The department could not tell a Senate inquiry whether existing legislation actually prevented human override of the assessment tool, as advocates warned the proposed fix remains dependent on rules Parliament has not seen.
The Department of Health, Disability and Ageing has defended the Integrated Assessment Tool as aged care advocates told a Senate inquiry the sector had “lost confidence” in an assessment system producing “strange outcomes that are causing harm”.
A Senate hearing yesterday afternoon into the Aged Care Legislation Amendment (Aboriginal and Torres Strait Islander Aged Care Commissioner and Other Measures) Bill 2026 exposed a sharp divide over the government’s proposed human escalation pathway in the Support at Home assessment process. DoHDA rejected suggestions the IAT was fundamentally flawed while advocates backed the measure only as an interim fix.
Schedule 4 of the bill would establish a new escalation pathway for some Support at Home classification and priority decisions informed by the IAT. It would allow an authorised assessor, with the older person’s consent, to refer a decision for additional human review where they believe the outcome does not adequately reflect the person’s needs.
The system governor or a departmental delegate who was not involved in the original decision could then set aside the normal rules and substitute a different classification or priority category in specified circumstances, with much of the detail about eligibility and how the pathway operates to be set out in rules.
DoHDA rejects ‘fundamentally flawed’ claim
Deputy secretary for the Department’s aged care group, Sonja Stewart rejected evidence from earlier witnesses that the IAT itself was fundamentally flawed.
“We would not agree with that submission overall,” she said.
Ms Stewart said the IAT involved “a series of at least 120 questions”, potentially rising to 240 depending on responses, completed by an experienced and trained assessor with the older person.
“It’s been tested. I note that the tool actually started in July 2024, and it is something that has got very much a human touch and a human connection with older people.” she said.
DoHDA officials said the proposed escalation pathway would allow an assessor who believed an outcome was wrong to refer it for a separate decision.
“It gives the assessor the capacity to say, in my judgement, this does not feel right, and to consider that against a set of criteria, and escalate that for the rules to be set aside and for a different classification or priority to be given,” first assistant secretary Robert Day said.
The department intends to establish a multidisciplinary team of clinical and administrative staff to consider escalated cases.
Mr Day said cases raised with the department and the fact that fewer than 1% of people sought review of existing decisions did not suggest problems with the IAT were widespread.
“They are a small fraction, and I accept that that would be not the full picture,” he said.
“But it … equally doesn’t suggest that it is the … majority of cases.”
DoHDA said it intended to monitor the escalation pathway and change the underlying mechanism if patterns emerged.
“If we see a pattern where certain types of cases are consistently being escalated and overridden through the pathway, then we would seek to change the mechanism so that that’s addressed directly through the system, rather than to always go through an escalation pathway,” Mr Day said.
Basic legal question goes unanswered
The hearing also failed to establish whether the Aged Care Act as it currently stood actually prevented human override of an IAT outcome.
Coalition aged care spokeswoman Anne Ruston repeatedly pressed DoHDA on why legislation needed to be changed rather than the rules governing the assessment process.
Officials initially said the amendment was necessary to create a mechanism allowing a decision maker to set aside the normal rules and substitute a different decision.
But Senator Ruston asked for “absolute clarity” on whether there was anything in the Act preventing human override being permitted in the rules, the department ultimately took the question on notice.
“I think perhaps to just note in the earlier commentary about the balance between legislation and rules, it’d normally be a structure or a function that you would have some reference to an escalation pathway in the legislation itself, rather than just in the rules,” said assistant secretary Stephen Bauhaus.
“But we’ll take on notice the question of whether you could actually just construct it in the rules itself.”
Greens Senator Penny Allman-Payne subsequently put the same issue to the department, asking whether existing legislation prevented the rules being changed to restore assessor discretion.
Ms Stewart said the department’s advice to government was that legislation needed to be amended.
“Our advice to government, the legislation needs to be amended because we think that the IAT still needs to stand as it is, and that we need those really important classification and priority mechanisms in the legislation,” she said.
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Confidence lost
Ageing Australia chief executive Tom Symondson said his organisation supported the escalation pathway because older people currently had no quick way of correcting clearly inappropriate assessment outcomes.
But he said broader reform was needed.
“The assessment system … we’ve lost confidence in it because it’s throwing out strange outcomes that are causing harm,” Mr Symondson said.
“Our preference has always been that this is a decision support tool, not a decision-making tool.”
He said Ageing Australia supported the amendment despite its shortcomings because of the consequences of waiting for more comprehensive reform.
“My fear is if we go right back to the drawing board now, how many people are going to fall through the already gaping cracks that we have in this system while we get that right?” he said.
“Which is why we do support the amendment, but it is definitely imperfect.”
Older Persons Advocacy Network chief executive Craig Gear said his organisation was hearing “every day” from older people who believed they had been assigned the wrong level of support.
The existing reconsideration process was “taking more than 90 days often to complete”, he said.
“Older people don’t have the time to wait for that level of care.”
OPAN supports the escalation pathway as an interim measure but wants further work on the IAT algorithm to “fully reinstate human oversight”.
Council on the Ageing Australia deputy chief executive Corey Irlam said the problem emerged when what had originally been conceived as an “automated recommendation tool” became effectively mandatory.
“I think everybody quite liked that – that the system said a level of consistency means this person probably sits here,” he said.
“But what then happened was we introduced rules and policy that made that recommendation mandatory.
“That’s where we fell over. That’s where we caused problems. That’s where we took away that human oversight at that front point.”
Parliament yet to see crucial rules
Much of the operation of the new escalation pathway will itself be contained in rules which have not yet been released.
Those rules are expected to specify the circumstances in which an IAT-informed decision can be set aside and an alternative classification or priority category substituted.
DoHDA could not confirm the rules would be available before senators were asked to vote on the bill.
When asked what would happen if the Senate disallowed the rules, Mr Bauhaus said: “I think it would be very difficult for the system to operate without the rules in force.”
Advocacy groups also warned that the detail could determine whether the proposed safeguard worked.
Mr Irlam warned against Parliament establishing a broad safeguard in primary legislation only for delegated legislation to narrow it.
“Simply replacing a computer algorithm with a bureaucratic checklist does not achieve meaningful human review,” he said.
“Parliament should not establish a broad safeguard in primary legislation only to allow delegated legislation to narrow it and reduce who can use it or what it will achieve.”
OPAN also wants the rules released publicly and warned that narrow eligibility tests or restrictions on genuine human judgement could undermine the reform.
Mr Gear said the sector needed action this year, but also needed to see the detail.
“We want to see the rules and for the public to see the rules,” he said.
“We think it can’t be too narrow, and it can’t be that it’s, I suppose, not going to allow the right people to get through, and so that will be the test to see whether that is able to get the right people the right care at the right time.”