By Jack Cumming
Staffing ratios have been much in the conversation about how care facilities should be regulated. The notion is that more care workers per patient is positive and that, therefore, care homes should be required to meet minimum staffing numbers.
Better would be a requirement that care providers meet quality, safety, and effectiveness standards. The mission for care is the well-being of those cared for. Mere staffing may not always be the best approach.
Mandated staffing ratios ignore the potential of emerging technologies. Let’s instead improve the quality, convenience, cost, and effectiveness of all we do, including caring for the frail and failing. This is a pressing opportunity for proactive advocacy by the trade associations that serve senior living. Aging people can benefit from progress, and trade associations are in the best position to help legislators and regulators better understand what’s possible.
Just One Example
Take something as common as the need of a resident (“patient” in medical parlance) for a two-person transfer. Transfers may be from a bed to a gurney, from a bed to a wheelchair, from a wheelchair to a chair, or from a wheelchair to a toilet.
The need for two people arises when the resident is too weak, unsteady, or otherwise unable to move safely or if the resident is overweight, unable to cooperate, act predictably, or bear weight on both legs. The purpose of requiring two people to assist with the transfer is to promote safety and prevent staff injury.
Obviously, such a transfer requirement directly affects the need for staffing, though automation can help alleviate such a need as well as help with bedsore wound avoidance. It’s not hard to imagine mechanisms or devices that might be devised to address these challenges. Japan, which has a much higher proportion of older people than the U.S., is already ahead in adapting to the need to assist older people with fewer staff.
Automation Barriers
We can ask why such automation is not more available in the U.S. After all, we pride ourselves on being technologically advanced. Several possible barriers come quickly to mind, though these are purely speculative. Here are a few such speculations:
- An industry that prides itself on its personal touch approaches automation with skepticism.
- Many eldercare functions are treated as medical, requiring expensive, delaying regulatory approvals.
- Other markets for inventive creativity are more promising and lucrative than eldercare.
- Mandated staffing ratios inhibit technological solutions that might provide better care at lower cost.
Obviously, the list could go on. The economic culture in the U.S. has long emphasized jobs as essential, though robotics and artificial intelligence may change that in the near future. The jobs culture is a byproduct of the industrial revolution, which is now giving way to the robotic revolution. Still, the mandating of staffing ratios may reflect the prevailing political belief that creating jobs is economically positive.
Change Takes Time
We’re only at the very beginning of a new age of labor transformation. We’ve already seen how it’s taken thirty years for society to absorb the benefits of the internet. Only now, for instance, is streaming replacing previous broadcast technologies. More and more productive efforts are now delivered remotely. Change takes time and is nearly always slower than anticipated.
In the meantime, the most constructive thing that might be done would be for the industry’s advocacy associations, LeadingAge and others, to proactively encourage automation. The emphasis should not be on staffing ratios or on merely opposing staffing ratios. The emphasis should be on improving the quality of life and care for those adversely impacted by age-related inabilities.
Realistically
We also need to be realistic. Automation can help free staff time to provide better personal interactions, but the telling impact will result in a reduction in staff. That will then free people for more meaningful work in other callings. A number of social programs have been proposed to help with the transition from jobs to meaning, but that challenge is beyond the scope of this article.
Robotics and artificial intelligence are likely to directly impact the affordability of providing care in institutional settings. They also seem likely to enable better care at a lower cost. Employment generally will probably be more meaningful for those staff members who adapt and remain. That’s been the case historically as technology has disrupted other industries.
Aside from technology’s ability to improve corporate caregiving, however, its bigger effect is likely to be in allowing aging people to stay longer in the general community without needing senior living as we now think of it. That is in evidence at the 2026 Consumer Electronics Show, where AARP is showcasing numerous initiatives to improve the consumer’s aging experience. Click for the agenda.
The overriding mission of the senior living industry, its regulators, and those it serves is to help older adults live with dignity, independence, health, meaning, security, and purpose in their communities. We do that best when we collaborate and innovate together to adapt emerging capabilities to those aims. As Dan Williams puts it in his recent Turnaround book, “Residents thrive. Families find peace. Teams discover purpose. Even when the odds say it shouldn’t be possible.” Isn’t that what we all would like?
However—let’s remember that tech companies are major advertisers and sponsors of Leading Age. How can tech safely perform a two-person move?
As you suggest, there are many “tech” companies in the exhibit hall at LeadingAge meetings, but I have seldom seen any technology like that one sees at an exhibit like the Appliance and Electronics World Expo 2026 (https://youtu.be/rVHQRGw9zpQ) held recently in Shanghai. Instead, technology at LeadingAge often has a humanistic façade, with comfort automatons and proprietary electronic health records programs that are not universal or lifelong. Salespeople are more prominent than technicians.
When I compare LeadingAge’s technology initiatives with those, say, at Amazon logistics, senior living comes across as stuck in the past. With AI and robotics, the world in moving into a new era of humans being served more than the current era of human jobs. Many senior living technology professionals seldom speak of the potential for staff reductions.
One might expect technology professionals to be on top of what’s happening and to bring that know-how to help the operating side of senior living. Less formally, I would expect a technology professional to have an interest in gadgets and to have an engineer’s sense for how they work, what value they have, and whether they should be pursued.
For instance, but I’ve never seen an exoskeleton vendor at a LeadingAge meeting. Exoskeletons might replace walkers (https://youtu.be/ZlHGRdRaU_M) with all the challenges they present. Exoskeletons may be there, but they haven’t been obvious to this observer. In short, although technology could do much to improve the lives of older people, as hearing aids and eyeglasses have done, I don’t think anyone would think of LeadingAge as leading in the exploration of possibilities.
Finally, that two-person transfer. The idea is to find a way to substitute technology for people tasks to improve care and preserve patient dignity. Since senior living is not a promising tech market, little has been done to develop solutions, but here are two intriguing possibilities. First is a bed to wheelchair or commode transfer device (https://youtu.be/0-ITujqSGxA). Click here for a scientific study of the device (https://pmc.ncbi.nlm.nih.gov/articles/PMC10759809/pdf/nihms-1950683.pdf). Second, is an imaginative variation on the bidet solutions that are so common in Japan (https://youtu.be/ew8q3dg_sGU).
These are first order ideas that don’t disrupt the current design of patient facilities and care in skilled nursing. Just imagine how much more might be possible if inventive engineering reconceived the entire layout and equipage of a disabled patient’s room to meet needs like toileting assistance etc.
It’s striking that toilets have not been materially redesigned or reconfigured since Thomas Crapper first had the idea of indoor plumbing. Actually, the truth is that my namesake ancestor, Alexander Cumming, was the first to patent a design of the flush toilet in 1775. Still, Crapper’s name has stuck to the idea, and I’m grateful for that.
Obviously, limiting market for a technological device to the age limited senior market raises the cost. Cost is further increased if the device follows the costly process to qualify as a medical device. Better is to make enabling devices available in the general consumer market.
That is what the exoskeleton developer HyperShell (https://youtu.be/fszSARmwIbY) has done in its video. Why residential engagement software isn’t similarly generalized is beyond my understanding. The positive potential for humans is vast. All that’s needed is imagination, capital, and practical implementation.