In countries far along in the demographic transition, rapidly aging populations are colliding with a severe shortage of health care and elder care workers. Japan may be the most pertinent case study of this and other impacts of demographic disruption. The country’s fertility rate is decreasing faster than projected, and as of 2025, 30% of its population was aged 65 or older. These trends have contributed to a persistent gap between surging demand for elder care and a shrinking care workforce.

To cope with this crisis, the Japanese government has implemented several programs to promote the use of robots in nursing home care. These care robots (or “kaigo robots”) assist care workers and support residents with daily needs. But how does their adoption affect workflows, staff retention, and overall staffing of long-term care facilities? Few studies have empirically examined these questions.

Shedding light on the debate surrounding new automation technologies and their impact on workers, a recent study, published on August 6 in the inaugural issue of the journal Health Affairs Review, finds that care robots help address challenges posed by population aging and care-labor shortages without necessarily displacing workers or lowering care quality.

The study, titled Robots and Labor in the Service Sector: Evidence from Nursing Homes, is part of a collaborative effort driven by the Asia Health Policy Program (AHPP) at the Walter H. Shorenstein Asia-Pacific Research Center. The study’s co-authors are Stanford health economist Karen Eggleston, the director of AHPP; Toshiaki Iizuka of the University of Tokyo’s Graduate School of Economics, a former AHPP visiting scholar; Yong Suk Lee of the University of Notre Dame’s Keough School of Global Affairs, formerly the SK Center Fellow at Stanford’s Freeman Spogli Institute for International Studies; and Ellie Xi, a rising junior at Stanford studying biomedical computation on the pre-med track and a former research assistant to Dr. Eggleston.

“One of the aspects of the paper that I found most interesting is its attempt to move beyond simply documenting where robots are being adopted and instead ask what their adoption may actually do to the long-term care workforce, especially given the sector’s high turnover rates and physically demanding working conditions,” says Xi.

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Lessons from Early Diffusion of Robotics in the Long-Term Care Sector

The researchers grouped the robots prevalent in Japanese nursing homes into three main categories:

• Transfer aids: Wearable and non-wearable devices that assist staff with lifting frail residents from beds to wheelchairs, significantly reducing back strain, a leading cause of caregiver burnout.
• Mobility robots: Assistive systems that help residents move, use the restroom, or bathe more independently.
• Monitoring and communication systems: Sensors that alert staff when a resident has slipped out of bed or fallen, as well as social robots designed to offer companionship and cognitive stimulation.

To examine early diffusion of these robots, the researchers used 2017 survey data on long-term care work across approximately 860 Japanese nursing homes. A second source of data is their compilation of prefecture-level care robot subsidy availability, using regional variation in robot subsidies as an instrumental variable. Think of this as a natural experiment driven by a “geographic nudge.” Starting in 2015, Japan’s central government began providing prefectural governments with funds to subsidize the cost of adopting care robots. Because different prefectures introduced these subsidies at different times and with varying levels of generosity, nursing homes in some regions had a much easier path to acquiring and deploying robots than those in neighboring areas.

By comparing staffing trends between nursing homes that received this external, subsidy-driven "nudge" to adopt robots and those that did not, the researchers could confidently isolate the technology’s causal effects on the caregiving workforce.

The results indicate that nursing homes that adopted robots saw a significant decrease in staffing retention problems. Robot adoption was also associated with a 28% increase in care workers and a 39% increase in nurses, resulting in approximately 26% higher total employment at the facility level. Importantly, this employment growth occurred entirely among non-regular employees – that is, staff members on flexible, often part-time, contracts. The findings also suggest that robot adoption may improve continuity and quality of care while mitigating careworker shortages.

“Using nationally representative data from Japan and an instrumental-variable strategy, the study provides evidence suggesting that robots can complement rather than simply replace care workers, including by alleviating retention difficulties in a sector facing persistent labor shortages and potentially supporting quality of care,” explains Xi. “The paper’s central finding is that robot adoption is associated with reduced retention difficulties and increased employment of care workers and nurses under flexible contracts.”

A Human-Robot Collaborative Future for Elder Care

Caregiving is a physically demanding and high-stress occupation. The study’s findings indicate that, by introducing robots to ease staff burdens and monitor residents, nursing homes were able to promote more flexible work, either by increasing the tasks performed by non-regular employees or potentially encouraging part-time work. This type of work structure is encouraged by the Japan Nursing Association as a means for reducing stress, preventing burnout, and promoting a healthier work-life balance.

“Given recent debates about AI use in healthcare and the future of work, I found it especially interesting that this research highlights the potential for technology to augment caregivers, particularly by supporting physically demanding or indirect tasks, while preserving the human aspects of care that are more difficult to reproduce,” says Xi.

The study's findings are relevant for policymakers seeking evidence on the social value of collaborative robots and their impacts on staffing and care delivery, particularly as aging societies facing demographic pressures similar to Japan consider how to meet growing demand for long-term care.

A Mentorship Story

The study is part of Eggleston’s Innovation for Healthy Aging research track, which investigates how East Asian economies adopt and adapt to emerging technologies, design incentives, and adjust their workforces to support older adults. It builds on an earlier research project focused on the impact of robots on nursing home care in Japan.

For Xi, co-authoring the paper represents an academic milestone. "As someone deeply interested in geriatrics, I first began working with Dr. Karen Eggleston as a research assistant during the summer after my freshman year," Xi recalls. "Last spring, we decided to continue working together through a directed reading."

During that directed reading, Xi was invited to help revise and update a project that had previously circulated as an Asia Health Policy Program working paper. She worked to update the research, framing the original findings within the rapidly shifting landscape of care robotics and artificial intelligence in long-term care.

"I worked on situating the original findings within more recent research and developments in care robotics and considering what Japan’s experience can tell us about the role of these technologies in aging societies today," Xi says. "It was an incredible opportunity to work closely with Dr. Eggleston, Professor Toshiaki Iizuka, and Professor Yong Suk Lee. I was especially grateful to see firsthand how a collaborative project evolves and to contribute to that process as the paper moved from a working paper toward publication.”

The following reflection is a guest post written by Sunny Park, a Fall 2020 alumna of Stanford e-Entrepreneurship Japan, which is currently accepting applications for Fall 2026.

A “smart” high school student is often defined by strong grades, perhaps alongside a few extracurricular activities to strengthen university applications. Before encountering Stanford e-Entrepreneurship Japan (SeEJ), that was largely how I viewed myself. 

I came across SeEJ during the COVID-19 pandemic through a Facebook advertisement. Like many students at the time, I was looking for something more engaging beyond school. I didn’t expect how much it would reshape the way I think about learning, ambition, and possibility. 

What made SeEJ distinct was its focus on people rather than definitions. Each session featured entrepreneurs from different industries, sharing not just what they built, but how they navigated uncertainty, failure, and personal ambition. Seeing such varied paths made me realize that entrepreneurship isn’t a fixed route; it’s a way of thinking. And that was probably the moment when things shifted for me. Until then, I had always thought of my future in fairly narrow terms: choose a subject, go to university, and follow a path that already exists. SeEJ made me realize that there are far more ways to build a life, and that entrepreneurship is less about starting a company and more about taking ownership of what you want to pursue. 

Since then, I’ve found myself saying yes to things I would have hesitated to try before. I’m now in my final year of studying Biology at Imperial College London, and I co-founded a biotech startup called Eidolon Therapeutics. At Eidolon, we’re pioneering microbial protein combinations to combat immunotherapy resistance and inflammation-driven toxicity in cancer. It was through my Year-in-Research program where I met my Co-Founders (i.e., my professor and post-doc supervisor), and I was so fascinated by the research they were conducting I couldn’t help but impatiently suggest building a company out of it. Since then, we’ve been working incredibly hard on making Eidolon real, including joining accelerator programs such as the Cancer Tech Accelerator, Venture Catalyst Challenge, and Conception X. Through building an early-stage startup, I’ve had the chance to meet people I once found intimidating, pitch ideas in front of large audiences, and build relationships that started from simple conversations. 

I don’t think any of that came from a single moment of confidence. If anything, it came from gradually becoming more comfortable with not knowing exactly what I’m doing… and trying it anyway. Based on my journey so far, here are a few reflections for students exploring a similar path:

1. Be intentional about the opportunities you choose.

There are so many opportunities available as a student! SeEJ, in particular, showed me the value of learning environments where you actively engage with ideas and people. There are many programs available, but depth matters more than quantity. Choose opportunities where you can contribute, ask questions, and grow. 

2. Focus on genuine connections!

One of the most valuable parts of SeEJ was the access to people with diverse experiences. What I learned is that meaningful connections come from curiosity and sincerity, not from trying to impress. When you approach people with a willingness to learn, they are often more open than you expect. 

3. Stay engaged beyond the program.

The real impact of SeEJ extended beyond the sessions themselves. Following up with people, continuing conversations, and sharing your own progress helps turn short-term interactions into long-term relationships. Small, consistent effort makes a difference!

4. Reflect as you go. 

Exploring entrepreneurship alongside academics can be exciting but also overwhelming. Taking time to reflect on what you enjoy, what challenges you, and what kind of path you want to build helps you stay grounded and intentional.

Looking back, SeEJ was a turning point not because it provided a single opportunity, but because it changed how I see opportunities altogether. It reminded me that there isn’t one path to follow, but many that you can create. 

Stanford e-Entrepreneurship Japan is currently accepting applications for Fall 2026. Apply at https://forms.gle/5gkHrhm3X4sycZGG8.

Stanford e-Entrepreneurship Japan is one of several online courses offered by SPICE.

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This essay first appeared in The Diplomat.

For decades, South Korean strategy rested on a stable hierarchy within the international order. The alliance with the United States provided security; Seoul then managed relations with Japan, Europe, China, and regional institutions around that anchor. The alliance remains indispensable, but Seoul can no longer assume that this foundation will stay stable.

The evidence is visible in the way Washington now deals with allies. In 2025, the United States initially announced sharply differentiated “reciprocal” tariffs on South Korea, Japan, and the European Union. Negotiations later produced a 15 percent baseline framework for all three, but the process mattered as much as the final rate. Trade access, industrial investment, defense procurement, and alliance politics were increasingly handled as one bargaining package. Allies were not exempt from economic pressure because they were allies.

At the same time, Europe and Asia have been building connections that would have seemed highly ambitious a decade ago. The European Union signed security and defense partnerships with Japan and South Korea in November 2024. This year, the EU and Japan launched a defense-industry dialogue, while the EU and South Korea signed a digital trade agreement and began implementing cooperation on maritime security, cyber and hybrid threats, information manipulation, space, and the defense industry. The strategic map is becoming more networked. 

The network, however, remains uneven. Japan already has a mature economic partnership with the EU and rapidly expanding defense-industry ties. EU-South Korea relations are deepening, but they still lack the density and regular strategic consultation found in EU-Japan ties. A trilateral format would therefore do more than add another meeting: it would reduce asymmetry among three partners whose capabilities are increasingly complementary.

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South Korea, Japan, and the EU now face four converging challenges and pressures.

The first is demographic. South Korea is aging faster than any other OECD society; Japan’s working-age population has been shrinking for decades; and the EU’s fertility rate reached a new low in 2024. Demography is not a social-policy sidebar. It affects defense recruitment, industrial capacity, fiscal room, technological adoption, and the ability to sustain long-term commitments. Each actor is experimenting with immigration, automation, workforce policy, and welfare reform, but the security implications remain largely compartmentalized.

The second is concentrated economic dependence. None of the three can or should decouple from China. Yet South Korea’s experience after the THAAD deployment, Europe’s debates over economic coercion, and China’s export controls on gallium, germanium, and other strategic inputs have shown that interdependence can be converted into leverage. De-risking therefore requires more than national stockpiles. It requires shared risk maps, compatible certification, co-investment in alternative suppliers, and advance consultation before export controls or industrial subsidies create collateral damage among partners.

The third challenge is U.S. volatility. The United States is still the only actor capable of providing extended nuclear deterrence to South Korea and Japan, and NATO remains central to European defense. But dependence on U.S. power now coexists with uncertainty about U.S. policy. The classic alliance dilemmas of abandonment and entrapment are no longer opposite ends of a spectrum. Today, U.S. allies fear both being left out and being drawn into bargains or contingencies they did not shape.

The fourth pressure is the collapse of the old geographic separation between European and Asian security. North Korean munitions, missiles, and troops have supported Russia’s war against Ukraine. Moscow, in turn, has provided Pyongyang with political cover, economic support, and the prospect of military know-how. What happens on a European battlefield is changing the military balance on the Korean Peninsula. A regional response to a cross-regional threat is structurally inadequate.

This is the case for an EU-Japan-South Korea strategic dialogue. This framework should not be described as strategic autonomy, equidistance, or a hedge against the United States. A better term would be institutionalized hedging: risk diversification through standing, rule-based consultation among allies and partners that remain anchored in the broader U.S.-led system.

The proposal is more feasible than ever before. Japan-South Korea relations have improved significantly in recent years. The January 2026 summit in Nara and the reciprocal summit in South Korea in May demonstrated continuity across leadership changes in both countries since June 2025. The EU already has free-trade, digital, green, and security frameworks with both countries. The task is not to invent three new bilateral relationships; it is to connect existing ones.

The dialogue should begin modestly, through a Track 1.5 process involving officials, experts, and industry. Its early agenda must be concrete and specific: a joint critical minerals and supply chain risk assessment; consultation on export controls and investment screening; cooperation on AI, cyber resilience, and digital standards; exchanges on demographic and defense workforce adaptation; and shared monitoring of North Korea-Russia military cooperation. Successful projects could then be elevated to ministerial working groups.

Two design choices are essential. First, the initiative must remain function-driven. It is not NATO, not the Quad, and not an anti-China coalition. Its purpose is to reduce vulnerability without demanding economic separation. Second, it should be complementary to relations with Washington and transparent about that purpose. Horizontal networks strengthen alliances when they help allies absorb shocks, coordinate positions, and arrive at consultations with greater capacity.

For South Korea, the need is particularly acute. Japan already has the G7, a mature economic partnership with the EU, and expanding European defense ties. Seoul’s international weight has grown faster than its institutional depth. An EU-Japan-South Korea dialogue would help close that gap.

Horizontalizing alliances is not a vote of no confidence in the United States. It is insurance for the moments when the United States wavers, overreaches, or changes course. The postwar hierarchy cannot simply be preserved by demanding more reassurance from Washington. Its resilience will depend on whether allies can build connective tissue among themselves before the next crisis forces them to improvise.