\n<\/p>\n
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.<\/p>\n
It also led to one senior <\/strong>state health official writing to the federal government to warn of \u201ccatastrophic\u201d outcomes from its algorithmic tool \u2013 used to determine support levels for in-home care \u2013 and that her staff were \u201cfielding calls from distraught clients and assessors\u201d.<\/p>\n 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) last November.<\/p>\n 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.<\/p>\n 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.<\/p>\n Days before the IAT was rolled out, the department barred the IAT\u2019s decisions from being overridden by assessors.<\/p>\n Sign up for the Breaking News Australia email<\/span><\/p>\n Within days of launch, people were being under-assessed by the algorithm, the documents released by the federal department of health and ageing reveal.<\/p>\n 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.<\/p>\n The director general of WA Health, Dr Shirley Bowen, became so concerned that she emailed her federal counterpart with a warning.<\/p>\n \u201cWithout a pathway for discretion, a small but vulnerable group of older people might experience catastrophic outcomes while waiting for algorithmically determined access to services,\u201d she wrote on 24 November.<\/p>\n \u201cThis also creates risks of further discharge delay, blocking access to acute care for others who need it.\u201d<\/p>\n <\/span>An excerpt of the 24 November email from Dr Shirley Bowen.<\/span> Illustration: Supplied<\/p>\n The documents released to Guardian Australia show departments around the country also emailed their concerns within days and weeks of the tool\u2019s rollout.<\/p>\n 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 \u201cconcerning outcomes from the IAT algorithm and the assessors not being able to override the outcome\u201d.<\/p>\n \u201cThe assessors are feeling conflicted as they do not agree that the IAT algorithm outcome reflects the clients\u2019 needs,\u201d the email said, providing a list of examples.<\/p>\n On 13 November, less than two weeks after the algorithm was introduced, a representative from NT Health emailed the federal government about \u201cconcerns regarding the algorithm and erosion of clinical judgement within the new assessment system\u201d.<\/p>\n \u201cAttached are some examples of clinical assessments conducted in the past week that have resulted in unexpected outcomes,\u201d wrote the NT Health planning system staffer.<\/p>\n \u201cAssessors and delegates are 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, to achieve optimal consumer outcomes.<\/p>\n \u201cThese outcomes have required many difficult conversations with consumers, families, and providers \u2026 this combined with the lack of respite in the NT is likely to lead to increased carer stress and increased hospital admissions.\u201d<\/p>\n The email said the algorithm was particularly failing those with \u201cgood\u201d physical abilities but have \u201csignificant cognitive impairment\u201d.<\/p>\n A day later, WA Health\u2019s strategy and governance department also emailed spreadsheets of issues and complaints about the algorithm to the federal government. It sent a second email \u2013 marked with high importance \u2013 on <\/strong>20 November that outlined \u201cnumerous concerns across most of our outlets regarding \u2026 inappropriate SAH (support at home) classifications\u201d.<\/p>\n \u201cApproving classifications and assessment outcomes that they [aged care assessors] do not agree with does not align with their professional ethics and they are concerned this has possible legal impacts,\u201d the email said.<\/p>\n The WA Health official said there needed to be a way to quickly escalate errors or override decisions. \u201cKeen for any quick advice you can provide on this to avoid negative impacts on older people,\u201d the email said. \u201cStaff attrition is a very real issue for us at the moment.\u201d<\/p>\n In Queensland, a state health staffer sent a spreadsheet listing more than 100 examples of \u201cunexpected IAT outcomes\u201d to the federal government on 18 November.<\/p>\n skip past newsletter promotionFree newsletter | When needed<\/p>\n Sign up to Breaking News Australia<\/span><\/p>\n Get the most important news as it breaks<\/p>\n after newsletter promotion<\/p>\n In all but a few cases, the algorithm had under-assessed the person\u2019s needs, the member of Queensland Health\u2019s policy and planning division said in the email, and they will \u201ccontinue to collect examples over the coming months\u201d.<\/p>\n <\/span>An excerpt from one log of cases sent to the federal health department.<\/span> Photograph: Supplied<\/p>\n 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.<\/p>\n 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.<\/p>\n Hospital staff would arrange discharge to short-term rehabilitation or other services in the interim, she said in the email.<\/p>\n \u201cThese same clients are now classified as \u2018medium\u2019 priority, with an estimated 8-9 month wait time until support at home services commence. Our hospital teams are at a loss as to how to manage discharge in such circumstances,\u201d she wrote in the email.<\/p>\n On 12 March, NSW Health sent a spreadsheet titled \u2018Misaligned IAT outcomes\u2019, recording more than 50 cases where state-employed clinicians found the algorithm\u2019s funding determination failed to match a person\u2019s needs.<\/p>\n Asked to comment on the logs of inadequate assessments and concerns revealed by the documents, a department of health spokesperson said: \u201cWe\u2019ve listened to people\u2019s experience of the system, and we\u2019ll deliver a practical, responsible safety net that supports the older people whose circumstances don\u2019t fit neatly into a tool\u201d.<\/p>\n \u201c\u2026 the government will legislate a new assessment escalation pathway to ensure decisions can be reviewed and changed when necessary,\u201d the spokesperson said.<\/p>\n The government has stopped short of returning human oversight and the ability for assessors to immediately correct wrong algorithm decisions, despite growing calls from clinicians, advocacy groups and politicians. Instead, the aged care minister, Sam Rae, said in July assessors would have the option to escalate cases to a system governor.<\/p>\n This differs from the existing, lengthy review process, as assessors will be able to escalate cases rather than relying on the older person to start the process. It remains unclear how long the new escalation and review process will take.<\/p>\n The documents released to Guardian Australia separately show a number of aged care advocacy organisations \u2013 including Ageing Australia, the Older Persons Advocacy Network (Opan), and Dementia Australia \u2013 also sent detailed examples of the algorithm\u2019s failures to the federal government soon after it was launched.<\/p>\n \u201cDelays 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,\u201d Opan wrote to senior department staff.<\/p>\n In December, a staff member of Dementia Australia wrote to the department to say the organisation was \u201cvery concerned\u201d by feedback about the IAT. The organisation said support services were telling people with dementia not to bother asking for an IAT assessment \u201cas they have seen a number of people with dementia receiving less or no support \u2026 even if their care needs are increasing\u201d.<\/p>\n In response, a staff member from the department wrote the algorithm had been designed to consistently determine an older person\u2019s home support classification.<\/p>\n \u201cThis approach ensures that people with similar characteristics and functional needs receive the same level of funding to support their aged care needs,\u201d the response said.<\/p>\n Guardian Australia previously revealed the experts consulted to develop the IAT questionnaire were not told the tool would be underpinned by an algorithm being developed internally by the government.<\/p>\n Do you know more? melissa.davey@theguardian.com<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":" 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 \u201ccatastrophic\u201d outcomes from its algorithmic tool \u2013 used<\/p>\n","protected":false},"author":1,"featured_media":52168,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[51],"tags":[5289,2029,165,3767,11038,546,481,116,37,3164,5481,2161,1786],"class_list":{"0":"post-52167","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health","8":"tag-aged","9":"tag-australias","10":"tag-care","11":"tag-cases","12":"tag-catastrophic","13":"tag-days","14":"tag-fears","15":"tag-funding","16":"tag-health","17":"tag-launch","18":"tag-lists","19":"tag-staff","20":"tag-tool"},"_links":{"self":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/posts\/52167","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=52167"}],"version-history":[{"count":0,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/posts\/52167\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/media\/52168"}],"wp:attachment":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=52167"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=52167"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=52167"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}\u2018Numerous concerns\u2019<\/h2>\n
\u2018Our hospital teams are at a loss\u2019<\/h2>\n