Cracks are starting to appear in the department’s belief in the controversial IAT used to assess Support at Home needs without human override.
The federal government will spend $18.1 million reviewing and refining the controversial algorithm used to determine Support at Home funding levels, following sustained criticism from clinicians, assessors and sector groups.
The funding was revealed during senate estimates on Tuesday as officials faced another lengthy examination over the integrated assessment tool (IAT) and the automated decision-making system used to assign SaH funding levels and priority categories.
Since 1 November, Department of Health, Disability and Ageing officials have consistently backed in the decision to prevent over-ride of the IAT’s decisions, saying the testing and development process involved over 200,000 historical assessments and the tool was doing exactly what it was designed to do – provide consistent allocation of needs-based packages.
Again, yesterday, the DoHDA’s first assistant secretary for access and home support, Greg Pugh, made it clear that the SaH assessors were “rattling through” over 40,000 SaH assessors a month for a total of 212,549 since 1 November. Only 0.5% had requested a review of the IAT decision, he said.
He then revealed that the government had allocated funding specifically to review the system.
“There is a measure that provides $389.8 million over four years,” Mr Pugh said.
Asked what portion of that funding related to the assessment system, Mr Pugh said: “$18.1 million to review and refine the support at home algorithms that are used to assign a funding level and priority category to participants.”
Related
The funding comes after months of criticism from aged care providers, assessors and advocacy groups over the inability of assessors to override algorithm-generated outcomes.
Mr Pugh acknowledged the department had received complaints from assessors.
“There have been a few,” he told senators. “By and large the most common complaint is less about the outcome and more about the ability to override to change that outcome.”
The review funding was revealed during a heated exchange prompted by concerns raised by the Australian and New Zealand Society for Geriatric Medicine (ANZSGM), as reported by The Medical Republic’s sister publication HSD on 9 April.
Independent senator David Pocock told estimates he had seen a letter sent to aged care minister Sam Rae and health minister Mark Butler on 1 April outlining concerns the ANZSGM’s had that the assessment system was failing to adequately identify key risks facing older Australians.
The society warned that the tool and algorithm “insufficiently captures frailty, the leading predictor of hospitalisation and mortality in older Australians”, “under recognises sensory impairment”, “fails to identify early nutritional risks” and “fails to properly screen for elder abuse”.
The society argued the issues needed to be addressed urgently to “avoid more complex and costly system corrections later”.
Despite the concerns, officials were unable to confirm whether Minister Rae had met with the organisation following receipt of the letter.
Mr Pugh said the department had been in contact with the organisation but had not yet met with its representatives.
“I’ve been in touch with the folks from that ANZSGM. We do have a time to come together in the coming weeks to talk about exactly what their concerns are,” he said.
The exchange highlighted ongoing tensions over the government’s defence of the IAT.
Senator Pocock questioned how the department could continue arguing the system had been extensively developed and clinically validated while specialist geriatricians were raising concerns about fundamental design flaws.
“You keep telling us how much consultation and care you took … creating this algorithm and this assessment tool,” Senator Pocock said.
“And then the Society for Geriatric Medicine says, hey, we’ve had a look at the algorithm, we’ve had a look at the tool, and it’s not working.”
Mr Pugh defended the development process but acknowledged the government was now funding a review.
“There is a budget measure that government has funded, and we’ll be going back through it and looking at how it is operating in practice and whether there needs to be any refinements made,” he said.
“We are listening to what the public are telling us.”
The review will examine both the IAT and the algorithms used to determine funding classifications and prioritisation under the Support at Home program.
The assessment system has become one of the most contentious elements of the aged care reforms, with critics arguing automated decision-making has reduced clinical discretion and may be producing inappropriate funding outcomes for some older Australians.
