An algorithm used by the federal government to assess the level of care older Australians are entitled to is unreasonable, unfair and lacks human oversight, according to a damning investigation by the commonwealth ombudsman. The investigation also found transparency recommendations from the robodebt royal commission have been ignored. The legislation must be changed to allow aged care assessors to change clinically incorrect algorithmic decisions themselves, and there are also significant legal issues with the tool, the commonwealth ombudsman, Iain Anderson, told Guardian Australia on Monday.
The investigation followed reporting by Guardian Australia that older people were being left distressed and without adequate care after their home support needs were assessed by an “inhumane” algorithm as part of the government’s mandatory Integrated Assessment Tool (IAT). Aged care assessors are barred from overriding the IAT’s funding package recommendation, even when the decision is wrong. Without this, the IAT is a technological black box.” AT 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.
Documents released under freedom of information reveal departmental panic, severe clinical distress among frontline assessors, and secret IT workarounds after officials realised in the hours before the rollout of the algorithm that legislation legally barred human override, and that this was causing distress within days of implementation. The report found: “Information provided by the department to the public suggests that key trials and consultation over several years directly supported the IAT and its associated decision-making framework in its current form, but that is not correct”. There was no meaningful consultation.” Since the rollout there had been a failure of oversight, the investigation found.
The qualifications and skill of assessors are critical to the IAT, but the Ombudsman found the department failed to enforce contractual quality controls or verify whether assessors held mandatory clinical qualifications. Senior staff raised concerns about a lack of review pathways for wrong decisions before the rollout of the algorithm, the Ombudsman found. One 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”.
Anderson said a range of concerns had been raised by the media and public about the operation of the IAT for support at home packages, triggering the investigation in April, and in particular there was a lack of transparency around how the IAT algorithm worked in making its decisions. The report calls for a comprehensive review of the legislation related to the needs assessment process, and of the rules underpinning the algorithm. Anderson said numerous legal concerns had been identified by the investigation that it is waiting for the government to address.
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 has been contacted for comment.
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