Aged Care Legislation Amendment (Aboriginal and Torres Strait Islander Aged Care Commissioner and Other Measures) Bill 2026

Dr RYAN (Kooyong) (11:43): I rise to commend the Aged Care Legislation Amendment (Aboriginal and Torres Strait Islander Aged Care Commissioner and Other Measures) Bill 2026, which establishes Australia's first permanent Aboriginal and Torres Strait Islander Aged Care Commissioner. In 2021, the Royal Commission into Aged Care Quality and Safety recommended a statutory role within the aged-care system dedicated to fostering and promoting culturally safe aged-care services for Aboriginal and Torres Strait Islander people.

An Interim First Nations Aged Care Commissioner was appointed in December 2023. Five years on from the royal commission's final report, it's pleasing to see a permanent independent statutory commissioner finally being legislated by this place. Older Aboriginal and Torres Strait Islander people are more likely to need aged care and more likely to need it earlier in life than other Australians, but they access the system at much lower rates.

For too many, aged care has felt like a system built by others for others, a system which asks Aboriginal and Torres Strait Islander people to leave community and country, to explain themselves in an unfamiliar language and to trust institutions that have, over generations, given their families very little reason for trust. A strong, independent commissioner based within the Aged Care Quality and Safety Commission is important.

It's critical that we have independent oversight of the system that delivers services to some of Australia's most vulnerable people. But independent oversight is only as valuable as the government's willingness to act on what it sees and hears. We've already seen independent statutory office holders elsewhere in the aged-care system raise serious and credible concerns which continue to go unanswered.

I don't want to see the office of the Aboriginal and Torres Strait Islander Aged Care Commissioner established only to have its findings and suggestions ignored and its authority quietly hollowed out as we've seen elsewhere in the aged-care system. Nowhere is that more obvious than with aged care's new algorithm. Two of Australia's inspectors-general of aged care have raised serious concerns about the Integrated Assessment Tool, but the Albanese government persists with using a tool which has been likened, repeatedly and in this place, to robo aged care.

In 2021, the royal commission recommended a 'single assessment process' to be followed by every assessor. That's a sound principle—that older Australians shouldn't have to navigate different assessment systems depending on where they live or which organisation is undertaking the aged care assessment. But the algorithm that underpins the Integrated Assessment Tool, which is a critical part of the new Single Assessment System, has become a critical concern.

The minister has repeatedly stressed that the tool involves skilled, well-trained clinicians filling out a detailed questionnaire about an older person's needs. It's true that skilled and well-trained clinicians are filling out those questionnaires, and I have no concerns about their abilities and competence, but not all of the data that those clinicians collect informs the IAT's result.

The minister has consistently failed to confront its most egregious flaw: clinicians can't override the algorithm's final funding outcome even when their knowledge, their experience and their judgement tells them that that result is wrong. Ian Yates, the former acting Inspector-General of Aged Care, said it plainly; this system is 'not what was recommended by the Royal Commission.' Natalie Siegel-Brown, who served as inspector-general until recently, raised the same alarm while she was in the role.

She's recently pointed out that Australians are dropping out of the aged care system because 'it's a maze for them and it's too hard to access care or even an assessment.' She said that older Australians are experiencing huge delays in obtaining assessments, and she's reported that she's heard of 'instances where people have sought an assessment through the Single Assessment System, had their assessments halved when they were seeking more care and subsequently died the day before they finally were able to get a reassessment.' She noted that giving people less support and care than they were assessed as needing just meant that they returned later needing more care—and more expensive care.

The inspectors general are not alone in expressing concerns about the IAT. Assessors, providers, older Australians and even the Commonwealth Ombudsman have all expressed their grave concerns about this tool. My office in Kooyong has heard repeatedly from constituents who believe that their needs have been badly under-assessed.

Last month, ABC's Four Corners broadcasted confronting testimony from families across the country describing the same experience—an assessment process that leaves older people, vulnerable Australians, without the care that they clearly need. For the benefit of the House, this is how the tool works: when an older Australian receives an assessment, they sit with a qualified, skilled assessor who asks them more than 500 questions, including more than 100 free-text boxes in which those assessors record important details about the person's life.

Professor Kathy Eagar, who is an expert in algorithms, has identified significant issues with this process. Although the tool includes more than 500 questions, the vast majority of responses are not assessed by or included in the algorithm. That includes the more than 100 free-text boxes.

That's where the detail is, and the devil is always in the detail when it comes to providing health care. From there, the algorithm determines the older person's functional score based on their ability to perform daily activities, like showering, preparing meals and getting around. It also determines their 'needs met' score, which is based on whether their need to complete those tasks is being met fully, partially or not at all.

Finally, the algorithm determines compounding factors like frailty, mental health problems and cognitive issues. I asked the Minister for Aged Care and Seniors about how the algorithm weighs the functional score, the 'needs met' score and the compounding factors in producing a final funding outcome in a written question I sent to him on 23 March this year. I asked that question in good faith, seeking to understand a complex issue.

But, rather than providing a detailed and respectful response, the minister's answer contained a one-sentence response, referring me to the 736-page Aged Care Rules, which do not include that detail. His response was evasive. It was inadequate.

Professor Eagar further alleges that crucial questions about cognition, frailty and other health conditions are being asked too late in the algorithm's decision tree to have an impact on outcomes and that the weighting of decisions can produce significant differences in funding based on only one or two questions out of those more than 500. The Minister for Aged Care and Seniors says that the tool is about getting more equitable, fairer outcomes for older people.

But applying a consistently wrong and inappropriate algorithm to clinical inputs is neither equitable nor fair. When Australians want those decisions reviewed, the algorithm, the flawed algorithm, is again tasked with performing that review. Former inspector-general Siegel Brown conceded the issues with this process when she said, 'Why would the second result from the algorithm be any different from the first, unless you're manipulating what you put in?' We're seeing that in the outcomes that this tool is producing.

Many older Australians without adequate support are being inappropriately and prematurely pushed into residential aged care much sooner than they need to be there. For a local Kooyong community member Graham Crossan, that was the only option that the minister advised, despite his ability and his desire to remain at home with more support. Consider this: in the tool's first months of operation, close to one in five people, almost 20 per cent, who formally contested their result received a higher level of funding once a human being was actually able to review the decision.

If a computer is getting it wrong that often, it's not a rounding error; it's the system failing people that it exists to serve. Now, in place of an override function, in the face of overwhelming pushback from communities like the one that I represent, the government has promised a new escalation option so that people in extenuating circumstances can request that their outcome be changed.

The government announced this change would be supported by a rapid review into the IAT, which the minister promised would be delivered within three months. That three-month mark passed last week, and my team has reached out to Minister Rae's office for an update on his 'rapid' review. But we've been told that the review hasn't yet landed with his office, and we have no eyes on legislation which would enact the promised escalation option.

I'm calling on the minister to bring that legislation forward to this house as a matter of urgency. The Minister for Aged Care and Seniors says: … we'll make whatever changes are necessary to get the best outcomes for older people. Well, there is an immediate fix on the table: restore human oversight.

There's also a majority in the Senate ready to pass government drafted changes. The crossbench, coalition and Greens are united in supporting this. There are Labor backbenchers who are demanding that this issue be fixed.

There are peak organisations, two former aged-care inspectors-general and thousands of older Australians who need and want urgent remediation. We need the minister to act with urgency to restore expert clinical oversight over use of the Integrated Assessment Tool. In the transition to the new aged-care system, the government's response to the 2024 Aged Care Taskforce was to provide older Australians with a 'no worse off' guarantee.

But we are seeing that older Australians are worse off under this new aged-care system. The guarantee was meant as a safeguard when Support at Home replaced home-care packages—a guarantee that people already receiving or approved for care before that cut-off date would not pay more for their care than they did under the old system. The Minister for Aged Care and Seniors, in correspondence with my office on 27 May 2026, confirmed, however, that the no-worse-off guarantee applies only to out-of-pocket costs for grandfathered participants.

It doesn't guarantee the same quantity of services and it doesn't guarantee the same type of services for grandfathered aged-care recipients. So quantity and quality of care for older, vulnerable Australians have now been relegated to a function of price. And because prices have risen, that funding is now buying fewer hours of care.

This has compounded the effects of the algorithm. Older people's needs are being underassessed and their funding is too low. Older Australians are worse off in many respects.

I would hate to see the office of the First Nations Aged Care Commissioner established in the expectation and the hope and with the promise that it will give Aboriginal and Torres Strait Islander people a stronger voice in the aged-care system only for that voice to be ignored when it raises difficult concerns—the sorts of concerns that statutory aged-care office holders have already raised in the context of the integrated assessment tool.

So, while I commend this bill to the House, and while I hope that it delivers on its promise, I cannot commend the government's continuing and flagrant disregard of independent advice and the provision of best practice care in the aged-care sector.