Australia's aged-care algorithm 'unreasonable and unfair', damning ombudsman investigation finds

An algorithm used by Australia's federal government to assess the level of care older Australians are entitled to is unreasonable, unfair and lacks human oversight, according to a damning investigation by the Commonwealth Ombudsman.

The investigation also found that transparency recommendations from the robodebt royal commission have been ignored.

The Commonwealth Ombudsman, Iain Anderson, told Guardian Australia on Monday that the legislation must be changed to allow aged care assessors to change clinically incorrect algorithmic decisions themselves, and that there are also significant legal issues with the tool.

The investigation followed reporting by Guardian Australia that older people were being left distressed and without adequate care after their home support needs were assessed by an 'inhumane' algorithm as part of the government's mandatory Integrated Assessment Tool (IAT).

Aged care assessors are barred from overriding the IAT's funding package recommendation, even when the decision is wrong. The 104-page ombudsman report found: 'Under the law, these automated decisions cannot be overridden and changed, even if they are clinically inappropriate.'

The report also found: 'There is no public information available that meaningfully explains how the algorithm converts inputs into outcomes. Without this, the IAT is a technological black box.'

The report found the IAT and its algorithm 'do not merely have the potential to undermine public confidence in the administration of a fair and consistent assessment system' — rather, 'a reasonable person would, in our view, lack confidence that the system is in fact fair and consistent.'

Guardian Australia reported that those involved in developing the IAT had no idea that an algorithm would be added to it by the government by the time the changes were rolled out in November.

Documents released under freedom of information reveal departmental panic, severe clinical distress among frontline assessors, and secret IT workarounds after officials realised in the hours before the rollout of the algorithm that legislation legally barred human override, and that this was causing distress within days of implementation.

Anderson said: 'It's very concerning that the department was telling people this system was going to operate in a particular way, showing them versions of that system, only to change it.'

The report found: 'Information provided by the department to the public suggests that key trials and consultation over several years directly supported the IAT and its associated decision-making framework in its current form, but that is not correct.' It said: 'Those trials and consultation related to earlier versions of the IAT and earlier legislation. There was no meaningful consultation.'

Since the rollout there had been a failure of oversight, the investigation found. The qualifications and skill of assessors are critical to the IAT, but the Ombudsman found the department failed to enforce contractual quality controls or verify whether assessors held mandatory clinical qualifications.

Anderson said a range of concerns raised by the media and the public about the IAT's operation for support-at-home packages triggered the investigation in April, in particular a lack of transparency around how the algorithm worked. The report found: 'The department has not complied with recommendations … of the royal commission into the robodebt scheme regarding transparency of government automated decision-making.'

The report calls for a comprehensive review of the legislation related to the needs assessment process, and of the rules underpinning the algorithm. Anderson said: 'The robodebt royal commission said that when government uses automated decision making or artificial intelligence, it needs to be very transparent so people can understand how decisions are being made that are impacting them significantly.'

While the Department of Health and Ageing in July announced a new review process, where aged care assessors can escalate wrong decisions to the department for review, Anderson said he is concerned this is not adequate. He said assessors being able to change decisions because they appear to be clinically inappropriate is really important, and the escalation pathway will not necessarily do that.

Anderson said numerous legal concerns had been identified by the investigation that it is waiting for the government to address. 'How can you actually challenge decisions when you don't know how they're made by the algorithm?' he said. 'There are significant legal issues, and we think that those need to be addressed as a matter of urgency. In our view, the department did not, and may still not, understand key components of the legal framework it created, nor did it understand what legal framework it was meant to create.'

The Department of Health and Ageing has been contacted for comment.