Australia’s Aged-Care Assessors Want Permission To Disagree With The Computer

An aged-care assessor can meet an older person, understand their needs and disagree with the computer’s funding decision. In Australia’s assessment system, that does not necessarily mean the assessor gets to correct it. Professional judgment has been welcomed into the building and asked to wait for a delegate.

The Guardian reported Tuesday that the Greens are pressing the government to restore a direct human override after a critical report from the commonwealth ombudsman. The dispute concerns the integrated assessment tool used to determine eligibility and funding levels for home-support packages.

Assessors meet people and enter answers about their needs. An algorithm produces the result. The ombudsman found that the system was generating unfair outcomes and undermining confidence in aged care, and recommended legislative changes so assessors could amend clinically inappropriate decisions.

The government's response includes a new escalation route: an incorrect outcome can be referred to a delegate for review. Aged-care minister Sam Rae says that adds human oversight and discretion. The government has also commissioned an independent review and accepted six of the ombudsman’s ten recommendations, while noting two, including direct assessor override and legislative change.

That is action, but it is not the same arrangement the ombudsman recommended. The distinction concerns which human gets to exercise judgment, how far that person is from the assessment, and what work is required to get an error corrected.

A nurse with more than four decades of experience told the Guardian anonymously that the delegate had not sat in front of the person she assessed. Referring cases adds time and administration, she said, and she described distress at having to accept decisions she considered wrong. Her account is one assessor’s experience, not a statistical estimate of the entire workforce. It is nevertheless a useful description of where the responsibility lands.

The person meeting the client must explain the result. The system producing it does not have to look anyone in the eye. There is a suspiciously convenient division of labour in which the software gets the decision and the human gets the conversation afterward.

The ombudsman has questioned whether the escalation route will provide the clinical discretion needed. Opposition figures and independent senator David Pocock are also calling for change, while the Greens want parliament’s remaining sitting weeks used to establish the override.

A direct override would still need standards, records and accountability. The choice is not between unquestionable software and any assessor doing whatever they like. It is whether the system can use qualified judgment at the point where a person’s needs are actually being examined.

The government’s review may produce improvements. It has not already resolved the dispute, and an escalation pathway should be judged on its results rather than the reassuring number of humans mentioned in its description.

For an older person seeking support at home, the relevant question is not whether a decision has travelled through the correct administrative itinerary. It is whether the support reflects the needs the assessor found.

If the experienced professional must spend evenings persuading the system to recognise the person they have already met, the computer has not eliminated bureaucracy. It has found somebody else to do it.