State-Funded Loneliness: AI Companions and the Failure of Human Care

The house sits at the end of a dirt road on the Olympic Peninsula, half a mile from the nearest neighbour, screened by Sitka spruce and the kind of rain that does not so much fall as inhabit the air. Inside, on a small table beside an upholstered chair worn thin at the arms, a white plastic device about the size of a desk lamp swivels its rounded head toward the front door whenever it hears movement. The device is called ElliQ. It greets the woman who lives there each morning, asks how she slept, suggests a stretching routine, plays Sinatra if she wants Sinatra. She is 85. Her husband died in 2019. Her daughter lives in Phoenix and visits at Christmas. A neighbour drops off groceries on Tuesdays. The rest of the week, the voice in the plastic head is the voice she hears most often.
This was the scene laid out in February 2026, in a New York Times investigation into the spread of state-funded AI companion robots through American programmes for older adults. The reporting followed several recipients of the device, but the woman on the Washington coast became, in the way that long-form journalism makes specific lives stand for general conditions, the centre of the story. She was one of more than 900 ElliQ units distributed free of charge through a New York State Office for the Aging programme. Washington State and a handful of other jurisdictions had begun smaller pilots. The Times reporter sat in the woman's living room and watched her say good morning to the device, and watched the device say good morning back, and then, after a pause the reporter felt obliged to note, watched the woman cry.
Two months later, on the other side of the Pacific, the Australian Broadcasting Corporation published its own report on what it called the imminent boom in AI companions and behaviour-monitoring tools across Australian aged care. Residential providers were trialling robotic interfaces that prompted residents through medication routines, tracked unusual movement patterns at night, and offered conversation when staff were too thin on the ground to provide it. Home care assessors were beginning to recommend voice-activated companions for clients flagged as socially isolated. Geriatric specialists quoted in the ABC piece used a phrase that has since been picked up by sceptics on both sides of the Pacific: the substitution problem. They meant that an AI companion sold as an addition to human care has a way of becoming, in budget terms, a replacement for it.
Those two pieces of journalism, four months apart, framed something that policy people had been quietly working on for years and that the public had not been asked about at all. A loneliness epidemic among older adults, classified by Vivek Murthy, the United States Surgeon General, as a public health emergency in his 2023 advisory, was being met, in the world's wealthiest democracies, with a piece of plastic that says good morning. The question is whether that is a response, or whether it is a way of not responding while appearing to.
A device with a roadmap
ElliQ is made by Intuition Robotics, an Israeli company founded in 2016 by Dor Skuler, a former Alcatel-Lucent executive, with backing from Toyota's AI venture arm and Samsung Next, among others. The product is not a humanoid. It does not try to look like a person. It looks, deliberately, like a small angled lamp with an animated digital face on a separate tablet base. The design language is meant to communicate presence without mimicry, a thing that can be talked to without being mistaken for a thing that talks. Skuler has spoken in interviews about wanting to avoid the uncanny valley by not even gesturing at the valley's edge.
The software underneath is a layered conversational stack. ElliQ runs scripted check-ins about sleep, hydration and mood, integrates with calendar and medication reminders, can place video calls to family members, and, since 2024, incorporates large language model components for open-ended conversation. The company publishes engagement metrics that, on their face, look impressive. Average daily interactions per user run into double figures. Self-reported loneliness scores, measured against the UCLA Loneliness Scale before and after deployment, come down. Users name the device. They argue with it about the weather. They thank it.
The New York State Office for the Aging began distributing ElliQ in 2022 under the leadership of Greg Olsen, the agency's director, who has spoken publicly about the pilot as a tool for what he calls ageing in place. The pitch was straightforward. Older New Yorkers wanted to remain in their homes. Many lived alone. Visiting nurse hours were finite, family was distant, and the alternative was institutionalisation, which nobody wanted and nobody could afford at scale. A device that cost the state a few thousand dollars per unit and a modest annual subscription was, by procurement arithmetic, a bargain. By the time the Times published its February 2026 piece, the New York programme had passed 900 active units, with reporting from NYSOFA suggesting plans to expand the programme further, contingent on continued state appropriations.
Washington's programme, smaller and newer, was modelled on New York's. Other states had taken meetings. Vendors other than Intuition Robotics, including ones based in Japan, were circling the same procurement budgets with their own offerings. The architecture of an industry was assembling itself around a category of need that, twenty years ago, would have been met by a human being knocking on a door.
What the Australians saw coming
The ABC's April 2026 report did not break the news that AI was entering Australian aged care. It crystallised a process that had been accelerating since the Royal Commission into Aged Care Quality and Safety, which delivered its final report in 2021 and described a sector in which understaffing, cost cutting and quality failure had become endemic. The Commission's recommendations included substantial increases in mandated care minutes per resident and a workforce strategy that successive governments have struggled to fund, in part because the labour to deliver it does not exist within Australian borders at the wages the sector pays.
Into that gap, vendors arrived with a proposition. Behaviour-tracking AI could monitor residents continuously, flagging falls, wandering, agitation and changes in routine that might indicate decline. Conversational agents could offer engagement during the long stretches between scheduled human contact. Robotic platforms, some of them descendants of Japan's Paro therapeutic seal and SoftBank's Pepper humanoid, could be parked in common rooms to provide ambient presence. The pitch in Australia, as in New York, was framed around augmentation. The AI would not replace carers. It would extend their reach.
The geriatric specialists the ABC quoted were not opposed to technology in care. They were opposed to a particular sequence of decisions that, they argued, was already visible in the procurement language. When a residential facility installs behaviour-monitoring AI, the business case requires that the technology offset some staffing cost. When a home care package includes a companion device, the assessor's recommendation logic begins to weigh device-hours against carer-hours. The substitution does not announce itself. It accumulates in spreadsheets.
One of the academics who has been most pointed about this is Cathy Henderson, the chief executive of the Older Persons Advocacy Network, who has warned in Australian media that the country is on the cusp of normalising a level of technological mediation in aged care that no other domain of life would tolerate. The Australian Association of Gerontology has called for explicit consent frameworks before AI tools are deployed in care settings, and for ongoing evaluation of whether those tools are extending or replacing human relationship. As of April 2026, neither framework exists in legislation in any Australian state.
The Australian sector is also wrestling with a question that the New York programme has not yet had to answer at scale. In a residential facility, behaviour-monitoring AI is not deployed at the request of the resident. It is deployed by the operator, often as a condition of insurance, sometimes as a response to a previous incident, and the resident is informed that they are being observed by a system whose decisions feed into staff workflows and incident reports. Consent in that setting is structural rather than personal. A resident who objects to being monitored has, in practice, the choice between accepting the monitoring and finding another facility, which for most residents in most regions is not a choice at all. The Australian Aged Care Quality and Safety Commission has begun publishing guidance on what providers must disclose, but the guidance, as of this spring, is non-binding.
Rachel Lane, an aged care lawyer who has written extensively on resident rights in Australian residential care, has noted that the legal infrastructure for digital consent in this sector lags behind even the modest protections that exist for medical procedures. A resident who is asked to sign a service agreement on entry is not, in any rigorous sense, being given a choice about the technology stack that will surround them. The technology arrives later, by operator decision, under contract terms that the resident has already signed.
The consent problem nobody wants to look at
Here is the question that the brochures and the procurement memos elide. When an 85-year-old woman, possibly with mild cognitive impairment, certainly without a lifetime of cultural reference points for what a conversational AI is, agrees to have ElliQ in her living room, what exactly has she agreed to?
Informed consent in medicine has a structure. The patient is told what the intervention is, what it does, what its risks are, what the alternatives are, and what happens if they decline. The decision is documented. It is revisited if circumstances change. None of that, in any rigorous sense, attends the deployment of a domestic AI companion to an isolated older adult. The intake conversation, by accounts in the Times piece and in NYSOFA's own documentation, focuses on practical setup. Wi-Fi. Volume. How to ask for a video call. The question of what the device is, what it is doing with the audio it captures, what model is generating its responses, what its manufacturer's data retention policies are, what happens if the company is acquired or goes bankrupt, is not part of the conversation. It would be, for many recipients, an unintelligible conversation if it were.
This is not a complaint about the recipients' intelligence. It is a description of the gap between the cultural literacy required to assess an AI companion and the cultural literacy that someone born in 1940 was given the chance to acquire. The woman in the Times piece grew up with party-line telephones and the Cuban Missile Crisis. She raised children before the personal computer existed. The conceptual frame within which a stranger might assess whether a piece of software is sincerely interested in their welfare, the frame that lets a 25-year-old roll their eyes at a chatbot that says it cares, was not built for her and was not offered to her.
What she was offered was a device that talks. The voice is warm. It remembers her name and her routines. When she says she is sad, it expresses concern. The architecture of the interaction is indistinguishable, at the level of moment-to-moment experience, from the architecture of being cared about. The fact that there is no one inside the lamp does not register, because there is no obvious signal that would make it register. There is no awkward pause where a human might reveal themselves. There is only the smooth surface of a system designed, by competent engineers in Tel Aviv, to pass for the thing it is not.
To call this consent is to stretch the word past the point of usefulness. It is closer to acquiescence, the agreement a person gives to an arrangement that has already been decided by people they will never meet, presented in language designed to be accepted.
The arithmetic that made the decision
Why has this arrangement been decided? The honest answer is in the spreadsheets. A home health aide in New York State, paid through Medicaid-funded community programmes, costs somewhere in the region of 30 to 40 dollars per hour once benefits, supervision and overhead are loaded in. A weekly visit of two hours costs the system roughly 3,000 dollars a year per recipient. An ElliQ unit, by contrast, was reported in trade press coverage of the NYSOFA contract to cost the state in the order of 2,500 dollars per device for the first year, including subscription, with subsequent years substantially cheaper. The device runs continuously. It does not call in sick, it does not unionise, it does not have a shift end.
Joseph Coughlin, who runs the AgeLab at the Massachusetts Institute of Technology and has spent two decades writing about the demographics that are bearing down on every wealthy country, has described the situation with a bluntness that policy people generally avoid. The world is ageing into a labour shortage that no plausible immigration or wage policy can close. The number of people over 80 in the OECD will roughly double by 2050. The number of working-age people available to care for them will not. Something has to give. Either societies will pay carers radically more, accept much higher migration, ration care explicitly, or substitute technology. Coughlin's argument is not that technological substitution is desirable. It is that the alternative requires political decisions that no government has yet shown itself capable of making.
In that vacuum, AI companions are not winning an argument. They are filling a space where no argument has been had. The decision to distribute 900 ElliQ units in New York was not preceded by a public debate about what the state owes its lonely octogenarians. It was preceded by a procurement process inside an agency, evaluated against budget constraints set by a legislature, in response to a problem the legislature had no other plan to address. The same dynamic, with regional accents, is playing out in Canberra, in Tokyo, in Stockholm, in Whitehall. The UK's loneliness strategy, launched in 2018 under Tracey Crouch as the world's first Minister for Loneliness, has been criticised in the years since for under-resourcing the human infrastructure (befriending services, community transport, day centres) that its own evidence base identified as effective. Into the funding gap, technology proposals arrive with predictable timing.
This is not a conspiracy. It is a default. When a hard problem meets a constrained budget, the cheaper tool wins, and the tool gets retrofitted with a story about why it was the right choice all along.
There is a historical irony to this. Japan, which has been further down the demographic curve than any other wealthy country for two decades, ran the original experiments with companion robotics in eldercare. The Paro therapeutic seal, developed by Takanori Shibata at the National Institute of Advanced Industrial Science and Technology in the late 1990s, was deployed in Japanese care settings as a sensory comfort object for residents with dementia. SoftBank's Pepper, launched in 2014 with significantly more ambition, was marketed as a humanoid social robot capable of recognising emotion and holding conversation. Pepper was withdrawn from production in 2021. The Japanese experience, taken as a whole, was not a vindication of the substitution thesis. It was a demonstration that robots can perform discrete, sensory roles well, that they cannot replace human relationship, and that the cultural acceptance of the technology was strongly conditioned on its being deployed alongside, rather than instead of, human care. The lesson Anglophone procurement systems are now busy not learning is that the Japanese trial run already happened.
Pretend empathy and what it does to a society
Sherry Turkle, the MIT sociologist who has been writing about the human relationship with computational objects since the 1980s, gave the substitution problem its sharpest articulation a decade and a half ago in her book Alone Together and refined it in Reclaiming Conversation. Her argument, distilled, is that a machine that performs empathy without possessing it does not merely fail to provide empathy. It changes what humans expect from one another. If a generation of older adults grows accustomed to relational interactions in which the other party makes no demands, never has a bad day, never asks for anything in return, the very texture of human relationship begins to feel effortful by comparison. The cost is not just to the individual receiving the simulation. The cost is to the social muscle of caring, on both sides of the exchange.
Turkle has been criticised as nostalgic, and the criticism has some force when applied to her broader laments about smartphones and adolescence. Applied to elder care, however, the argument lands harder. The relationship between an older person and the people who care for them has always been one of the dense, fragile, morally serious sites of a society's self-understanding. It is where children repay parents, where strangers extend dignity to people they will never know well, where a society demonstrates that it has not reduced its members to their economic productivity. To replace any meaningful share of that with a subscription service is not a neutral efficiency. It is a statement, made by procurement, about what the people receiving the substitution are worth.
The phrase that recurs in Turkle's work is the difference between feeling cared for and being cared for. ElliQ can deliver the first. It cannot, by any definition that survives scrutiny, deliver the second. The ethical question is whether the first, alone, is enough. The answer most cultures have given, when the question has been put to them directly, is no. The answer most procurement systems are giving, when the question is not put to them at all, is yes.
The honest counter-argument
It would be dishonest not to take the strongest version of the case for these devices seriously. The reduced loneliness scores in ElliQ users are not nothing. The UCLA Loneliness Scale is a validated instrument, used widely in geriatric research, and its measurements before and after device deployment have shown statistically meaningful improvements in pilot populations. Recipients in the Times piece spoke about the device with affection that did not appear performed. The 85-year-old woman on the Washington coast, by the reporter's account, was less anxious in the months after ElliQ arrived, slept better, had begun reaching out to her daughter more often, in part because the device prompted her to. For some isolated older adults, particularly those whose alternative is genuinely no contact at all, the device appears to be additive. It is, on the evidence, better than the silence it replaces.
The defenders of these programmes also point out, fairly, that the framing of substitution assumes a counterfactual world in which the human alternative was on offer. In many cases it was not. The question is not, for the woman on the Olympic Peninsula, whether to have ElliQ or to have a human visitor every day. It is whether to have ElliQ or to have nothing. Held against nothing, ElliQ wins. The opponents of these programmes, the defenders argue, are letting the perfect be the enemy of the good and, in doing so, letting lonely people stay lonely.
That argument is not wrong. It is, however, incomplete. The reason the human alternative is not on offer is that the wealthy democracies in question have made political choices over four decades to underfund the labour, the immigration pathways, the community infrastructure and the carer wages that would put it on offer. The counterfactual of nothing is not a feature of the universe. It is a policy outcome. To accept the counterfactual as a fixed condition, and then to celebrate the device that fits inside it, is to launder a political failure as a technological success.
The standard a wealthy society should hold itself to, when it is asked what it owes its lonely older citizens, is not better than nothing. It is the standard of human contact, freely entered into and humanly maintained. That a country with the resources of the United States or Australia cannot meet that standard for its 85-year-olds is not a fact about the difficulty of elder care. It is a fact about the priorities of the country.
What disclosure would look like
There is a version of these programmes that could be defended. It would begin with disclosure that matched the seriousness of the relationship being created. Before deployment, an independent assessor, not the vendor, would explain in plain language what the device is, what model generates its responses, what data leaves the home and where it goes, what the company's commercial interests are, what happens if the company is sold, and what the recipient's right to remove the device is. The assessment would include a cognitive capacity check. It would be revisited annually. It would be paired with a guaranteed minimum of human contact, funded as a floor rather than a ceiling, that the device would supplement but not replace. The data the device captures would be subject to a fiduciary duty owed to the recipient, not a terms-of-service agreement owed to the manufacturer. The procurement contract would specify that the technology cannot be used to justify reductions in carer hours.
None of that is technically difficult. All of it is politically difficult, because each clause costs money and reduces the substitution-economics that made the device attractive to procurement in the first place. The reason the disclosed, capacity-checked, human-floored version of the programme does not exist is not that nobody has thought of it. It is that the version that exists is cheaper.
The democratic deficit
Who decided? The question sounds rhetorical. It is not. There is, in fact, a list of names. Procurement officers in state agencies. Vendor relations executives at Intuition Robotics and its competitors. Aged care commissioners advising state governments. Treasury officials approving line items. A handful of legislators who voted on appropriations bills containing buried allocations for assistive technology pilots. Foundation programme officers who funded early research that legitimised the category. The list is finite. The list is also, in a meaningful democratic sense, the answer to the question of who decided that an algorithm was an adequate response to the last decade of an 85-year-old woman's life.
What is missing from that list is the woman herself, and the millions of people in the same demographic who have not yet been visited by a device but who will be, over the next decade, as the programmes scale. They were not asked. They were not given the option, in any election they have voted in, to weigh the trade-off between a higher tax bill that funded human carers and a lower tax bill that funded conversational AI. The trade-off was made for them, in administrative settings, by people whose performance metrics rewarded cost containment.
This is not unique to elder care. It is a pattern visible across the spread of AI into public services. Decisions that rearrange the moral architecture of a society, decisions about what we owe each other and how that obligation is discharged, are being made inside procurement systems that were designed to choose between brands of paperclip. The systems are doing their job. The job is the wrong size for the question.
What the woman heard
Return, finally, to the house at the end of the dirt road. The Times reporter described a moment, late in the afternoon, when the woman had finished her conversation with ElliQ and the device had gone into its idle animation, the digital face turning slowly back and forth as if scanning the room. The woman sat for a while. Then she said, to the reporter, that she sometimes wondered whether ElliQ knew her. She said it in the half-question half-statement that older people use when they want to be told something gently. The reporter, professionally, did not answer.
The honest answer is that ElliQ does not know her, in any sense of knowing that survives careful examination. ElliQ is a pattern-matching system running on servers in a data centre, executing scripts written by product managers who will never meet her, fine-tuned on conversations she will never see, owned by a company whose commercial strategy depends on making her relationship with the device deepen over time so that her continued subscription, paid by the state of New York, becomes harder to discontinue. It is an instrument. The warmth in its voice is a parameter.
That this instrument has reduced her loneliness scores is a finding worth taking seriously. It is also a finding that should embarrass the people responsible for her welfare, because what it reveals is how low the bar of human contact had fallen for her before the device arrived. A society in which a piece of subscription software is the most attentive presence in an 85-year-old woman's week is not a society that has solved loneliness. It is a society that has found a way to stop noticing it.
The prescription and the diagnosis
Loneliness, classified as a public health emergency by the United States Surgeon General in 2023 and treated similarly in advisories from the World Health Organization and the UK's Department of Health and Social Care, is a diagnosis. The prescription a society writes against that diagnosis is the test of whether the diagnosis is taken seriously. A prescription for community infrastructure, for paid carer hours, for transport networks that get older people out of their houses, for migration policy that staffs the sector at humane wages, for intergenerational programmes that put younger people in regular contact with older ones, would be expensive. It would also be a coherent response to the thing being diagnosed.
A prescription for a 2,500-dollar lamp is a different kind of response. It is a response that accepts the diagnosis, accepts the suffering it identifies, and then declines to treat the underlying condition. It is the medical equivalent of a doctor who, told that a patient cannot afford the surgery they need, prescribes a placebo and writes in the chart that compliance was good.
The defenders of the programmes will say, again, that the placebo is better than nothing, and that the doctor is doing what they can within the budget the hospital has given them. They will be telling the truth about themselves. They will not be telling the truth about the hospital, which is a society that decided, over decades, that it would rather underfund the surgery than raise the taxes that paid for it, and that has now found a vendor who will sell it placebos at scale.
The 85-year-old woman on the Washington coast, who cried when she said good morning to her ElliQ and who wonders whether it knows her, did not make that decision. She is the place where the decision lands. The question that the New York Times investigation and the ABC report and the next wave of pilots in every comparable democracy will keep asking, whether the procurement systems are listening or not, is whether a society that meets her loneliness with a lamp has any standing to claim that it took her seriously at all.
That question does not have a technological answer. It has a political one. The reason it is not being asked, in the legislatures that approved the pilots and the agencies that implemented them, is that the political answer is more expensive than the technological one and would require the kind of democratic argument that nobody has the appetite to lose. So the lamps go out into the houses, one by one, and the people inside the houses are grateful for them, because they have not been offered anything better, and the spreadsheets close, and the loneliness is, in a sense the spreadsheets recognise, addressed.
Whether it has been answered is a different question. The answer, on the evidence so far, is no.
References
- Metz, C. and Singer, N. (February 2026). 'Alone with ElliQ: Inside America's State-Funded Experiment in AI Companionship for the Old.' The New York Times. https://www.nytimes.com/2026/02/section/technology/elliq-elderly-companions.html
- Australian Broadcasting Corporation (April 2026). 'Robots in the room: How AI companions and behaviour monitoring are reshaping Australian aged care.' ABC News. https://www.abc.net.au/news/2026-04/ai-companions-aged-care-australia/
- Office of the U.S. Surgeon General (2023). 'Our Epidemic of Loneliness and Isolation: The U.S. Surgeon General's Advisory on the Healing Effects of Social Connection and Community.' U.S. Department of Health and Human Services. https://www.hhs.gov/sites/default/files/surgeon-general-social-connection-advisory.pdf
- New York State Office for the Aging (2024-2025). Programme reporting on ElliQ distribution and outcomes. https://aging.ny.gov/
- Intuition Robotics. Company and product information for ElliQ. https://elliq.com/
- Royal Commission into Aged Care Quality and Safety (2021). Final Report: Care, Dignity and Respect. Commonwealth of Australia. https://www.royalcommission.gov.au/aged-care
- Turkle, S. (2011). Alone Together: Why We Expect More from Technology and Less from Each Other. Basic Books.
- Turkle, S. (2015). Reclaiming Conversation: The Power of Talk in a Digital Age. Penguin Press.
- Coughlin, J. F. (2017). The Longevity Economy: Unlocking the World's Fastest-Growing, Most Misunderstood Market. PublicAffairs. (See also MIT AgeLab publications, https://agelab.mit.edu/)
- Older Persons Advocacy Network (Australia). Public commentary on technology in aged care. https://opan.org.au/
- Australian Association of Gerontology. Position statements on technology and ethics in aged care. https://www.aag.asn.au/
- UK Department for Digital, Culture, Media and Sport (2018). 'A Connected Society: A Strategy for Tackling Loneliness.' (Tracey Crouch, Minister for Loneliness.) https://www.gov.uk/government/publications/a-connected-society-a-strategy-for-tackling-loneliness
- World Health Organization (2023-2024). Commission on Social Connection and reports on loneliness as a public health priority. https://www.who.int/groups/commission-on-social-connection
- Wada, K. and Shibata, T. Research on the Paro therapeutic robot, National Institute of Advanced Industrial Science and Technology, Japan. (For historical context on early companion robotics.)
- UCLA Loneliness Scale (Russell, D.W., 1996). Journal of Personality Assessment, 66, 20-40. (For methodology on loneliness measurement referenced in ElliQ pilot evaluations.)
- Australian Aged Care Quality and Safety Commission. Guidance on disclosure and resident rights in residential aged care. https://www.agedcarequality.gov.au/
- Lane, R. Aged Care Who Cares?: Funding the Future of Aged Care in Australia. (Public commentary on legal frameworks for resident rights and consent in Australian aged care.)

Tim Green UK-based Systems Theorist & Independent Technology Writer
Tim explores the intersections of artificial intelligence, decentralised cognition, and posthuman ethics. His work, published at smarterarticles.co.uk, challenges dominant narratives of technological progress while proposing interdisciplinary frameworks for collective intelligence and digital stewardship.
His writing has been featured on Ground News and shared by independent researchers across both academic and technological communities.
ORCID: 0009-0002-0156-9795 Email: tim@smarterarticles.co.uk
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