The report, Automation and oversight in Aged Care, is the Ombudsman’s own motion investigation into the Single Assessment System: the 22 contracted assessment organisations and the Integrated Assessment Tool they use for every home care assessment. It runs to 104 pages including the department’s response. We have followed the escalation pathway since the draft rules in October and its 2027 end date; this is the first independent finding on the problem that pathway is meant to fix.
What the Ombudsman found
After the assessor finishes the questions, the tool’s algorithm decides whether the
person is eligible for the Commonwealth Home Support Programme or Support at Home and, for
Support at Home, the funding level and priority category. The report puts the consequence
plainly: Currently, under the law, these automated decisions cannot be overridden and changed, even if they are clinically inappropriate.
It adds that the tool appears to have been built with an override mechanism, but that the Act and
the Rules give no one the power to use it.
a reasonable person would, in our view, lack confidence that the system is in fact fair and consistent.
The findings that matter most for families:
- The department told assessors the opposite of the law. Until the new Act
started, it had been advising assessment organisations and the public that automated
outcomes could be changed. It told the organisations otherwise by telephone, the report says,
the day before the Act and the Rules commenced in November 2025. By December 2025 most of
them had raised serious concerns. The department considered amending the Rules to allow
overrides in some cases, a path the report says was
ultimately not adopted.
- No public explanation of how inputs become outcomes. As recently as August 2026, the report says, nothing public meaningfully explained how the algorithm turned answers into a classification. The department published the business rules and plain English material on 6 October 2026, after responding to the draft report; the Ombudsman wrote it would be premature to conclude the concerns are addressed.
- Launched without a meaningful risk assessment. The report says the tool in its current form went live without any meaningful risk assessment, evaluation or analysis, and that the trials the department cited publicly related to earlier versions of the tool and earlier legislation.
- Thin oversight of the assessors. The department ran 3,658 audits or reviews of needs assessments between 9 December 2024 and 25 March 2026, which the report calculates as 0.6% of assessments in that period. It does little to check assessors hold the qualifications and training it requires, and key performance data showed instances of underperformance of 20% or more against targets such as completing high priority assessments within 10 days. KPI data was available only for July to December 2025.
The report is careful about one limit. The Ombudsman did not test whether the algorithm
actually produces clinically inappropriate outcomes; the report says its findings do not establish that the algorithm in fact produces clinically inappropriate outcomes
,
but raise serious questions that call for an independent clinical review.
The review route that exists now
Until January, the route to change a decision is to ask for reconsideration, the department’s internal review, within 28 days, and then the Administrative Review Tribunal. The report explains the catch. The internal reviewer must also use the tool, so the algorithm still makes the decision; what the reviewer can do is correct the answers fed into it, where the evidence shows an input was wrong.
Department figures as reported by the Ombudsman, pages 33 and 34 of the report. The 915 requests compare with 105 from December 2024 to June 2025 and 188 from July to October 2025, before the new Act.
The report also records that when it asked whether the Tribunal may decide a classification or priority without running the algorithm, the department did not know the answer and was still considering it with related legal issues.
What the department accepted
The Secretary, Blair Comley, replied to the draft on 2 October. On the wrong advice to
assessors the Secretary wrote: I acknowledge that this is a significant issue.
The letter also said the department does not accept several propositions that are significant
and asked the Ombudsman to reconsider the finding that a reasonable person would lack
confidence. The finding stayed in the published report.
| Recommendation, in short | Response |
|---|---|
| 1. A bill letting assessment delegates substitute their own decision for the tool’s | Noted (directed at Government) |
| 2. Matching rule changes and guidance on when to substitute | Noted (directed at Government) |
| 3. Review the Act and Rules on assessment for legal defects | Accepted; second stage proposed for 2027 |
| 4. Public consultation before changing the Act, Rules or algorithm | Accepted in principle |
| 5. Plain language fact sheets and the business rules made public | Accepted; staged across 2026-27 |
| 6. More audits of assessment organisations | Accepted; scaled up from February 2027, subject to government decisions |
| 7. A new complaints framework for assessment organisations | Accepted; complaints policy by April 2027 |
| 8. A root cause analysis | Accepted; expected in 2027 |
| 9. A full review of the algorithm’s business rules | Accepted in principle |
| 10. That the Auditor-General consider a performance audit | Not applicable (a matter for the ANAO) |
From Attachment A of the department’s response, printed at the end of the report. The short labels are ours; the dates are the department’s own expected timeframes.
What starts on 11 January, and how it differs
The Act that creates the escalation pathway received Royal Assent on 26 October, and the Minister made its final rules on 29 October. They keep the draft’s settings: 14 days from the decision for the request, 28 days for the department to decide, and a priority that can be lifted only as far as high, never to urgent. The pathway covers decisions made from 11 January to 31 December 2027.
What the Ombudsman asked for, and what was legislated
- AskedAssessment delegates, the people who approve your services, can substitute their own decision for the tool’s in appropriate circumstances (Recommendation 1).
- LegislatedAn approved needs assessor from the same organisation may ask the department to review the decision, with your consent; you cannot ask yourself (new section 90B).
- The testA classification can change only if your circumstances are significantly different from others at your level and you are at risk of significant harm without a higher level (new rule 90E-15).
- The windowDecisions made from 11 January to 31 December 2027 (Act Schedule 4 and new subsection 90A(1A)).
The Ombudsman called the pathway a positive step towards strengthening human oversight
and said the office will monitor it. Asked on ABC television on 26 October why the Government had not
accepted the broader human override, the Minister for Aged Care, Sam Rae, said the pathway was
principally consistent
with it. On 15 October the Minister had also announced an independent, clinically informed review of the
classification and prioritisation mechanisms, with terms of reference due in the coming weeks
and a report to be published and tabled in the first half of 2027.
Our view
The pathway is not what the Ombudsman recommended. The report asked for the human who approves your services to be able to set the algorithm aside when its answer is clinically wrong. Parliament has instead created a referral, started only by an assessor, decided by the department under tests strict enough that a local shortage of services, high costs or a long wait will not generally be enough on their own, and available for decisions made in one calendar year. That may be a sensible first step; the department’s own figures show a quarter of the internal reviews decided so far changed the outcome, mostly because of new information or corrected inputs, so a first decision is not settled ground. But a safety valve this narrow will only be judged fairly if the department publishes how many requests are made, granted and refused. Nothing in the new Act provisions or rules for the pathway requires it to.
For families, the practical points: if an assessment result looks wrong, ask the assessment organisation straight away whether its assessor will request an additional review once the pathway opens, because the window is 14 days. Ask for reconsideration as well, within 28 days; that right is separate and does not end in 2027. And if you complain about the assessment itself, the department told the Ombudsman it will publish a My Aged Care complaints policy by April 2027.
We will report the independent review’s terms of reference when they are published.