Across my career I have rarely heard anyone say they wanted to move into residential care. Most people want to remain at home safely with the right services and support.
But we have not yet confronted what that may require. Are we comfortable with privacy becoming the price of remaining at home?
AI may offer valuable support. The harder question is who decides what it is permitted to hear, see and infer, and whether an older person can refuse it without losing the support that makes staying at home possible.
Three recent stories show why that question is becoming urgent.
In Wired’s My Father Wants to Age in Place. AI Will Be Watching, an 86-year-old man’s home is monitored by Sensi, an always-on, AI-enabled microphone. It listens for signs of a fall, illness or cognitive change and sends information to his caregivers.
The Associated Press reports A Robot Is Helping an Ailing Couple Stay in Their Home that Robbie, a wheeled robot, helps Brian and Brenda Marquis remain in their apartment. It reminds Brian, who has dementia following a traumatic brain injury, to eat, drink, exercise and take medication.
In The Washington Post’s Meet Abi, the AI-Powered Robot Companion for Senior Care, Abi is introduced as an AI-powered companion used in senior care settings. It leads activities, speaks many languages and remembers details from earlier conversations with residents.
These technologies are not the same.
Robbie assists. Abi accompanies. Sensi observes.
All three carry the promise to help people remain safer, more independent and better supported when human care is limited.
Siri and Alexa have already made speaking to a device in the home feel ordinary. Yet there is a significant difference between asking Alexa to play music, tell you a joke and living with a little black box that interprets your cough, movement, tone of voice or spaces in conversation.
One waits for a command.
The other is assessing you.
The hardest ethical questions are not raised by technology that clearly fails. They are raised by technology that genuinely helps.
The same device that identifies a fall or a concerning change may also capture conversations, habits and moments never intended for a caregiver.
Research does not resolve this tension. It confirms it. A review of 15 studies found that 13 raised concerns about privacy, while nine also reported enthusiasm about the potential safety benefits. Other research found that some older people were willing to accept what they regarded as an invasion of privacy if it allowed them to remain safely at home and avoid residential care.
Technology may preserve the freedom to remain at home, by requiring the surrender of the freedom to live without being watched.
Nor should we romanticise home or treat residential care as automatically undignified. A good care home may provide skilled support, companionship and relief from isolation. But leaving home may still mean giving up familiarity, privacy and control.
The ethical question is not simply which setting is safer. It is whether a person has enough real options to choose either freely.
When the only alternatives presented are surveillance at home or admission to residential care, consent may still be real, but it is under certain pressures.
A person may welcome the support. But agreement may also be shaped by anxious family members, unavailable home-care hours or the possibility of having to leave home.
That is still a choice, but one shaped by necessity.
Consent cannot be reduced to a signature collected when a device is installed. How will it be revisited if cognition or decision-making capacity changes?
Can the system be paused for a private conversation?
Can consent be withdrawn without the services also being withdrawn?
This is where policy must catch up.
AI should not simply be installed in the home. Its use should be negotiated as part of the care plan.
That plan should set out: what is monitored, what information is retained, who can access it, what triggers an alert, when human follow-up is required, how the system can be paused and, how consent will be reviewed as circumstances change.
The WHO’s guidance on AI in health places ethics, human rights and accountability at the centre of its design and use.
Those principles need to become enforceable protections inside the home, not aspirations in a document.
Most importantly, refusing surveillance should not automatically disqualify someone from receiving care at home.
Governments should not call it ageing in place when technology is being used mainly to compensate for care hours they have chosen not to fund.
AI may support human care. It must not become the policy excuse for withdrawing it.
Would I accept some monitoring if it helped me stay in the home I loved? Perhaps.
I would want to understand the bargain.
I would want the power to limit it, pause it and change my mind.
I would want to know that refusing it would not mean losing care.
The future of care may include artificial intelligence.
But the terms of that care must remain human.
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