When robots care: Public deliberations on how technology and humans may support independent living for older adults.

While assistive robots receive growing attention as a potential solution to support older adults to live independently, several scholars question the underlying social, ethical and health policy assumptions. One perplexing issue is determining whether assistive robots should be introduced to supplement caregivers or substitute them. Current state of knowledge indicates that users and caregivers consider that robots should not aim to replace humans, but could perform certain tasks. This begs the question of the nature and scope of the tasks that can be delegated to robots and of those that should remain under human responsibility. Considering that such tasks entail a range of actions that affect the meaning of caregiving and care receiving, this article offers sociological insights into the ways in which members of the public reason around assistive actions, be they performed by humans, machines or both. Drawing on a prospective public deliberation study that took place in Quebec (Canada) in 2014 with participants (n = 63) of different age groups, our findings clarify how they envisage what robots can and cannot do to assist older people, and when and why delegating certain tasks to robots becomes problematic. A better understanding of where the publics draw a limit in the substitution of humans by robots refocuses policymakers' attention on what good care entails in modern healthcare systems.

[Morbidity developments in the demographic change: availability of medical services in regional care]. / Morbiditätsentwicklung im demographischen Wandel: Verfügbarkeit medizinischer Leistungen in der regionalen Versorgung.

The proportion of older people will increase strongly in Germany in the coming years. A consequence is an increase in patient numbers particularly for age-associated diseases and multimorbidity. Higher numbers of patients mean greater use of medical services and a higher demand for home visits with older patients. Although the total population is declining, the need for doctors will increase in certain medical areas, for example in the primary care sector. In many rural areas the reoccupation of vacant practices is already becoming a problem. Innovative, flexible and regionally organized healthcare concepts are necessary to ensure adequate medical care. Duties and responsibilities must be transferred between health professions and across sector boundaries, for example on the basis of delegation concepts, telemedicine and better cooperation between the outpatient and inpatient settings.

[Delegation and substitution of specific medical tasks as a future model of health care supply]. / Delegation und Substitution spezifischer medizinischer Tätigkeiten als künftiger Versorgungsansatz.

Changing health care needs caused by changing demographics lead to an increasing demand for medical and nursing care in Germany. A declining number of general practitioners will soon cause a lack of health care supply in a growing number of regions. Nurses constituting the largest occupational group in the health care system contribute by filling the resulting gap. Internationally, models have been developed to incorporate new responsibilities for nursing professionals. However, nursing education needs to be adapted as well. Presently nurses are not qualified to take on medical tasks. The current nursing curriculum needs to include medical skills and content to reach a qualification status comparable to other European countries. The transition towards a more team-oriented medical care will have to be supervised and evaluated by health services research in both nursing and clinical care. The aim is to also provide a basis for the further development of the relevant socio-legal framework.

Looking at the past to see the future: the role of the dental hygienist in collaborating with dentists to expand and improve oral health care.

As dental hygiene approaches its 100th anniversary in 2013, it is clear that the profession has evolved far beyond the initial vision of Dr. Alfred Fones. Much of this evolution has been driven by changing oral health needs of the public as well as the way dentists practice, based on innovations in dentistry, to concentrate on more advanced procedures and delegate other duties to the dental hygienist. By and large, these changes have been achieved by dentists, dental hygienists, and other team members working together. We have an opportunity to overcome initial resistance and, based upon evidence of successful outcomes, further extend the reach of the dental team for the benefit of patients, especially the most vulnerable among them.

[Paradigm shift of German medicine by introduction of nurse practicioners. Does it make sense in view of experience in the United Kingdom?]. / Paradigmenwechsel in der deutschen Medizin durch die Substitution ärztlicher Leistungen. Sinn oder Unsinn angesichts der Erfahrungen in Großbritannien?

Germany wants to introduce some models to allow nurses to work in medical roles. Although hospital nurses worked hard during the last couple of years to concentrate on pure patient care and to detach themselves from medicine, a short additional training of 6-12 months duration is planned to allow them to work independently in well defined areas of medicine (high blood pressure, wound care, dementia, diabetes). However, success of such models has only been tested in a few studies. Study results and experience with such models in the UK - where these developments are much more advanced - are not only positive. Generally, work of nurses in medical roles does not make patient care less expensive and doctor´s work less onerous. The benefit lies more in an add-on effect to doctor´s care. Therefore, a close scientific surveillance of such models must be guaranteed and results must be considered without any kind of ideology.