Let me answer your question with an anecdote.
When my grandfather was approaching the grave and had to battle several serious medical issues, he hired a live-in nurse to help him with everything from cooking dinner to helping him on and off the toilet (she was a large Samoan lady). She took care of him full-time (not on a live-in basis, though) for a couple years, occasionally having someone from her family fill in if she needed to take care of something. The whole family got to know her quite well, and in a way she became a part of the family, performing the duties that the rest of us, for whatever reason, could not.
Would she have been there had she not been getting paid? No, but part of that has to do with the fact that had we not been paying her, she wouldn't even be able to afford a place to live or be able to fuel her car to come over every day.
Similarly, if insurance companies weren't paying the company that creates these avatars, which in turn pays the people who operate the avatars, these relationships would never have an opportunity to form in the first place.
As for my grandfather's nurse, she attended my grandfather's funeral with the rest of the family. Even brought her young granddaughter along with her. She wasn't being paid that day.
In other words, I think you're worrying too much.