Aged Care Algorithm Sparks Outcry Over 'Cruel' and 'Inhumane' Outcomes
Clinicians and carers across Australia are raising alarms about an algorithm-based assessment tool that determines federal home support funding packages for the elderly, labelling it as "cruel" and "inhumane." The integrated assessment tool (IAT), introduced in November, is used to assess eligibility and classification for aged care services, including residential care, but critics argue it undermines clinical expertise and leaves vulnerable seniors with insufficient support.
Experienced Nurse Quits Over Algorithmic Decisions
Mark Aitken, a registered nurse with 39 years of experience, including 16 years in aged care roles, resigned from his position in regional Victoria after just four months of using the IAT. He expressed frustration that the tool's classifications, which must be accepted by assessors in most cases, often contradict professional recommendations. "Eight times out of 10, the outcome was different to one that I would have recommended, or my colleagues would have recommended," Aitken stated, highlighting a system that prioritises algorithmic outputs over human judgement.
The government's IAT user guide reveals that assessors have limited ability to override the tool's decisions, with disagreements over classification of need not permitted as grounds for change. Aitken recounted instances where the algorithm misclassified patients, such as a 100-year-old woman with good cognitive skills living with family, who was assigned a higher need level than necessary, while a woman in her 70s with advanced dementia and neglect was deemed lower priority, potentially delaying support for up to a year.
Lack of Transparency and Ethical Concerns
Aitken criticised the lack of transparency in how the algorithm weighs risk, need, or complexity, noting that this information was never disclosed to assessors. When he inquired about the evaluation framework at a government seminar, he felt "shut down," raising concerns about accountability and accuracy. "The government valued the algorithm more than people with skills, intelligence and knowledge," he lamented, drawing parallels to past controversies like the robodebt welfare scandal.
Independent MP Dr Monique Ryan has questioned the IAT during parliamentary estimates, receiving assurances from the minister for aged care and seniors, Sam Rae, that the tool does not replace assessor input. However, Ryan argued this response "misses the point," emphasising that algorithmic outputs can be flawed despite correct inputs. She described the IAT as "effectively robo-aged-care" and expressed worries over diminishing clinical judgement and limited transparency in its development and evaluation.
Real-World Impacts and System Gaming
Linda Nicholson, a support coordinator in Queensland, shared a distressing case where a client with severe incontinence, cognitive decline, and high fall risk in a remote area was denied an upgrade in support after an IAT assessment. "We were all shocked, including the assessor," Nicholson said, noting that appeals could take up to 90 days for a response. She condemned the algorithm as "inhumane" and a "debacle," arguing that it overrides the nuanced assessments of experienced professionals.
Aitken revealed that some assessors have resorted to "gaming" the system by inputting inaccurate information to generate appropriate care levels, a practice he deemed unethical. "People shouldn't have to put in fake information," he asserted, adding that he left his job to avoid complicity in a system that removes decision-making from skilled individuals. The Department of Health, Disability and Ageing did not respond to requests for comment, leaving concerns unaddressed as the tool continues to impact aged care services nationwide.
