There is a detail buried in the transition rules of Support at Home that undercuts the government’s line on the Integrated Assessment Tool (IAT) more plainly than almost anything raised in the Four Corners fallout so far: people who transitioned across from the old Home Care Package system get to keep their previous classification instead of dropping to whatever the new algorithm decides. Fresh applicants get no such protection.
Dovida CE, Geoff Hogg points to a client living with Parkinson’s disease as an example. She had suffered multiple falls and hospitalisations, and her care team could see her condition had clearly declined. When she was reassessed, the standardised outcome pointed to a lower level of support than she’d previously had.
“As she was a transitioned Home Care Package recipient, she was able to retain her existing classification rather than move to the lower outcome,” Hogg said. “This case highlights a broader concern. We need to make sure the lived experience and changing needs of older people remain central to decisions about the support they receive.”
That grandfather clause exists for a reason. It suggests the system’s designers already suspected the new outcomes could land lower than what people actually need, and built in a safety net for the transition cohort while leaving everyone assessed fresh to take the result as it comes.
Support at Home isn’t yet a year old, and Hogg is upfront that Dovida doesn’t have statistically robust data. But he’s not vague about what the pattern looks like on the ground.
“What I can say anecdotally is that we see a higher proportion of clients receiving an assessment outcome at lower levels than what they would have been under the previous system,” he said. “It’s not a handful of edge cases. It’s a pattern our care teams across multiple offices and states are consistently raising.”
Asked who absorbs the shortfall when a client is under-classified, Hogg doesn’t point to providers stretching services beyond what’s funded. He points to families.
“When funding doesn’t match need, families step in first, often adult children or spouses who are already stretched,” he said. “For the so-called ‘sandwich generation’, that can mean caring for an ageing parent while raising young children and juggling work plus other family responsibilities. For an older spouse, it can mean taking on a level of caring that simply isn’t sustainable.”
He calls what results an “invisible second care system.”
“Family support can quickly become an invisible second care system, with adult children reducing their hours at work, parents missing out on time with their own children, or older spouses being expected to provide personal care that they are physically unable to manage safely,” he said. “Where there’s no family close by, the person often simply manages with less than they need, until something changes, sometimes a fall, a hospital admission or another kind of crisis point.”
On the pressure this puts on unpaid carers specifically, Hogg says it tends to stay hidden until it isn’t.
“There is significant pressure placed on unpaid family carers and it’s often invisible until something breaks,” he said. “Family carers are frequently absorbing gaps well beyond what’s sustainable, and the tipping point tends to come when the carer’s own health or capacity starts to decline alongside the person they’re supporting.”
Hogg says the IAT’s 500-plus questions and 100-plus free-text clinical fields capture only a slice of what his staff actually observe day to day.
“Our care staff routinely rely on detailed observations of a person’s day-to-day functioning and changing needs that may not be fully captured by a standardised assessment,” he said. “They see how someone manages a shower at 7am, whether they are eating properly, whether they are repeating themselves or forgetting medication, how their mobility changes throughout the day, and whether a family member’s own health is holding up under the strain of providing care.”
Much of that detail is recorded in clinical notes and passed between care staff, families and other health professionals, he says, “but it does not always translate neatly into a checkbox on a standardised response.”
On which conditions the tool struggles with most, Hogg names dementia and other fluctuating conditions first.
“Someone living with dementia can present very differently depending on the day, or even the hour, so a single point-in-time assessment can miss the reality of what a family is managing week to week,” he said.
“Multiple sclerosis is another example, where symptoms can fluctuate as well as progress over time. With a condition such as MND, the challenge is different again. Needs can deteriorate rapidly, so there is a risk that an assessment captures where someone is today rather than where their care needs are heading.”
Similar sentiments were echoed by others in the aged care space, including Older Persons Advocacy Network (OPAN) CEO Craig Gear more than a month ago.
Hogg describes under-support turning into hospitalisation or premature residential care as a slow build rather than one dramatic event.
“A person may not receive enough support with mobility and attempt a task alone, resulting in a fall,” he said. “The fall leads to a hospital admission and by the time they’re ready for discharge, their care needs may be greater than they were before the fall. In some cases, the home is no longer considered safe, making a move into residential care more likely.”
Dovida hasn’t yet formally tracked hospitalisation or residential-entry data specifically tied to clients it believes were under-classified. Hogg says the program is too young for that kind of robust, program-wide evidence, but the organisation wants to build one as it matures.
The cost argument, in his view, is not complicated. Home care runs at roughly $30,000 a year against roughly $120,000 for residential care.
“When people are under-supported in the community, there is a greater risk of falls, hospital admissions, functional decline and earlier entry into residential care,” he said. “All of these can increase the cost to government. Investing appropriately in home care can therefore help prevent a relatively small funding gap today from becoming a much larger public cost later.”
Asked whether providers risk being blamed for gaps in care that are actually a function of what the algorithm assigned, Hogg is direct.
“There is a real risk that providers and care workers are blamed for gaps in care when the underlying constraint is the level of funding assigned through the assessment process,” he said. “Families and clients sometimes understandably direct their frustration towards the people delivering care, even when those care workers are limited in what they can provide by the funding available.”
“At its core, this is a funding and assessment issue, not necessarily a service delivery failure,” he said. “Providers can only deliver the level of care that a person’s funding allows.”
Hogg’s position isn’t that algorithms have no place in aged care assessment. It’s that professional judgement has been pushed out of a process it should still sit inside.
“Getting the right level of care early enough means giving qualified assessors better tools and support to do their job well, not replacing their judgement with a standardised algorithmic outcome,” he said. “A clinical override is a reasonable short-term safeguard, but the more durable fix is technology that helps assessors make better decisions, not one that makes the decision for them.”
On the 90-day silent-rejection appeals process, he wants a hard timeframe and an actual hearing for clinical judgement, not a resubmission into the same system.
“A workable pathway needs a clear timeframe, transparency about why a decision was reached, and a real opportunity for the treating team’s clinical judgement to be heard, not just resubmitted into the same process,” he said. “Ninety days of silence isn’t a genuine review pathway, and for people who may need care urgently, that length of delay is a real concern.”
Asked what he’d push Minister Sam Rae to change first, Hogg named two things: cut assessment wait times, and put professional judgement back at the centre of the process.
“Rather than the algorithm making the final call, I’d like to see technology used to support assessors, giving them better tools and more time with each person, so their professional judgement drives the outcome rather than a standardised score,” he said.
