The growing importance of AI and robots in elderly care

More and more people require nursing care. However, there is a growing shortage of staff to provide this care. There are many reasons for this: a shortage of skilled workers, high rates of people leaving the profession, a rapidly ageing society and a continuing shift in responsibility for care from families to professional institutions. Can artificial intelligence offer a sustainable solution and alleviate the care situation in the long term?

According to the Federal Statistical Office, the demand for nursing staff is expected to increase by a third between 2019 and 2049. At the same time, there is a threat of a massive shortage of qualified specialists. According to estimates by the German Nursing Council, this would amount to around 150,000, and in ten years this figure could rise to one million.

Can artificial intelligence help close the gap?

In December 2024, the Federal Ministry of Health published the brochure ‘AI meets health’. In it, it presents initial approaches for nursing care, such as documentation aids and intelligent assistance systems.

The ministry is already funding ETAP. Since 2022, the project has been testing an AI system in nursing homes that detects falls, immediately sounds an alarm and generates a case report. A two-stage mixed-methods study will then examine whether this partial automation can save time, shorten documentation tasks and noticeably reduce the workload of nursing staff. If this is the case, ETAP will prove that artificial intelligence could already take over routine tasks today – an important milestone on the road to the widespread use of care robots in nursing homes. Testing is expected to be completed by the end of this year.

The Federal Ministry of Education and Research also wants to drive developments forward. The Fraunhofer Institute is leading the ViKI pro (Versorgungsintegrierte Künstliche Intelligenz im professionellen Pflegeprozess, or care-integrated artificial intelligence in professional care processes) project to develop a web application that will enable care professionals to accurately record the needs of their nursing home residents and plan appropriate measures. The focus is on ‘mobility’ and ‘pain.’ The AI is fed with digitised specialist knowledge that learns from every documented measure. In this way, practical experience flows directly into the planning of measures. This saves time, conserves scarce human resources and at the same time improves the quality of care in inpatient facilities. It remains to be seen whether the AI-implemented solution will prove viable in everyday use. Results are also expected here by the end of 2025.

First humanoid robots with AI technology already in use

It can talk, gesticulate and react to facial expressions – the humanoid robot Pepper has been undergoing trials in care facilities since 2019. What began as an entertaining experiment is now being scientifically investigated: researchers at the BTU Cottbus-Senftenberg are examining how Pepper needs to behave in order for older people to interact with it. On his large display, senior citizens can choose from categories such as ‘entertainment’, ‘current events’, ‘brain training’ and ‘exercise’. Pepper then conducts quiz rounds on his integrated screen, suggests songs to sing along to or movement games. The ROBUST (Robotics-based Support for Prevention and Health Promotion in Residential Care Facilities) project is currently investigating the effect of Pepper on mental and physical health promotion in residential care in selected nursing homes in North Rhine-Westphalia and Schleswig-Holstein. The data collected aims to identify potential for long-term use and further applications.

The social robot Navel from the Munich-based company navel robotics was also initially used on a trial basis. Since January 2024, it has been used as a permanent daily companion in the first facilities for senior citizens. The robot with human-like features costs almost 30,000 euros. It runs on a Linux system and uses simple image processing (ten images per second) to recognise the face, mood, head and gaze direction of its counterpart. Equipped with a 3D microphone, it listens to them and transmits what is said to a cloud for speech recognition. There, an AI-supported dialogue system creates its response, which it then reproduces in a very natural-sounding Acapela voice with synchronised lip movements. Thanks to a depth camera and motors, the little robot navigates safely through the facilities and keeps a respectful distance from the residents. With its cute 3D display button eyes, it can blink and, together with its woolly hat, which is part of its standard equipment, it looks pleasantly human-like. The childlike, cuddly Navel, whose name can be customised by the facilities, always shows a friendly side. He engages in simple conversations and responds to sensitivities or everyday questions as empathetically as possible. Telling jokes, singing songs and reciting poems are also part of his repertoire. The residents often tell him their life stories. This creates opportunities for more intensive interaction. If Navel doesn't know the answer to a question, he likes to sidestep his ‘uncertainty’ with a counter-question: ‘Shall I tell you another joke?’ Although he is certainly no substitute for real human closeness and relationships, he can serve as a substitute when carers don't have the time.

Assistance for carers and those in need of care

In the long term, social robots should be able to do more than just activate or entertain people in care facilities. So-called assistance robots already exist. The technology is based on what we know from industrial robotics. They can lift and transport things. Robots of this type are already in use in Swiss care homes and hospitals.

The AIREC care robot, which has been undergoing testing in Japan since March 2025, goes one step further. Japan is by far the most rapidly ageing country among the industrialised nations: in 2023, almost 30% of the population was aged 65 or over. The 150-kilogram robot with integrated artificial intelligence is designed to take on tasks that often push nursing staff to their physical limits, such as lifting or turning people in bed. Fine motor skills such as putting on socks or assisting with daily personal hygiene are also on AIREC's training schedule. However, the demands placed on a robot in nursing care are significantly more complex than those in industry. Pre-programmed sequences are sufficient there. In nursing care, however, adaptation is key: every movement must be sensitively tailored to the situation and the individual. The robot must grip securely – but never too tightly. It must be able to help without causing harm or injury. AIREC therefore uses a learning system that uses sensors and deep neural networks (deep learning) to analyse movements, plan ahead and precisely dose the necessary force. The developers expect the market launch in 2030 at the earliest. The estimated entry-level price is around 70,000 dollars.

China is also preparing for the coming care crisis – with state-led research and development for AI-supported robotics. Companies such as Ubtech Robotics and Unitree are working flat out to perfect humanoid helpers – including for domestic use. In the long term, care and assistance robots are likely to provide support not only in nursing homes but also in private households. It will probably be some time before they are ready for series production in living rooms. However, one thing seems clear: a new industry is emerging. Similar to buying a car, in the foreseeable future we could configure individual equipment packages for our care assistants from sensors, circuits and learning algorithms.

Small AI solutions with a big impact are already taking effect

While large-scale solutions are still a long way off, small ones are already having an impact. Examples include the therapeutic robot seal Paro and the assistance robot dog Xiaoxi. Both impressively demonstrate how an emotionally effective relationship between humans and machines can develop. In the case of robot dogs and with regard to physically impaired senior citizens, this also means no walking, no feeding, no cleaning. All these four-legged friends made of material and technology need is electricity and occasional updates. Perhaps they will become furry door openers that build trust where technology is often met with rejection.

In general, people living and working in care facilities seem to be positive and open-minded about physical AI. At least that was the finding of the recently published trend study ‘Care 2024’. According to the study, what is lacking are clear commitments on the financing and regulation of AI in care.

Text: Alexa Brandt