The promise of streamlined, equitable support for older citizens is clashing with the realities of a rigid, technology reliant assessment system. At the heart of this tension is the Integrated Assessment Tool (IAT), introduced as part of broader reforms stemming from the Royal Commission into Aged Care Quality and Safety.
Designed to simplify assessments and eliminate redundancies, the IAT was meant to ensure that elderly individuals receive tailored care based on their unique needs. However, emerging concerns reveal a troubling disconnect: an algorithmic process that often overrides human expertise, leading to outcomes that fail to reflect real world vulnerabilities.
This shift raises profound questions about transparency, fairness and the human cost of prioritising efficiency over empathy.
The role of the IAT in modern aged care
The IAT, which rolled out in mid-2024 and fully integrated with the new Aged Care Act by November 2025, serves as the primary mechanism for evaluating eligibility for government subsidised services like in-home support, respite care and residential placements.
It replaced outdated forms with a dynamic, question-based framework that adapts to individual responses, incorporating factors such as mobility, cognition and daily living challenges. Assessors, typically trained clinicians from nursing or allied health backgrounds, input data during home or phone evaluations, and the tool generates recommendations for service levels under the Support at Home (SaH) program.
On the surface, this sounds progressive: a single, comprehensive tool that reduces the need for multiple assessments and minimises storytelling repetition for seniors. It draws on validated clinical elements and pre-populates data from initial screenings, aiming for consistency across the country.
Yet the core issue lies in how outcomes are determined. The system employs a classification algorithm that processes assessor inputs to assign one of eight funding levels for ongoing home support.
While the Department of Health, Disability and Ageing insists this is not artificial intelligence, emphasising it is a rule based process outlined in the Aged Care Rules 2025, critics and frontline workers describe it as an opaque black box that diminishes professional judgement.
The override dilemma
One of the most contentious changes involves the ability to override algorithmic outcomes. Early guidance, such as the May 2025 Guide for the Single Assessment System Workforce, explicitly allowed assessors to accept or adjust IAT results, encouraging them to incorporate the older person’s goals and add manual recommendations where needed.
This flexibility aligned with the tool’s design, which included buttons for overrides, suggesting an intent to blend technology with clinical insight.
However, by 1 November 2025, the delayed start date for key legislative changes, new directives in documents like the Assessor Portal User Guide 6 and Aged Care Assessment Manual v8.1 reversed this stance. Assessors are now instructed not to override classifications for ongoing SaH levels, except in limited scenarios like transitioning to restorative care or end of life pathways.
The rationale is compliance with specific sections of the Aged Care Rules, which prioritise algorithmic consistency over individual discretion. This pivot, implemented with minimal notice, has left assessors feeling sidelined, reduced to data entry roles rather than advocates for vulnerable clients.
Frontline accounts highlight the frustration. Experienced assessors report spending hours gathering nuanced details, such as a senior’s risk of falls due to cognitive decline, only to see the algorithm output a low priority classification that ignores evident dangers.
In one instance, a woman with vascular dementia and other comorbidities requiring round the clock care was deemed to have no impairment, locking her out of adequate support. Such mismatches not only delay care but also heighten risks, forcing families and providers to bridge gaps while appeals drag on.
Lack of consultation and transparency
The abrupt policy shift has sparked accusations of inadequate stakeholder engagement. Industry voices, including advocates and former working group members, claim no broad consultations occurred before restricting overrides.
Assessment organisations were reportedly informed just days before the November launch, leading to rushed retraining and plummeting morale. Many assessors say it feels as if they are handcuffed, echoing a sentiment that the system now prioritises budgetary constraints over personalised care.
Transparency remains a glaring shortfall. The algorithm’s inner workings are not publicly detailed, making it impossible to scrutinise how inputs like domestic tasks or cognitive risks are weighted. While delegates in assessment teams review outcomes for legal compliance, this does not address underlying mismatches.
The department conducts oversight through desktop audits, but without algorithmic audits or independent analysis, doubts persist about bias or errors. Critics argue this opacity contradicts the reforms’ goal of building trust, especially when similar profiles yield inconsistent results.
The human impact
The consequences extend beyond bureaucracy. Seniors with complex needs, such as dementia or mobility issues, are often underclassified, resulting in interim packages funded at only 60 per cent of assessed levels. This exacerbates wait times and strains carers. Providers face onboarding challenges with mismatched funding, while assessors grapple with ethical dilemmas, with some considering leaving the field altogether.
This echoes wider debates in aged care, where algorithmic efficiency is pitted against human variability. Comparisons to the National Disability Insurance Scheme surface in support groups, with frustrations over perceived inequities, although experts caution against pitting systems against each other. Ultimately, the focus should be on outcomes. Is the system meeting seniors’ needs, or merely adhering to rules? As one advocate noted, legislation can be amended, but an older person’s declining health cannot wait.
Australia’s aged care reforms were born from a royal commission’s damning findings, yet the IAT’s implementation risks repeating past failures by sidelining human elements.
In the end, technology should enhance, not eclipse, compassionate care. As the population ages, ensuring assessments prioritise people over processes is not just ethical, it is essential for a sustainable, dignified system. Without swift action, these wobbles could cascade into a full blown crisis, leaving Australia’s elderly to pay the price.
