- Aged Care Reform
- Regulatory Bodies
Ombudsman finds aged care funding algorithm unfair, urges human override
Key points5 points
- The government has not accepted the Ombudsman's recommendation to allow senior assessors to override algorithm classifications, and passed only an escalation pathway for exceptional appeals.
- The Ombudsman found the algorithm was deployed without meaningful risk assessment, and the in-use version was modified by the department without external validation.
- Appeals against algorithm decisions rose more than five-fold in the past year, prompting scrutiny of fairness and consistency in funding classifications.
- A comprehensive review of the Aged Care Act's assessment process and algorithm is underway, with a report due in the first half of next year.
- The Ombudsman has recommended a possible ANAO audit of the Single Assessment System and Independent Assessment tool, examining efficiency and ethics of resource use.
Summary
The Commonwealth Ombudsman found the Department of Health, Disability and Ageing's automated aged care funding classification algorithm lacked adequate risk assessment and produced unfair outcomes.
Appeals rose more than fivefold year on year after the algorithm launched on 1 November last year. The Ombudsman recommended legislative change to allow human override and an ANAO audit of the Single Assessment System and Independent Assessment tool. The government accepted six of ten recommendations, noted the override proposals, and committed to a comprehensive Aged Care Act review due in the first half of next year.