Anne Ruston (SA, Liberal Party, Shadow Minister for Health and Aged Care) | Link to this | Hansard source

The Aged Care Amendment (Restoring Human Override for Aged Care Needs Assessments) Bill 2026 restores a simple principle: decisions about care should be made by a qualified person, a qualified professional, not a computer algorithm with no human capacity. The current system allows an algorithm to determine outcomes without any capacity for a trained assessor to override it. This bill ensures the tool supports, not replaces, professional judgement, and it enshrines it in primary legislation.

The Integrated Assessment Tool should be a tool that assists assessors, not replaces professional judgement. The bill achieves this in three very practical ways. First, it restores the discretion of qualified assessors to override or adjust an algorithm's recommendation where their clinical judgement tells them that that outcome is wrong. Second, it improves transparency by requiring decision notices to explain how the algorithm was used and how the assessor's professional judgement influenced the final outcome, giving older Australians greater confidence in the process. And, third, it creates the right for people assessed since 1 November 2025 to seek a fresh assessment if they believe the algorithm produced an incorrect classification, ensuring people are not locked into decisions that have been wrong.

This bill responds to the significant concern raised by assessors, advocacy organisations and older Australians that the current system is failing to accurately assess people's care needs. It recognises that no algorithm can replace the experienced judgement and clinical expertise of a trained assessor when making complex decisions about an older person's care needs. The bill strengthens accountability by making the assessment process more transparent. Importantly, this is not about changing eligibility or increasing funding levels; it is about ensuring the existing assessment system produces fair, clinically-sound decisions about an older person's care needs.

The department confirmed in estimates in June 2026 that the algorithm was never tested as part of the live trial in 2023; it was developed and tested internally only within the department. There was never any consultation. The tool has never been clinically validated, and the decision to remove human override was a budget decision. If the government is genuinely committed to protecting older Australians, it should support this bill this morning and enshrine human override into the primary legislation.

Our bill provides lasting protection by embedding the right of qualified assessors to exercise their professional judgement in primary legislation, ensuring future governments cannot remove human override without proper parliamentary scrutiny. We know what happens when those protections are absent. The government removed human override without consultation with assessors, providers, older Australians or their representatives. Decisions of this magnitude—decisions that determine the level of care an older person receives—should never be made behind closed doors or altered by regulation alone; they should be subject to the full parliamentary oversight and accountability of this place. To the thousands of older Australians who've had their care packages slashed or been deemed ineligible altogether, even as their conditions deteriorate and worsen, we will support you.

Families and frontline assessors are watching vulnerable seniors denied the support they need to stay safely in their own homes. This is not the person centred, rights based aged-care system Labor promised the Australian people. Minister Rae's rapid review is a damning admission that the tool is failing, yet he has ruled out reinstating human override while only tinkering around the edges. Labor has failed older Australians at every single turn. Their reckless algorithms-first approach is driving assessors out of the sector in droves and leaving older Australians worse off than they have previously been. This is just another example of how the Labor government is leaving older Australians behind at a time when they are most vulnerable.

Older Australians have told us that they want this bill passed, and their families have asked for it, too. Unlike the Labor government, the coalition and others in this chamber have listened, and we will act.

Nita Green (Queensland, Australian Labor Party, Assistant Minister for Tourism) | Link to this | Hansard source

At the outset, I want to put two things on the record. I think senators around this chamber have genuine care and concern for older Australians in ensuring that they get dignity in their later years; I'm not doubting that in any way. There was bipartisan support for the government's reforms, and we certainly want to continue in that way. Unfortunately, though, at the outset, I do need to make it clear that while the government shares the intent of this private senator's bill, the Aged Care Amendment (Restoring Human Override for Aged Care Needs Assessments) Bill 2026, we're not able to support its passage as it's currently drafted. We're concerned that, in practice, its provisions will be counterproductive and may not achieve what they set out to do. There is a lot of nuance when we talk about the way that these assessments are happening, so I am going to put on the record the information that Australians need to understand and know about how the government is progressing the most historical reforms in the aged-care system ever delivered and the most funding ever delivered to the aged-care system.

The integrated assessment tool that we're talking about today, also known as IAT, and associated classification and prioritisation mechanisms, are central parts to fixing a system that was previously slow and inconsistent, and, in too many cases—this is very important to understand—unfair to older Australians. It was unfair because they weren't getting the right assessment that they needed. It is part of a broader reform agenda that is fixing a system that was failing not just older people but their loved ones, aged-care workers and, indeed, all of those committed to the task of caring for those who have given us so much.

The Royal Commission into Aged Care Quality and Safety shocked Australians with its damning assessment of a failing aged-care system. The final report, tabled in parliament on 1 March 2021, made 148 recommendations calling for fundamental reform. Since coming to government, we've been getting on with the job of delivering those recommendations, putting in place the once-in-a-generation reforms that are needed to deliver high-quality, world-class aged-care services to the older Australians who built this community and to whom we owe compassionate care. But we know that generational reform is not a single moment; it is a long-term project. With the commencement of the new Aged Care Act 2024 on 1 November 2025, we've already seen many improvements to the way that care is delivered to older Australians, and this has meant that we are now providing more care to more people more quickly.

As of 31 March, a record 300,000 older Australians have access to an ongoing Support at Home place, and, with the delivery of an additional 83,000 places last financial year and another 32,000 to come this financial year, by the end of 2026-27, 420,000 older Australians will have access to Support at Home. This is almost three times as many older Australians as the number that had a home-care package in 2020. This is the volume that we are talking about. But we've also said that we will watch closely as these reforms roll out and will make adjustments to ensure that they are delivering what older Australians need. We've been really clear about that.

The IAT is about delivering a system that's efficient, accurate and fair. It shouldn't matter where someone lives or who does their assessment. Every older Australian should be treated equitably by our aged-care assessment systems. To deliver on that aspiration, design decisions have specifically been made to ensure that consistency, so that, for a given set of clinical characterisations, the assessment system produces the same outcome. This is what it means to bring together clinical expertise, of course, and consistent national rules to deliver more equitable outcomes. The explanatory memorandum to this bill states:

This Bill clarifies that the IAT functions in a supporting capacity only, and that the approved needs assessor retains authority to record an assessment outcome based on their professional judgment.

The bill itself says that an assessor's discretion may not be limited by the assessment tool or any other requirements prescribed by the rules.

As I said at the beginning, I understand the intent of the private senators' bill. But a broader, unfettered discretion for assessors to override the classification or priority assigned under the rules, as is proposed by this bill, would actually risk undermining fairness, and, importantly, slowing access to care for many of those who need it. This is a matter of debate. We take a different view from those opposite and those at the end of the chamber about the need for fairness in the system, and that is what we will be debating today. But, under the former Home Care Packages Program, senators will be aware that there was a high degree of assessor discretion in determining funding and priority levels, and what that actually resulted in was that people with very similar needs received very different outcomes depending on where they lived or who conducted the assessment. In 2024-25, for example, around 20 to 25 per cent of packages were approved nationally at level 4, but, in some jurisdictions, that figure was as high as 60 per cent. That variation created serious equity issues and had a direct impact on wait times for care.

We also saw the consequences of that inconsistency in the accumulation of large volumes of unspent funds across the system, highlighting the limitations of process based, subjective decision-making with an inadequate focus on fairness and consistency. By the time the new act commenced, $4 billion in unspent care funding was sitting in people's accounts—money that could have delivered more care more quickly to more people.

I want to be clear about this. The government understands and appreciates the intent of the private senators' bill. It's not that I think that Senator Ruston or other senators are not genuine in their concern for older people. But we are concerned that the consequences of these provisions would have significant cost implications. An early analysis from the Department of Health, Disability and Ageing is that the cost of these amendments to the act would be significant. The senators proposing this bill have not explained how these costs would be met within the aged-care system. We are also concerned that departmental advice also shows that the provisions could have major implications for wait times, blowing those out by an estimated five months. These concerns should not just be brushed away as if they are of little consequence. Wait times, the cost of aged care and where that money is spent are so important to older Australians.

There is a reason why the assessment system had to change from what it was before; I can't be clearer about that. There was an unfair system resulting in people not getting the care they needed. There is a reason why the rules that govern the process were decided and went through a robust parliamentary scrutiny process. There is a reason why the parliament agreed that these rules would be what they are, and a provision, as is included in this bill, to allow assessors to in any circumstances set aside what is prescribed by the rules decided by parliament will not deliver the equity that this system should be maintaining for older Australians who deserve dignity, equity and fairness.

Being a responsible steward of this system upon which so many older people rely means approaching changes like this in a careful and considered way. It means working together, hopefully in the same bipartisan way that we brought the new Aged Care Bill to this parliament, to deliver on the needs of those in our community. That's why the government has announced that it will establish a new legislated escalation option, so that outcomes of the aged-care integrated assessment tool can be changed in extenuating circumstances. This means that, in the same number of cases where a person's complex circumstances are not fully captured by the integrated assessment tool, under this new pathway their assessment can be escalated to the system governor and adjusted if necessary so they get appropriate care. This will provide practical, responsible protection without compromising the care of older people, and we'll use the parliamentary break to consult on what this will look like so it can be implemented.

We are willing to work together with those opposite, as we are with all senators in this chamber, to find a way to achieve the intent of this private senator's bill without the adverse consequences currently before us. This is what older Australians expect. When the royal commission report was delivered, it shocked Australians. It shocked Australians because we expect that older Australians who have lived their lives, paid their taxes and contributed to our communities and our economy are taken care of in the most dignified way—and that was not happening under the previous government. Those 143 recommendations from the royal commission need to be implemented, and the government has been working to do that.

We know this is a challenge. We know this is generational reform. But it is this government that has taken it on. It is this government that is delivering. We want to ensure that the expectations older Australians have of their government to meet their needs, to deliver on the recommendations, to make sure that the system is fair and equitable no matter where you live and no matter who does your assessment—those are the expectations that older Australians, and indeed all Australians, have of us.

Just to finish here, I understand there is a genuineness to the debate that will happen today. I don't dismiss the care and concern that anyone in this chamber has for older Australians. The government shares that concern, and that's why it's implementing these reforms. It's why we are making sure those 143 recommendations are implemented. That is why the government introduced the new Aged Care Bill. We brought it to parliament, parliament decided on the rules that would be implemented, and the system we've developed is making sure that the rules are implemented in a fair and equitable way. This bill would result in longer wait times in and higher costs to a system that cannot afford either.

So I want to say that the government will not be able to support this bill, but we are working incredibly hard to review the system to ensure that there is an escalation system in place. We will consult on what that looks like and bring that back after the break to ensure that it is legislated, hopefully with bipartisan support.

Penny Allman-Payne (Queensland, Australian Greens) | Link to this | Hansard source

The Greens stand as co-sponsors and supporters of the Aged Care Amendment (Restoring Human Override for Aged Care Needs Assessments) Bill 2026 alongside Senator Ruston and Senator Pocock, and I thank Senators Ruston and Pocock for the work that we continue to do together to make sure that older Australians get the care that they need at the time that they need it. I think the minister belled the cat in their contribution because they said, if this bill were to pass, there would be significant cost implications around aged-care assessments, which seems to me to support our view that the Integrated Assessment Tool has been designed to reduce costs of care. Every older person in this country has a right to have a human make the decision about their care needs, and any tool that is used in that process should be simply that—a tool, not the decision-maker.

The Labor government has outsourced the decision-making for older people's complex care needs to a computer algorithm with no ability for human override. That is unconscionable. Whilst the minister gets up and says that this parliament passed the rules, notwithstanding that the Greens didn't vote for them, those rules did not say that no human could override the decision of a computer tool that gets the decision wrong. When we questioned the department during our inquiry hearing and at estimates, it was clear that there has been no clinical review of this tool, that there have been no human trials of the tool—it was just tested on data from other decisions—and that the testing was internal only. Older Australians have lost trust in this government's ability to fairly assess their care needs. The minister talks about unfairness, and yet the community affairs committee, during estimates and in our inquiry hearings, has been given no evidence of unfairness. Simply stating that more people in one state had higher levels of care assigned to them than another is not a demonstration that the system is unfair. How do we know that a majority of people in a particular location have particularly complex needs? If you're going to put in a tool to assess the care needs of older people, then at least back it up with evidence instead of just falling back on this idea of unfairness. I'll tell you what's unfair: an older person having their complex needs put through a computer program and spat out the other end and then being told, 'That's it,' and no human—no clinician, no doctor, no geriatrician—can override that if it appears that it is wrong. When the geriatricians in this country are saying that the tool is not working, this government needs to listen.

The Royal Commission into Aged Care Quality and Safety said that we needed a person centred, rights based system. There is nothing person centred in outsourcing the assessment of people's care needs to a computer algorithm. The government also say that they really care about older people and they're doing everything they can to give as many people as possible as much care as possible. Well, the government is still rationing care. The minister talked about 83,000 packages in the last financial year and 32,000 this year. There are 220,000 people on the waitlist. If you really cared about older people and their care needs, you would release the same number of packages as there are people on the waitlist.

This is about cost. This is about putting a tool in place that regularly underassesses people's care needs, forcing them into a process that requires at least a 90-day review to go back through the process again, rather than simply acknowledging that a person with clinical judgement should be allowed to override any decision that the tool makes that is unfair.

Labor has announced some minor changes to the IAT this morning. That's not surprising, because they have been dragged kicking and screaming at every turn to acceptance of the fact that their aged-care rollout isn't working. They were dragged kicking and screaming by this chamber to release 20,000 home-care packages sooner when they'd stopped releasing packages. They were dragged kicking and screaming by the senators in this chamber on the community affairs committees, and through our work in the community and through the media, to finally shift showering, dressing and incontinence care into free care, notwithstanding that people are still waiting until November. This Labor government that cares so much about older people is still making them wait until November before they can stop having to pay for assistance with showering, dressing and continence care.

The government say that they care, so it's unsurprising that they've gone out this morning and told everybody, 'We're changing the IAT.' Only some people, in a narrow section of exceptional circumstances, are going to have the benefit of potential human override, but everybody else out there who's waiting for their aged-care assessment will still be subject to the IAT, without the ability of a human to make those decisions.

How can older people trust this government when the minister goes on the radio this morning and says, 'The system is basically working fine'? Older people will tell you it is not fine. Just this week, I had an older couple email my office, telling me that they're too scared to get an assessment, even though their doctor has told them that their needs are higher than CHSP, because they are terrified that the algorithm will underassess them and that they won't be able to afford their care. That is the system that this government is overseeing. Trust is gone. How can older people trust you when you tell us that it's only a very small number of cases that are getting it wrong when we know it's thousands?

The government clearly do not understand the consequences of their own policy, so their hand needs to be forced, which this bill does. Every older person in this country deserves to have their essential care needs assessed by a human. Basic dignity should not be reserved for exceptional cases. That is why the Greens will be supporting this bill.

David Pocock (ACT, Independent) | Link to this | Hansard source

I want to start by thanking the opposition and the Greens for their work on this, and the outstanding work that Senator Ruston and Senator Allman-Payne have done through estimates and through other inquiries. I'd like to thank all the journalists who have covered the case studies—the real human impact of systems that aren't delivering for Australians. Often, we hear about numbers. We hear about big numbers in terms of cost, the number of Australians affected et cetera. Those numbers are humans. Behind every number is the story of an older Australian, their families, their support networks and their carers.

I want to share one story that was sent to my office by a Canberran about a woman in her 70s that we'll call 'Donna'. Donna was admitted to the Canberra Hospital with confusion, cognitive decline and cellulitis after being unable to manage her own wound care. Over recent months, she has become lost in her community and been picked up by police. She has not been eating and was not managing her own finances, spending well beyond her means. Her family had spent nine months trying to arrange an ACAT assessment, without success. In hospital, staff requested an ACAT. I'm hearing a worrying trend. It has been the case for the last few years, where older Australians are having to go to hospital to then get priority ACAT assessments. Despite the cognitive decline, despite the fact that she wasn't eating and despite the fact that she was getting lost in her own neighbourhood, the algorithm said she qualified for a level 1 package. That's less than two hours of care a week, and that can only be challenged through some complex reconsideration process with the department. Donna couldn't be discharged, because, obviously, the hospital knew that Donna's needs were far above a level 1 package, so she stayed in hospital. That's hardly a good outcome for anyone—for Donna, for her family or for all of us, who pay for our hospital system.

We've heard from the government many times that there are humans involved, but it turns out that the humans involved are inputting the data and then we pay someone to rubberstamp whatever the algorithm says. The person who's rubberstamping can't actually change the outcome. That's not proper oversight, and that needs to change. There was a welcome announcement from Minister Rae after the pressure from the Senate, but it's very unclear exactly what that's going to deliver, so I really thank the Senate for debating this important issue and for having brought forward the Aged Care Amendment (Restoring Human Override for Aged Care Needs Assessments) Bill 2026 to stand up for older Australians, to stand up for our communities and to listen to the robodebt royal commission.

Commissioner Holmes was so clear about the need for human oversight when it comes to automated decision-making. Recommendations 17.1 and 17.2 of the royal commission talked about the need for a government-wide act that actually governs the use of automated decision-making in laws and in delegated legislation. As yet, we have not seen such a bill, and it's my understanding that the government is a fair way off doing that. Recommendation 17.2 talked about the need for independent oversight, and this is a real frustration for us as senators—when we ask the department how the algorithm actually works, we're told: 'Well, it's commercial in confidence. We can't let you know that, because then people could game the system.' So, clearly, we need an independent, well-resourced regulator of sorts that can actually look at the algorithm and decide, 'Yes, this is in line with what we would expect.'

I commend this bill. Again, I thank Senators Ruston and Allman-Payne, the coalition and the Greens for their work on this bill, and I commend it to the Senate.

Michaelia Cash (WA, Liberal Party, Leader of the Opposition in the Senate) | Link to this | Hansard source

I move:

That the question be now put.

Steph Hodgins-May (Victoria, Australian Greens) | Link to this | Hansard source

Senator Ananda-Rajah, are you seeking to raise a point of order?

Michelle Ananda-Rajah (Victoria, Australian Labor Party) | Link to this | Hansard source

I have a contribution to make. I'm just a little emotional because this conversation is actually, for me, dredging up some family issues. I have an 85-year-old father who's going through this, and I'm just a little distracted. I'm listening to the contributions and I appreciate them, and I do want to share my own story desperately, because I think it's very pertinent to this debate.

Steph Hodgins-May (Victoria, Australian Greens) | Link to this | Hansard source

Thank you, Senator. Let me seek some advice from the clerks. The question is that the question be put.

Steph Hodgins-May (Victoria, Australian Greens) | Link to this | Hansard source

The question is that the bill be now read a second time.