This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

Betty* just got a new dog to help her get through the loneliness of the COVID-19 pandemic – but her new pup is battery-powered and its fur is a washable synthetic material.

Betty lives at a Wayne County long-term care facility, and she got her new dog – which she promptly named Cuddles – from The Senior Alliance (TSA), Area Agency on Aging (AAA) 1C. TSA has distributed 80 robotic pets to help combat pandemic-associated isolation among elders in its service area, and other AAAs and senior services agencies across Michigan are either considering or actively preparing similar programs.

"[Betty] kept saying how much she loved [Cuddles]," Betty's direct care worker wrote in a TSA testimonial. "... Thank you for allowing me to refer this companion to her. It has already made a difference and he just arrived!"

During the pandemic, elders who were already experiencing some degree of social isolation and loneliness have found themselves even more alone – which takes more than just an emotional toll. According to the Centers for Disease Control and Prevention, social isolation significantly increases risks for premature death as much as smoking, obesity, and physical inactivity — with risks increasing by 32% for stroke, 29% for heart disease, and about 50% for dementia. Loneliness is also a factor in depression, anxiety, and suicide — and quadruples mortality for heart failure patients.

"Loneliness has always been an issue in the senior community. Social networks naturally shrink as we age," says Andrew Dabrowski, community care program manager for TSA, which serves Wayne County and Detroit. "For seniors, being the most vulnerable during the pandemic, this isolation has been exacerbated."

Like other agencies working with elders, TSA has kept its clients engaged through friendly reassurance phone calls, meal pick-ups and deliveries, and, when possible, virtual events and classes. However, none of these are enough to counter the day-in, day-out isolation of COVID-19. Elders living in long-term nursing facilities or group homes have been isolated in their rooms and not allowed visitors for much of the pandemic's duration.

Adopting a pet has been one way that Michiganders of all ages have dealt with COVID-19's social isolation. Researchers at Ohio State University have found that the most common reason people had for having a companion animal was avoiding loneliness, and pet therapy and emotional support animals have been recognized as effective for years.

Unfortunately, long-term care facilities do not allow residents to own pets, and even elders living in their own homes may be unable to care for a cat or dog. But Dabrowski and others at TSA have placed robotic pets like Cuddles to help overcome those challenges.

Andrew Dabrowski, community care program manager for The Senior Alliance, holds a Joy for All robotic dog.

"They are deployed in hospital settings for a variety of reasons – relieving delusions experienced with dementia [or] for comfort in the ICU setting," Dabrowski says. "And they have trickled into use in the home."

Because assistive devices and adaptive technology are already funded by the Older Americans Act via Michigan's Aging and Adult Services Agency, and by Medicaid via the MI Choice Waiver Program, TSA did not have to seek additional funding to start placing the pets with clients.

"The idea was to really emulate the benefits of having a live pet for a population of folks who could not care for one. The pets are adorable and highly engineered to feel like a real pet," Dabrowski says. "The initial feedback we have gotten has been very positive."

TSA has already received testimonials confirming that robotic pets can successfully provide companionship to Michigan's elders.

"I cannot begin to thank you enough," wrote one Wayne County family member. "… My mother in-law has had pets all her life, but at [her advanced age], having a pet is obviously not an option. Our family would visit [her independent living facility] with our dog, but then COVID-19 hit. … This leaves [her] literally 'locked' in her room with little, if any, human interaction. Her [pet] was God-sent! She has named him Rocky. … Rocky is a soft and cuddly friend who will keep her company during this difficult time when friends and family cannot hold or give comfort to her."

The dogfather … and the cat's meow

Ted Fischer, co-founder and CEO of Ageless Innovation LLC, led the team that developed the robotic pets under Hasbro Inc.'s Joy For All brand. He and his team acquired the brand as a separate entity in 2018.

"Well before the pandemic, there was an epidemic of loneliness and isolation in most developing countries. Hasbro didn't have a whole lot of experience with older adults, so we went to older adults and asked what they wanted," Fischer says. "They wanted something realistic, familiar, and affordable. Our designers and engineers went to work."

Hasbro first got the idea 20 years ago, when sales analytics came back on an animatronic toy that targeted eight-year-old girls. 20% of people purchasing the toy bought it for an aging loved one.

"We saw this incredible need for interactive companionship. No one is marketing fun and joyful products to the aging population. We started to see this real desire for more play and joy," Fischer says. "Why do we do all of that work our whole lives, if not so we can play more? It all made sense."

As the design team began work, they aimed for a pet that both felt and looked like a live dog or cat and responded to its owner's actions. Built-in sensors and speakers respond to motion and touch. Dogs respond to commands with a friendly bark. Cats request love with a realistic meow. Both can roll over. The dogs have a subtle heartbeat that slows when their owner calms them. When stroked, the cats gently vibrate while they purr.

A Joy for All robotic dog.

"People told us that cats never do what you want them to do, so the cat's play pattern is random. You're not going to get the same response. You can pet it and think it's going to roll over and it won't. The puppy is much more predictable," Fischer says. "We wanted the pets to be simple and easy for older adults to operate. You take it out of the box, turn it on, name it, and the magic happens."

Features like tapered, lifelike whiskers and paw pads make the robotic pets seem even more lifelike. For the cats and kittens, the design team listened to thousands of soundtracks to pick the perfect meows vocalized by voice actors who sought to mimic real felines.

"We couldn't be more excited in this really difficult time to build partnerships with agencies who are really committed to helping those in need," Fischer says. "Just to be a small part of that has been an incredible blessing."

Finding homes for 1,800 robotic pets

Other Michigan agencies are currently preparing plans to distribute many more robotic pets to the state's elders. Salli Pung is the state long-term care ombudsman with the Michigan Elder Justice Initiative's Michigan Long Term Care Ombudsman Program, which advocates for improving quality of care and quality of life for residents of Michigan's long-term care facilities. The program is planning to provide robotic pets to 1,800 residents of Michigan nursing homes and adult foster care facilities. Pung concurs with research that has shown how profoundly loneliness and social isolation impact older adults, and says robotic pets are a useful intervention.

"Think about individuals in a facility who are no longer getting out of bed to go to activities or to engage with others. They physically decline. Family members have reached out to our program saying that they can't believe the decline in their parents," Pung says. "The pets can be helpful in slowing down that decline, especially the seclusion and isolation they are experiencing during COVID-19."

Facilities participating in the Ombudsman Program's effort will identify residents living with dementia and other cognitive declines, those most apt to embrace a pet. As COVID-19 continues to restrict those residents' visits with family and friends, Pung believes the pets will give them something to look forward to each day.

Andrew Dabrowski, community care program manager for The Senior Alliance, holds a Joy for All robotic dog.

"I love the idea that the dog is interactive and talks back and that the cat purrs and, depending on which sensory spot you pet, rolls over. That interaction has got to help people make a real connection and feel like they have a companion there," Pung says. "Relationships are what are so important to everyone in life, to feel needed and wanted. I think that is what these pets can offer."

*The client's name has been changed to protect confidentiality.

A freelance writer and editor, Estelle Slootmaker is happiest writing about social justice, wellness, and the arts. She is development news editor for Rapid Growth Media, communications manager for Our Kitchen Table, and chairs The Tree Amigos, City of Wyoming Tree Commission. Her finest accomplishment is her five amazing adult children. You can contact Estelle at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Photos by Nick Hagen.