. As demand for institutional elderly care in Japan escalates due to population aging and a move away from familial care, the shortage of professional care staff is also intensifying. Attributing this shortage partly to carers’ endemic back pain, the Japanese government and corporations have poured resources into developing high-tech robotic lifting devices. Yet contrary to their expectation, many Japanese caregivers seem reluctant or even hostile to the idea of using such devices. I use fieldwork data to explore why this is the case, and find that lifting is situated within a practice of tactile, joking care aimed at ensuring anshin (安心; “peace of mind”) for both care staff and residents. Mechanical replacement of this tactile connection was strongly resisted as “disrespectful” by care staff.
Acknowledgement
I would like to thank both X and the care staff and residents at Sakura, as well as Prof. Matsumoto Yoshio and the robotics engineers at AIST, without whose kind assistance my research would have been impossible. I would also like to thank Profs. Gonçalo Santos and Izumi Nakayama at the University of Hong Kong, the STS PhD workshop group organized by Wakana Suzuki at Osaka University’s Anthropology Department, and Russell Henshaw, for their helpful comments on earlier drafts of this article. The anonymous reviewers also provided many invaluable comments that greatly improved my manuscript.
Notes
1. This is a tokuyō (tokubetsuyougoroujinhoumu; 特別養護老人ホーム), one of several types of elderly care facility in Japan established under the 1963 Law for the Welfare of the Elderly, and is funded through the Long Term Care Insurance system. Although the direct translation is closer to “special elderly nursing home,” I have translated it as “public elderly nursing home” in order to avoid possible confusion that might arise from the use of the word “special” (it is in fact a common type of care facility), and to emphasize the fact that the home is publicly funded.
2. The term “carer” is used here to refer to institutional care staff (kaigoshokuin; 介護職員) at the home. Carers are responsible for duties such as helping residents to dress, taking them to the toilet, helping them wash and take a bath, serving them meals, entertaining them, giving out medicine, and doing transfers (see note 3). It is important to differentiate carers from nurses (kangoshi; 看護師) at the home, whose job includes arranging and checking the medicine to be given out, monitoring blood pressure and other vital signs, and assisting the doctor on his rounds.
3. In this article I use the terms “lifting” and “transfer”; the Japanese terms used by carers are toransu (トランス), ijou (移乗) and idou (移動). Transfers involve lifting elderly care recipients and transferring them between wheelchair, bed, and toilet, and may be done by one or two carers (in cases of a heavy resident or one who is difficult to carry). Lifting can also include lifting residents who are slumped in their wheelchair into a more upright position.
4. See, for example, a report by a publicly financed organization, the ATA (The Association for Technical Aids Citation2015). Although my survey did not specifically ask carers to specify the cause of their back pain, all carers I asked linked their back pain to the lifting of residents.
5. Cf. The Association for Technical Aids Citation2015.
6. Formerly often referred to as “no lifting” policies. The first such piece of legislation was passed in the UK in 1992 in the form of the Manual Handling Operations Regulations, which obliges employers in all industries to avoid or reduce the need for employees to manually lift any load where there is a risk of injury. This is interpreted, for example, on the website of the UK’s Royal College of Nursing (as of 6 June 2017), as follows: “No-one should routinely manually lift patients. Hoists, sliding aids, electric profiling beds and other specialized equipment are substitutes for manual lifting. Patient manual handling should only continue in cases which do not involve lifting most or all of a patient’s weight.” An ISO standard for “Ergonomics – Manual handling of people in the healthcare sector” (ISO/TR 12296:2012) was created in 2012, which further aimed to provide guidelines on identifying risks and problems associated with patient handling and applying strategies to address them.
7. The National Institute of Advanced Industrial Science and Technology, a leading Japanese public research institute.
8. Interview, 5 June 2015.
9. For example, both the Japan Industrial Safety and Health Association and the National Institute of Occupational Safety and Health, Japan, have published guidance documents on preventing back pain among carers. However, these efforts have met with limited success, as most care homes in Japan continue the practice of manually lifting residents.
10. AMED (the Japan Agency for Medical Research and Development) is a recently created cross-ministry agency in charge of all state medical research projects.
11. This is based on interviews I conducted with robotics engineers at AIST in 2016.
12. The term “robot” is applied rather loosely in this context by government agencies such as METI, and in fact there is no universally accepted definition in Japan.
13. As envisaged, for example, in the 2007 government strategy paper Innovation 25 and its accompanying science fiction story of the “Inobe” family’s embrace of robots, or in books such as “Robots are friends!” (ロボットは友達だ！) by Kobayashi Hisato (1999) and “Robots will save Japan” (ロボットが日本を救う) by Nakayama Shin (2009) (as in Robertson Citation2007; Wagner Citation2010, Citation2013).
14. “Resistance” here is used in the vernacular sense and is not intended to refer specifically to more specialized usages or theorizations of the term in political anthropology or STS.
15. Interview, Prof. Matsumoto Yoshio 11 May 2016.
16. The names of the care home, carers, and residents are pseudonyms to protect anonymity. All translations from Japanese are my own.
17. Staff use the term “users” (riyousha; 利用者), equivalent to “service users” in English, to refer to care recipients at the home. However, due to the potential ambiguity of the term “users” in the context of introducing technological devices which are used by both residents and staff, I mainly refer to them in this article as “residents.”
18. Permanent residents are those who live in Sakura continuously for the rest of their lives; short-stay residents visit temporarily during periods when relatives are unable to care for them.
19. The exact number of residents and staff at Sakura fluctuated slightly during my fieldwork period.
20. This includes lifting from bed to wheelchair, wheelchair to toilet, toilet back to wheelchair, wheelchair to bath, and so on, as well as lifting residents up in their chairs.
21. This is a rough scale intended only to provide an indicative level of back pain.
22. It is important to add the caveat that staff members may not have felt that back pain alone was an “acceptable” reason to give for resigning.
23. Interview, 27 March 2017. This interview was conducted at Fuji’s offices with members of the business development department during meetings to arrange the lending of a trial model of the Hug.
24. I base this conclusion on separate fieldwork I conducted at AIST for three months in 2016, as well as the numerous academic papers by robotics engineers on robot care which frequently do not mention caregivers.