A controversial algorithm designed to determine funding levels for home-based aged care in Australia began severely under-assessing vulnerable older people within days of its rollout, internal government documents reveal. Health officials across multiple states and territories raised urgent warnings that the tool, which cannot be overridden by clinicians, was leaving at-risk seniors without the support they desperately needed.
The Integrated Assessment Tool (IAT) was introduced in November 2025 to determine the level of funding and urgency of care that older Australians receive for support at home. But documents obtained under freedom of information laws show that from the very beginning, assessors reported feeling powerless as the algorithm produced outcomes that failed to reflect patients’ actual needs.
A Systemic Failure Across Multiple States
Within the first week of the IAT’s introduction, health departments in at least four states and the Northern Territory had begun documenting cases of systemic error. Officials in Victoria, Queensland, Western Australia, New South Wales and the NT all emailed the federal Department of Health and Ageing with detailed evidence of the tool’s failures.
In Queensland alone, a staff member from the state’s policy and planning division compiled a spreadsheet of more than 100 examples of unexpected outcomes. In all but a handful of cases, the algorithm had under-assessed the person’s needs. A similar log was sent by NT Health within a week, while Northern NSW health officials separately called for legislation to be changed to allow assessors to correct wrong decisions.
The NT Health planning system staffer wrote on 13 November, less than two weeks after launch, that assessors were “feeling very disheartened that they are no longer able to use their clinical judgement and years of clinical experience to over-ride the IAT recommendations.” They warned that the failures were already causing distress to consumers and families, and were likely to increase carer stress and hospital admissions.
The algorithm appeared particularly ill-equipped to identify people with significant cognitive impairment who retained good physical abilities — a combination common in dementia and other neurological conditions.
Clinicians Warn of Catastrophic Consequences
Dr Shirley Bowen, director general of WA Health, became one of the most prominent voices raising the alarm. In an email dated 24 November, she warned the federal government of “catastrophic” outcomes for a small but vulnerable group of older people.
“Without a pathway for discretion, a small but vulnerable group of older people might experience catastrophic outcomes while waiting for algorithmically determined access to services,” she wrote. She also flagged serious risks to hospital operations, noting that delays in assessments could block access to acute care for other patients who needed it.
The consequences for hospital discharge pathways were stark. Dr Bowen explained that older people who previously received an urgent Commonwealth-funded home support package within four weeks were now being classified as “medium” priority, facing estimated waits of eight to nine months. “Our hospital teams are at a loss as to how to manage discharge in such circumstances,” she wrote.
WA Health’s strategy and governance department sent a second email on 20 November, marked as high importance, outlining numerous concerns about inappropriate support-at-home classifications across most of their outlets. The official warned that assessors were being asked to approve outcomes they did not agree with, raising serious professional and potential legal concerns. “Staff attrition is a very real issue for us at the moment,” they added.
By March, NSW Health had recorded more than 50 additional cases in a spreadsheet titled “Misaligned IAT outcomes,” in which state-employed clinicians found the algorithm’s determinations did not match patients’ needs.
Government Responds With Escalation Pathway, Not Override
Despite the mounting evidence, the federal government has stopped short of restoring assessors’ ability to immediately correct algorithmic errors. Instead, Aged Care Minister Sam Rae announced in July that assessors would be able to escalate cases to a system governor, rather than relying on the older person to initiate a review.
A department spokesperson said the government had “listened to people’s experience of the system” and would “deliver a practical, responsible safety net.” The spokesperson confirmed the government would legislate a new assessment escalation pathway to ensure decisions could be reviewed and changed when necessary. However, it remains unclear how long the new process will take.
Advocacy organisations have also reported alarming trends. Ageing Australia, the Older Persons Advocacy Network (Opan), and Dementia Australia all sent detailed examples of the algorithm’s failures to the federal government soon after launch. Dementia Australia said in December that support services were telling people with dementia not to bother applying for an IAT assessment, having witnessed numerous cases in which people received less or no support despite increasing care needs.
Opan warned that delays, misclassification and inaccessible review processes were creating a devastating cycle. “Delays in assessment, algorithmic misclassification, and inaccessible review processes create a cycle in which urgent needs are not recognised, carers are pushed to exhaustion, older people deteriorate without support, preventable hospitalisations and premature residential aged care entry increase, [and] some individuals die before receiving any assistance,” they wrote.
The IAT 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 its rollout, the department barred assessors from overriding its decisions — a move that has drawn sharp criticism from clinicians and aged care professionals nationwide.
Why it Matters
The failures of the IAT algorithm represent more than a technical glitch — they expose a fundamental tension between efficiency-driven automation and the nuanced, deeply personal nature of aged care assessment. When a tool designed to allocate support to some of society’s most vulnerable people systematically under-assesses their needs, the consequences are not abstract: they are measured in delayed discharges, mounting hospital pressures, exhausted carers, and older Australians who deteriorate or die without the help they were entitled to receive. The fact that clinicians across multiple jurisdictions raised alarms within days, and were largely ignored or overruled, raises serious questions about accountability and the role of human judgement in decisions that affect life and death. As governments worldwide explore algorithmic tools in public services, Australia’s experience offers a sobering reminder that technology must serve people — not the other way around.
