Greens seek human override for incorrect aged care funding decisions

Ombudsman’s report found the assessment tool produced unfair outcomes

Greens leader David Shoebridge has used a Commonwealth Ombudsman report to press the Australian government to give aged care assessors direct power to change incorrect algorithm-driven funding decisions. He called on lawmakers to act during parliament’s last two sitting weeks: “We have two more sitting weeks of parliament, where the Senate and the House of Reps can come to some arrangement and put in place a human override for aged care.”

The ombudsman’s report made 10 recommendations. The government accepted six, while two — including assessor-level human override and an amendment to aged care legislation — were listed as noted. Aged care minister Sam Rae and health minister Mark Butler said in a joint statement that the government would “consider the Ombudsman’s report carefully” and was acting on some recommendations. The government also commissioned an independent review of how the Integrated Assessment Tool assesses and prioritises people.

Rae said a new escalation pathway had already been introduced, allowing a wrong outcome to be escalated for review by a delegate, “adding a further layer of human oversight and nuance to the assessment system.” Rae defended the government’s response: “Our response aligns with the principles of the ombudsman’s report, allowing for human discretion to overturn assessment decisions that are not fit for purpose in a way that is fair and responsible for all older people.”

The ombudsman’s 104-page report, published Monday, recommends changing aged care legislation so workers assessing older Australians for home support packages can amend an outcome when the Integrated Assessment Tool makes an incorrect funding decision. The report found the tool was leading to unfair outcomes and undermining public confidence in aged care.

The Integrated Assessment Tool operates through a combination of human interviews and automated decisions. Assessors meet older people and complete questionnaires about their needs. An algorithm then determines whether funding should be allocated and, if so, at what level. State health officials were so alarmed by algorithmic changes introduced to the tool in November that they maintained a log of hundreds of cases in which vulnerable older Australians were severely under-assessed, Guardian Australia previously reported.

Shoebridge said, “People are tearing their hair out at what’s happening.” He also said: “We’ve got aged care workers who are trying to help their clients … and the computer just says no.” Shoebridge said: “The ombudsman has told us now that this has been unfair from the moment it was conceived of. That it’s producing arbitrary and unfair outcomes for people who are at a stage of life where they desperately need help and support.”

Commonwealth Ombudsman Iain Anderson said: “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.”

An aged care assessor with more than four decades of nursing experience, who spoke to Guardian Australia on condition of anonymity, said escalation pathways were not good enough. The delegate in her workplace received special training to review cases, but the process added time and administrative work. “The delegate has not sat in front of that older person,” the assessor said. “The delegate has not laid eyes on that person. I have.” She said she and her colleagues were experiencing severe anxiety and distress because of the work.

The assessor described the pressure to follow the tool’s decision. “I’m too scared to ‘accept’ on the algorithm’s decision, but I have no choice,” she said. “It feels like I’m telling the algorithm and the government, ‘great choice’ and sometimes I need to walk away from the computer because I can’t hit the button.”

The assessor said ministers did not face the consequences of those decisions: “It’s not Sam Rae or Mark Butler that then has to face the client. They’re not standing there after spending hours with clients, some of them in tears, and then telling them what the outcome is. I want the ministers to come to work with me and see what is happening.”

She said she had become “so anxious, and I get so agonised over every question that I ask my clients, that it puts me into a situation where I’m not finishing my work on time, I’m not reaching my KPIs, I’m working weeknights and weekends, and I am considering leaving this job.”

Shadow aged care minister Anne Ruston told ABC’s Radio National on Tuesday that “the government needs to actually put proper human override back in.” She described the escalation pathway as “only a Band-Aid on a symptom.”

Independent senator David Pocock accused the government of “resisting attempts to fix a problem it created.” He said, “The Senate has offered a solution, the Ombudsman has now backed it, and the government needs to explain why it’s still standing in the way.” Pocock also said: “The Ombudsman’s findings are extraordinary, including a finding that the department responsible for designing this system didn’t even understand the legal framework it had created.”

For older people whose home support funding depends on the tool, the immediate question is whether the final two sitting weeks will produce an assessor-level right to amend an incorrect result or leave corrections to delegates.