Geriatricians' peak body warns IAT risks under-identifying frailty

The Australian and New Zealand Society for Geriatric Medicine (ANZSGM) wants an urgent review of the Integrated Assessment Tool (IAT).

A new position paper by the peak body for doctors who specialise in the care of older people says the IAT "risks under-identifying frailty, vulnerability and clinical complexity" at the point of entry to the aged care system.

"The IAT is the front door to care. It must be clinically robust enough to identify risk before harm occurs," the ANZSGM states.

The organisation cautions that underestimation of need will translate to "insufficient support packages, preventable hospital admissions, and earlier entry into residential aged care".

"This is not a technical paperwork issue; it is a clinical safety issue."

Following a review of the IAT manual, ANZSGM specialists concluded the tool fails to adequately capture the complexities of ageing.

Central to the concerns is the tool's "overly rigid", "'black and white' structure" that "limits nuanced clinical judgement".

"Outcomes can vary significantly depending on assessor experience" and the tool's design can be "highly sensitive to wording, with small differences in responses leading to very different results.

"An assessment tool that relies on broad categories, binary logic or limited depth risks missing that early vulnerability.

"When vulnerability is missed, prevention fails," said the ANZSGM.

The ANZSGM identifies gaps in the tool's ability to assess frailty, sensory impairment, malnutrition, continence, and elder abuse. Assessor inexperience and lack of training is also identified as a key risk.

Introduced in July 2024, the IAT was a recommendation of the Aged Care Royal Commission. The tool underpins eligibility decisions for Government-subsidised aged care, including home care, flexible care and residential placement.

Problems compounded by removal of human oversight

The Weekly SOURCE has been reporting since last year the IAT is generating unexpected outcomes, some even described as "bizarre". Last week, the tool came under intense scrutiny during a hearing for the Support at Home Senate Inquiry.

Evidence presented at the hearing showed 834 requests for review of IAT decisions since 1 November 2025, compared to 170 in the previous financial year—a near five-fold increase.

Greg Pugh, First Assistant Secretary, Reform Implementation Division, Department of Health, Disability and Aged Care, said the volume of complaints at around 0.5% of the total number of assessments was "within the realms of what we would expect".

The Government has also come under fire for removing human oversight of IAT Support at Home decisions and was questioned heavily during the hearing on why that decision was made. Representatives from the Department said it was a decision of the Government.