The introduction of the Single Assessment System (SAS) in aged care was intended to streamline the process of evaluating older Australians’ support needs, making it easier for individuals to access care services without unnecessary delays or complications.
However, the reality of this transition has raised significant concerns within the sector. Experts, including Paul Sadler, have pointed out fundamental issues with the system, particularly around privatisation, conflicts of interest, assessment quality, and delays in accessing appropriate care.
One of the most contentious aspects of the shift to the Single Assessment System has been the outsourcing of aged care assessments to private providers.
Previously, assessments were conducted by contracted private Regional Assessment Services (RAS) and state and territory-run Aged Care Assessment Teams (ACAT). Under the new model, a mix of private organisations and state/territory governments – including some that also deliver aged care services – have been awarded contracts to conduct all assessments for people living at home. State and territory governments provide all in-hospital assessments.
This raises serious concerns about potential conflicts of interest. When organisations that provide aged care services are also responsible for assessing individuals’ needs, there is a risk that financial incentives may influence decision-making.
This could lead to situations where assessments are either inflated to secure more funding or minimised to limit the level of support allocated. While the government has implemented measures to manage these conflicts, there is no truly independent assessment model in place.
Paul Sadler, a veteran in the aged care sector with over 38 years of experience, has noted that conflicts of interest have long been a challenge in aged care assessments. The new system, rather than eliminating these conflicts, has instead shifted them into a different framework.
“We’ve seen conflicts of interest in aged care assessments for at least a decade, when the first RAS contracts were issued,” he explains. “The challenge is not just who conducts the assessments but ensuring the integrity of the process so that older people receive the care they genuinely need.”
Another significant concern with the new system is the quality of assessments being conducted. Reports have emerged of assessors receiving minimal training – sometimes as little as eight hours of online education – before being sent out to evaluate complex aged care needs.
Comprehensive assessments, which determine eligibility for higher-level aged care services, must be conducted by clinically qualified staff. These assessors not only ask questions but also probe deeper into responses, recognising that older people with cognitive impairments can present well despite underlying needs.
In contrast, home support assessments – used for lower-level care needs – do not require assessors to hold tertiary qualifications.
Many new assessors working for private companies reportedly receive just a few hours of online training before being sent out to conduct these assessments. In some cases, assessments are even conducted over the phone rather than in person, raising concerns about accuracy and fairness.
This lack of thorough training can lead to misinterpretations of an individual’s care requirements, resulting in inadequate support being allocated or unnecessary reassessments that further delay access to services.
For many older Australians, these assessments determine their ability to live safely and independently. If an assessment underestimates a person’s needs, they may struggle without essential home modifications, mobility aids, or support services.
Conversely, if an assessment overestimates their needs, limited funding resources may be wasted on unnecessary services, potentially leaving others without the care they urgently require.
Sadler emphasises that aged care assessments require more than just a checklist approach.
“Aged care is complex, and assessors need to understand the full picture of a person’s physical, emotional, and social needs. There is a risk of creating a system where people fall through the cracks.”
The challenges associated with aged care assessments did not originate with the introduction of the Single Assessment System. As Sadler points out, systemic issues have plagued the process for years.
The previous dual-assessment structure of RAS and ACAT had its own inefficiencies, and conflicts of interest existed even before the transition to the new system. The key difference now is that private providers have more control over the process, and without strong oversight, there is a risk that the quality of assessments will decline further.
While the new system aims to create a unified and consistent approach to assessments, there are concerns that it is not truly a “single” system at all.
Different assessment agencies continue to conduct assessments independently, with their reports feeding into the central My Aged Care system. This means that inconsistencies between assessors and organisations remain a possibility, and the hoped-for simplification of the process has not yet been fully realised.
One of the most critical failings of the new system is the delays in getting people assessed accurately and in a timely manner. Cases have emerged where individuals have been incorrectly assessed or have waited months to receive an appropriate reassessment after an initial error.
Consider the story of an older woman who, after experiencing a significant decline in mobility, was assessed as requiring minimal support despite clear indications that she needed higher-level care.
It took months of advocacy and reassessment before she was finally granted the support she needed. In that time, her condition deteriorated further, making it even more difficult for her to regain independence.
Sadler warns that these delays are not just an inconvenience – they can have serious consequences for the health and wellbeing of older Australians.
“When assessments are delayed or inaccurate, people can end up in hospital or residential care prematurely. The whole point of the aged care system is to support people to live independently for as long as possible. If assessments are not done right the first time, we are failing in that mission.”
For an assessment system to be effective, it must be independent, transparent, and free from undue influence. However, the current model does not fully meet these criteria. While the government has taken steps to separate assessment functions from care provision, the involvement of private providers means that independence remains questionable.
A truly independent model would require assessors to have no financial ties to service providers. It would also involve stronger regulatory oversight to ensure assessments are conducted fairly and consistently. As it stands, the risk of bias – whether intentional or not – remains a major concern for stakeholders in the sector.
Sadler believes that ensuring independence in assessments should be a top priority for policymakers.
“If we want a fair and effective aged care system, assessments must be based purely on need, not on who is conducting them or what financial incentives may be in play. Strengthening oversight and ensuring assessors have the right qualifications will be key to fixing these issues.”
Paul is a very experienced and his comments are considered, measured and need to considered by the government, an audit needs to conducted to test the quality of the assessments and the assessors
The new aged care arrangements are even more heavily dependent on assessments than the Home Care Package (HCP) program. An HCP participant’s services can be readily re-adjusted within their budget to meet new, changing or inaccurately assessed needs. In Support at Home, the participant needs to wait for a new assessment (by another organisation) to receive a different service. Incorrect initial assessments will have an even greater impact than they do now.
Having had to use the new system for my parents recently, it was certainly a different experience! The assessor was lovely, however non-clinical. So we ended up with not much more in the way of support other than cleaning, which was already in place, and gardening monthly – we live rural, and are unable to find a service to help!
My father is most unwell and required a full clinical assessment, not a non clinical one, to get the best support for his needs while still at home, however this was not done. So I am still stuck working full time in aged care and caring for my parents as well full time, with minimal in home supports!
The system is broken all round, both in residential aged care and the new single service assessment process.
I have been an aged care nurse for 30 years, 18 of those years have been in Australia, I have noticed over the years how the assessments have changed and how less information is given. So when we go to admit we are not getting the true picture of the resident. Even though we ask the family regarding behaviours, hygiene cares and how much they can do for themselves etc. we do not get the full truth. Families are so desperate due to carers stress or other reasons that they will not tell us the truth for fear that we will not take them.
In my last company I used to go to the homes if they were still at home or the hospital (hospitals I went unannounced) to meet the prospective resident and I could see for myself a little clearer on how they were, physically and cognitively, so that I could place them in the right wing of our home.
You would be surprised on how much I learnt this way, especially the hospitals, as they would report over the phone that they had no problems with the patient, and I turn up and they are either specialled due to wandering or behaviours, or I talk to the RN and ask about medication and have been informed that they are on an antipsychotic for behaviours .
Thank you Paul, it is a deeply disturbing backward step. Luckily you have the long view. And the breadth of understanding. Thanks again for calling it out. We used to audit our own Assessment Team at Bundoora – one of the first teams in Australia. And in the past all ACAS were assessed/ audited and results published annually. Rigorous research and QA have disappeared – and not just in assessment services but across the board in government aged care “ initiatives”.
I so agree with this article. The New System has just too many pepole making descisions about us and these people have liitle or no training. I am a retired nurse educator from the Aged care industry and I have to “suffer” with a care co-ordinator who has no health training, unyet decides what is written on my careplan and how my needs can be met. On my annual updates I find myself having to spell words out as the co-rdinator has no concept of my aged body and needs, and no comprehension of what I am telling her. All annual care updates are completely subjectable as it is the client who describes the situation, but no one comes to see us after the first assessment. I might point out that I no longer live in the same house from when my primary assesment was done.
My husband was assessed in the early stages of his dementia by someone who conducted a classic tick and flick questionnaire. At this stage he was able to mask symptoms which a qualified and experienced assessor would have easily detected. The outcome was that, because we live in a rural area, and I am in receipt of a HCP level 3 that we, not him, did not need any other support apart from having our gutters cleaned (living without mains water in a potentially bushfire area). He deserved more and better – what about some early intervention? Cognitive retention strategies? Overall health check? Fitness plan? Counselling? Mental health check? Options for social connection? Nothing! My anger fuels my advocacy.