State health officials were so alarmed by a controversial federal government aged care funding tool that they kept a log of hundreds of cases where vulnerable older Australians were severely under-assessed. It also led to one senior state health official writing to the federal government to warn of “catastrophic” outcomes from its algorithmic tool – used to determine support levels for in-home care – and that her staff were “fielding calls from distraught clients and assessors”. Documents obtained by Guardian Australia under freedom of information laws show officials from four states and the Northern Territory recorded systemic errors that had occurred since the federal government rolled out the Integrated Assessment Tool (IAT) algorithm last November.
The IAT includes a questionnaire completed by aged care assessors from state and territory health departments. The information is then analysed by an algorithm which determines the level of funding a person receives for support at home packages, as well as their urgency of need. The documents reveal the algorithm was designed by federal health and ageing staff, led by four assistant secretaries overseeing five departmental data scientists, a principal cost modeller and a director.
Days before the IAT algorithm was rolled out, the department barred the IAT’s decisions from being overridden by assessors. Within days of launch, people were being under-assessed by the algorithm, the documents released by the federal department of health and ageing reveal. Assessors reported feeling powerless and ethically challenged while clients were left at risk of deteriorating, remaining in hospital, or being forced into aged care, the documents show.
The director general of WA Health, Dr Shirley Bowen, became so concerned that she emailed her federal counterpart with a warning. In a 7 November email, a staff member with Aged Care Assessment Victoria wrote to the federal health department about feedback it was receiving about “concerning outcomes from the IAT algorithm and the assessors not being able to override the outcome”. On 13 November, less than two weeks after the algorithm was introduced, a representative from NT Health emailed the federal government about “concerns regarding the algorithm and erosion of clinical judgement within the new assessment system”.
A day later, WA Health’s strategy and governance department also emailed spreadsheets of issues and complaints about the algorithm to the federal government. It sent a second email – marked with high importance – on 20 November that outlined “numerous concerns across most of our outlets regarding … inappropriate SAH (support at home) classifications”. The WA Health official said there needed to be a way to quickly escalate errors or override decisions.
In all but a few cases, the algorithm had under-assessed the person’s needs, the member of Queensland Health’s policy and planning division said in the email, and they will “continue to collect examples over the coming months”. Within a week, a similar spreadsheet was sent by NT Health, while a representative from the Northern NSW health district separately raised a number of issues with the IAT and asked for legislation to be changed to allow for assessors to override wrong algorithm decisions. In her 24 November email, Bowen, who heads WA Health, said older people who needed commonwealth-funded home support in order to be discharged from hospital previously received an urgent funding package within four weeks.
Extract — continue reading at the source.
