Could an algorithm decide how much aged-care help you receive?

Serious concerns have emerged about the system used to determine how much help older Australians receive at home. Here’s how it works and what you can do if you believe an assessment is wrong.

For an older Australian hoping to remain independent at home, an aged-care assessment can have enormous consequences as it can influence how much government-funded assistance they receive through Support at Home and how urgently that assistance is provided.

Now an investigation by Guardian Australia has raised serious questions about the algorithm used as part of that process.

Documents obtained by the publication show health officials in several states and the Northern Territory raised concerns with the Federal Government after the Support at Home program began in November 2025.

Clinicians recorded cases in which they believed older people had been assessed at a lower level than their circumstances warranted. WA Health director-general Dr Shirley Bowen warned the Federal Government that without a pathway for discretion, some vulnerable older people could face “catastrophic outcomes”.

The concerns are particularly significant because assessors cannot simply change an algorithm-generated Support at Home classification when their clinical judgement tells them the result is wrong.

How does the assessment work?

The Integrated Assessment Tool, known as the IAT, has been used in aged-care needs assessments since July 2024.

According to the Department of Health, Disability and Ageing, it helps independent assessors gather detailed information about an older person’s health, circumstances and support needs.

The assessment covers areas including health and function, existing support, social circumstances and the home environment. It also incorporates a number of established health assessment tools.

For Support at Home, information collected through the assessment is used to determine eligibility, a funding classification and priority for services.

There are eight ongoing Support at Home classifications and four priority categories: urgent, high, medium and standard.

The distinction can have a major impact.

My Aged Care’s latest published estimates put the wait for ongoing funding at within one month for urgent and high-priority cases, compared with five to six months for medium priority and seven to eight months for standard priority.

As at June 30, 106,977 Australians were waiting for an ongoing Support at Home place and that makes an accurate assessment especially important.

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What if you believe the decision is wrong?

Start with your Notice of Decision and assessment outcome.

Look closely at the information used to reach the decision and consider whether it accurately reflects what is happening at home.

If an important issue was missed or circumstances have changed, gather information that helps demonstrate the person’s actual care needs.

Older Australians have the right to seek an internal review of an assessment decision, free of charge.

The Department of Health, Disability and Ageing says a request should generally be made within 28 days of being notified of the original decision. New information can be provided to support the request.

A registered supporter can also help an older person seek a review if asked to do so.

If you remain unhappy after the internal review, you may be able to apply to the Administrative Review Tribunal for an external review. Unlike the internal review, a Tribunal application can involve a fee.

Independent assistance is also available through the Older Persons Advocacy Network, or OPAN. Its aged-care advocacy service is free, confidential and independent.

Changes are coming

The Federal Government has acknowledged concerns about cases that do not fit neatly within the assessment system.

In response to the issues raised, it has committed to legislating a new escalation pathway that would allow assessors to refer cases for further consideration when an outcome appears inappropriate.

That would be different from the existing review process because the assessor could initiate the escalation rather than leaving an older person or their family to challenge the decision afterwards.

The details of that new pathway, including how quickly cases would be resolved, are still to be settled. Until then, older Australians and their families do not have to assume an assessment outcome is beyond challenge.

If the decision does not appear to reflect the level of assistance someone needs to live safely at home, check the assessment, gather supporting information and consider requesting a review.

Need help? My Aged Care can be contacted on 1800 200 422. The Older Persons Advocacy Network’s Aged Care Advocacy Line is 1800 700 600.

This story was prompted by reporting from The Guardian Australia.