Requests for assistance to aged care advocacy services have surged since the government introduced a controversial assessment tool for home care support, with one woman in her 80s describing it as “the stuff of nightmares”.
Guardian Australia previously revealed that aged care clinicians and support workers have raised serious concerns about the Integrated Assessment Tool (IAT), an algorithm-driven system introduced in November to determine eligibility for aged care services and funding levels.
The way it assesses home support eligibility has become a central concern, with the government’s IAT user guide showing the tool generates a classification of need that must be accepted by aged care assessors, who have limited scope to override an incorrect outcome.
A spokesperson for the Older Person’s Advocacy Network (Opan) said it responded to 7,500 requests for information and advocacy between 1 October and 31 December in relation to support at home or home care packages.
This was a 50% increase from the previous quarter before the IAT was introduced, when about 5,000 requests were made.
While those figures include any issues with home support packages – not just the tool’s outcome – the spokesperson said the organisation is hearing about numerous IAT-related concerns.
These include people seeking help to get reassessed; those who have had funding reduced; and people living with dementia not being assessed as a high priority.
“Currently assessors are unable to override the IAT algorithm, leaving older people without access to the care they need,” the spokesperson said.
While they can request a review, it can take up to 90 days for a response.
“The uncertainty and confusion being experienced by older people is unfair and impacts their health and wellbeing.”
‘Terrible and inhumane’
A 77-year-old woman who cares for her husband, 83, described the IAT as “terrible and inhumane”.
The woman, who wished to remain anonymous to protect her husband’s health information, told Guardian Australia he was “practically immobile with constant back pain”, leaving her responsible for all everyday tasks and decision-making.
Despite this, he was rejected for any home support after being assessed through the IAT.
“The assessor was surprised and disappointed, as was our doctor and my husband’s specialists,” she said.
“I am clearly not coping with all this … it is a terrible system that overrides human and professional judgments.”
Bernice Brown, 83, lives alone with disabilities in a regional town, about 100km from her family. Her health problems have increased and she said she hoped undergoing an IAT assessment would increase her home support funding.
Her hope “quickly became despair”, she said.
“Things became the stuff of nightmares when the assessment was no longer made by a human but, to my horror, an algorithm,” she said.
“That algorithm decided no increase to my level of funding was allowed. I watched the assessor’s face and she was in just as such turmoil at the outcome as I was.”
‘Real risk of people being under-assessed’
Jim Moraitis is the founder of VillageLocal, an aged care navigation and advocacy community, and he said he has been “hearing consistent concerns from older Australians and families who feel they have been under-assessed, as well as from clinical assessors who are frustrated by their limited ability to apply discretion”.
“Our concern is not with the intention behind standardising assessments but with the unintended consequences of over-reliance on algorithmic outputs in complex, human situations.”
Moraitis said many older Australians struggle to fully articulate the extent of their day-to-day challenges during an assessment, minimising their difficulties out of pride and stoicism, or because decline has been gradual and hard to notice.
“Historically, experienced clinicians have used judgment and discretion to interpret what is not being said,” he said.
“When that discretion is constrained, there is a real risk of people being under-assessed for both level and urgency of support.
“At scale, even a small percentage of under-assessment can have significant consequences for older Australians trying to remain safe and independent at home.”
The shadow minister for health and aged care, Anne Ruston, said her office is hearing “increasing concerns from nurses and frontline aged care professionals that the IAT tool is producing inaccurate assessments that may place older Australians at risk”.
“The Albanese government is refusing to come clean on how the IAT tool actually works, how many complaints have been made, or whether health professionals were even consulted before it was rolled out,” Ruston said.
“It is deeply alarming that there’s no way to override the outcome … even when a qualified healthcare assessor says the result is clearly wrong.”
The Department of Health, Disability and Ageing has yet to respond to a series of questions about the tool’s accuracy.
The royal commission into aged care quality and safety, which delivered its final report in 2021, found most Australians want to age in their own homes and should be supported to do so as much as possible.
But Guardian Australia previously reported the IAT risks pushing people into aged care homes before they are ready.
The commission found the amount funded for home care packages was insufficient to meet the care needs of many, and recommendations included boosting in-home support and supporting independence and dignity at home.
“Without access to home care services that meet their assessed needs, people face risks of declining function, preventable hospitalisation, carer burnout, premature entry to residential aged care and even death,” the commission found.
Do you know more? melissa.davey@theguardian.com
