The Albanese government has announced another change to its controversial aged care assessment tool, this time creating an escalation pathway for complex cases where the algorithm’s funding decision does not appear to match a person’s actual needs.
It is a more significant concession than last month’s “error-correction fix.” It is also, by the minister’s own admission, still being worked out.
Aged Care Minister Sam Rae announced the change in an interview on ABC Radio National late last week, describing a new process by which an assessment organisation’s clinical delegate can refer a case to the Secretary of the Department, the so-called System Governor, when they believe the Integrated Assessment Tool has failed to adequately capture a person’s circumstances.
The Older Persons Advocacy Network welcomed the announcement but was pointed in noting that several critical details remain unresolved.
Under the proposed escalation pathway, if a clinical assessor delegate within an assessment organisation believes the automated process has not properly reflected a person’s complex or interrelated needs, they will be able to refer the case upward to the Department Secretary for a discretionary decision.
Rae was at pains to reframe the debate around what he described as a misunderstanding. The clinical assessment itself, he argued, has always been conducted by humans. The automated component, in his framing, is simply the application of the Aged Care Rules to that clinical data, an objective process that must be consistent for everyone.
“The automated component is the application of the rules, and they have to be the same for everyone,” he told host Melissa Clarke. “That’s how we get fairness and consistency in the system.”
It is a framing the government has used before, and it continues to sit awkwardly with the experiences of assessors who have quit their jobs rather than stand behind algorithm outputs they believed were wrong, and with the finding from Senate estimates that the tool was not trialled in its final form before rollout.
The interview revealed as much about what has not been decided as what has. Clarke pressed Rae repeatedly on the specifics and found them in short supply.
Who can trigger the escalation? Rae’s view is that it will be the assessment organisation’s clinical delegate, not the older person or their family. Families retain their existing right to seek a formal review, but the new pathway sits within the assessment organisation itself.
What conditions would trigger it? Rae pointed to complex comorbidities and interrelated conditions as examples, but acknowledged the precise triggers are subject to consultation over the parliamentary winter break.
How long will it take? Rae said he wanted the process completed rapidly and noted the existing review process runs to 90 days. He did not commit to a timeframe.
Will it apply retrospectively? Rae’s answer here was telling. Rather than create a retrospective mechanism for people who have already been through the process, the government’s preference is for people to be reassessed regularly as their needs change. For families who have spent months trying to navigate an inadequate funding decision, that is unlikely to feel like an answer.
Clarke put it plainly: “These decisions and reviews seem to come only after the Government is dragged to these.” She noted that the Senate was on the verge of passing a private member’s bill on exactly this issue before the announcement was made.
Rae did not engage with the substance of that observation. “I’m not going to weigh in on the politics of the Senate,” he said.
The Older Persons Advocacy Network welcomed the announcement while making clear it expects to be part of shaping what comes next.
OPAN chief executive Craig Gear said the changes must be built around an agile process that includes independent aged care advocates. “These assessments have a real impact on an older person’s life, so it is crucial that a human remains part of the decision making and outcomes,” he said.
OPAN specifically called for advocates to have the ability to trigger an escalation themselves, a detail that has not been confirmed by the government. Given that OPAN’s own data shows requests for information and advocacy have risen 50 per cent since the Support at Home program launched, the question of who can actually initiate the new pathway is not a minor one.
Gear also flagged that the changes must account for older people’s changing circumstances, a pointed reference to the system’s ongoing difficulty in capturing deteriorating or complex conditions in a timely way.
This is now the third visible adjustment the government has made to the Integrated Assessment Tool in a matter of weeks. First came the special priority pathway for people with Motor Neurone Disease. Then came the error-correction mechanism allowing assessors to fix mistakes in finalised assessments. Now comes this escalation pathway for complex cases.
Each change represents a partial acknowledgement that something has not been working. Taken together, they sketch the outline of a system the government is modifying incrementally under sustained political and public pressure, rather than reconsidering in any structural way.
The Opposition’s private member’s bill, which would restore full human override of the algorithm’s funding decision and give everyone assessed since November 2025 the right to seek reassessment, remains before the Senate. The crossbench has been vocal in its criticism of the tool. The Commonwealth Ombudsman’s investigation is ongoing. The Australian and New Zealand Society for Geriatric Medicine has labelled the tool unsafe.
Against that backdrop, an escalation pathway whose triggers are yet to be determined and whose legislation has not yet been drafted is a promise more than a fix.
Rae has said he wants to engage in good faith with the sector over the coming weeks and bring legislation back to parliament in the next sitting period. That timeline, and the detail that fills it, will matter a great deal to the older Australians currently waiting on care decisions a computer made and a human cannot override.
Why is anyone claiming that this is an improvement? The government is planning to allow a Canberra public servant who has no clinical expertise and who doesn’t know the person to override the algorithm but not a clinical assessor. Human override is not what everyone has called for and it is not the solution. Clinical assessor decision making is what everyone has been lobbying for and it is still the right solution. This latest tinkering is little more than a fast track appeals system for the complex cases that land in the media