Australian Senate Passes Bill to Reinstate Human Oversight in Aged Care Algorithm

The Senate has passed legislation to return human oversight to an aged care algorithm described by elderly Australians and their carers as “cruel” and “inhumane”, with the government conceding some decisions made by the tool need review.

The integrated assessment tool (IAT), introduced in November, is used to determine the level of home support funding and care elderly people are entitled to.

But, as revealed by Guardian Australia, the algorithm underpinning the tool has frequently under-assessed people and left them without adequate care, while expert assessors were explicitly prohibited from overriding the tool when it made a wrong assessment.

The Senate on Thursday morning passed a bill to reinstate human override in all aged care assessments, due to concerns it was consistently under-assessing care need and priority. The bill would need to pass the lower house to be enacted.

The legislation was co-sponsored by the Greens, the Coalition and the independent senator David Pocock. If passed by the House of Representatives, it would protect the discretion of an assessor to make professional determinations about care.

There has been months of scrutiny of the IAT during Senate estimates, the launch of an investigation by the commonwealth ombudsman, and concerns raised by the Australian Human Rights Commission.

The aged care minister, Sam Rae, told the ABC’s Radio National program on Thursday that IAT decisions could soon be changed by a human in “extenuating circumstances” – which would probably capture fewer cases than that proposed by the bill passed in the Senate.

“We’re creating an additional option here where, if in the assessment organisation’s clinical view, the needs of the older person aren’t catered for through the tool, then they have this option to escalate that to the system governor,” Rae said.

It is unclear how long that escalation and review process will take.

Decisions of the IAT have triggered hundreds of complaints to aged care advocacy services, along with hundreds of calls for internal reviews of decisions, a process which can take months.

Rae has previously defended the IAT, but on Thursday said: “In some limited circumstances, people’s complex circumstances don’t necessarily fit neatly into a framework.

“And in those small number of circumstances, we want the system governor to be able to make the necessary decisions to get the most appropriate outcomes for older people … we’ve listened and we’ve done the policy work to make sure that we get the best outcomes for older people.”

But the Greens senator Penny Allman-Payne, who has long called for reforms to the IAT and aged care in general, said the change flagged by Rae does not go far enough as it would only allow for human override in outlier cases.

During debate of the bill, she said “thousands” of cases have been affected by incorrect assesments and criticised the government for suggesting it’s “only a very small number”.

“This government clearly does not understand the consequences of their own policy,” she said.

Pocock told Guardian Australia that there was “very little detail” in the changes Rae announced.

“It appears to be an eleventh-hour announcement, made only because the government knew it was about to lose a vote on the floor of the Senate,” he said.

“I’ll take the minister at his word that he wants to work with older Australians, clinicians and advocates to fix this. But if this change simply creates a new escalation pathway to the department after the algorithm gets it wrong, I struggle to see how it will materially address the concerns that have been raised.”

He added that the government is yet to implement the robodebt royal commission’s recommendations for guardrails on the use of algorithms, and an independent expert body to evaluate automated decision-making.

The outgoing inspector general for aged care, Natalie Siegel-Brown, called out the government’s reforms to the support at home program for “fast-tracking” people’s “entry into aged care”.

“Aged care is now the outlier in aged care,” she told estimates. “It’s a system where clinical judgment informs the data entry, but not the decision.”