MELBOURNE, The federal ombudsman is investigating the way Australians assess funding for home aged care.
Critics say flaws in the assessment of funding under the home support scheme are preventing some older people from receiving the appropriate level of care they need to live safely at home.
Complaints about the process are increasing significantly. Even the experts who helped design the system are unsatisfied.
That’s why the Commonwealth should rethink its approach.
What are the key issues?
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The new Support at Home scheme is launching in 2025. One of its goals is to support more Australians to stay at home rather than entering residential aged care facilities.
When seniors want to join the program, they are assessed during an interview with a structured digital assessment called the Comprehensive Assessment Tool. The tool assesses the support they need – physical, cognitive and psychological. It also assesses the urgency and level of assistance needed.
An algorithm then analyzes the answers and determines the level of household support funding.
To be useful, assessments need to predict the actual levels of services required to deliver high-quality outcomes for older people with varying levels of need.
When developing assessment tools, the gold standard is to first do a lot of assessments to see what kind of care the older person needs, and what level of care they need. The next stage is to determine whether the services actually provided deliver high-quality outcomes for people with different levels of need.
But there is no public evidence that this has been done.
Instead, the next best option is adopted. Experts assign scores based on assessment answers to estimate the level of support someone needs.
But even if experts use proven tools, there is room for disagreement.
The comprehensive assessment tool includes 11 independently validated tools, each with inherent error rates. When these error rates are combined, they compound.
Worse, given that there are no studies on how well comprehensive assessments predict actual services and outcomes, it’s hard to say how good the algorithm is. The lack of transparency means it’s a black box, which is why the ombudsman’s inquiry is welcome.
This is particularly true since funds determined by algorithms may be systematically lower than funds determined by experts. This means that the cognitive, safety and complex care needs of older adults may be underestimated.
What about human oversight?
Despite these limitations and against expert advice, the Federation has explicitly removed the authority to manually override the algorithm’s support level assignments. The idea is to have the algorithm deliver consistent results for thousands of seniors.
However, this approach has many serious potential consequences.
The Family Support Program has eight levels of support, ranging from $10,731 per year at Level 1 to $78,106 per year at Level 8.
If the algorithm assigns a level of support that is higher or lower than an individual actually needs, this could mean a difference of between $5,300 and $20,000 per year, depending on the level.
The number of appeals continues to increase
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If a senior or their family wants to challenge the allocation of funds, they can appeal. But they often don’t know the specific reasons behind the ratings that lead to the assignments. And the appeals process can be cumbersome and stressful.
Since the new system was launched, around 800 older people have requested a review of their assessments.
The Elders Advocacy Network said requests for information and advocacy increased by 50% in the same three months.
Lynda Henderson, one of the system’s designers, said she was “angry” that the tool she helped design was turned into a prescriptive algorithm.
What needs to happen next?
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The Robodebt royal commission has warned government agencies that automated systems must ensure transparency, fairness and human oversight.
But that doesn’t happen when it comes to assessing individual home aged care funding situations.
The best approach is to use the algorithm as a guide for making individual decisions about an older person’s support needs, and allow the assessor to override the algorithm if the situation requires it.
System-level data should then be used to refine the algorithm and provide guidance to evaluators as the system matures. SKS
SKS
This article was generated from automated news agency feeds without modifications to the text.
