New Algorithm System Sparks Aged Care Advocacy Surge and Oversight Concerns
A new algorithm-driven system for assessing home care eligibility and funding, the Integrated Assessment Tool (IAT), has led to a significant increase in requests for aged care advocacy services since its implementation in November. The tool's design, which limits assessors' ability to override classifications, has drawn criticism from advocacy groups, clinicians, and an original developer of the assessment questions, prompting calls for greater human oversight and transparency.
Implementation and System Design
The Integrated Assessment Tool (IAT), introduced in November, is an algorithm-driven system designed to determine eligibility and funding levels for home care support services. The Department of Health's stated rationale for the algorithm's introduction is to create a consistent, national approach to assessing care needs and reduce variation in outcomes.
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. The department has not specified when the decision to introduce the algorithm was made or who developed it.
Lynda Henderson, a member of the federal government's advisory group for the IAT, has expressed concerns regarding the tool's current implementation. Henderson, who participated in developing the IAT assessment questions starting in late 2020, stated that the questions were crafted to allow for nuance and assessor input.
"She expressed strong disapproval upon learning that the government introduced a new algorithm to classify responses, assign scores, and categorize individuals' levels of need, which subsequently determines their funding packages."
Henderson stated that neither the working group nor the health consultancy involved in development were aware an algorithm would be applied. She noted that the assessment was initially designed to aid clinical judgments, rather than determine needs via an algorithm.
Increase in Advocacy and Reported Under-assessments
The Older Person’s Advocacy Network (Opan) reported a 50% increase 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 prior quarter. Opan indicated that numerous concerns are related to the IAT, including individuals seeking reassessments, those experiencing reduced funding, and people with dementia not being classified as a high priority.
An Opan spokesperson stated that the inability for assessors to override the IAT algorithm can result in older individuals not accessing necessary care.
While a review can be requested, responses may take up to 90 days.
Individual Experiences Highlight Challenges
Individual experiences have highlighted challenges with the IAT:
- A 77-year-old woman reported that her 83-year-old husband, despite being largely immobile, was denied home support following an IAT assessment. The assessor, doctor, and specialists involved reportedly expressed surprise at the outcome.
- An 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 also expressing dismay at the result.
- Lynda Henderson, the advisory group member, stated that her personal health has declined, requiring more home support. She expressed concern about applying for reassessment with the IAT due to the risk of under-assessment, identifying the disallowance of assessor overrides as a significant concern.
Jim Moraitis, founder of VillageLocal, an aged care navigation and advocacy community, has noted consistent concerns from older Australians and families feeling under-assessed, as well as from clinical assessors constrained by limited discretion. Moraitis explained that older Australians may not fully articulate their challenges during assessments. He cautioned that limiting clinician discretion poses a risk of under-assessment for both the level and urgency of support.
Political and Systemic Concerns
Shadow Minister for Health and Aged Care, Anne Ruston, reported receiving increasing concerns from frontline aged care professionals about the IAT producing inaccurate assessments that may put older Australians at risk. Ruston has requested clarity on the IAT's operation, the number of complaints received, and whether health professionals were consulted before its rollout, specifically highlighting the inability to override outcomes even when assessors identify errors.
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 the impact on older Australians and their families.
The Department of Health has not yet responded to inquiries regarding the tool's accuracy.
The 2021 royal commission into aged care quality and safety emphasized the importance of supporting Australians to age in their homes. The commission's findings 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. Previous reports indicate that the IAT may increase the risk of individuals entering aged care homes prematurely.