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 \u201cthe stuff of nightmares\u201d.<\/p>\n
Guardian Australia previously revealed that aged care clinicians and support workers have raised serious concerns<\/a> about the Integrated Assessment Tool (IAT), an algorithm-driven system introduced in November to determine eligibility for aged care services and funding levels.<\/p>\n The way it assesses home support eligibility has become a central concern, with the government\u2019s IAT user guide<\/a> 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.<\/p>\n A spokesperson for the Older Person\u2019s 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.<\/p>\n This was a 50% increase from the previous quarter before the IAT was introduced, when about 5,000 requests were made.<\/p>\n While those figures include any issues with home support packages \u2013 not just the tool\u2019s outcome \u2013 the spokesperson said the organisation is hearing about numerous IAT-related concerns.<\/p>\n 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.<\/p>\n \u201cCurrently assessors are unable to override the IAT algorithm, leaving older people without access to the care they need,\u201d the spokesperson said.<\/p>\n While they can request a review, it can take up to 90 days for a response.<\/p>\n \u201cThe uncertainty and confusion being experienced by older people is unfair and impacts their health and wellbeing.\u201d<\/p>\n \u2018Terrible and inhumane\u2019<\/p>\n A 77-year-old woman who cares for her husband, 83, described the IAT as \u201cterrible and inhumane\u201d.<\/p>\n The woman, who wished to remain anonymous to protect her husband\u2019s health information, told Guardian Australia he was \u201cpractically immobile with constant back pain\u201d, leaving her responsible for all everyday tasks and decision-making.<\/p>\n Despite this, he was rejected for any home support after being assessed through the IAT.<\/p>\n \u201cThe assessor was surprised and disappointed, as was our doctor and my husband\u2019s specialists,\u201d she said.<\/p>\n \u201cI am clearly not coping with all this \u2026 it is a terrible system that overrides human and professional judgments.\u201d<\/p>\n 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.<\/p>\n Her hope \u201cquickly became despair,\u201d she said.<\/p>\n \u201cThings became the stuff of nightmares when the assessment was no longer made by a human, but to my horror, an algorithm,\u201d she said.<\/p>\n \u201cThat algorithm decided no increase to my level of funding was allowed. I watched the assessor\u2019s face, and she was in just as such turmoil at the outcome as I was.\u201d<\/p>\n \u2018Real risk of people being under-assessed\u2019<\/p>\n Jim Moraitis is the founder of VillageLocal, an aged care navigation and advocacy community, and he said he has been \u201chearing 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\u201d.<\/p>\n \u201cOur concern is not with the intention behind standardising assessments, but with the unintended consequences of over-reliance on algorithmic outputs in complex, human situations.\u201d<\/p>\n 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.<\/p>\n \u201cHistorically, experienced clinicians have used judgment and discretion to interpret what is not being said,\u201d he said.<\/p>\n \u201cWhen that discretion is constrained, there is a real risk of people being under-assessed for both level and urgency of support.<\/p>\n \u201cAt scale, even a small percentage of under-assessment can have significant consequences for older Australians trying to remain safe and independent at home.\u201d<\/p>\n The shadow minister for health and aged care, Anne Ruston, said her office is hearing \u201cincreasing concerns from nurses and frontline aged care professionals that the IAT tool is producing inaccurate assessments that may place older Australians at risk\u201d.<\/p>\n \u201cThe 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,\u201d Ruston said.<\/p>\n \u201cIt is deeply alarming that there\u2019s no way to override the outcome \u2026 even when a qualified healthcare assessor says the result is clearly wrong.\u201d<\/p>\n The department of health, disability and ageing has yet to respond to a series of questions about the tool\u2019s accuracy.<\/p>\n The royal commission into aged care quality and safety, which delivered its final report in 2021,<\/a> found most Australians want to age in their own homes and should be supported to do so as much as possible.<\/p>\n