Department shows inner workings of IAT

The Department of Health, Disability and Ageing has published several resources related to how the Integrated Assessment Tool functions.

The resources include a dataset outlining the technical details of the Support at Home classification algorithm, a Support at Home classification system guideline and two classification algorithm decision tree infographics.

The technical details dataset includes:

• a classification tree
• a table outlining how conditions are applied to different support levels
• complexity equations
• a list of questions
• class correspondence to CHSP and Support at Home
• questions-to-rules mapping
• rules-to-questions mapping.

Also included in the data set is a list of constructed variables for the IAT classification algorithm, including those related to:

• functional sum
• needs met score
• continence score
• wellbeing
• available carer support
• Fatigue, Resistance, Ambulation, Illnesses and Loss of weight (FRAIL) score
• Patient Health Questionnaire (PHQ4) score
• cognitive score
• Barthel sum
• Older Americans Resources and Services Instrumental Activities of Daily Living (OARS IADL) score.

The classification algorithm decision tree infographic includes a breakdown of the functional ability component of the classification algorithm decision tree and a table outlining the classification levels and criteria associated with the different algorithm tree scores.

Meanwhile the high-level classification algorithm tree infographic shows how the functional ability score, needs met score and compounding factors are combined to provide a classification category outcome for either the Commonwealth Home Support Program or the Support at Home program.

Understanding the classification system

The Support at Home classification system guideline outlines the two steps involved in the classification system:

1. determining eligibility: assessing whether a person meets the criteria to receive an ongoing home support classification
2. determining the funding level: assessing the person’s needs and circumstances to determine the appropriate classification level and associated funding amount.

The eligibility algorithm is used to assess an older person’s clinical acuity against a minimum threshold to determine whether the person is eligible for government-funded care. It is primarily based on assessing a person’s clinical characteristics against the Barthel sum, the OARS IADL, PHQ4 and FRAIL scores and cognitive impairment, the guideline notes.

If eligible, the funding algorithm then looks at functional sum, needs met score and compounding factors to allocate a home support classification level.

The funding algorithm is guided by a set of rules built into the IAT to generate a funding level and considers an older person’s needs at three levels:

• identification of their functional abilities
• assessment of how well their functional needs are being met
• consideration of compounding factors.

The 15-page guideline also provides detail on the meaning behind each of the dataset tabs and outlines the roles they play in the overall classification system.

It features a case study of how a person is categorised as needing a level 1 Support at Home package.

Clinical needs weighted low

As raised by Bolton Clarke executive general manager of policy and external relations Tim Hicks via LinkedIn, there is “almost zero weight” given to clinical needs throughout the Support at Home assessment algorithm process.

“It is sort of included in the frailty score, which asks about health conditions. But it is one question in one factor that determines the final branch of the classification,” Mr Hicks wrote on LinkedIn.

“The underweighting of clinical needs has been clear for a while in the overall structure of the tool, but it’s particularly stark now that we have all the details.”

Mr Hicks wrote that he does not think people are being systematically under assessed by the IAT, adding that “like with all systems there are unders and overs.”

Access the resources here:

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