Commonwealth Ombudsman faults algorithm used to assess older Australians' care

Aged care assessors cannot override clinically inappropriate funding decisions

A Commonwealth Ombudsman investigation has found that the algorithm in Australia’s mandatory Integrated Assessment Tool is unreasonable, unfair and lacks human oversight. The 104-page report concerns a federal tool used to assess how much care older Australians are entitled to receive and to recommend funding for support at home packages.

Guardian Australia had previously reported that older people were left distressed and without adequate care after their home support needs were assessed by what it described as an “inhumane” algorithm. The ombudsman’s investigation followed that reporting and examined whether the system was fair, consistent, transparent and properly overseen.

Aged care assessors are barred from overriding the IAT’s funding package recommendation, even when the decision is clinically inappropriate. “Under the law, these automated decisions cannot be overridden and changed, even if they are clinically inappropriate,” the report found. Anderson said the legislation must change to allow assessors to change those decisions themselves.

The report also found that no public information meaningfully explains how the algorithm converts inputs into outcomes. “There is no public information available that meaningfully explains how the algorithm converts inputs into outcomes. Without this, the IAT is a technological black box,” it said. It meant the IAT and its algorithm “do not merely have the potential to undermine public confidence in the administration of a fair and consistent assessment system,” the report found. “Rather, a reasonable person would, in our view, lack confidence that the system is in fact fair and consistent.”

The report also examined how the government introduced and supervised the tool. Guardian Australia reported that those involved in developing the IAT had no idea that an algorithm would be added by the government by the time changes rolled out in November. Freedom-of-information documents revealed what The Guardian described as “departmental panic,” as well as severe clinical distress among frontline assessors and secret IT workarounds after officials realized in the hours before the rollout that legislation legally barred human override; the distress emerged within days of implementation.

“It’s very concerning that the department was telling people this system was going to operate in a particular way, showing them versions of that system, only to change it,” Anderson said. The report found that information provided by the department to the public incorrectly suggested that key trials and consultation over several years directly supported the IAT and its associated decision-making framework in its current form. Those trials and consultation related to earlier versions of the IAT and earlier legislation, the report said, adding: “There was no meaningful consultation.”

The investigation found failures of oversight after rollout. The qualifications and skill of assessors were critical to the IAT, but the Department of Health and Ageing failed to enforce contractual quality controls or verify whether assessors held mandatory clinical qualifications. Senior staff raised concerns before rollout that the framework lacked a clear path for people affected to seek review.

One internal email read: “I am concerned that our current framework does not satisfy the first of these requirements (that there be a clear path for those affected to seek review), because it appears [that] the review pathways only allow for the algorithm outcomes to be confirmed”. The ombudsman found that this review pathway did not amount to adequate oversight.

Anderson said a range of concerns raised by the media and public about the IAT’s operation for support at home packages triggered the investigation in April, particularly concerns about a lack of transparency around how the algorithm made decisions. The report calls for a comprehensive review of the legislation related to the needs-assessment process and the rules underpinning the algorithm.

Anderson said the robodebt royal commission called for transparency when government used automated decision-making or artificial intelligence, so people could understand how decisions significantly affecting them were made. The investigation found the Department of Health and Ageing had not complied.

Anderson said the department needed more effective oversight of assessment providers because the inputs they supplied were critical to the algorithm’s output.

In July, the Department of Health and Ageing announced a new review process under which assessors can escalate wrong decisions to the department for review. Anderson said escalation may not be sufficient because it does not necessarily let assessors change clinically inappropriate decisions. “I think that assessors being able to change decisions because they appear to be clinically inappropriate is really important, and so I am concerned that the escalation pathway will not necessarily do that,” he said.

Anderson said the investigation had identified numerous legal concerns that were awaiting a government response. “How can you actually challenge decisions when you don’t know how they’re made by the algorithm?” he said. “There are significant legal issues, and we think that those need to be addressed as a matter of urgency,” he said.

He added: “In our view, the department did not, and may still not, understand key components of the legal framework it created, nor did it understand what legal framework it was meant to create.” The Department of Health and Ageing was contacted for comment.