Calls to aged care advocacy services have surged in the months since the Federal Government rolled out its new AI driven assessment system, fuelling an escalating dispute over whether algorithms are quietly overriding clinical judgement.
Advocacy groups report a sharp spike in older Australians and their families seeking help with home care assessments, funding reductions and rejected upgrade requests. The increase coincides with the introduction of the Integrated Assessment Tool, known as the IAT, a digital system designed to standardise eligibility decisions for home support.
While the Department of Health, Disability and Ageing says the tool promotes accuracy and consistency, frontline workers and older people tell a different story.
The Older Person’s Advocacy Network says it handled about 7,500 requests for information and advocacy related to home support in the three months after the IAT was introduced. That represents a roughly 50 per cent rise on the previous quarter.
Not all of those enquiries relate directly to the algorithm. However, advocates say a significant proportion involve concerns about assessment outcomes, including people seeking reassessments, funding cuts and cases where dementia or complex care needs were not reflected in priority ratings.
Under the current settings, assessors input clinical information into the system, which then generates a classification that determines funding and urgency. Critics say assessors have little or no practical capacity to override the result, even if they believe it does not reflect the person’s real circumstances. Review processes exist, but can take up to 90 days, leaving vulnerable older Australians in limbo.
Several older Australians have described feeling blindsided by outcomes they and their clinicians did not expect.
One carer in her late seventies said her husband, who lives with severe mobility limitations and chronic pain, was deemed ineligible for additional home support despite medical evidence of deterioration. She said both the assessor and their treating doctors were surprised by the result.
Another older woman living alone in regional Australia said she felt the process shifted from a conversation with a professional to a computer generated verdict. She described watching the assessor’s reaction as the funding level appeared on screen, saying it was clear the human in the room had little room to move.
Advocates warn that when clinical discretion is constrained, there is a real risk of under assessment. Many older people downplay their struggles out of pride or because their decline has been gradual. Experienced clinicians have historically read between the lines, adjusting for cognitive impairment, carer strain or unsafe living conditions. An algorithm, they argue, cannot easily capture those nuances.
The concern is not simply about individual cases. At scale, even a small percentage of under assessment can translate into thousands of people going without adequate support, increasing the risk of hospitalisation, carer burnout or premature entry into residential aged care.
The controversy has spilled into Parliament. Independent MP Monique Ryan recently challenged the government, asking whether the reforms amounted to “robo aged care”.
Aged Care Minister Sam Rae rejected the characterisation. He told the House that the IAT “does not replace assessor input” and relies on clinicians documenting their advice within the system. He emphasised that assessors continue to play a critical role and that the tool is designed to ensure consistency.
On paper, that distinction is important. In practice, many workers argue it is semantic.
Assessors contributing to professional forums say that once information is entered, the algorithm allocates a level that cannot be changed through clinical judgement alone. Some describe feeling reduced to data entry operators. Others claim that training materials initially suggested overrides would be possible, only for that discretion to be removed when the system went live.
The minister has also pointed to ongoing monitoring and future refinements. But critics say refinement is not the same as transparency. They are calling for clearer information about how the algorithm weighs different factors, how many complaints have been lodged, and what safeguards exist to prevent systematic under assessment.
The IAT was introduced in the wake of the Royal Commission into Aged Care Quality and Safety, which found most Australians want to age at home and recommended stronger, fairer assessment processes.
The government argues that a single, standardised tool reduces postcode lotteries and subjective variation. However, workers counter that consistency should not come at the expense of compassion or clinical expertise.
Providers report a noticeable rise in rejected upgrade requests since the tool’s launch. Families describe months long waits for reassessment, during which frail parents or partners struggle without adequate support.
The broader context is an ageing population and growing fiscal pressure. With nearly five million Australians aged over 65, the stakes are high. Every misclassified assessment represents not just a bureaucratic error, but a person trying to remain safe and independent at home.
The debate now centres on a simple but profound question. When a clinician and an algorithm disagree, who decides?
Until that tension is resolved, advocacy lines are likely to keep ringing
