By A Concerned Reader
(This article draws only from publicly available information, media reports, Senate Estimates transcripts, and policy documents.)
Introduction
As the new Support at Home (SaH) program begins rolling out across Australia, an unexpected problem has emerged at the centre of the reform: an automated classification algorithm now determines an older person’s SaH level – and unlike the previous system, clinicians can no longer override its output, even when it is clearly wrong.
Department officials insist that the tool is “not AI”, just an algorithm. Yet for assessors, providers, advocates and families, it functions exactly like the automated decision-making systems that have caused trouble across multiple government portfolios.
Public reporting has already highlighted disturbing inconsistencies. Senate Estimates questions have been raised. OPAN has signalled significant consumer confusion and emerging issues in the Single Assessment System. Assessors and providers across several states report that similar clients are receiving different SaH levels, cognitive impairment appears under-weighted, carers are burning out, and older people are being assigned service levels too low to meet their needs – with no way for clinicians to correct the error.
The public deserves clarity. The Parliament deserves straight answers. And older Australians deserve transparency about how essential care decisions are being made.
Below is a summary of the key issues now being reported publicly, followed by a list of questions that Senate Estimates, OPAN and the media should be asking.
1. What We Already Know From Public Reporting
a) Algorithm now determines SaH level; overrides prohibited
Multiple media outlets (The Weekly Source, Invox, HelloCare, Medical Republic) have confirmed:
- The SaH level is set by the IAT algorithm, not by clinician judgement.
- Clinicians cannot override the outcome for SaH levels.
- Assessments “lock” once submitted and cannot be corrected.
- Similar clients can receive different results without explanation.
b) Inadequate weighting of cognitive decline, safety and carer strain
Reporters quote assessors describing:
- Dementia and safety risks under-weighted.
- Domestic tasks skewing results.
- Carer exhaustion barely shifting the level.
- These descriptions match the emerging national pattern.
c) Department defensive about terminology
In Senate Estimates, the Department stressed the tool is “not AI”, only “business rules”. However:
- It automatically determines eligibility levels.
- It is opaque.
- It overrides human judgement.
- It cannot be inspected externally.
Functionally, this is automated decision-making in the same family as Robodebt’s system, even if technically simpler.
d) OPAN and older Australians are already raising concerns
OPAN’s mid-2025 “Presenting Issues” report notes increasing anxiety about the Single Assessment System, long wait times and the upcoming SaH transition.
COTA and OPAN jointly pushed for delaying the Aged Care Act commencement because consumers lacked clear information about what SaH would actually deliver.
e) FOI disclosures are beginning – but not about the algorithm itself
Recent FOI releases on SaH show internal reviews and risk assessments, but not the weighting logic or scoring rules.
No FOI release yet contains the “black box” that determines level 1–8 outcomes.
2. Why This Matters
An automated system that cannot be corrected by clinicians introduces three major risks:
- Systemic under-classification (people incorrectly assessed at low levels).
- Increased reassessments (expensive, time-consuming and stressful).
- Erosion of public confidence in the fairness and transparency of aged care.
If the algorithm is rationing access based on predetermined budget targets or percentage caps – something no journalist has been able to confirm or reject because the rules are opaque – then Australia risks creating a second Robodebt moment in aged care.
3. Questions Senate Estimates Should Ask
(These questions cannot harm operational teams. They target governance, transparency and public accountability at the Commonwealth level.)
Algorithm Transparency
- What is the full rule set, weighting system, and scoring logic used by the IAT classification algorithm?
- Has the algorithm been independently validated, and will that validation be published?
- Does the algorithm incorporate budget constraints or target percentages for each SaH level? If not, can the Department explicitly rule this out?
Clinical Overrides
- Why are assessors prohibited from overriding incorrect algorithmic outputs for SaH levels?
- What appeal mechanism exists for clients when the algorithm assigns an obviously wrong level?
- How many override requests have been made, and how many denied?
Risk, Safety and Harm
- Has the Department conducted a risk assessment into harms caused by algorithmic under-classification (e.g., falls, carer burnout, failed discharge)?
- What monitoring is in place to detect systematic bias?
Resourcing and Cost Blowouts
- What modelling was done to estimate the increased reassessment workload caused by incorrect algorithmic outputs?
- Has the Department costed the likely surge in reassessments expected over the next 12–24 months?
4. Questions OPAN Should Be Asking
- Is the classification algorithm producing unsafe outcomes?
- How can older people dispute or appeal an incorrect SaH level?
- Are clients being placed on waitlists because the algorithm minimises their level?
- Is automated decision-making compatible with the Aged Care Act’s new rights-based framework?
- Should the algorithm be independently audited for fairness and harm?
5. Questions the Media Should Be Asking
- Why is the Department reluctant to publish the IAT weighting rules?
- How many older Australians have already received incorrect SaH levels?
- How many reassessments are being triggered compared to last year?
- Why are clinicians forbidden to correct errors?
- Has the government quietly embedded rationing mechanisms into the algorithm?
- What comparisons exist between this system and Robodebt’s automated processes?
6. What a Strong FOI Request Should Target
A powerful FOI request should seek:
- The full internal design documentation for the classification algorithm.
- All weighting tables, scoring logic and rule sets used to assign SaH levels.
- Testing and validation reports that show accuracy, bias, or known issues.
- Risk assessments or hazard logs identifying harms from misclassification.
- Any correspondence where rationing, budget constraints or target distributions were discussed in relation to the algorithm.
- Guidance documents given to system vendors and assessors.
Justification:
These documents relate directly to public safety, service eligibility, accountability, and the rights of older Australians, and therefore meet the public-interest test.
7. Closing Observation
Australia has spent years rebuilding aged care after the Royal Commission. We cannot afford to replace one broken system with another that hides its logic, overrides clinicians, and cannot be appealed when it makes mistakes.
If the SaH algorithm is safe, fair and clinically sound, the government should publish it. If it is not, then transparency is the first step toward fixing it.
Either way, silence helps no one.
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Thank you, A Concerned Reader for a clear, concise and extremely important article. Also, thanks to the Older Persons’ Advocacy Network for the work they do.
Your article exposes an alarming situation, the problems raised suggest strongly that the program is not working at all for many, and working in a poor and unsustainable manner for many more. Australians should reflect on the adage ‘the standard you walk past is the standard you accept.’
When looking at this problem Australians would be do well to keep in mind the bigger picture and direction Labor is taking our country.
If I have it right Labor has privatised aged care assessment against the recommendation of the Royal Commission, “The Labor government has done what the Coalition didn’t, and the Aged Care Royal Commission warned against, privatizing aged care assessment and awarded $1.5 billion worth of contracts to for-profit operators. Sarah Russell reports.” (MWM)
Then followed that by introducing a transactionalized, ‘free marketized’ pay-for-showers home care packages, “The new Support at Home Program for older people is introducing a ‘free market’ transactional aged care system. It’s a retrograde step, Sarah Russell reports.” (MWM)
And now, despite the lessons of Robodebt, handed assessments within the SaH program over to an automated classification algorithm.
This is consistent with the planned changes to the NDIS that Labor is pushing for – algorithm based assessments, no human oversight and even worse no appeal to a human mechanism.
On top of all this is the secrecy, the arrogance, the disdain for human understanding that has become a key trait of the Albanese Labor government.
The monetization, dehumanization and disdain for human oversight are alarming; it is consistent with neoliberal extremism.
There is an alarming trend of Australians, as soon as being surplus to needs, being treated as a ‘cost’ to the system. “Supporting the elderly is a reflection of our humanity”. (HCA) We are meant to turn our heads to genocides, ignore blatant breaking and undermining of International law, and treat many with a disability as a cost. We are being stripped of our humanity at our own peril.
Aged care assessments were privatised, put out to contractors, way before Labor came to government. In 2017 my husband was assessed by a rather rude, pushy, private contractor who wrongly filled out sections of the form based on her assumptions. The contractor originally said she worked for the federal government, until pressed when she said she worked for a contracted entity.
The packages my husband was approved for never were delivered. I have often wondered if the private not=for=profit company actually got the funding or if it was only a promise in case they could actually deliver the services at any time.
The allocated service provider rang in 2023 to see if my husband was happy with the service he was receiving – a year after he passed away.
By all means criticise the service, or lack thereof, but don’t lay the blame at Labor’s feet. Blame the mulititude of previous players in the system.
Lorraine, they are all obsessed-both parties- over AUKUS. Everything of worth seems to be under-financed to pay for the wretched things.
Agreed, the ALP have walked into a mess, but they must regain a real sense of their true role or it becomes beholden on folk to look elsewhere.
People need action on some fronts and studied indifference is NOT the solution.
Hi Lorraine, that’s odd, I wonder if we are talking about two different but related things because Dr. Sarah Russell should know what she is talking about as she was formerly Director of Aged Care Matters and is Principal Researcher at Research Matters.
What she said is supported by the AMA as evident in a media release from 7th September 2021, where they said:
“The AMA is urging the Federal Government to scrap plans that could potentially privatise the assessment process for aged care services, warning the move would risk the health of older Australians and open the system up to conflicts of interest.
The Government abandoned similar plans last year after strong opposition from state governments, aged care advocates and medical peak bodies.
AMA President, Dr Omar Khorshid, has written to the Minister for Senior Australians and Aged Care Services, the Hon Senator Richard Colbeck expressing his concern with the market approach to aged care assessments.
The AMA has long supported a single assessment workforce, but believes it must remain with the state and territory health services, and be based on Aged Care Assessment Teams (ACAT), rather than the Regional Assessment Services (RAS) model that only assesses lower needs.
While a proposal to replace ACATs and RAS with a single assessment process was a recommendation of the Royal Commission into Aged Care Quality and Safety, the Commissioners did not recommend privatisation.”
https://www.ama.com.au/media/privatised-aged-care-assessments-will-result-poorer-health-outcomes
In an ABC article from 5th November:
“For the past 40 years, it’s been Aged Care Assessment Teams (ACAT), based with state and territory health departments, who have done assessments and decided on the level of care needed.”
https://www.abc.net.au/news/2025-11-05/older-australians-face-long-wait-for-aged-care-assessments/105971968
Sorry Lorraine but whenever I’m faced with either believing the AMA, ABC and a doctor who was a director of Aged Care Matters, or a commentator with a personal story on social media, I’m going with Dr. Sarah Russell and the AMA – I think maybe you’ve mixed up something with who actually does the assessment.
There is no doubt in my mind that Labor did privatize aged care assessment in contradiction to the 2021 royal commission and that even the Coalition baulked at doing so.
I blame Labor for this as I blame Labor for leaving millions of Australians for 2 years struggling in a cost of living crisis. Just as I blame Labor for making housing less affordable than when they took office. I blame Labor for failing to tackle gas price hikes in 2022 at the source, and failing to stop profiteering driving inflation in 2022/3. I blame Labor for doing too little to meet the renters crisis. I blame Labor for AUKUS, and many other things.
Since when is a government that’s been in power for basically 4 years beyond blame?
I don’t let anyone off the hook, but too often it is easy to only blame the politicians. The long time the previous lot were in power set up these privatised welfare and service delivery, however it was the individual woman who tried to railroad my husband by filling out parts of forms that explicitly said she was not to do.
It is the people running the local, state, and federal privatised organisations that are failing to deliver.
Simply blaming the current politicians sitting in the halls of power without holding the individual managers and workers responsible for their actions in delivering services is one of the reasons things are as they are.
I agree that action, positive action, is needed, but it needs to come from across the board.
Thanks Lorraine, that reminds me, I blame Labor for no one yet being held accountable for Robodebt, as Labor designed the NACC.
Australia is arguably the wealthiest country per capita in the entire world, certainly amongst developed countries. Yet we have millions of Australians living in poverty, hundreds of thousands of homeless people, one in three have recently faced food insecurity, our education system divided into ‘haves’ and ‘have nots’, Medicare still in crisis, our hospital system in crisis, increasing job insecurity, children sexually abused in childcare, aged care in a mess, manufacturing declining and increasing mental health problems.
I blame the duopoly for that, and that includes Labor. If we stick our heads in the sand and say the Coalition left us a mess, are we doing the best by our children?
Labor has had 4 years to help Australians suffering poverty, how long does it take to increase job seeker payments and the like to make meaningful changes to the lives of those trying to live off what is almost universally acknowledged as too little? another 4 years?
I am afraid Goggongche is winning this one. Even Albanese mentioned in the election speech back in Morrison’s last days that the ALP was now neoliberal. Neoliberalism is NOT benign, it is Toryism with a scalpel.
“Neoliberalism is NOT benign,” yes Paul, I agree.
Neoliberalism has led to an explosion in wealth inequality, deplorable privatization of public utilities at an enormous cost to the public and the benefit of those with enormous wealth, the dominance of the finance industry at the expense of the economy, a return to rampant corporate polluting of the environment, a power shift to almost total power to employers leaving employees with little power at all, a shifting of productivity growth rewards to employers, increased wage inequality, an erosion of working conditions, a hollowing out of public utilities, and a nasty shift in sentiment towards the unemployed.
And yes, Labor (under Hawke-Keating) introduced neoliberalism into Australia. Howard took it further still, and now the Albanese Labor government is doing its best to make Howard look like a Marxist lefty.
The danger of this is the impact AI will have on employment. We know robotics will affect low-skilled jobs, but with AI almost everything will be up for grabs; clerical work, doctoring, almost you name it, and we’ve seen how Labor threw the vulnerable under a bus during a cost of living crisis, what will it do if AI annihilates employment?
There are some things in politics where we need to decide what kind of country we want to live in, and I believe this is one of those things, especially with the parallels between this and the changes Labor is bringing into the NDIS.
Do we want to be a country that cares for our aged, or are they just another ‘cost’? Do we want to have a first-rate aged care system or a third-rate or worse aged care system?
This might help:
How to navigate the Support at Home maze.
By Kathy Eagar, Paul Sadler. P&I. December 13, 2025.
https://johnmenadue.com/post/2025/12/how-to-navigate-the-support-at-home-maze/
Quite a few years ago my family had a nightmarish time with our local ACAT people who seemed determined to move my mother out of her home and into a facility. We had to face them in front of the Guardianship Board to maintain family decision-making over her situation. That is, our family members were appointed my mother’s joint guardians after the Board examined all the evidence – much of which had been put forward by the local ACAT, and which was quite biased.
While it may be that the new system is imperfect, and difficult, the ACAT system was not perfect, as experienced by Lorraine.
I am also disappointed by the attitude voiced by Gonggongche that prefers the declarations of officials over lived experience. Perhaps listening to the families would be a good idea.