Robots and labor in the service sector: Evidence from nursing homes

Karen Eggleston; Toshiaki Iizuka; Yong Suk Lee; Ellie Xi; Karen Eggleston; Toshiaki Iizuka; Yong Suk Lee; Ellie Xi

doi:10.3934/har.2026001

Health Affairs Review

2026, Volume 1, Issue 1: 1-27. doi: 10.3934/har.2026001

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Research article

Robots and labor in the service sector: Evidence from nursing homes

1.
Freeman Spogli Institute for International Studies, Stanford University and NBER, USA
2.
Graduate School of Economics, The University of Tokyo, Japan
3.
Keough School of Global Affairs, University of Notre Dame, USA
4.
Stanford University, USA

Received: 18 April 2026 Accepted: 20 June 2026 Published: 06 August 2026

A new wave of technologies including robots, artificial intelligence, and digital platforms has raised concerns about automation and unemployment, while also bringing optimism that innovation can extend lifespans and improve quality of life. This paper is among the first studies using institution–level data to examine service–sector robots, focusing on Japanese nursing homes. Using regional variation in robot subsidies as an instrumental variable, we investigated how robot adoption affects staffing outcomes. We found that robot use reduces staffing retention difficulties and increases employment of care workers and nurses under flexible contracts. Our results suggest that robots help address challenges from rapid population aging and care–labor shortages, and do not necessarily harm workers or care quality.
- robots,
- employment,
- nursing homes,
- automation,
- aging,
- long–term care
Citation: Karen Eggleston, Toshiaki Iizuka, Yong Suk Lee, Ellie Xi. Robots and labor in the service sector: Evidence from nursing homes[J]. Health Affairs Review, 2026, 1(1): 1-27. doi: 10.3934/har.2026001

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Abstract

A new wave of technologies including robots, artificial intelligence, and digital platforms has raised concerns about automation and unemployment, while also bringing optimism that innovation can extend lifespans and improve quality of life. This paper is among the first studies using institution–level data to examine service–sector robots, focusing on Japanese nursing homes. Using regional variation in robot subsidies as an instrumental variable, we investigated how robot adoption affects staffing outcomes. We found that robot use reduces staffing retention difficulties and increases employment of care workers and nurses under flexible contracts. Our results suggest that robots help address challenges from rapid population aging and care–labor shortages, and do not necessarily harm workers or care quality.

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