Aged Care Algorithm Sparks Outcry as Clinicians Decry 'Inhumane' System
Clinicians and carers across Australia are raising alarms over an algorithm-based assessment tool used in aged care, labeling it as "cruel" and "inhumane." The integrated assessment tool (IAT), implemented in November, determines federal home support funding packages, but critics argue it undermines clinical expertise and leaves elderly Australians with insufficient care.
Human Expertise Overridden by Automated 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 must be accepted by assessors in most cases, with limited override options available. "We weren't allowed to use the override button, and even my manager, who had 25 years of experience, wasn't allowed to use it," Aitken stated. "There was no ability for anyone to say: 'The algorithm has it wrong, we need a human to adjust this.'"
He provided stark examples of the tool's failures, such as classifying a 100-year-old woman with good cognitive skills and family support at a higher need level, while a woman in her 70s with advanced dementia and neglect was deemed lower priority, potentially delaying support for up to a year. Aitken estimated that eight out of ten assessments produced outcomes differing from professional recommendations.
Lack of Transparency and Ethical Concerns
The IAT user guide does not disclose how the algorithm weighs risk, need, or complexity, leaving assessors in the dark. Aitken recounted feeling "shut down" when questioning the evaluation framework at a government seminar. "The government valued the algorithm more than people with skills, intelligence, and knowledge," he lamented. This opacity has led some assessors to "game" the system by inputting inaccurate data to secure necessary care levels, a practice Aitken condemned as unethical and reminiscent of past scandals like robodebt.
Political and Sectoral Backlash
Independent MP Dr. Monique Ryan has challenged the IAT in parliamentary estimates, receiving assurances from the minister for aged care and seniors, Sam Rae, that the tool does not replace assessor input. However, Ryan countered that this "misses the point," noting that algorithmic outputs can be flawed despite correct inputs. She highlighted concerns that the IAT strips the sector of clinical judgment and nuance, with earlier override permissions now revoked. Ryan described the system as "effectively robo-aged-care" and criticized the lack of transparency in its development and evaluation.
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, adding that appeals could take 90 days for a response. She condemned the algorithm as "inhumane" and a "debacle," arguing that it overrides professional assessments without accounting for individual complexities.
Broader Implications and Calls for Reform
This controversy follows previous issues with automated decision-making tools in government, such as the robodebt welfare scandal and algorithm-driven disability funding through the NDIS. The aged care sector now faces mounting pressure to address these flaws, with clinicians and advocates demanding greater human oversight and transparency in algorithmic systems. As the debate intensifies, the need for ethical frameworks that balance technology with human expertise becomes increasingly urgent to ensure elderly Australians receive the care they deserve.
