Voices, Boundaries, and Belonging: Ethical Considerations of In-Home Robot Use in Dementia Care
ABSTRACT:
Person-centered care is a holistic approach built around the preferences and goals of an individual receiving healthcare to promote dignity and shared decision making with medical professionals. Person-centered care is central to quality in aging services, particularly for older adults who are seeking to maintain autonomy and age in place. As assistive needs increase and caregiver burden intensifies, assistive technologies, including in-house robots, are emerging as useful tools to support activities of daily living for both caregiver and care recipient. The ethical implications of these devices are still being established, especially considering populations that are cognitively impaired or who have not grown up with such technology.
In this study we focused on person-centered care and ethics to examine a robot’s design features, familiar voice options, and to understand the perception of the robot’s role in shaping ethical relationships between technology and its users. Our goal was to investigate how dementia care dyads interpret, interact with, and emotionally respond to an in-home, newly developed assistive robot during the early months of use, with attention to ethical considerations. To do this, we recruited five dyads of older adults living with cognitive impairment and their primary caregiver to participate in a three-month exploratory qualitative study. After completing a baseline interview, each dyad housed a socially assistive robot in their home, and we conducted monthly follow-up interviews while the robot was in use. Interviews were conducted and recorded in participants’ homes and later analyzed and coded. Interviews primarily focused on needs, expectations, and day-to-day experiences with a focus on ethical concerns. All interviews were audio-recorded, transcribed, and coded by three researchers using thematic analysis with an ethical lens.
Early findings indicate that dyads often personalize the robot through names, treating it as though it is another household member, and had the option of selecting the voice of a family member to be used as the voice of the robot to create trust and enhance comfort and compliance. Participants described emotional connections alongside strains that occurred; this entailed the robot causing frustration or increasing dependence on the technology, varying on context. One dyad reported a familiarity and appreciation with reminders from the robot when they were repeated, allowing for a routine to form and persist for when the robot was removed; however, another dyad reported frustration with reminders, constantly replying “Yeah, I know” to the robot when being reminded to put shoes on. Person-centered care remained central as dyads adjusted settings, evaluated privacy, and set boundaries to align the robot’s abilities with participants’ values and routines. Interviewers questioned participants if they were worried the robot would take away autonomy, dignity, or privacy for their household, but it was generally accepted that the robot was there to support autonomy and improve quality of life. Transparency and working with the research team allowed for a better person-centered experience, allowing for the full potential of the robot and for participants to feel safe and build a connection with both the robot and the team. Our findings revealed that emerging ethical dynamics emphasize the need for flexible design controls, transparent communication, and ongoing relational support as robots become integrated into dementia care. Cautious and thoughtful implementation is essential to ensure that the robot enhances autonomy, dignity, and caregiver well-being.
I want to extend my gratitude to Chloe Mitchell who has been working alongside me since we started working with Dr. Jing Wang two years ago. She aided in brainstorming and editing my abstract and poster. Chloe is also a third-year student in the School of Nursing who works with the geriatric population and is driven to support a better care environment for the elderly and medical professionals. I would also like to thank Dr. Jing Wang for providing amazing opportunities and guiding me on managing the world of research. Her endless support has allowed me to go to both NISBRE and ENRS 2026 conferences, give a poster presentation for the first annual undergraduate research showcase during URC week on campus, and get published as a co-author. Everything she has taught me and the support she has given will stick with me through the rest of my academic career as well as working in the field of healthcare. Lastly, I would like to thank NIH (NIBIB) for their funding via the NH-INBRE SEED grant, as none of this would have been possible without their aid.
Author and Mentor Bios
Aubrie Woodward is a third-year nursing student at the 鶹app who has been working as a research assistant to Dr. Jing Wang for the last two years. At the 2026 Eastern Nursing Research Society Conference in March 2026, Aubrie won first place for her poster presenting this research. In addition to working with Dr. Wang, she also works with the geriatric population as a licensed nursing assistant in her hometown of Berlin, New Hampshire. She is hoping to take her patients' first-hand experiences into the world of research to promote person-centered care, improve quality of care, and implement new technologies in caring for older adults.
Jing Wang, PhD, RN, FAAN, is an assistant professor at the 鶹app’s School of Nursing. As a leading nursing scientist, her research focuses on long-term care, healthy aging, and person-centered dementia care, with an emphasis on global, transdisciplinary, and cross-cultural collaboration to improve the well-being of older adults and their caregivers.
Copyright 2026 © Aubrie Woodward
