She helped design aged care reform. Now she is questioning how it works in practice

Aged care consultant Lynda Henderson helped shape the assessment tool now underpinning Support at Home. As a care recipient herself, she says the system being implemented looks very different from what was originally intended.

For years, Lynda Henderson worked behind the scenes on Australia’s aged care reforms, helping shape parts of the system meant to make care fairer and easier to navigate.

Today, she is experiencing those reforms from the other side.

Henderson, an aged care consultant and advocate, served as the Older Persons Advocacy Network (OPAN) representative on the working group that helped develop the Integrated Assessment Tool (IAT). The tool now sits at the centre of the government’s Support at Home program.

But as someone now receiving in-home care herself, Henderson says the system being rolled out is not the one she and others believed they were designing.

“I think we came up with a tool that was practical, flexible and really extensive and fitted the purpose,” she said.

The original vision

The IAT was designed to simplify how older Australians are assessed for care.

Instead of navigating multiple assessments across different programs, the aim was to create a single tool that could capture a person’s needs and determine the level of funding required.

The working group designed the assessment to be structured but flexible. Assessors would follow a consistent framework, while still being able to include notes and professional judgement.

If a person’s situation changed, such as declining health or the loss of family support, the assessment could be revisited.

The goal was a practical, person-centred assessment that could be completed efficiently while still capturing the complexity of people’s needs.

Where the system diverged

According to Henderson, the system now being implemented works differently from what the working group envisaged.

Assessors complete the assessment questions, but the final funding classification is generated through a scoring system based on the responses entered. Under the current model, assessors are not able to override the classification produced by that scoring process.

While the IAT itself is not artificial intelligence, the algorithm applied to the assessment responses ultimately determines the funding level.

The government has rejected suggestions that the system removes human judgement.

Aged Care Minister Sam Rae has stated that the assessment relies on assessor input and clinician advice, with documentation entered before the classification is generated.

However, Henderson believes the system has become too rigid.

“He talked around it. He intentionally went around it,” she said, referring to responses given during parliamentary scrutiny of the reforms.

When reform becomes personal

For Henderson, the issue is no longer abstract.

Since transitioning into the Support at Home system, she says some services she relies on have increased in cost, in some cases by around 10 per cent. As a result, she has had to reduce the level of support she receives.

She is also concerned about the growing workload pressures faced by case managers responsible for coordinating care.

The experience is particularly frustrating, she says, because she spent years contributing to consultations and working groups aimed at ensuring the reforms would work in practice.

Through OPAN’s National Reference Group and the assessment working group, Henderson helped develop recommendations intended to prevent unintended consequences.

She believes much of that advice was ultimately not reflected in the final system.

“I’m unbelievably furious,” she said. “The government cheated, and tricked us.”

A broader challenge for the reforms

Henderson’s experience highlights a wider issue facing the aged care reform agenda.

Digital tools and structured assessments can improve consistency across a complex system. But care needs are rarely simple, and rigid classifications can struggle to capture changing or complex circumstances.

Appeals against assessment outcomes have already begun to increase following the rollout of the new system, while advocates continue to call for greater flexibility in how classifications are determined.

For leaders across the sector, Henderson’s story illustrates a familiar challenge in policy reform.

Designing a system on paper is one thing. Ensuring it works for people in real situations is another.

And sometimes the people best placed to see the gap between intention and implementation are those who helped build the system in the first place.