Ombudsman: Aged Care Algorithm Flawed

Commonwealth Ombudsman Iain Anderson published a 104-page report on Monday finding that the algorithm determining aged care entitlements operates unfairly and unreasonably. The investigation concluded that the system suffers from inadequate human oversight and that the government failed to follow transparency recommendations established by the robodebt royal commission.

The report examines the mandatory Integrated Assessment Tool, or IAT, which recommends funding packages for older people. Assessors are legally barred from overriding the tool’s recommendations, even when they believe the clinical judgment is incorrect. Anderson stated that legislation must change to allow assessors to correct these decisions independently.

The investigation launched in April following public and media concerns regarding home support package assessments. Prior reports indicated that older individuals experienced distress and received inadequate care due to algorithmic determinations. The ombudsman’s team described the IAT as a technological black box, noting that publicly available information did not meaningfully explain how the system converted input data into final decisions.

Anderson also challenged the Department of Health and Ageing’s account of the consultation process behind the system. While public information suggested years of trials informed the current tool, the investigation found that those activities related to earlier versions and legislation. The report determined that no meaningful consultation occurred regarding the system in its current form.

Documents obtained through freedom of information requests revealed that developers did not know the government would add an algorithm before changes took effect in November. Departmental records showed alarm among frontline assessors and undisclosed IT workarounds. Officials discovered only hours before implementation that the legislation prevented human overrides, leading to immediate distress among users.

The report identified major failures in oversight of assessment providers. The department did not enforce contractual quality requirements or verify whether assessors held compulsory clinical qualifications. Senior staff had warned prior to implementation that review procedures could only confirm algorithmic outcomes. Anderson emphasized that the quality of information entered by providers directly shaped the results.

The ombudsman called for a comprehensive review of the legislation governing needs assessments and the rules behind the algorithm. In July, the department announced a process allowing assessors to refer incorrect decisions for review, but Anderson questioned whether this route adequately addresses clinically inappropriate outcomes. He noted that significant legal problems require urgent attention and that the department may not fully understand its own legal framework. The department has been approached for comment.