One of the people involved in developing the federal government’s controversial aged care assistance tool says she is now too afraid to use it, saying she never wanted it to be determined by an algorithm.
While her fellow advocates warned that people’s care and funding needs were being underestimated, Lynda Henderson, who was part of the expert advisory group to develop the Integrated Assessment Tool (IAT), said the assessment questions were intended to help those making clinical judgments.
But Henderson said he was “furious” when he learned that the government had introduced an algorithm to classify responses collected through the IAT to assign scores to responses and categorize people according to level of need. The resulting ranking is used to determine the funding package allocated.
“I had no idea that an algorithm would eventually be applied to the assessment we were developing, which we started working on in late 2020,” Henderson said.
“My background is in psychology, psychometrics and statistics, and when we developed it, it was through the eyes of an evaluator who would conduct the evaluation, so we made sure there was room for nuances, notes and changes.”
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As Guardian Australia previously reported, the IAT has come under fire after the government removed the ability of assessors to override an incorrect result when assessing people for home support. Aged care workers and clients say the algorithm frequently underestimates levels of need, leaving people with inadequate funding and care.
Some people who were previously receiving home support packages (and who required reassessment because their health deteriorated) said the IAT ranked them at a lower level than before, leaving them with less funding and support despite greater needs, and assessors were unable to overturn the result.
Henderson said task force members were sworn to confidentiality while developing the evaluation and believed it would continue to rely on the judgment of an evaluator.
After the evaluation questionnaire was handed over to the government for testing, she said she was proud of the work they had done, although she expected some improvements.
“But neither we on the task force nor the health consulting firm that ran it knew that the government was going to use an algorithm to score each question and assign categories,” Henderson said.
“The problem is not the assessment or the questions. It is the absolutely ridiculously simplistic scoring algorithm that has been applied to it.”
‘I’m so terrified’
Henderson’s partner, Veda Meneghetti, died two years ago with dementia. Since then, his own health has worsened.
When asked how she feels about the assessment she helped develop now, Henderson said, “I really need more support at home, and my case manager agrees.”
“But I am so terrified of the prospect of requesting a re-evaluation and having all my support cut if (the IAT) underestimates me that I am not going to move forward with that evaluation in the immediate future.
“I think that says a lot, really.”
He said he feels “white rage and frustration” at what the assessment has become. “The worst thing the government did was not allow the evaluators to overrule it.”
The department did not respond to questions about when the decision to introduce the algorithm was made and who developed it. But Guardian Australia understands the motive was to create a consistent national approach to assessing care needs and reducing variation in outcomes. The algorithm then uses the information collected through the IAT to determine eligibility and support levels.
Documents seen by Guardian Australia confirm the IAT became a prescriptive tool that could no longer be overridden when assigning home support classifications on November 1.
“An ongoing SaH (Support at Home) classification result cannot be overridden by a lower or higher SaH classification result,” the documents state.
Greens senator Penny Allman-Payne said the volume of complaints she has received about the IAT prompted her to write to aged care minister Sam Rae on Wednesday urging him to “immediately reinstate human oversight of the IAT and give assessors the ability to overturn insufficient assessments”.
“I am very concerned about the use of algorithms and automation to make decisions about the complex individual care needs of older Australians,” he wrote.
“Older people are being denied urgent support at home, leaving them trapped in hospital or without the assistance they need to live safe and fulfilling lives at home.
“This is also putting incredible pressure on family members, many of whom are forced into unpaid caring roles.”
The letter also raised concerns about transparency and asked Rae to make public details about who developed and tested the algorithm and what methodology was used.
