Clinical Advisory Review

Vera 75 : Every family's starting point as they care for ageing loved ones.

A scalable solution for early recognition and family-centred ageing, caregiving, and system navigation Built on validated clinical frameworks and empathetic AI.

Endorsed by the Vera Advisory Group 31 March  2026

Vera’s Clinical Advisory brings together leading experts in palliative care, health system design, and whole-person care to guide the development of Vera 75. Their role is to ensure the model is grounded in validated clinical frameworks, ethically sound, and appropriate for real-world use by families. Through rigorous review and challenge, the Advisory supports the integrity, safety, and credibility of the product as it scales.

Dr Ira Byock
Dr Ira Byock is a global leader in palliative and end-of-life care, with over 40 years of experience in clinical practice, research, and advocacy. A past President of the American Academy of Hospice and Palliative Medicine and recipient of its Lifetime Achievement Award, he has shaped modern approaches to whole-person care and pioneered models integrating palliative and curative treatment. He is the founder of the Institute for Human Caring, an emeritus professor at Dartmouth, and author of Dying Well and The Best Care Possible. (Full bio in Appendices)

Dr Tracey Tay
Dr Tracey Tay is a senior clinical leader with more than 35 years’ experience across hospitals, aged care, virtual care, and health system redesign. She is Chief Medical Advisor at Calvary Health Care and Clinical Executive Director of the NSW Agency for Clinical Innovation’s CATALYST program, and practises as an anaesthetist at John Hunter Hospital. Dr Tay is a leading advocate for cross-system collaboration, focused on driving practical, large-scale improvements in care for patients, families, and communities. (Full bio in Appendices)
________

1.0 Introduction

Across the developed world, ageing populations are growing faster than the systems designed to support them. For most families, the moment they realise something needs to change is also the moment of crisis - a fall, a hospitalisation, a diagnosis that arrives without warning and without a plan.

Vera was founded on a proactive premise: that families deserve to be ready before crisis arrives.

Vera 75 is an AI-enabled tool designed for the midlife family caregiver - the adult son or daughter, typically in their 40s, 50s, or 60s, navigating an ageing parent's life alongside the demands of their own. Often described as the sandwich generation, these adults carry significant responsibility with little time, information, or support. They are deeply invested in their parent's wellbeing but lack a clear framework for what they are seeing, what it means, and what to do next. Vera 75 is built for them.

The assessment gives midlife caregivers a structured way to make sense of what they are observing, understand where their parent is on the ageing journey, and know what to do - before those steps become urgent.

The personalised guide that results is not intended to sit in a drawer. It is a catalyst for the conversations families need to have: about changing needs, future preferences, and what living well looks like for their parent. It becomes a shared reference point that siblings, partners, and other family members can review together - so that when decisions need to be made, families are already aligned and can act in agreement rather than conflict.

At its heart, this reflects a principle Vera holds firmly: nothing about me without me. The older person is never an object of planning, they are a participant in it. Central to this is dignity of risk: the right of every individual to make their own choices about how they live, even where those choices involve uncertainty. Autonomy is not something to be managed away in the name of safety. It is something to be honoured.

We’re confident in Vera 75’s clinical foundations but we recognise that no tool reaches its potential in a design room. It improves in the hands of the people it’s built for. This release is about getting Vera 75 to families quickly so we can learn what works, what doesn’t, and what to build next. It will be better in six months, and better again in twelve. That’s not a limitation of today’s version, it’s the point of a tool designed to continuously grow in knowledge and capability.

The sections that follow describe the clinical foundation of Vera 75, the framework underpinning the assessment, and the findings from our initial user cohort. This paper has been reviewed and endorsed by the Vera Advisory Group.

2.0. What is Vera 75?

Vera 75 is an AI-enabled observational, situational assessment that helps family members notice what is changing in an ageing parent's life and understand what to do next. Designed for families with a parent or relative aged 75 or over, it supports earlier recognition of functional change, clearer conversations, and more confident decisions about when and how to seek help.

Vera 75 is provides a structured framework for families to organise their observations, understand urgency, and connect with appropriate professional resources and support. It is built on established functional assessment principles from geriatric medicine, adapted for non-clinical family observers.

It is not a diagnostic tool, not a clinical screening instrument, and not a replacement for professional medical or aged care assessment.

Intended outcome: Vera 75 is designed to shift families from reactive to ready - turning what is often a crisis response into something more proactive, considered, and dignified. Earlier recognition leads to earlier conversations, earlier professional input, and better outcomes for everyone involved.

How Vera 75 Works

Vera 75 is delivered as a structured voice conversation. Vera’s questions are designed to feel natural - about what the family has noticed, how things have been going, what is worrying them most. Beneath that, they are carefully designed to draw out information across the domains that matter most to people seeking to age well: function and independence, cognition, emotional wellbeing, physical health, social connection, identity and personal meaning, the home environment, and the experience of the family carer.

The assessment draws from validated clinical frameworks across geriatric medicine and carer assessment, adapted for a non-clinical audience. It is rigorous without being clinical, and comprehensive without feeling burdensome.

From conversation to clarity

Once complete, Vera maps what has been shared against 14 situation profiles - patterns that reflect the range of circumstances real families face when supporting an ageing parent:

1. You've Noticed Something — and You're Not Sure if You Should Be Worried

2. Something Is Changing — and It's Starting to Affect Daily Life

3. Your Parent's Behaviour Has Changed — and It's Causing Problems and Hard to Manage

4. You're Running on Empty

5. You're Exhausted — and Grieving at the Same Time

6. It's Complicated — and You're Showing Up Anyway

7. Your Parent Needs Full-Time Support Now

8. Something Has Happened — You Need Help Right Now

9. Your Parent Needs More Help Than They're Getting

10. Everything Is Fine — and You Want to Keep It That Way

11. You're Making the Most of the Time You Have

12. Your Parent Has a Life-Limiting Illness

13. You Are Working Out How to Manage Dementia

14. After Loss

Each situation reflects a meaningfully different set of needs, priorities, and emotional realities. The mapping ensures that what Vera asks and suggests is responsive to what the family is experiencing and needs.

The Vera Guide

The assessment output is a personalised Vera Guide - a plain-language document that summarises the situation clearly, validates what the family is experiencing, and sets out a small number of prioritised next steps. The Vera Guide is written  in the voice of a steady, informed companion, and designed to be shared as a common reference point for conversations with GPs, aged care providers, and other family members.

Clinical safeguards

Vera 75 is built around a core non-negotiable principle: when in doubt, recommend professional input.

Where responses suggest risk - physical, cognitive, or carer-related - the Vera Guide directs families toward appropriate professional assessment. Certain patterns trigger immediate escalation: sudden confusion (which may indicate stroke, delirium, infection, dehydration, or medication reaction), multiple falls with injury, and safety concerns in a person living alone. In these situations, the Vera Guide names the concern explicitly and directs the family to act without delay.

For all other situations, outputs direct families to the professionals best placed to help: a GP for medical assessment (including the Medicare 75+ Health Assessment), My Aged Care for aged care services, specialist referral where cognitive assessment is indicated, and the Carer Gateway for carer-specific support.

Throughout, language is precise about what Vera can and cannot determine. Vera 75 identifies patterns that suggest a need for assessment by a professional, notes factors that may indicate cognitive change, and flags risk factors that warrant professional evaluation. Vera does not diagnose, does not render clinical judgements, and never discourages a family from seeking medical help.

The situational taxonomy, assessment logic, and guide architecture underpinning Vera 75 are proprietary and not disclosed in full in this paper.

3.0. The Problem We're Addressing

Eight in ten families navigating an ageing parent's care say the same thing: "I don't know where to start." There is no clear framework for ageing - no map that helps families understand what they're seeing, what it means, and what to do next.

No Framework, No Starting Point

• Families notice changes in their parent but have no way to understand whether what they're seeing is a normal part of ageing - or something that needs attention

• By the time most families seek help, a crisis has already arrived: a fall, a hospitalisation, a moment of acute confusion that could not be ignored

• Late intervention means fewer options, harder decisions, and worse outcomes - for the older person and the family supporting them

• There is no accessible, non-clinical tool to help families make sense of what they're observing, assess risk and urgency, and understand what to do next

• Family misalignment doesn't just cause distress - it changes what care a person receives. When families disagree on care goals, inappropriate hospital admissions are four times more likely (47.4% versus 10.7% when families are aligned). The patient's own wishes are frequently the casualty.

• Family conflict is common: 40% of adult caregivers report serious conflict with another family member, with sibling disagreement being the most prevalent form.

The Cost of Being Unrecognised, Unreported, Unprepared

• Up to 90% of people say they want to be cared for at home with the appropriate supports, and at least half say they would prefer to die at home – yet as few as one in twenty deaths actually happen at home

• 86% of families have no plan in place for the later stages of their parent's life - and only 14% of Australians have any end-of-life plan at all

• An estimated 62% of all people living with dementia remain undiagnosed or unreported - a gap with significant consequences for families who are observing changes but have no clinical framework to understand them.

• Half of all falls resulting in hospitalisation occur at home and fewer than half of older adults who fall tell their doctor.

• More than one in five older Australians with unmet care needs say a lack of awareness of available services stopped them from seeking help

• A large proportion of deaths (65%) occur among individuals aged 75 years and over

• 70% of all deaths are predictable and can be planned for

• Despite this, 1 in 2 people die in hospital, not only our least preferred place to die  but also the least designed at any level to manage dying, with people spending an average of 33 days across four hospital admissions in their final year of life

What's Missing

The tools, services, and information that do exist are fragmented, hard to find, and rarely designed with families in mind. What's missing is not more content - it's personalised guidance that meets each family where they actually are: in their specific circumstances, at their level of emotional readiness, and with their particular complexity. A coherent starting point that makes sense of what they're seeing, and tells them clearly what to do next.

• No accessible tool for families to organise their observations and understand patterns of age-related change in their parent's function, independence, living situation, and quality of life

• No support for having the conversations that matter - with a parent, with siblings, with other family members — about what is changing and what to do about it

• No simple, non-clinical framework to assess the level of risk to health and wellbeing, or to understand urgency

• No clear guidance on when to escalate to professional help - and who to call

• No recognition that the family caregiver is also carrying a significant load, and that their own wellbeing shapes the quality of care their parent receives

Caring for Those Who Care

87% of family members say they faced significant challenges talking about, planning for, or organising the help they needed as they cared for a loved one. They are navigating one of life's most demanding responsibilities - often without a map, without a team, and without anyone asking how they are doing.

Most caregivers feel invisible to the very systems they hold up. They are the ones who notice the changes first, who make the calls, who sit in the waiting rooms and carry the worry home. They are present at every appointment, every crisis, every quiet moment of decline — constant companions through one of life's most demanding journeys. And yet they are rarely seen, rarely heard, and rarely supported by the systems that depend on them most.

Most caregivers feel invisible to the very systems they hold up  - and the data confirms it. When carers accompany someone to a GP appointment, only one in four are asked about their own needs. At hospitals, nearly two in three are not asked at all.

The cost of that invisibility is measurable. Research consistently shows carers experience psychological distress at rates substantially higher than the general population-  with Australian studies estimating between one quarter and one half of carers affected depending on the intensity of care. The 2024 National Carer Survey puts the current figure at more than half (53.7%) - a rate 3.7 times that of the general population, and one that has worsened every year since 2020. Among carers aged 25 to 44, it rises above 71%. Average wellbeing sits at 55.7% on the Personal Wellbeing Index, against a national average of 74.7%, and nearly two in three carers are socially isolated. Caregiving strain is associated with a 63% higher risk of mortality over four years

The physical and financial toll compound this. Almost one in four carers cannot reliably access affordable healthcare for themselves. Among those in paid work, two in three have reduced their hours and nearly half have missed out on promotions or career opportunities. More than one in three have stopped paid work entirely - temporarily or permanently. 68% of primary carers are women, meaning these losses fall disproportionately on female lifetime earnings and retirement security

Vera sees this. Vera 75 checks in on the caregiver, not just the person being cared for.

4.0 Clinical Principles Underpinning Vera 75

The Vera 75 is not built on intuition - it is built on evidence. Each domain of the assessment is grounded in validated clinical frameworks, adapted for the context in which most ageing is actually experienced: not in a clinic, but at home, within a family, observed by the people who know and love the older person best.

Families are not clinicians. But they are often the first - and most consistent - observers of change. The principles below describe the clinical evidence base that shapes what Vera asks, why it asks it, and what it does with the answers.

Principle 1: Functional Decline is Observable

Families are valid observers of functional change. Clinical geriatric assessment guidelines use:

• Activities of Daily Living (ADL): Basic self-care (bathing, dressing, eating, toileting, mobility)

• Instrumental ADL (IADL): Complex tasks (finances, medications, shopping, cooking, housework)

Vera 75 application: Questions 1-4 assess ADL/IADL domains using language families understand. Vera doesn’t ask families to conduct clinical assessments. Instead, Vera helps families recognise patterns they're already seeing.

Clinical references:

• Katz Index of ADL (1963) - validated globally for functional assessment

• Lawton IADL Scale (1969) - gold standard for complex function measurement

Principle 2: Frailty Exists on a Continuum

The Clinical Frailty Scale (CFS) (Rockwood et al., 2005) describes a person’s functional status as a spectrum from fit to severely frail, not binary categories.

Vera 75 application: Instead of numerical scores, Vera uses descriptive situations that mirror frailty progression:

• Situation 10 (Thriving, Planning Ahead) ≈ CFS 1-2 (Very Fit to Well)

• Situation 1 & 2 (Something is Changing) ≈ CFS 3-4 (Managing Well to Vulnerable)

• Situation 9 (We Need More Support) ≈ CFS 5-6 (Mildly to Moderately Frail)

• Situation 7 (Full-time Support Needed) ≈ CFS 7-8 (Severely Frail to Very Severely Frail)

This approach is descriptive, but is intentionally not diagnostic. Vera is designed to help families understand where their parent or relative sits on the continuum.

Frailty related to ageing and a person’s living situation may be reversible or a person’s functional decline may be slowed. Early assessments make it possible to support a relative in their home, maintain their independence, enhance their enjoyment of life, while lowering safety risks, and obtaining clinical evaluations when necessary. 

Clinical reference:

• Clinical Frailty Scale (Rockwood et al., 2005) - validated predictor of mortality, hospitalisation, institutionalisation

Principle 3: Certain Events Escalate Risk

Clinical prognostic indicators identify high-risk situations requiring urgent intervention:

• Multiple hospitalisations (2+ in 6 months) = indicator of 6-12 month mortality risk

• Recurrent falls = 85% probability of serious fall with injury in next 6 months

• Recent bereavement = 50-66% increased mortality risk in first year after spousal loss

• Sudden confusion = potential medical emergency (dehydration, a new medication or drug, stroke, infection, delirium)

Vera 75 application: Vera asks about these validated risk indicators and flag urgency accordingly. Vera does not diagnose medical conditions, but does identify patterns that may indicate a need for professional evaluation. 

Clinical references:

• SPICT-AU™ (Supportive & Palliative Care Indicators Tool) - prognostic indicators

• WHO Global Report on Falls Prevention (2007)

• Harvard Bereavement Studies, Australian Longitudinal Study on Ageing

Principle 4: Cognitive Decline Requires Specialised Assessment

Early detection of cognitive change improves outcomes:

• Enables planning while capacity exists (legal documents, care preferences)

• Encourages professional evaluations and that improve access to medications that may slow progression

• Provides relevant family education and support

• Encourages and supports individual planning to improve safety and response to crises 

Vera 75 application: Vera asks about observable memory or behaviour changes families can recognise. When indicated, Vera then directs to professional cognitive assessment. Vera doesn’t diagnose dementia, instead Vera helps families to identify patterns warranting professional evaluation.

Clinical references:

• GPCOG (General Practitioner Assessment of Cognition)

• Neuropsychiatric Inventory (NPI) for behavioural symptoms

• Clinical guidelines: Dementia diagnosis requires specialist assessment, neuropsychological testing, often neuroimaging

Principle 5: Emotional Wellbeing and Personhood Are Central to Quality of Life

Depression, anxiety, and apathy are common in adults aged 75 and over — yet they are routinely under-detected, often mistaken for normal ageing, and rarely the subject of proactive family conversation.

But emotional wellbeing is not only about the absence of distress. Who a person is - what brings them joy, what they value, what gives their days meaning - is as clinically relevant as their physical function. Person-centred care frameworks are unambiguous on this point: preserving identity, routine, and a sense of self is essential to dignity and quality of life. Knowing that Mum lights up when her grandchildren visit, or that Dad's day is anchored by the morning paper, is information that shapes every care decision that follows.

Vera 75 application: Vera screens for mood, anxiety, apathy, and withdrawal using validated indicators, then explores what matters most to the person  - their interests, routines, sources of meaning and enjoyment  -  to ensure planning is oriented around the whole person, not just their needs.

Clinical references:

• Geriatric Depression Scale (Yesavage et al., 1982)

• Neuropsychiatric Inventory (Cummings et al., 1994)

• Person-centred care frameworks (Kitwood, 1997)

• DEMQOL (Smith et al., 2007)

Principle 6: Caregiver Wellbeing Impacts Care Sustainability

Caregiver burden is measurable (validated scales exist), predictive of care breakdown and residential placement, and modifiable through respite, support services, and counselling.

Yet caregiver wellbeing is not only about burden. Some of life's hardest tasks also carry profound meaning and satisfaction. Parenting is the clearest example -  sleeplessness, fatigue, doubt, and anxiety can coexist with experiences that many describe as among the most meaningful of their lives. Without denying or diminishing the strain that caregiving can cause, It is neither pandering nor wishful thinking to acknowledge that caring for an ageing parent can similarly also deepen a person's sense of purpose, satisfaction, and even joy.

Vera 75 application: Vera screens for caregiver strain using validated indicators, then may direct families to support services (Carer Gateway, respite, counseling).

Clinical references:

• Carer Strain Index (Robinson 1983, Australian adaptation Thornton & Travis 2003)

• Carer Experience Scale (Carers Australia)

5. Methodology

Vera 75 is built on a structured assessment of XX questions across six domains. Each question is purposefully designed - drawing from validated clinical frameworks and adapted for a non-clinical audience - to build a picture of the older person's situation and the family's capacity to support them.

Domain 1: Functional Independence (Q1-4)

• Mobility and falls
  Personal care (ADL)
  Complex life tasks (IADL)

• Based on: Katz ADL Index, Lawton IADL Scale, WHO fall risk assessment

Domain 2: Cognitive & Behavioural (Q5-5B)

• Memory, thinking, judgment

• Pattern of change (gradual vs. sudden)

• Behavioural symptoms (if dementia suspected)

• Based on: GPCOG principles, NPI framework, CAM for delirium detection

Domain 3: Critical Life Events (Q8-10)

• Recent bereavement

• Life-limiting diagnoses

• Hospitalisations and falls

• Based on: SPICT-AU prognostic indicators, bereavement risk research

Domain 4: Living Context (Q11-13)

• Living situation (alone, with family, etc.)

• Support network

• Distance from family

• Based on: Social isolation research, aged care vulnerability factors

Domain 5: Emotional Wellbeing and Personhood (QXX)

• Mood and emotional state

• Signs of anxiety, apathy, or withdrawal

• What brings joy, meaning, and satisfaction

• Personal interests, routines, and identity

• Based on: Geriatric Depression Scale (GDS), Neuropsychiatric Inventory (NPI), person-centred care frameworks (Kitwood), DEMQOL

Domain 6: Caregiver Wellbeing (Q12)

• Physical, emotional, social, financial strain

• Access to supports – emotional support and social services 

• Based on: Carer Strain Index (Australian adaptation), Carer Experience Scale

6. Validation Approach

Phase 1: Expert Review (Pre-Launch)

The design and validity of Vera 75 has been overseen by two senior clinical advisors whose combined experience spans frontline practice, health system leadership, and internationally recognised research. Their role has been to endorse the overall non-clinical approach and the validated frameworks selected for each domain; to oversee the appropriateness of the 14 situation profiles and the question set that drives the assessment; to oversee the use of the AI model at the heart of the conversation; and to stress-test assumptions, challenge framing, and nuance language - ensuring that the assessment and its outputs meet the standards families and health professionals should expect.

Prior to release, both advisors reviewed Vera 75 in full, with particular attention to clinical accuracy, clarity of language for non-clinical users, appropriateness of triage logic, ethical principles and  safety of recommendations. Their review, alongside the Consumer Review Panel findings detailed below, forms the basis for this white paper's endorsement.

Dr Ira Byock — Bio, see Appendices

Dr Tracey Tay — Bio, see Appendices

Phase 2: Consumer Review Group

Vera 75 underwent structured user experience validation with a review panel of 16 adults with a parent aged 75 or over. Participants completed the assessment independently before joining a facilitated session with the Vera Advisory Panel to discuss their experience - what worked, what didn't, and what they were looking for.

This exploratory review was designed to assess user experience and inform product iteration rather than to measure clinical outcomes. Findings are directional.

The following selected responses are drawn from facilitated review sessions held with the Consumer Review Panel. They are offered not as representative data - the sample is small and the methodology exploratory -  but as early qualitative signal: evidence that Vera 75 is doing the specific things it was designed to do. 

Participants were not prompted to speak to particular themes. These are the things they chose to say, unprompted, about what the experience felt like and what it gave them. They are presented here because they speak directly to the core design intentions of the assessment - emotional safety, accessibility for non-clinical users, the caregiver being seen alongside the person they are caring for, and the creation of a starting point for families who describe themselves as not knowing where to begin.

1. On emotional safety and non-judgement — directly validates tone design
"There's no sense of you doing the right thing or the wrong thing. In these circumstances, there very rarely is a right thing or wrong thing. There are just things that have to be done — and that's very much the tone of my interaction with Vera." — Adult son, parent living independently overseas

2. On the caregiver being seen — validates Principle 6
"Vera was redirecting me back to myself. It got me thinking - what about me? I made a little plan for myself. I don't know, it just got me thinking: what about me?" — Transnational caregiver, parent overseas

3. On accessibility for non-clinical users — validates language design
"I found her language really gentle and soft and inquiring, which you don't often get through a manufactured system. It felt like there was a really nice person at the end of the phone who could help me through the process." — Adult daughter, caring for mother with dementia

4. On the assessment as a catalyst for difficult conversations — validates core purpose
"Having that conversation yesterday with the tool took the emotion out of it. It made it easier for me to have that conversation about what the conversations I've had with my mum. I found that a very useful approach." — Adult son, parent living independently 

5. On trust and clinical credibility — validates the assessment framework
"The responses were just as good as a Violet guide in terms of explaining back to me what I must have been feeling — in a couple of cases, if not better. That was next level empathy. I don't know how that was achieved." — Sandwich generation carer, balancing young children and an ageing parent

6. On the value of AI as a non-judgmental observer — validates the AI delivery model
"When an AI acknowledges the difficulty you are dealing with, that's actually quite supportive. Because it's not lying to you. You've just told it some basic facts — and then it says, 'You must be experiencing this. That would be exhausting.' So I'm not sure how you programmed that, but that is almost, if not more useful than just finding out about the aged care process." — Adult son, caring for ageing parent

7. On the breadth of the assessment — validates domain coverage
"She clearly has learned to explore a vast array of areas — lifestyle and concerns of the individual. The questions were very comprehensive." — Adult daughter, caring for father with dementia

8. On the core problem Vera solves — validates the rationale
"I didn’'t know where to start. I don't know what I don't know." — Primary carer, parent recently entered residential aged care

9. On immediate real-world application — validates product-market fit
"This is a tool I would recommend — and I have already, to my five girlfriends who are in a constant state of distress and feeling very overwhelmed. Just for them to sit down and tell somebody something. Just for reassurance. Just to feel like they've got it off their chest." — Caregiver, parent recently deceased

10. On the loneliness of the caregiver journey — validates the whole-person framing
 "Caring for a parent can be a very lonely journey. And even though you're talking to an AI, when it acknowledges the difficulty you are dealing with — that's actually quite supportive. It feels like you've got someone on your side." — Adult child, parent in early stage of functional decline

Phase 3: Initial Scale Validation (First 200 Users)

Phase 2 moves from structured recruitment to organic reach. Rather than recruiting participants through specific channels, this phase will capture feedback from the first 200 users who complete the Vera 75 assessment through the vera.guide platform - people who have found Vera through their own need, in their own time, in the real circumstances that bring families to this kind of tool.

This is a deliberate methodological choice. Organically acquired users reflect the actual population Vera 75 is designed to serve, and their feedback carries a different kind of validity than recruited participants who may approach the experience as testers rather than as people genuinely navigating an ageing parent's care.

Two-Stage Survey Design

Feedback is collected at two distinct points in the user journey. The conversation and the guide are different components of Vera 75, a process and a products, that are experienced at different emotional moments - separating the feedback ensures clarity about what is and isn't working in each.

Survey 1: The Conversation Experience
Triggered immediately after the Vera 75 assessment concludes, before the personalised guide is delivered

Seven items, five-point Likert scale (1 = Strongly disagree → 5 = Strongly agree):

1. Vera understood what I was trying to tell her

2. The conversation felt relevant to my situation

3. The tone felt calm and appropriate

4. I felt comfortable sharing openly during the conversation

5. The length of the conversation felt manageable

6. The conversation helped me think about things I hadn't previously considered

7. I would recommend Vera to someone in a similar situation

Optional open text:
Is there anything you'd like us to know about your experience of the conversation?

Survey 2: The Personalised Guide
Triggered 48 hours after the guide is delivered — allowing time to read and reflect

Six items, five-point Likert scale:

1. The guide accurately reflected what I shared in my conversation with Vera

2. The guide gave me a clearer picture of my parent's current situation

3. The next steps felt relevant and actionable for my family

4. I felt more confident about what to do after reading the guide

5. I have shared or would consider sharing the guide with another family member

6. I would recommend Vera 75 to a family in a similar situation

Optional open text: What would have made the guide more useful for you?

Core Metrics

• Completion rate for the full assessment

• Time to complete

• Mean scores and top 2 box scores across all 13 survey items

• Net Promoter Score proxy (Q7, Survey 1 and Q6, Survey 2)

• Guide sharing rate (Q5, Survey 2) — a behavioural proxy for the family alignment purpose of Vera 75

• Qualitative themes from open text responses

Refinement Trigger

Findings will be reviewed at 100 completions for early signal, and a full analysis conducted at 200. Adjustments to conversation design, guide structure, and routing logic will be made on an ongoing basis as findings emerge. At 200 completions, the white paper will be updated to reflect preliminary user experience data, replacing exploratory review panel language with mean scores and top 2 box figures.

Phase 4: Ongoing Validation

As Vera 75 reaches scale, a programme of ongoing validation will develop alongside it. The immediate priority is continuous improvement - quarterly review of assessment data, refinement of questions based on real-world performance, and updates to guidance as user outcome evidence accumulates. 

Beyond this, Vera is committed to building a meaningful evidence base over time: examining whether situation routing aligns with subsequent professional assessments, whether early detection leads to earlier consultation, and whether the assessment has a measurable impact on caregiver wellbeing. This includes tracking the real-world value of the personalised guide — -whether families act on it, return to it, and use it as a springboard for the broader planning that ageing requires. Completion rates for downstream tools covering care planning and preferences, legal and financial preparation, and end-of-life considerations will provide a longitudinal picture of whether Vera 75 is doing what it was designed to do: moving families from a moment of clarity into sustained, meaningful action.

A powered validation study incorporating pre/post caregiver strain measures, drawing on the Carer Strain Index and the Carer Experience Scale, is planned as a future phase of research, when sufficient scale and the right research partnerships make it possible to do this rigorously and well. 

We are not in a hurry to claim what we cannot yet demonstrate.
We are in a hurry to build something worth demonstrating.

7. Limitations and Disclaimers

Explicit Limitations

What Vera 75 Cannot Do:

• Cannot diagnose medical conditions
•  Vera can identify patterns requiring professional evaluation
• Only doctors can diagnose dementia, depression, etc.
• Cannot replace professional assessment 
• Not substitute for ACAT or SAS (Aged Care Assessment Team, Single Assessment System)
• Not substitute for GP comprehensive geriatric assessment
• Not substitute for specialist cognitive assessment
• Cannot determine care eligibility 
• Only My Aged Care determines Home Care Package eligibility
• Only professionals can determine residential aged care needs
• Cannot provide medical advice 
  
  

Vera provides general education and guidance on when to seek professional help

• Individual medical advice must come from a treating doctor
• Reliant on family observer accuracy 
• Assumes family member has reasonable knowledge of parent's function
• Distance, limited contact, denial may affect accuracy
• Assessment results reflect observer's perceptions, not objective clinical measurement
• In the current release, Vera helps family members support aged parents and other relatives, but does not directly assist the ageing parent or relative. 

Vera assumes good intentions on the part of family members
Vera raises family members’ awareness of issues of independence in aging, dignity of risk, honouring personal autonomy during cognitive impairment and decline

Known Limitations

1. Observer bias:
Family members may minimise or overestimate decline
Emotional factors (denial, anxiety) affect reporting
Mitigation: Questions ask for specific observable behaviours, not subjective judgments

2. Snapshot vs. trajectory:
Single assessment captures one point in time
Functional status fluctuates
Mitigation: Encourage reassessment every 3 months or if a change occurs. Track changes over time

Cultural context:
Developed for Australian aged care context
Language assumes English-speaking, Australian cultural norms
Mitigation: Plan for multilingual versions, cultural adaptations in Phase 2

Complex situations:
Algorithm simplifies complex clinical reality
Some users may fit multiple situations
Mitigation: Combined situational profiles, multiple pathways offered

8. Ethical Considerations

Beneficence (Doing Good)

Intended Benefits

• Earlier recognition of concerning changes
• Earlier professional consultation
• Better care planning while capacity exists
• Improved completion rates for documented care preferences, care planning, and legal and financial preparation
• Reduced family anxiety through structured understanding
• Reduced family conflict through shared information and aligned goals
• Connection to appropriate resources at the right time
• Recognition of opportunities for improved personhood, enjoyment, and wellbeing

Evidence Supporting Benefit

• Early intervention improves dementia outcomes - enabling legal planning, medication access, and family education while capacity exists
• Fall prevention after a first fall reduces serious injury risk by 50%
• Early palliative care involvement improves quality of life and in some studies is associated with extended survival
• Carer support reduces burnout and delays residential care placement
• Documented care preferences significantly reduce low-value care: patients with an advance care plan are less likely to be hospitalised in the last year of life, less likely to die in hospital, and more likely to receive care consistent with their stated wishes
• When families are aligned on care goals, the rate of inappropriate hospital admissions drops from 47.4% to 10.7% — a fourfold reduction
• Up to 38% of hospitalised patients currently receive non-beneficial interventions at end of life; preference documentation is one of the most effective tools for reducing this
• Early engagement with aged care services delays functional decline and supports longer time living independently at home
• Advance care planning is associated with reduced hospitalisation and care more consistent with patient preferences
• Families who engage in early planning report significantly lower decisional conflict and higher satisfaction with care outcomes when health crises do occur

Non-Maleficence (Avoiding Harm)

Potential harms:

• False reassurance: Low situation assessment when actually concerning
• Unnecessary alarm: High situation assessment when actually managing well
• Family conflict: Siblings disagree on assessment results
• Premature care decisions: Residential care when home still viable
• Digital exclusion: Families without digital literacy or access completing the assessment on behalf of the older person without their knowledge or involvement, leading to decisions made about rather than with them
• Culturally unsafe framing: Assessment language or situation descriptors that don't translate meaningfully across cultural contexts, producing misleading outputs for CALD families
• Carer bias: A stressed or overburdened carer may unconsciously (or consciously) rate situations as more severe than the older person would, skewing results toward unnecessary intervention
• Premature disclosure: The guide or its language surfacing information (e.g. references to decline, end-of-life planning) that the older person encounters unexpectedly, before they are ready or have been appropriately prepared
• Over-reliance on a single guide: Families treating the personalised guide as a definitive clinical document rather than a starting point, particularly in legal or financial decision-making contexts
• Privacy and data concerns: Sensitive family information shared in the assessment being misunderstood as clinical record or accessible to third parties

Mitigation strategies:

• Conservative triage (err on side of caution): Where the assessment sits between two situation pathways, Vera routes to the more cautious outcome. This reduces the risk of false reassurance where genuine concern exists.
• Encourage professional confirmation before major decisions: The guide explicitly states that no significant care, legal, or financial decision should be made on the basis of the Vera 75 assessment alone. Professional confirmation - from a GP, Aged Care assessor, or relevant specialist - is recommended before any major action is taken.
• Acknowledge tool limitations clearly: The assessment reflects the caregiver's observations at a single point in time. It is not a clinical diagnosis, cannot account for information the caregiver does not have, and should not be treated as a substitute for professional assessment. These limitations are stated explicitly in the guide.
• Provide nuanced guidance (not black-and-white answers): Vera 75 avoids definitive conclusions. Situation descriptions are framed as observations, not diagnoses, and next steps are offered as options to consider rather than directives to follow.
• Reassessment prompts (don't rely on single assessment): The guide encourages families to return to Vera 75 when circumstances change, and notes that a single assessment captures one moment in what is often a gradual and evolving journey.
• Carer bias acknowledgement: The assessment reflects one family member's observations and may not represent the full picture - particularly where the caregiver is stressed, overburdened, or not the primary observer of the older person's day-to-day functioning. The guide acknowledges this explicitly and encourages families to share the assessment with other observers before drawing conclusions.
• Observational framing maintained throughout: All language in the assessment and guide describes what the caregiver has noticed, not what is clinically true of the older person. This distinction is preserved consistently - in question design, situation titles, and guide copy - to reduce the risk of the assessment being misread as a clinical finding.
• Cultural and linguistic limitations: The assessment has been developed primarily in English and for Australian family contexts. It may not translate meaningfully across all cultural frameworks for ageing, caregiving, and family decision-making. Families from CALD backgrounds are encouraged to seek culturally appropriate support in interpreting findings, and Vera commits to ongoing cultural adaptation as the platform develops.
• Privacy and data framing: Families are informed before the assessment begins how their information is stored, who can access it, and that the guide is a personal planning document - not a clinical record accessible to health services or aged care providers without the family's explicit consent.
• Digital access and proxy completion risks: Where a family member completes the assessment without the older person's knowledge or involvement, there is a risk of decisions being made about rather than with them. The assessment opening acknowledges this and encourages families, where possible, to involve the older person in reviewing the guide before acting on it. This reflects Vera's core principle: nothing about me without me.

9. References

Functional Assessment

Katz S, et al. (1963). Studies of illness in the aged: The Index of ADL. JAMA, 185(12), 914-919.Lawton MP, Brody EM. (1969). Assessment of older people: Self-maintaining and instrumental activities of daily living. The Gerontologist, 9(3), 179-186.

Frailty Assessment

Rockwood K, et al. (2005). A global clinical measure of fitness and frailty in elderly people. Canadian Medical Association Journal, 173(5), 489-495.

Prognostic Indicators

Scottish Government (2017). SPICT-AU™: Supportive & Palliative Care Indicators Tool (Australian adaptation).
Murray SA, et al. (2005). Illness trajectories and palliative care. BMJ, 330(7498), 1007-1011.

Fall Risk

World Health Organisation (2007). WHO Global Report on Falls Prevention in Older Age.
Australian Commission on Safety and Quality in Health Care (2009). Preventing Falls and Harm From Falls in Older People.

Cognitive Assessment Principles

Brodaty H, et al. (2002). The GPCOG: A new screening test for dementia designed for general practice. Journal of the American Geriatrics Society, 50(3), 530-534.
Inouye SK, et al. (1990). Clarifying confusion: The Confusion Assessment Method. Annals of Internal Medicine, 113(12), 941-948.

Behavioural Symptoms (Dementia)

Cummings JL, et al. (1994). The Neuropsychiatric Inventory: Comprehensive assessment of psychopathology in dementia. Neurology, 44(12), 2308-2314.

Caregiver Burden

Robinson BC (1983). Validation of a Caregiver Strain Index. Journal of Gerontology, 38(3), 344-348.
Thornton M, Travis SS (2003). Analysis of the reliability of the Modified Caregiver Strain Index. Journals of Gerontology Series B, 58(2), S127-S132.
Al-Janabi, H., Flynn, T. N., & Coast, J. (2011). Estimation of a preference-based carer experience scale. Medical Decision Making, 31(3), 458–468.

Bereavement Risk

Elwert F, Christakis NA (2008). The effect of widowhood on mortality by the causes of death of both spouses. American Journal of Public Health, 98(11), 2092-2098.
Australian Institute of Health and Welfare (2021). Ageing and Aged Care in Australia.

The Cost of Waiting: Unrecognised, Unreported, Unprepared

Bharat, C., Hickie, I. B., Skinner, A., & Degenhardt, L. (2023). Different estimates of the prevalence of dementia in Australia, 2021. Medical Journal of Australia, 218(7), 308–311.
Australian Institute of Health and Welfare. (2025). Dementia in Australia. AIHW.
Bergen, G., Stevens, M. R., & Burns, E. R. (2016). Falls and fall injuries among adults aged ≥65 years — United States, 2014. MMWR Morbidity and Mortality Weekly Report, 65(37), 993–998
Xie, Z., et al. (2024). Barriers experienced by community-dwelling older adults navigating formal care: Evidence from an Australian population-based national survey. The Gerontologist.
Buck K, Nolte L, Sellars M, Sinclair C, White BP, Kelly H, Macleod  A, Detering KM. Advance care directive prevalence among older Australians and associations with person-level predictors and quality indicators. Health Expect. 2021 Aug;24(4):1312-1325. doi: 10.1111/ hex.13264. Epub 2021 May 1. PMID: 33932311; PMCID: PMC8369087.

 Appendices

Appendix A: Clinical Advisory Members

Dr Ira Byock
Ira Byock, MD, FAAHPM is one of the world's foremost voices in palliative and end-of-life care, with more than four decades of clinical, research, and advocacy experience. A past president of the Academy of Hospice and Palliative Medicine - and recipient of its Lifetime Achievement Award - he has shaped conceptual frameworks for the lived experience of serious illness and pioneered models of concurrent palliative and life-extending care across hospital, community, and primary care settings. He founded the Institute for Human Caring at Providence Health System and leads Clinical Transformation Specialists, a consultancy advancing whole-person, outcomes-oriented care. An emeritus professor at Dartmouth's Geisel School of Medicine, his books include Dying Well and The Best Care Possible. He continues to publish actively in leading journals including Health Affairs, NEJM Catalyst, and the Journal of Palliative Medicine.

Dr Tracey Tay
Dr Tracey Tay brings more than 35 years of experience across hospitals, aged care, virtual care, and health system redesign. Currently Chief Medical Advisor at Calvary Health Care and Clinical Executive Director of the NSW Agency for Clinical Innovation's CATALYST program - spanning care across the life cycle and society - she is also a practising Staff Specialist Anaesthetist at John Hunter Hospital, Newcastle. Dr Tay is a passionate advocate for cross-system collaboration, working closely with patients, communities, and clinicians to drive meaningful, upstream change rather than surface-level reform. Her career has been defined by bold vision and practical action: convening across silos, building diverse partnerships, and co-creating solutions that improve care for whole people and whole populations.

 

_______

31 March 2026