Who Will Take Care of Italy’s Older People? Robots, Maybe.

CARPI, Italy — The older woman asked to hear a story.

“An excellent choice,” answered the small robot, reclined like a nonchalant professor atop the classroom’s desk, instructing her to listen closely. She leaned in, her wizened forehead almost touching the smooth plastic head.

“Once upon a time,” the robot began a brief tale, and when it finished asked her what job the protagonist had.

“Shepherd,” Bona Poli, 85, responded meekly. The robot didn’t hear so well. She rose out of her chair and raised her voice. “Shep-herd!” she shouted.

“Fantastic,” the robot said, gesticulating awkwardly. “You have a memory like a steel cage.”

The scene may have the dystopian “what could go wrong?” undertones of science fiction at a moment when both the promise and perils of artificial intelligence are coming into sharper focus. But for the exhausted caregivers at a recent meeting in Carpi, a handsome town in Italy’s most innovative region for elder care, it pointed to a welcome, not-too-distant future when humanoids might help shrinking families share the burden of keeping the Western world’s oldest population stimulated, active and healthy.

“Squat and stretch,” said the French-made robot, Nao, climbing to its feet and leading posture exercises. “Let’s move our arms and raise them high.”

“We all have to look for all the possible solutions, in this case technological,” Loredana Ligabue, the president of Not Only Elderly, a family caregiver advocacy group.Credit…Alessandro Grassani for The New York Times

The mostly women in the room looked on, some amused, some wary, but all desperate to know how new technology could help them care for their aging relatives.

Together, they listened to the robot’s calm, automated voice and offered real-world feedback at a focus group organized by a nonprofit advocacy group representing so-called family caregivers. The goal was to help the robot’s programmers design a more engaging and helpful machine that might one day lighten the load on increasingly overwhelmed Italian families.

Italy, which has one of Europe’s lowest birthrates, is bracing for an elderly population boom. Already, more than seven million of Italy’s nearly 60 million people are over 75. And 3.8 million are considered non-self-sufficient. Diseases such as dementia and chronic illnesses weigh on the health system, and families.

“The revolution,” said Olimpia Pino, a professor of psychology at the University of Parma, who designed the robot project, would be if a “social robot can assist in care.”

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Leaps in artificial intelligence would only make robots more responsive, she said, keeping older people self-sufficient longer, and providing more relief to caregivers.

“We all have to look for all the possible solutions, in this case technological,” Loredana Ligabue, the president of Not Only Elderly, the caregiver advocacy group, told the participants. “We’ve seen the big fear of being alone.”

Advocates like Ms. Ligabue worry that the government’s definition of caregiver is overly narrow and could leave many exhausted and unsupported.Credit…Alessandro Grassani for The New York Times

Robots are already interacting with the old in Japan and have been used in nursing homes in the United States. But in Italy, the prototype is the latest attempt to recreate an echo of the traditional family structure that kept aging Italians at home.

The Italy of popular imagination, where multigenerational families crowd around the table on Sunday and live happily under one roof, is being buffeted by major demographic headwinds.

Low birthrates and the flight of many young adults for economic opportunities abroad has depleted the ranks of potential caregivers. Those left burdened with the care are often women, taking them out of the work force, providing a drag on the economy and, experts say, further shrinking birthrates.

Yet home care remains central to the notion of aging in a country where nursing homes exist but Italians vastly prefer finding ways to keep their old with them.

For decades, Italy avoided a serious reform of its long-term care sector by filling the gap with cheap, and often off-the-books, live-in workers, many from post-Soviet Eastern Europe — and especially Ukraine.

“That’s the long-term care pillar of this country,” said Giovanni Lamura, the director of Italy’s leading socio-economic research center on aging. “Without that, the whole system would collapse.”

In January, unions representing legal Badanti, as the workers are called here, won a pay raise that added as much as about 145 euros, or more than $150, a month for in-home care. Struggling Italians say that their paychecks and pension benefits have not kept pace, forcing many to do the caring themselves.

Daniela Lucchi, 67, with her Moldovan caregiver, Danalachi Parascovia.Credit…Alessandro Grassani for The New York Times

When it comes to family caregivers, Italy has for decades provided government benefits to a single person in a family with a gravely ill person. Later this year, paid leave and other relief will be allowed to be shared in a family, in practice meaning that more men can help.

In Emilia-Romagna, the region that includes Carpi, there are also plans to create a work force of caregivers with experience caring for their own family members who can ultimately, when their own loved ones die, be employed to care for others.

“There is an enormous demand,” Ms. Ligabue said.

This week, Prime Minister Giorgia Meloni celebrated passage of a new law intended to streamline access to services for the elderly and to bring greater government engagement in the growing field of long-term care.

But the law does not include specific measures to support family caregivers. Alessandra Locatelli, Italy’s minister for disabilities, explained that the government did not want to prioritize Italians who cared for older family members over those who tended to younger disabled ones.

She said she expected a new measure by the end of the year to provide tax breaks and other benefits for “live-in family caregivers” for “all of the types of non-self-sufficient people.”

But the meeting in Carpi made clear that many Italians do not necessarily live with the parents and grandparents they care for. Some of those women were already looking beyond the government for help — to machines.

As Nao, the posture-performing robot from France, made herky-jerky movements on the desk, Leonardo Saponaro, a psychology student who ran the focus group and whose grandfather suffered from dementia outside Rome, explained that the robot wasn’t “a replacement for socializing with other people.”

“It can nevertheless be company,” he said.

Daniela Cottafavi, 65, asked whether the robot would be able to get the doctor on the phone. Credit…Alessandro Grassani for The New York Times

Still, the caregivers were tentative. First, they wanted to check that the friendly looking robot, whose eyes lit up with orange, yellow and magenta lights when they got answers right, would first do no harm.

Ms. Poli wanted to make sure that none of its materials would interfere with a pacemaker. Viviana Casella, 58, a widow who looks after a father with dementia, asked whether there were robots that could physically move a person from the couch to the bed, a question that prompted some nightmare scenarios.

“I’d pull the plug,” Franca Barbieri, 69, said from the back of the room.

One caretaker asked whether the robot knew how to listen, because older people tell stories. Ms. Casella asked whether the robot could give a caretaker a break, “maybe to go food shopping.”

The robot’s operators assured the caregivers that the robot could help, but mostly in the realm of mental stimulation. Nao played a song and asked Ms. Casella to identify the singer. “Little Tony,” she said.

“Is tiramisu a sweet or a savory?” it quizzed Daniela Cottafavi, 65. “Romulus or Remus was the first king of Rome?”

When it had problems deciphering answers, something the students chalked up to different dialects, Ms. Cottafavi shouted, “We need to give it a hearing aid!”

By the end of the session, it had clearly won some of the caregivers over.

“You want to hug it,” said Annarita Caliumi.

Many, like Mara Poggi, 51, a mother of two who also cares for her 71-year-old mother who suffers from dementia, were not persuaded that a robot could be a substitute for human contact.

Mara Poggi, a mother of two, said that her mother, who is 71 and has dementia, above all things needed human contact.Credit…Alessandro Grassani for The New York Times

That morning Ms. Poggi had fought with her mother, who resisted being dropped off at the senior center, while pausing to take a call from her 14-year-old son who was “having problems” at school, she said. She went to work at the knitwear factory, where many colleagues discussed similar situations over coffee breaks.

“I feel like slice of prosciutto in between two pieces of bread,” she said. “Squished.”

After consoling another exhausted caregiver at the afternoon meeting, she drove to a local Badanti center to interview a woman who could possibly help her mother out. The Badanti are “our oxygen tanks,” she said.

Then she went back to her car and girded for another tough day.

“That robot is more for me than for my mother,” she said. “My mother would throw it in the garbage. It will be my companion.”

Robots are the latest attempt to recreate an echo of the old family structure that can keep aging Italians in their homes. Credit…Alessandro Grassani for The New York Times
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