Commonwealth Ombudsman finds use of automation in aged care system lacks safeguards + Independent expert review of aged care assessment tool announced
The Commonwealth Ombudsman found that the Department of Health, Disability and Ageing (the Department) and its Single Assessment System (SAS), including its Integrated Assessment Tool (IAT) and oversight of the SAS workforce, has led to unfair outcomes, undermined public confidence and raised serious questions about outcomes that are clinically inappropriate.
The aged care system in Australia provides subsidised and fully funded aged care services to older persons. To access aged care services, older persons are required to undergo a needs assessment. The IAT is the legislatively prescribed tool used for home care assessments. Its algorithm makes automated decisions that determine the level of access to aged care services an older person can receive.
‘The IAT and its associated decision-making framework do not merely have the potential to undermine public confidence: rather, a reasonable person would, in my view, lack confidence that the system is in fact fair and consistent. Currently, under the law, automated decisions made by the IAT's algorithm cannot be overridden and changed, even if they are clinically inappropriate,’ said Commonwealth Ombudsman, Iain Anderson.
85% of older persons, (around 1.1 million) access aged care services in Australia through the home support system. Since the introduction of the SAS, many concerns have been raised about the contracted assessment providers using the IAT and how the IAT algorithm works.
Concerns about the SAS workforce included poor communication, substantial waiting times, slow review processes, insufficient assessors and assessors lacking appropriate training and qualifications. Criticism of the IAT focuses on underassessing care needs, diminishing the role of clinical expertise, the lack of algorithmic transparency and the inability to change automated decisions.
There is no publicly available information that explains how the IAT reaches its outcomes. This is inconsistent with the intentions of the Robodebt Royal Commission recommendations about transparency of government automated decision-making, the Ombudsman said
‘In my 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. This had serious consequences, including that up until the introduction of the legislation in October 2025, the Department had been incorrectly advising assessment providers and the public that automated IAT outcomes could be changed,’ added Mr Anderson.
The SAS assessment provider performance has been falling short of KPIs, often significantly so. Despite individual assessors inputting information into the IAT, the Department has taken a limited role in checking compliance with learning requirements, and there are no safeguards or mechanisms to protect the integrity of online training.
The Ombudsman made 10 recommendations that include amending the legislation to allow assessment decision-makers to override automated IAT decisions, a comprehensive review of the legislation related to the needs assessment process, and a comprehensive review of the business rules underpinning the algorithm.
The Ombudsman also recommended that all changes be preceded by meaningful consultation with the public, and that the Australian National Audit Office consider a performance audit to assess whether the Department’s use of public resources was efficient, economical and ethical. The Department accepted the recommendations relevant to it.
Read the full report, 'Automation and oversight in Aged Care: Flaws in the design and operation of the Single Assessment System', on the Commonwealth Ombudsman website or download in full via link provided. (PDF: 2.47) NB: not all Recommendations have been adopted.
The reality of automated decision-making – case study
‘My mother has a rapidly progressive and non-curable neurological condition, with a [very limited] lifespan. Despite approving her for the second highest level of home care support, the Department has assigned her a standard priority wait time of 10 to 11 months. During this period, she is receiving only minimal support, which is wholly inadequate and places her at risk of deterioration, hospitalisation and avoidable harm. The Department has relied on an algorithmic decision-making process to refuse escalation of priority despite acknowledging that the outcome is inappropriate in the circumstances’. (emphasis added) - A complaint to the Ombudsman
The 10 Recommendations:
Recommendation 1
The government, with the assistance of the Department, introduces a bill to amend the Aged Care Act 2024 (Cth) (the Act) to allow assessment delegates to substitute their own decision for that of an automated IAT decision in appropriate circumstances.
Recommendation 2
As far as necessary to give effect to the above recommendation, the Minister amends the Aged Care Rules 2025 (Cth) (the Rules) and separately, either the Minister or the Secretary as the designated System Governor of the aged care system provides meaningful policy guidance to assessment delegates about applying any test for substitution.
Recommendation 3
The Department undertakes a comprehensive review of the Act and the Rules as they relate to the needs assessment process, including use of the IAT, to identify legal defects, inconsistencies, ambiguities or unintended consequences and, using that information, address those issues in a timely way.
Recommendation 4
That any proposed amendments to the Act, the Rules and the algorithm be preceded by and informed by meaningful consultation with the public.
Recommendation 5
In accordance with recommendation 17.1 of the Royal Commission into the Robodebt Scheme, the Department:
- develops and publishes a fact sheet, in plain language, that informs the public about how the IAT works and the existence of automated decision-making,
- develops and publishes a fact sheet, in plain language, that informs the public about how internal and external merits review operates for SAS decisions and what limitations exist for those seeking review, and
- makes the business rules underpinning the algorithm available to the public and in doing so, provides a plain language explanation of how these operate.
Recommendation 6
The Department more effectively oversights the performance of assessment providers by undertaking:
- significantly more proactive audits/reviews of IAT usage, and
- consistent assurance activities in relation to:
o compliance with learning requirements,
o compliance with quality assurance requirements outside of IAT usage, and
o compliance with meeting key performance indicators.
Recommendation 7
The Department amends its approach to receiving and dealing with complaints about assessment provider performance by developing a new complaints framework that:
- outlines how complaints will be dealt with, by who and by when, and
- implements a method to analyse complaints and use the resulting insights to inform the planning and prioritisation of systemic assurance activities.
Recommendation 8
The Department undertakes a root cause analysis to determine the underlying factors that contributed to the findings in this report, including any other issues identified by the Department, and in doing so uses the results to implement corrective actions.
Recommendation 9
The Department undertakes a comprehensive review of the business rules underpinning the algorithm.
Recommendation 10
The Australian National Audit Office consider undertaking a performance audit in relation to the implementation of the SAS and the design of the IAT, and in doing so, assesses whether the Department’s use of public resources was efficient, economical and ethical
Independent expert review of aged care assessment tool announced
On Thursday October 15 the Australian Government announced it will 'commission an independent review of the aged care classification and prioritisation assessment mechanisms, as the latest step in a series of refinements the Government is making to ensure older Australians can have confidence in the assessment process'.
'Since the commencement of Support at Home, on 1 November 2025, the Government has been listening and responding to feedback from older Australians, their families and stakeholders, and in particular about how the Integrated Assessment Tool works.' the Hon Sam Rae MP, Minister for Aged Care and Seniors, said in a released statement
''We have made refinements where people’s experience of the system shows it is needed. We’ve changed the Aged Care Rules to help more people receive care faster, to ensure the accuracy of assessment inputs and to recognise Motor Neurone Disease as a discrete, specific condition warranting urgent priority for Support at Home.''
''This review will build on that work and respond to feedback that while these changes have made improvements, the assessment systems are not always getting it right. The Government will set out a clear plan to ensure the classification and priority mechanisms reflect the care needs of older Australians.''
''With nearly 12 months of real-world assessments now completed, this independent, clinically informed review will examine how the classification and prioritisation mechanisms work, building on the refinements already made to get it right for every older person. ''
''The reviewer will be empowered to recommend what changes, if any, are needed to the assessment mechanisms to ensure they appropriately allocate care based on an older person's circumstances and priority, while maintaining sustainability in the broader aged care system.''
''To ground the review in clinical expertise, an expert advisory group will also be convened, bringing together experts in gerontology and assessment. The group will contain geriatric medicine, dementia care, allied health, CALD and First Nations health expertise, alongside assessment organisations, aged care providers, unions and advocates for older people.''
''Terms of Reference will be released in the coming weeks. The review will report to Government, and the report will be published in full and tabled in Parliament, in the first half of 2027.''
''This review is in addition to the new escalation pathway set to be delivered through the Aged Care Legislation Amendment (Aboriginal and Torres Strait Islander Aged Care Commissioner and Other Measures) Bill 2026, which is before the Parliament. Its commissioning reflects constructive engagement with the Coalition on the passage of that bill.
''From January 2027, older people in exceptional circumstances will be able to access a new option for case review – with the Health Department able to change Support at Home classification and priority levels where needed.''
''The Government previously commissioned a rapid review of the prioritisation algorithm, focused on identifying immediate adjustments to the way priority is assessed. This review will build on that work by looking at the underlying structure of the assessment mechanism. '' the release states
ABC's Afternoon Briefing on Commonwealth Ombudsman's report: Monday October 26
During an interview on ABC's Afternoon Briefing of October 26 with Patricia Karvelas, Ms Karvelas asked:
''This report says the use of automation in the aged care system lacks safeguards, it's led to unfair outcomes for elderly patients. Why not just scrap it?''
The Hon Sam Rae MP, Minister for Aged Care and Seniors, responded:
''the old system that we had prior to November 1 last year wasn't working for older people, it wasn't working for our community, PK. A single assessment system with a tool to support fair assessments was a key recommendation of the Aged Care Royal Commission, and that's what we have sought to implement through this process.
Of course, we are getting fairer outcomes, more efficient outcomes, and more accurate outcomes, but, as the report outlines we admit freely that it's not always getting it right. It's why, since it was implemented in November, we've already made a number of changes throughout the process. We’ve changed the queuing rates to make sure that people are getting the care they need at the most appropriate time. We've implemented the MND pathway. Last sitting week we legislated a pathway for escalation for people. And there's an independent review to come as well.''
''I think the recommendations that we see in this report are constructive recommendations, many of them the Government has already put into motion prior to the report being published. And the Department has, at least in principle, accepted some of those other recommendations along the way as well. So, this is about an iterative process to making sure that we do have an assessment system that is fair, that is getting the best possible outcomes for older Australians.''
Ms Karvelsas: ''But the most significant course, which hasn't been adopted by the Government, is the one calling for a human override. Why won't you accept it? ''
The Hon Sam Rae MP, Minister for Aged Care and Seniors, responded:
''that's what the escalation pathway that we announced some time ago, and indeed was legislated in the parliament last sitting week, that's what it provides for. It provides for in circumstances where people's complex conditions can't be appropriately assessed using the IAT - that those can be escalated and there can be an alternate clinically informed approach to determining the best care for those folks.''
Transcript:
KARVELAS: But that's not this recommendation. It’s for a broader human override, and you haven't accepted that recommendation.
RAE: I think it's consistent - principally consistent. I think the recommendation imagines some version where the IAT may not be the most appropriate or getting the most appropriate outcomes and that those circumstances need to be escalated, and that's what we have provided for. It's what we announced some time ago, it's what we've legislated in the Parliament, and it's what we're implementing on January 11.
KARVELAS: So, this recommendation is quite clear that it wants a broader human override. It doesn't trust the system itself - it says it's failed too many people. So are you looking at making further changes? Because out of the 10 recommendations six have been accepted by the Government but the other two, including that human override, have not been accepted.
RAE: The recommendation points to an assessor delegate providing override. We're building a pathway where a delegate of the department can accept the assessor's advice that the IAT not be the appropriate method for determining the care, and that be the override option.
KARVELAS: Okay, explain what that means in English. I'm saying this very respectfully, I'm not trying to be rude, but I don't know what that means. What does that look like? Doesn't everyone get a right for an override?
RAE: Unfortunately, this is a really complicated system. We're on track to see about [half] a million assessments go through the system this year. So the volume of assessments in a system where we know demand is going through the roof is very, very high. It's why we need a standardised approach - to make sure that no matter who does your assessment or what they have done, everybody can get a fair assessment. It's a clinical assessment. A person comes in, it's always done by a human being, and then that data goes through the standardised process to determine the care.
We acknowledge that in some cases it's not getting it right. In those cases, those are the ones that need to be escalated, that's why we've put in place this escalation pathway. So it's an alternate route, if you like, for…
KARVELAS: But if it doesn't cover everyone, you're still going to have the potential for flaws.
RAE: I think what we need to realise is that we're trying to build an assessment system that does meet the needs of people more broadly. We're seeing that. We've seen significant improvements from the old system. But we have to be careful here. We have to find a space in this discourse where we can say, this is what's working and this is what’s not. There's always opportunities for improvement. We can't keep throwing the baby out with the bathwater. We've seen waiting times coming down. We're seeing more accurate assessments occurring. We're seeing better outcomes for older people. We want to keep improving that system, and that's what the Government's approach is all about.