Aged Care Crisis: Algorithmic Failures and Funding Delays Plague Australian Home Support

"Decisions made by the IAT cannot be overridden by human assessors."

Several individuals and families in Australia have reported difficulties accessing timely and adequate government-funded aged care home support. These reports, which emerged in early 2024, involve challenges related to a new algorithmic assessment tool, delays in equipment and service delivery, and a lack of transparency in funding management.

Algorithmic Assessment and the Case of Graham Crossan

Background

Graham Crossan, 80, is in the late stages of motor neurone disease (MND). He requires ventilation for 22 to 23 hours daily and cannot eat, move, or breathe unassisted. His primary carer is his wife, Gaynor Crossan, 79. Because Mr. Crossan is over the age of 65, he is ineligible for the National Disability Insurance Scheme (NDIS) and instead receives funding through the My Aged Care system.

Assessment Process

In November 2023, the federal government implemented changes to aged care support assessments. As part of these changes, Mr. Crossan's level of need was determined using the Integrated Assessment Tool (IAT), an algorithm. According to reports, decisions made by the IAT cannot be overridden by human assessors.

The algorithm assessed Mr. Crossan as ineligible for a higher funding level. Prior to this assessment, Mr. Crossan's family had been receiving 14 hours of carer support per week. Following the reassessment, the family reported that funding was reduced to nine-and-a-half hours per week.

A subsequent review of the decision—which included a new occupational therapy report—was rejected in March 2024.

The Department of Health, Disability and Ageing stated it rejected the review because there was "no significant change in functional independence."

Review Process and Government Response

To challenge an IAT assessment, a postal letter must be sent to the System Governor at the Department of Health, Disability and Ageing within 28 days of the decision, with a response aimed for within 90 days.

The Department of Health, Disability and Ageing reported receiving 1,117 review requests between November 1, 2023 and March 31, 2024. Of the 606 reviews that were finalized during that period:

• 92 original decisions were upheld
• 132 were amended
• The remainder were either withdrawn or deemed ineligible

Federal Health and Ageing Minister Mark Butler announced a three-month rapid review of the Support at Home prioritisation mechanism. This review includes a fast-track process for people with MND. Aged Care Minister Sam Rae stated that the review "will not be the end of the government's work." A spokesperson for Minister Rae said the assessment process is based on assessor input and clinical advice to achieve accurate and consistent outcomes.

Reports of Delays in Equipment and Service Access

Case Studies

Individuals approved for government-funded home support packages have reported significant delays in receiving necessary equipment and accessing services.

• Emma Nicolle, caring for her father Alan who had cancer, reported that a mechanized bed was delivered four months after funding was approved—less than two weeks before his death. She also faced challenges in obtaining a wheelchair, oxygen mask, and bathroom modifications.

• Kirilly Mallard, caring for her mother-in-law who was in palliative care, reported difficulties accessing care and understanding how funds were being allocated. She stated that some support, including overnight care, was funded by a charity because her mother-in-law's package did not cover it.

• An anonymous carer in Victoria managing her mother's self-managed package reported discrepancies in invoices, including charges for days carers were not working and unauthorized fee increases. She was informed that the package was over budget.

Concerns Over Funding Management and Transparency

Carers have reported a lack of clarity and control over how Support at Home funding is managed. Some reported being told that changing providers was "not an option," despite the policy allowing for provider changes. The option to "self-manage" a package, which allows families to choose workers and equipment directly, is reportedly not widely communicated. Even self-managed funds require families to use an approved provider to hold the funds, and few organizations offer this service, leading to waiting lists.

"The algorithm is not adequately identifying the urgency or complexity of individuals' situations."

Richelle Napoli, CEO of Generation Care, reported that clients approved for assistive technology are often placed on waiting lists for care supports. She cited an example of a 70-year-old man being placed on a waitlist for care supports despite receiving funding for a bed. She also noted that some clients are advised to declare themselves palliative to expedite access to services.

Geoff Rowe from Aged and Disability Advocacy Australia reported an increase in similar cases. He stated that the algorithm is not adequately identifying the urgency or complexity of individuals' situations. He also noted that inadequate home support can lead to increased hospital admissions or accelerated transitions to residential aged care.

Political Statements

Greens Senator Penny Allman-Payne criticized the aged care reforms, stating they increase costs for older people while reducing transparency.

Political Proposals

Shadow Aged Care Minister Anne Ruston announced plans to introduce a private member's bill that would allow for human override of algorithm decisions and mandate reassessment for those affected.