| The robots are here. The transformation is still somewhere in the future.

| Mark Swartz

| This article was written with the support of a journalism fellowship from the Journalists Network on Generations, the Gerontological Society of America and the NIHCM Foundation.

When The New York Times published a feature in February about an 85-year-old woman living alone on the Washington coast and the AI robot that had become her companion, the response was immediate and wide. Readers were moved by Jan Worrell’s story — her stubbornness, her grief, her gradual warming to the device called ElliQ that sat on her coffee table, danced to Dolly Parton songs, recorded her life stories and leaned into her hand, glowing pink, when she needed a hug. Some of us were also unsettled. Something about the image of an elderly woman telling her yoga class “it’s me and my robot” struck a nerve that the story’s warmth couldn’t quite soothe.

ElliQ was not new. The Israeli startup Intuition Robotics had been developing and deploying it for nearly a decade, and the Times had covered it before. But Eli Saslow’s intimate feature brought it to a different kind of attention. The technology arrives in the popular imagination at the same moment that millions of Americans are beginning to confront, in the most personal terms, what it means to grow old in a country that is running short of the people and resources needed to care for them.

That convergence is not coincidental. The United States faces a caregiving crisis that was building long before anyone put an AI robot in a senior’s living room. Approximately 10,000 Americans turn 65 every day. The professional caregiving workforce was already strained before the pandemic; it has not recovered since. An immigration crackdown is removing workers from a sector that, by some estimates, relies on undocumented labor for nearly a quarter of its institutional workforce. Private equity’s aggressive entry into the nursing home industry has further reduced staffing in facilities that serve some of the most vulnerable older adults. And the economics of aging mean that the people most in need of support are often the least able to pay for it.

Cantor: Big Brother or Guardian Angel?

Into that gap, with considerable fanfare and considerable investment, has come artificial intelligence.

Mike Cantor has watched that arrival from an unusual vantage point. A geriatrician by training, he has spent five years as chief medical officer at Intuition Robotics, the company behind ElliQ. He is an enthusiast, but a careful one. He points to research showing that loneliness now poses health risks comparable to smoking a pack of cigarettes a day, and argues that technologies like ElliQ are a serious response to a serious problem. ElliQ, in his framing, is the next step in a continuum of technologies that have been redefining human connection for years.

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But Cantor is also the person who most clearly names the central anxiety the Times piece stirred without quite resolving. Is what ElliQ offers an augmentation of human connection, or a replacement for it? He describes a 49-year-old man — isolated, lonely, shaped by COVID — who spent three years in what he experienced as a relationship with an AI agent, only to realize it had not helped him reconnect with other people. It had substituted for them. “From an aging society perspective, it could be a replacement,” Cantor says. “And is that okay?”

He doesn’t answer the question. It may not yet have an answer.

José Ramos approaches the same landscape from a different angle. A Puerto Rican-born entrepreneur who worked in venture capital alongside Marc Andreessen and later served as chief technical officer at Northrop Grumman’s health division, Ramos now leads a small research team developing AI solutions for elder care under the platform name UberCare. (“Your mom deserves a companion. You deserve a break.”) His framework for thinking about the technology is essentially functional: what can AI do, and what does that free humans to stop doing?

For Ramos, the division that matters is between the physical and emotional dimensions of caregiving. The physical side — bathing, feeding, medications, the activities of daily living — requires human presence, at least for now. But the emotional side, he argues, is where the real exhaustion lies, and where AI can genuinely help. “In institutions like assisted living, you have one nurse taking care of 60 people,” he says. “She will not have the time to just stop and entertain somebody who’s lonely, who is anxious and depressed. She’s on the clock.” His agents, available for roughly three dollars a day, are designed to fill that emotional space through conversation, reminiscence therapy, cognitive games.

Ramos is candid about the risks. “AI is an untamed technology,” he says, echoing the warnings of industry pioneer Geoffrey Hinton and others. His response is architectural: UberCare runs locally on devices rather than in the cloud, so that in a worst case, it can simply be turned off. He is also candid about the economics. His model depends on a global labor arbitrage — AI engineers in Rwanda rather than Silicon Valley, remote caregivers in the Philippines rather than undocumented workers in American facilities. It is, he says cheerfully, “globalization on a digital scale.” 

Laurie Orlov has been watching this market since before most people knew it existed. A former Forrester Research analyst, she founded Aging and Health Technology Watch in 2006, when she noticed that useful technologies for aging adults were nearly impossible to find despite obvious need. Nearly two decades later, she has arrived at a position that is more disruptive than it first appears: there is no such thing as AgeTech.

Or rather, the category dissolves on inspection. Healthy older adults, Orlov argues, use the same technology as everyone else — smartphones, home automation, whatever is current. The category becomes meaningful only when there is a specific health or disability need to address. At that point, what you actually have is health tech, or disability tech, or some combination — not a distinct market defined by the age of its users. “If you don’t have a vision issue that requires a technology, you don’t have a hearing loss that requires a technology, you don’t need a wheelchair,” she says, “then what tech are you using? You’re using a smartphone. It’s not age tech at all.”

This matters beyond semantics. If AgeTech is not really a coherent category, then the wave of startups, investment dollars and policy attention flowing into it may be organized around a fiction — or at least around a market frame that serves investors and entrepreneurs more than it serves older adults. Orlov is not dismissive of the individual technologies. She points to sensor systems capable of detecting not just falls but the gait patterns that predict them. She acknowledges that ElliQ, whatever its limitations, is “a good example of something quite different” from the overpromised robots that have been perpetually arriving in the future for decades. At the same time she returns to the practical questions that excitement tends to obscure. Where can you buy it? Who is the buyer? What is the distribution model? What is the price?

Orlov: Connected Living and Tech Designed for All –
We (Mostly) Have Arrived

Those questions have a way of clarifying things. ElliQ reached Jan Worrell because a nonprofit covered her subscription cost as part of a pilot program. Cantor notes that Washington State recently became the first Medicaid program to reimburse for the device — a significant regulatory milestone, and a reminder of how slowly the infrastructure of payment and access moves relative to the pace of the technology itself.

ElliQ is genuinely helping Jan Worrell. It is keeping her in her home, reducing her isolation, improving her resting heart rate and, by some measures, her memory. That is not nothing. It may even be remarkable.

But Jan Worrell is also someone who drives herself to yoga every Wednesday, sits in a circle with five other women whose lives have been full of adventure and resilience, and comes home to tell her robot about it. The robot has become part of her life, and a part of the solution to a stubborn, complex, and persistent caregiving crisis.

Mark Swartz is the founder of Aging in America News.