Letter: Home care decisions need people, not algorithms
Defending the indefensible
After a week in hospital in June that began in intensive care, my Respiratory Physician and my GP both recommended that I seek an ACAT assessment for a Home Care Package. Increased emphysema and fibrosis have reduced my lung capacity and lung function to such low levels that I am now extremely vulnerable to secondary infections.
My ACAT assessment took place on Monday 13th July less than a month after I had applied for it. I had letters from my Respiratory Physician and my GP, and the Hospital Discharge Summary to establish my medical need for support, and the ACAT assessor also had accessed my medical history. As he had medical experience as a nurse, he was familiar with the information that these documents provided.
What followed was an hour interview that covered such issues as my capacity for independent living, family and community support, and physical strength and cognitive acumen as well as better managing my deteriorating health. The assessor took detailed clinical notes of my responses. When he finished, he expressed confidence that I would be offered a package but warned me it would take several weeks for a decision on which package would be most appropriate for my needs and then 9 to 10 months for anything to happen.
I felt the process was very professional and thorough and that Aged Care had all the information it needed to make an informed decision.
On Monday 17th August, a Four Corners Program shattered my confidence. I learnt that a new Integrated Assessment Tool, an AI generated, untrialed and untested algorithm not approved by any medical authority would decide the level of support I would be eligible for. This program, introduced last year to improve support services for the aged, has already been challenged by health and administrative professionals as a disaster. I was so concerned that I watched the program a second time to better understand why.
Like many of those interviewed, I became concerned that this flawed algorithm would select and prioritise pre-selected data in a way that could omit key health requirements. A health algorithm expert was able to explain that the algorithm prioritised functionality over needs and health considerations. This meant that the very reasons that support was needed were often give little if any priority.
Another cause for my concern was my doubt that AI could factor in the human aspects of support needed. Could AI weight the importance of respect, value, social interaction, care, worth, physical contact and the full range of emotional responses that make us human. Is it possible for a computer program to understand and respond to these factors that it can never experience. Meaningful support is so much more than toileting, feeding and medicating.
It was made clear that there are two reasons why this new program is such a disaster; its actual concept and design is flawed and the delivery systems put in place are inadequate if not deliberately difficult for seniors to navigate. This combination has resulted in indefensible decisions that have led to physical and emotional trauma for aged care recipients being offered reduced support at higher costs.
The Honourable Sam Rae attempted to defend the program. Despite expert analysis he denied the very design of the algorithm was statistically flawed. He seemed unaware that the clinical notes taken by assessors were never entered into the algorithm for consideration and that its very design led to health considerations could often have the lowest priority.
However, his defence of how the program was delivered was even more damaging. Despite evidence that waiting times to be assessed could blow out to 5/6 months, he thought the one-month median was a more accurate measure. Although you have to ask why he chose median and not mean to capture a more accurate record of wait times.
This cynical manipulation of statistics is an all too familiar tactic of politicians trying to confuse the gullible but it does shift the focus away from the fact that over a quarter of a million are waiting to be assessed. Similarly, he was called out when denying that over 4,500 people had died waiting to receive the approved support and that the number of people waiting for approved support was over 150,000 not 100,00 as claimed.
He went on to argue that there was an appeal process in place for recipients unhappy with the level of support approved, but this process is so complicated and unresponsive that very few bother to use it. While the Minister uses this statistic as an indicator of the success of the assessment process, others believe it reflects the department’s unwillingness to review poor decisions.
The Minister’s attempt to defend the new program was in itself revealing. His obvious lack of authority over his portfolio left him ill-prepared to engage in credible explanation. His responses at best suggested a high level of incompetency and at worst, dishonesty. It also reflects on his department, implying extreme incompetence and negligence in administrating such a blatantly failing program.
Despite a government commitment to increase funding to support older Australians to remain in their own home as the best option for them and the cheapest option for the government, it has failed to deliver on this policy commitment. Once again, aged care support has been reduced to rationing as a failing program denies them access to the most cost effective and humane option and forces them into the more expensive, less desired option of residential aged care.
Get rid of the Integrated Assessment Tool, get rid of the Algorithm, get rid of the Minister, get rid of trying to fit the needs of everyone into one of 4 predetermined packages, sort out the Aged Care Department and bring back the professionals with the experience to offer a more personalised support for aging Australians. And perhaps more importantly, ditch the notion that government services can be better delivered by private enterprise whose focus is profit not service.
Governments, particular Labor Governments, are elected to protect and serve the people, not abuse and manipulate them.