Algorithms overriding clinicians: why aged care’s new IAT system is eroding trust and burning out assessors

Australia’s aged care reforms promised a more consistent, equitable, and person-centred system. But as the Integrated Assessment Tool (IAT) rolls out nationally, the reality emerging from the frontline is one of frustration, confusion, and – increasingly – despair.

The IAT was designed to streamline assessment, reduce duplication, and create a single, national approach for determining eligibility under Support at Home. Yet what was heralded as a modernisation is now exposing a fundamental tension: technology-driven decision-making is overriding clinical judgement, often with devastating consequences for older people and deep morale impacts on the workforce.

A tool built for consistency, not complexity

The IAT, introduced through 2024–25 and embedded into the new Aged Care Act from 1 November 2025, uses a structured, rules-based algorithm to classify older people into one of eight funding levels.

The Department strongly emphasises that the system does not use artificial intelligence. But for assessors, whether it is technically “AI” or not is beside the point.

It is still an automated system making binding decisions – without the capacity for nuance, clinical reasoning, or contextual understanding.

And in some ways, assessors argue, that is worse.

If it’s not AI and there’s no human or machine-learning “sense checking,” then what remains is a rigid formula with no built-in ability to interpret risk beyond the rules it has been given.

When a clinician becomes a data entry officer

Early drafts of the Single Assessment System allowed for professional overrides. Assessors could adjust outcomes, add clinical nuance, and reconcile the algorithmic suggestion with the person’s real-world presentation.

This aligned with the sector’s expectations: a blended model of structure + judgement.

But by November 2025, new guidance abruptly reversed course.

Overrides are now prohibited for determining ongoing Support at Home levels, except in rare, tightly prescribed scenarios.

This means assessors enter the data, the algorithm produces a classification, and – regardless of what the assessor has seen, heard, or clinically interpreted – they must accept the result.

Leaders across assessment organisations describe the shift as “handcuffing clinicians.”

Many assessors describe it more bluntly: “Why am I even here?”

Real-world mismatches, real-world harm

Frontline accounts point to a growing pattern:

• People with dementia being classified “low risk.”
• Individuals with falls histories not meeting the threshold for higher support.
• Older people with combined cognitive, functional, and behavioural issues receiving minimal hours.
• Providers receiving interim levels funded at 60% of what would previously have been approved – leaving them unable to onboard safely.

One assessor recounted a woman with vascular dementia, continence issues, and 24-hour supervision needs being deemed to have no impairment.

Families are left re-appealing, often while care needs escalate.

This is not an isolated story – it is becoming a systematic trend.

Morale is collapsing: “I didn’t train for this”

Behind the policy debate lies a workforce crisis that leaders cannot ignore.

Assessors – predominantly nurses, social workers, occupational therapists, and physios – are reporting:

• Despondency
• Moral injury
• Loss of professional identity
• Questioning their career choice

Many say they feel reduced to “typing into a computer while the tool makes the real decision.”

Assessment providers were given only days’ notice of the override changes before the November commencement date. Retraining was rushed. Delegates now review outcomes purely for legal compliance, not clinical accuracy.

Leaders in assessment organisations report increasing sick leave, resignations, and “quiet quitting.”

A system meant to strengthen aged care is instead driving away the very clinicians it depends on.

The transparency problem

The Department asserts that the IAT algorithm is rule-based and not AI, but the reality for the workforce is that the decision-making process is effectively invisible.

• There is no published breakdown of how inputs are weighted.
• There are no independent algorithmic audits.
• There are no mechanisms for frontline feedback loops.
• Similar client profiles are producing inconsistent results.

For a system built in response to a Royal Commission that emphasised transparency and trust, leaders are expressing growing concern that the IAT is becoming a black box – just without the label.

The leadership question: what happens next?

The situation now facing aged care leaders goes well beyond a technical issue. It raises broader strategic concerns:

• How do we ensure older Australians are fairly granted funding based on legitimate need – especially when the outcomes contradict what assessors are seeing in front of them?
• What safeguards must be put in place to prevent long-term harm to consumers who are under-classified or left without appropriate support?
• How will the sector respond if systematic under-classification becomes the norm rather than the exception?
• What cultural and operational pressures will fall on providers who receive clients with insufficient funding to deliver safe, appropriate care?
• How do we retain and protect a workforce that is feeling professionally devalued, ethically compromised, and increasingly burnt out?

A system born from a Royal Commission – designed to restore dignity – is now at risk of repeating the same mistakes by prioritising process over people.

Technology should support clinical care – not replace it

Automation has a role in aged care. Leaders agree on that.

But automation without flexibility, transparency, or clinical override is not reform – it’s regression.

Older people do not fit neatly into boxes, and neither do the assessors who support them.

The risk now is profound:

If the system does not adapt quickly, Australia could find itself facing not just under-classified clients, but a critical loss of the very workforce required to deliver the reforms.

In aged care, efficiency matters – but empathy matters more.

And technology should enhance, not eclipse, the humanity at the heart of care.