Aged care's Single Assessment System has "undermined public confidence", ombudsman finds

In October 2026, the Commonwealth Ombudsman released a report finding that the Department of Health, Disability and Ageing and its Single Assessment System (SAS), including its Integrated Assessment Tool (IAT) and oversight of the SAS workforce, “has led to unfair outcomes, undermined public confidence and raised serious questions about outcomes that are clinically inappropriate”.

Being the legislatively prescribed tool used for home care assessments, the IAT’s algorithm makes automated decisions that determine the level of access to aged care services an older person can receive. With around 1.1 million or 85% of older persons accessing aged care services in Australia through the home support system, the Commonwealth Ombudsman said that “many concerns have been raised about the contracted assessment providers using the IAT and how the IAT algorithm works” since the SAS’s introduction.

“The IAT and its associated decision-making framework do not merely have the potential to undermine public confidence: rather, a reasonable person would, in my view, lack confidence that the system is in fact fair and consistent. Currently, under the law, automated decisions made by the IAT’s algorithm cannot be overridden and changed, even if they are clinically inappropriate,” Commonwealth Ombudsman Iain Anderson said.

Poor communication, substantial waiting times, slow review processes, insufficient assessors and assessors lacking appropriate training and qualifications were the concerns about the SAS workforce; while criticisms were that the IAT focuses on under-assessing care needs, diminishing the role of clinical expertise, the lack of algorithmic transparency and the inability to change automated decisions.

Further, the Commonwealth Ombudsman noted that there is no publicly available information that explains how the IAT reaches its outcomes. “This is inconsistent with the intentions of the Robodebt Royal Commission recommendations about transparency of government automated decision-making,” the Commonwealth Ombudsman said.

“In my view, the Department did not, and may still not, understand key components of the legal framework it created, nor did it understand what legal framework it was meant to create. This had serious consequences, including that up until the introduction of the legislation in October 2025, the Department had been incorrectly advising assessment providers and the public that automated IAT outcomes could be changed,” Anderson added.

The Commonwealth Ombudsman found that the SAS assessment provider performance “has been falling short of KPIs, often significantly so”. The Commonwealth Ombudsman also said that the Department has taken a limited role in checking compliance with learning requirements, despite individual assessors inputting information into the IAT, and there are “no safeguards or mechanisms to protect the integrity of online training”.

Amending the legislation to allow assessment decision-makers to override automated IAT decisions, a comprehensive review of the legislation related to the needs-assessment process, and a comprehensive review of the business rules underpinning the algorithm were among the 10 recommendations the Commonwealth Ombudsman made.

That all changes be preceded by meaningful consultation with the public, and that the Australian National Audit Office consider a performance audit to assess whether the Department’s use of public resources was efficient, economical and ethical, was also recommended by the Commonwealth Ombudsman.

The Department accepted the recommendations relevant to it, the Commonwealth Ombudsman said, with the full report — titled ‘Automation and oversight in Aged Care: Flaws in the design and operation of the Single Assessment System’ — available at www.ombudsman.gov.au/__data/assets/pdf_file/0019/331264/Automation-and-oversight-in-Aged-Care.pdf.

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