Algorithmic Aged Care Tool Sparks Advocacy Surge and Developer Concern
The Integrated Assessment Tool (IAT), an algorithm-driven system implemented in November to assess eligibility and determine funding levels for aged care home support, has led to a notable increase in requests for advocacy services. Concerns have been expressed by advocacy organizations, individuals receiving care, and even a key developer of the tool regarding its assessment outcomes and the limited ability for human assessors to override algorithmic classifications.
Surge in Advocacy Service Requests
The Older Person’s Advocacy Network (Opan) reported a 50% rise in requests for information and advocacy related to home support between October and December, totaling 7,500 requests compared to approximately 5,000 in the preceding quarter. Opan indicated that a significant number of these concerns are linked to the IAT. These involve individuals seeking reassessments, experiencing reduced funding, or observing that people with dementia are not being classified as a high priority.
An Opan spokesperson stated that assessors currently lack the ability to override the IAT algorithm, which can result in older individuals not accessing required care.
While a review process exists, responses may take up to 90 days.
Individual experiences further illustrate the challenges with the IAT. One 77-year-old woman reported that her 83-year-old husband, despite being largely immobile, was denied home support following an IAT assessment. This outcome was reportedly found unexpected by assessors, doctors, and specialists. Similarly, 83-year-old Bernice Brown, who lives with disabilities, reported that her IAT assessment denied an increase in her home support funding level, with the assessor expressing surprise at the result.
Jim Moraitis, founder of VillageLocal, an aged care navigation and advocacy community, noted consistent concerns from older Australians and their families about feeling under-assessed. He also reported similar concerns from clinical assessors who feel restricted by limited discretion within the system. Moraitis suggested that older Australians might not fully articulate their challenges during assessments due to factors such as pride or the gradual nature of decline.
Concerns from Tool Developer and Implementation Details
Lynda Henderson, a member of the federal government's advisory group for the IAT and a professional with a background in psychology, psychometrics, and statistics, has expressed concerns about the tool's current implementation. Henderson participated in developing the IAT assessment questions starting in late 2020. She explained that the questions were designed to allow for nuance and assessor input.
Henderson stated that she had not been informed that an algorithm would be introduced to classify responses, assign scores, and categorize individuals' levels of need to determine funding packages.
Neither the working group nor the health consultancy involved in development were aware such an algorithm would be applied to score each question and assign categories.
Documents confirm that as of November 1, IAT classifications for Support at Home became prescriptive, meaning outcomes cannot be overridden to a lower or higher classification by assessors. Henderson, whose personal health has declined, stated she is now hesitant to apply for reassessment with the IAT due to the perceived risk of under-assessment, highlighting what she views as a significant change in the tool's application.
Government Rationale and Political Response
The department's rationale for introducing the algorithm is understood to be the creation of a consistent, national approach to assessing care needs and reducing variation in outcomes. However, the department has not specified when the decision to introduce the algorithm was made or who developed it.
Shadow Minister for Health and Aged Care, Anne Ruston, reported receiving increasing concerns from frontline aged care professionals regarding the IAT producing inaccurate assessments that may pose risks to older Australians. Ruston has requested clarity on the IAT's operation, the number of complaints received, and whether health professionals were consulted prior to its rollout. She highlighted the inability to override outcomes even when assessors identify errors. The department has not yet responded to inquiries regarding the tool's accuracy.
Greens Senator Penny Allman-Payne has written to the Aged Care Minister, Sam Rae, urging the immediate reinstatement of human oversight and assessors' ability to override under-assessments. Senator Allman-Payne also called for public disclosure of details regarding the algorithm's developers, testing, and methodology, citing concerns about its impact on older Australians and their families.
Broader Context
The 2021 royal commission into aged care quality and safety emphasized the importance of supporting Australians to age in their homes. Previous reports indicate that the IAT may increase the risk of individuals entering aged care homes prematurely. The commission's findings also noted that existing home care package funding was often insufficient, recommending increased in-home support to prevent declining function, preventable hospitalizations, carer burnout, premature entry to residential aged care, and death.