By Sarah Pedersen
Last month, Professor Kathy Eagar helped expose the inner workings of the Integrated Assessment Tool on Four Corners, and the findings sparked real alarm across the aged care sector. Since then, further evidence given to a Senate inquiry has only added to the picture. Here’s what we now know, and why Inner Sydney Voice believes it’s time for change.
Older Australians accessing aged care at home now go through the Integrated Assessment Tool, or IAT, a single assessment that determines what support someone can get under Support at Home. Inner Sydney Voice has real concerns about how this tool works, and we think it’s time for change.
A 622 question tool that barely uses most of what it asks
An assessor works through 622 questions covering things like daily living, cognition, physical mobility and medical needs. That’s a lot to sit through, especially for someone who’s older, possibly unwell, and just trying to get some help around the house.
But according to Professor Kathy Eagar, only 23 of those 622 questions actually decide what funding someone gets. More than 80 per cent of the tool isn’t used in the calculation at all. Things that matter enormously to someone’s day-to-day life, like dementia, mental health and carer strain, are barely factored in.
The result is a tool that’s broad but shallow.
When one point changes everything
Because the scoring gets sliced into bands, a single point can decide a lot. On one part of the scale, moving from one score to the next can shift someone’s funding by around $39,000 a year. Elsewhere on that same scale, a single point also decides whether a person is routed towards CHSP or into Support at Home altogether.
That’s a significant outcome to hinge on one point in a 622 question form, and right now, if an assessor can see the result does not reflect the person in front of them, there is little they can do to step in and change it.
Why we are pushing for clinical oversight
Inner Sydney Voice is calling for clinical oversight to be reinstated in the IAT. Assessors should be able to use their clinical judgement to override an algorithm-driven outcome when it clearly doesn’t match a person’s actual needs. An algorithm can be a useful starting point, but it shouldn’t be the final word, especially when the stakes for someone’s independence and safety are this high.
Why CHSP needs to stay a standalone, entry-level pathway
Our other major concern is what this means for how people get into the system in the first place. At the moment, everyone, regardless of how simple or complex their needs are, goes through the same central assessment and joins the same waitlist before they can access any support at all.
We believe there needs to be a genuine entry-level pathway into aged care, where CHSP providers can carry out initial assessments themselves and connect people to basic support more quickly. Someone who just needs a bit of help with cleaning or transport shouldn’t be stuck waiting behind people with far more complex and urgent needs, simply because there’s only one door into the system.
We will keep advocating for CHSP to remain a standalone, entry-level program with proper, indexed funding for providers, and for a broader assessment system that puts clinical judgement, not just an algorithm, back at the center of aged care decisions.