Ombudsman finds serious flaws in Australia’s automated aged care assessments

Australia’s commonwealth ombudsman has found that an algorithm used to determine older people’s aged care entitlements operates unfairly and unreasonably, with inadequate human oversight. The investigation also concluded that the government had failed to follow transparency recommendations made by the robodebt royal commission.

The 104-page report examined the mandatory Integrated Assessment Tool, known as the IAT, which recommends funding packages for aged care. Assessors cannot override its recommendations even when they consider them clinically wrong. Speaking to Guardian Australia on Monday, ombudsman Iain Anderson said legislation needed to change so assessors could correct such decisions themselves.

The investigation began in April after concerns from the public and media about assessments for support at home packages. Guardian Australia had reported that older people were experiencing distress and receiving inadequate care after their needs were assessed through the algorithm. The report found that publicly available information did not meaningfully explain how the system translated assessment inputs into decisions, describing the IAT as a “technological black box”.

The ombudsman also challenged the department’s account of the consultation supporting the system. Although public information suggested that years of trials and consultation had informed the current IAT and its decision-making framework, the investigation found those activities concerned earlier versions and earlier legislation. It concluded there had been no meaningful consultation on the system in its current form.

Guardian Australia previously reported that people involved in developing the assessment tool had not known the government would add an algorithm before changes were introduced in November. Documents obtained through freedom of information showed departmental alarm, serious clinical concerns among frontline assessors and undisclosed IT workarounds. Officials realised only hours before implementation that the legislation prevented human overrides, with distress emerging within days.

Oversight of assessment providers was another major concern. The department had neither enforced contractual quality requirements nor checked whether assessors possessed compulsory clinical qualifications, the investigation found. Anderson said the quality of information entered by providers was crucial because it shaped the algorithm’s results. Senior staff had also warned before implementation that review procedures appeared capable only of confirming algorithmic outcomes.

The report called for a comprehensive examination of the legislation governing needs assessments and the rules behind the algorithm. It found that the department had not complied with the robodebt royal commission’s recommendations on transparency in automated government decisions. Anderson said people needed to understand how decisions significantly affecting them were reached, and questioned how they could challenge outcomes without that knowledge.

In July, the department of health and ageing announced a process allowing assessors to refer incorrect decisions to the department for review. Anderson questioned whether that route would adequately address clinically inappropriate outcomes. He said significant legal problems required urgent attention and that the department had not understood, and might still not understand, key elements of the legal framework it established. The department has been approached for comment.