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A super-smart society: Smart care made in Japan

12. July 2022 Published by Raphael Doerr

A Japanese filmmaker shocked audiences at this year’s Cannes Film Festival with a dystopian vision of her country in which old people agree to euthanasia to solve the problem of a rapidly aging population. The “Plan 75” – the title of the film by Japanese director and writer Chie Hayakawa – is based on a very real problem. In the film, everyone over the age of 75 is encouraged to sign a contract with the government under which they’ll receive a sum of money if they agree to be euthanized. A collective funeral is thrown in for free. Japan is the fastest aging industrialized society, a trend that’s causing enormous economic and political problems as a dwindling number of younger people has to support a growing army of the elderly. Nursing and retirement homes are expensive and few Japanese have the financial means to afford them. New smart home & care solutions are needed to enable an aging society to lead a self-determined life in their own four walls. In this blog article, we want to briefly present Japan’s Society 5.0 model and highlight current trends in the smart home & care sector.

Old, pre-old and Society 5.0

Japan’s vision of the new old “platinum society” has little in common with the publicity-grabbing images of elderly people petting little robot dogs or being put to bed by a robot nurse. In aging Japan, under 75 is the new “pre-old.” Linguistically, however, Japan is at the forefront of change. Millions of people have learned that they are no longer old, but just “pre-old,” in other words, they belong to the 65 to 74 age group. But whether old or pre-old, the problems facing Japanese society apply to almost all Western ones. Because the fact is, the world is aging. That might mean a smaller workforce and overburdened healthcare systems worldwide. The solution? For Japan, it could be an AI-powered future called Society 5.0.

The super-smart society

Japan is seeking salvation in a digital future in which, if everything goes as envisioned by those in charge, all aspects of life will be interconnected. Japan expert Dr. Franz Waldenberger believes this “super-smart society” is a utopian blueprint for “a perfectly networked, highly efficient and inclusive society that integrates the cyber world and the physical world in equal measure.”

In the Japanese government’s vision of the “super-smart society,” cyberspace and the physical world are to gel and deliver into a perfectly networked, highly efficient and inclusive society. The responsible players from science, industry and politics don’t have much time left. The goal is for people to be able to move and act free of physical, cognitive, spatial and temporal restrictions by 2050. The intention behind that is to create solutions to address the declining birth rate and over-aging of Japanese society and, in particular, the resultant labor shortage. According to the Ministry of Health, Labor and Welfare, Japan’s population is expected to shrink by a third by 2060. The result is high demand for nursing care coupled with rising costs and an increasing need for facilities to care for and look after senior citizens. Both are very difficult to finance as things stand today.

The “super-smart society” naturally also needs a “smart city” that allows all this and makes it possible. It is being established at the foot of Mount Fuji. Toyota is building Woven City, the city of the future, on a 175-hectare site.

Life in Woven City

The blueprint for the city of the future envisages citizens living in connected smart homes with sensor-based AI (artificial intelligence) to monitor residents’ health and understand and meet their needs, as well as with robots in the home to assist them and make their daily life easier. “Building a complete city from the ground up, even on a small scale like this, is a unique opportunity to develop future technologies, including a digital operating system for the city’s infrastructure. With people, buildings and vehicles all connected and communicating with each other through data and sensors, we will be able to test connected AI technology – in both the virtual and the physical realms,” stated Akio Toyoda, President of Toyota Motor Corporation.

But the reality is different. One-in-four pensioners is still in the workforce, a figure that is even one-in-two for those between the ages of 65 and 69. Together with South Korea, Japan therefore leads the world in terms of gainful employment in old age. That’s a trend the government in Tokyo is actively promoting: For example, all employees are legally entitled to continue working for their existing employer until 70, if they so choose. Pensions in Japan aren’t exactly lavish, reports the German radio station Deutschlandfunk – especially for women, who have often only worked part-time. Every one-in-five pensioners earns less than half the median income and is therefore officially regarded as poor.

Nursing care in Japan is expensive

The Sincere-Kourien nursing home in Osaka was founded in 2001 by the electronics group Matsushita and offers top-class comfort: Sprung floors reduce the risk of bone fractures in the event of falls, and raised vegetable beds on its flat roof can also be cultivated as a hobby by residents in wheelchairs. Human nursing staff provide a homely all-round service. But all that has its price: Depending on the level of care, the rent per month is between 120,000 and 260,000 yen, or about 930 to 2,000 euros. Not all people in need of care are able to pay the rent, which includes not only guaranteed care but also the latest technical innovations. Japan’s long-term care insurance (LTCI) system now partly finances some robot nurses for private households, but the majority of old people still live alone without technical aids. According to the Ministry of Health, Labor and Welfare, some 3,660,000 senior citizens are waiting for places in homes in Japan – 40,000 in the capital Tokyo alone. It openly admits that the country lacks senior-friendly housing, nursing homes and outpatient care facilities – not to mention care workers. By 2025, there will be a shortage of around 380,000 caregivers – at a time when Japan’s baby boomer generation will be 75 to 80 years old. The number of persons who need caring for already exceeds six million. In order to cope with the costs, care services have already been pared back, explains a former geriatric nurse.

In order to reduce costs, the elderly are to be cared for more cheaply at home by their own family instead of in homes or clinics. Yet most relatives are also no longer the youngest – and their children have to earn a living. Home care is an excessive burden for many. In order to implement the concept of Society 5.0, the Japanese government is increasingly relying on AI, robots and sensors.

Smart home – the concept of smart spaces

“I’m moving toward the target now. I’m starting to follow the pedestrian.” That’s how an autonomous wheelchair communicates with its user via loudspeaker and informs its surroundings at the same time. The machine is one of the future projects for the aging society at the Cybernetics Laboratory of Chuo University in Tokyo, as Deutschlandfunk Kultur reports. In addition to autonomous wheelchairs, director Mihoko Niitsuma is primarily developing “smart spaces” so that senior citizens can stay and live in their familiar surroundings for as long as possible.

What is a smart space?

According to Gartner, one of the leading U.S. market research and consulting firms, important and rapidly evolving technologies such as the digital twin, Internet of Things (IoT) platforms, smart spaces, multimodal user interfaces and advanced virtual assistants will change the way people interpret and interact with the world by the year 2026. In the study, Gartner’s experts examined 20 emerging technologies and trends that will have the greatest impact on technological developments in the coming years. The smart space is one of them. In their eyes, “a smart space is a physical or digital environment in which humans and technology-enabled systems interact in increasingly open, connected, coordinated and intelligent ecosystems. Smart spaces can be referred to by a variety of names, including ‘smart cities,’ ‘digital workspaces,’ ‘smart venues’ and ‘ambient intelligence.’ Common uses include preventive maintenance for building infrastructure, and automated tolls and billing. Smart spaces are changing how people interact with one another and influence decision support systems within various spaces (e.g., buildings, factories and venues).”

For Mihoko Niitsuma, the concept of the smart space has a practical benefit. “We can distribute the sensors and computing power of a robot in a space and connect them via the Internet. That allows us to observe everything in the space from a distance and recognize the situation of the people in it.” The exciting thing is, it’s not a person who decides what to do, but the smart space itself. Thanks to the integrated AI, it’s able to do so at any time. “Then the smart space can decide how to help the person, for example by providing required information, changing the room temperature or adjusting the brightness of the lighting. That’s the concept of the smart space.”

The technology that is already being used is based on lidar detectors, which are also used by autonomous cars to detect people in traffic. According to the professor, such “smart spaces” will be commercially viable in just a few years. Professor Niitsuma estimates that the sensor system will cost the equivalent of 2,000 euros. “We’ll probably still need a human interface between the smart space and the users,” she says, adding that it’s crucial to trust the system. “Old people will gradually get used to it – for example, we also share private information with our smartphone because that delivers benefits for us. So I think the concept of privacy is changing with technology.”

For example, outpatient care services could use the system to remotely monitor seniors in need instead of sending a caregiver out to them. After all, there’s a shortage of nursing staff. Robot nurses keep cropping up in official strategy papers as the ultimate solution. However, they are apparently more of a myth.

Robots in nursing are still the exception

Despite many prototypes, however, virtually no nursing home or hospital in Japan uses real robot technologies in nursing. That’s what German scientist Patrick Grüneberg from Kanazawa University found out when he interviewed numerous doctors and nursing staff. “When we asked about the current situation as regards nursing technology, they said it’s just not really an issue,” he tells Deutschlandfunk. Even though robots have not yet become established in nursing and in the smart home, that will change in the future.

There are numerous ways to make life and everyday activities easier in old age. To enable independent living at home, there are simple technologies to start with, such as sensor systems that detect movement and also issue an alert when nothing happens, e.g. an alarm is sent as soon as the refrigerator has not been opened for a day.

However, they can also be intelligent robotic systems, for example a robot based on artificial intelligence that accompanies a senior citizen through the day. In the future, this may be an interesting solution, especially for people with incipient dementia, to enable them to remain in their familiar living environment for as long as possible and with a high level of safety. However, systems that remind people with dementia of all the things they need to do, such as taking medication, etc., and that support them in structuring their day are also conceivable – a kind of digital everyday coach, so to speak.

But as Sabina Misoch, Professor and Head of the Institute for Ageing Research (IAF) in St. Gallen, points out, the acceptance of innovations depends not only on their functionalities, but also very greatly on the age of the target group. “Today’s elderly generation has grown up accustomed to analog devices and is less familiar with new technologies than, for example, the baby boomers. Interestingly enough, however, they’re still open to innovations if they can clearly see their benefits and if they enable them, for example, to live independently in their own four walls for longer. Many bite the bullet, even though they aren’t otherwise tech-savvy.”

The scientist feels sure that robotic solutions will become increasingly common. “In 10 to 20 years, we’ll have intelligent robots at home that will support us in doing the things we either can no longer manage so well due to age or we don’t want to take on ourselves for reasons of comfort.{…} In Japan, there are already communication robots for young people. When they get home, the robot greets them and asks what their day at work was like. It suggests recipes for dinner and reads out the top movies on TV. The robot performs a communicative function a human would otherwise do.”

Growth forecasts

There is an increasingly growing demand in the Japanese market for safe home environments, especially in terms of security functions and discreet monitoring for the elderly, as reported by the Internet portal yahoo!finance. If this trend continues, experts anticipate that the smart home market in Japan will exceed the 13 billion US dollar mark by 2027. In Germany, revenue from smart home hardware is expected to grow from around €7.8 billion this year to €10.6 billion by 2027 – or at an annual rate of 6.4 percent. The Hamburg-based data portal Statista recently published the figures as part of its Technology Market Outlook.

By comparison, the largest smart home market in 2020 was the U.S. with revenue of $23.3 billion, according to data from Statista; that figure is expected to grow to $51.2 billion by 2026. The European market was worth $20.1 billion in 2020 and will surpass the U.S. by 2026, when its revenue is expected to climb to $53.9 billion. China, with $15.0 billion in revenue in 2020, is expected to reach $45.3 billion in 2026.

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