A controversial new algorithm-based assessment tool is facing widespread criticism from aged care clinicians and carers, who are labelling it “cruel” and “inhumane.” The Integrated Assessment Tool (IAT), implemented in November, is now the primary method for determining federal home support funding packages and eligibility for aged care services, including residential care. Critics argue that the IAT strips away essential clinical expertise, leaving elderly Australians with inadequate support and failing to account for the complex realities of individual needs.
The Algorithm’s Grip on Aged Care Funding
The core of the concern lies in how the IAT assesses eligibility for home support. According to the government’s own user guide, the tool generates a classification of need that assessors are generally required to accept to secure support. There are only very limited circumstances where an assessor can override the IAT’s decision, and crucially, disagreeing with the generated classification of need is not one of them.
Mark Aitken, a registered nurse with 39 years of experience, including 16 years specifically in aged care assessment, recounted his decision to leave his role in regional Victoria just four months after the IAT’s introduction. “We weren’t allowed to use it (the override button), and even my manager, who had 25 years of experience in aged care assessment, wasn’t allowed to use it,” Aitken stated. “There was no ability for anyone to say: ‘The algorithm has it wrong, we need a human to adjust this’.”
Aitken provided stark examples illustrating the tool’s perceived failings. In one instance, he assessed an elderly woman living with family, possessing strong cognitive skills, and recommended a “decent” mid-range level of home assistance. However, the IAT classified her as having a much higher level of need and high priority. Conversely, he assessed a woman in her 70s with advanced dementia, who he believed was experiencing neglect and had no services in place. He deemed her high risk and urgently in need of substantial support, but the algorithm categorised her as lower need with no priority, potentially delaying crucial assistance for up to another year. “Eight times out of 10, the outcome was different to one that I would have recommended, or my colleagues would have recommended,” Aitken lamented.
Echoes of Past Automated Failures
This controversy surrounding the IAT is not an isolated incident. It follows previous government initiatives that have faced scrutiny over automated decision-making. The infamous “robodebt” welfare scandal and ongoing concerns about algorithm-driven disability funding through the National Disability Insurance Scheme (NDIS) highlight a pattern of unease with the increasing reliance on technology for critical human services.
A significant point of contention with the IAT is its lack of transparency. The user guide offers no explanation of how the algorithm weighs factors such as risk, need, or complexity, and Aitken confirmed this information was never disclosed to assessors. He described feeling “shut down” when he attempted to inquire about the evaluation framework, data collection methods, accuracy assessments, and public reporting of results at a government seminar.
The Human Cost of Algorithmic Decisions
Aitken’s decision to resign stemmed from his unwillingness to be part of a system he felt devalued human judgment. “I left my job because I didn’t want to be part of a system that removed the ultimate decision-making about support from real, experienced people who care,” he said. “The government valued the algorithm more than people with skills, intelligence and knowledge.”
The pressures of the IAT have reportedly led some assessors to resort to “gaming” the system. This involves inputting information they know will generate the required level of care for a client, even if it doesn’t accurately reflect their actual situation. “People shouldn’t have to put in fake information,” Aitken stressed. “I just started to feel like it was going to be another robodebt; I became very uncomfortable, and just felt the tool wasn’t ethical.”
Parliamentary Scrutiny and Constituent Concerns
Independent MP Dr Monique Ryan has raised questions about the IAT algorithm in parliament. While the Minister for Aged Care and Seniors, Sam Rae, stated that the IAT classification algorithm does not replace assessor input, Dr Ryan believes this misses the fundamental issue. “The input might be right, but the algorithmic output can be entirely wrong,” she told Guardian Australia.
Dr Ryan has been increasingly hearing from constituents who share her concerns that the IAT is “stripping the sector of clinical judgement and nuance.” She highlighted that while earlier guidance allowed aged care assessors to override the algorithm, “This is no longer the case.” A lack of transparency regarding how the tool evaluates vulnerabilities, complexities, and other factors, along with limited information on its pre-rollout evaluation, is a significant worry for her. She has starkly described the IAT as “effectively robo-aged-care.”
A Support Coordinator’s Frustration
Linda Nicholson, a support coordinator based in Queensland, shared a recent experience that exemplifies the frustrations felt by those on the front lines. She assisted a client on a Level 3 care package who required an assessment due to escalating needs. This client lives alone in a remote area, suffers from severe incontinence, experiences cognitive decline, and is at high risk of falls, with no family support nearby.
Despite the clear evidence of deteriorating health, her client was denied an upgrade in support in January after being assessed by the IAT. “We were all shocked, including the assessor,” Nicholson stated. Her attempt to appeal the decision resulted in being told to write a letter, with a potential response time of up to 90 days.
Nicholson’s sentiment echoes the broader criticisms: “Aged care assessors with years of experience are having their professional assessments overridden by a rigid algorithmic system that doesn’t account for individual complexity,” she said. “This algorithm is inhumane; it’s a debacle, and it’s just cruel.”
A spokesperson for the Department of Health, Disability and Ageing has defended the algorithm, stating that it “consolidates key information about an older person’s needs across several domains, providing a holistic view of their health and circumstances.” However, for many in the aged care sector, this “holistic view” appears to be a rigid, one-size-fits-all approach that is failing those who need it most.
