Australia's aged care algorithm sparks warnings as dementia patients told to avoid reassessment

In early December, weeks after Australia's new aged care assessment algorithm went live, Dementia Australia sent an urgent letter to senior health officials. The organization had been hearing troubling stories from families and care workers across the country. One case stood out: a woman with advancing dementia was entitled to about eight hours of weekly home support through a level three care package. Her condition had worsened. She needed to be reassessed to access more help. But when her husband approached the local assessment service, they advised him not to pursue it. The reason was stark—assessors had begun seeing a pattern where people with dementia came out of the new system with less support than before, or none at all, even when their needs were clearly growing worse.

The Integrated Assessment Tool, or IAT, had launched in November as the government's mechanism for determining how much funding older Australians would receive for home support and where they ranked in priority for care. Days before the rollout, the government had removed assessors' ability to override the algorithm's decisions, even when they believed the funding levels were wrong or dangerously low. The timing created a bind: people who might have benefited from reassessment were now being quietly discouraged from applying, trapped between deteriorating health and the fear that seeking help would make things worse.

By February, the warnings had intensified. The Older Persons Advocacy Network submitted a paper to department officials documenting something grimmer still—deaths they attributed to the failing system. People with extreme care needs were being left without adequate support before they died. The organization pointed to a specific mechanism of harm: clinicians could no longer intervene when the algorithm made decisions they knew were wrong, and the over-reliance on automated decision-making was contributing to preventable decline and, in some cases, death. In one example, the algorithm refused to approve a funding upgrade for someone whose health was rapidly deteriorating. The assessor believed the existing package was grossly inadequate, but the person had to pay for private care out of pocket because the system would not budge.

Ageing Australia, the national peak body for aged care, sent its own detailed paper to senior officials that same month. It documented systematic under-assessment across the board, with particular problems for people with dementia. The organization provided multiple examples of people being approved for the same level of support they already had, or less, despite clear evidence their health was declining. Two cases involved people living with Parkinson's disease—both with complex medical needs, no family support, requiring intensive medication management, diabetes care, and wound dressing. Both were reassessed under the algorithm as needing no additional support whatsoever, despite their deteriorating condition. One assessor even suggested the person seek a new diagnosis rather than apply for reconsideration, as if the algorithm's logic could be worked around by changing the label on the illness.

Internal health department emails from late December revealed that assessment organizations were explicitly telling people not to seek reassessment because there was no guarantee they would receive more funding. Assessors themselves reported they had not been properly trained on the new tool. A senior department staff member flagged this reality ahead of a meeting with advocacy groups, documenting what was happening on the ground in plain language.

State and territory health departments added their voices. Hundreds of cases were logged and passed to federal counterparts, each one a record of the algorithm systematically under-assessing older Australians. The head of the Western Australian health department, Dr. Shirley Bowen, used the word "catastrophic" to describe the outcomes she was seeing.

Tanya Buchanan, CEO of Dementia Australia, told the Guardian the organization remained concerned the assessment process could not meet the needs of people living with dementia, their families, and carers. She called for a return of clinical oversight—the ability for trained assessors to make judgments that the algorithm could not or would not make.

The government's response was to propose a new "assessment escalation pathway" rather than restore the override function. Under this system, assessors could refer cases to a system governor—the secretary of the Department of Health, Disability and Ageing—if they believed the algorithm's decision was wrong. But advocates and carers have repeatedly raised concerns that review processes for algorithm errors are already lengthy, and that older people are deteriorating or dying while waiting for decisions to be reconsidered. Samantha Edmonds, director of policy at the Older Persons Advocacy Network, said without more details about how the escalation pathway would work, it was difficult to know whether it would actually help. She emphasized that human oversight must remain part of the decision-making process, because these assessments have real consequences for how people live and die. The Commonwealth Ombudsman is investigating.