Projects Aged CareCommunity CareRural Health

Indian Ocean Territories Aged Care Review

Projects Aged CareCommunity CareRural Health

Indian Ocean Territories Aged Care Review

Projects Aged CareCommunity CareRural Health

Indian Ocean Territories Aged Care Review

  • Services

    Evaluation & Advisory

  • Status


  • Client

    Department of Infrastructure & Regional Development

  • Jurisdiction


The Indian Ocean Territories is an Australia external territory, made up of Christmas Island and the Cocos (Keeling) Islands, located to the north-west of mainland Australia. As a remote external territory, the IOT faces a unique set of challenges in delivering aged care services.

The Indian Ocean Territories (IOT) consists of:

  • Christmas Island (CI) – a 135 square kilometre island located 2,650 kilometres north-west of Perth.
  • The Cocos (Keeling) Islands (C(K)I) – two atolls and 27 coral islands, of which two, West Island and Home Island, are inhabited. The islands are located approximately 900 kilometres south south west of Christmas Island, 2,950 kilometres north-west of Perth, and 3,700 kilometres west of Darwin.

The total population of the IOT is approximately 2,622 people.

Reviewing aged care

The Commonwealth appointed Australian Healthcare Associates (AHA) to undertake a review of Aged Care in the IOT.  The review required AHA to:

  • Assess the aged care needs and expectations of the IOT community. This entailed analysis of the population age structure data and projections into the future.  Stakeholders had the opportunity to explain their expectations about aged care in their community and provide the evaluators with a culturally informed perspective
  • Review and evaluate the current services and facilities relating specifically to aged care in the IOT
  • Evaluate the capacity and feasibility of the Indian Ocean Territories Health Service (IOTHS) or other not-for-profit or private provider delivering the required aged care services
  • Review and assess the services, facilities and models of provision of aged care services in comparable communities. This included consideration of funding mechanisms, workforce, fabric, transport and applicability to the IOT
  • Develop and provide a report to the Department that includes options or models of aged care service provision that would be suitable for implementation and sustainability in the IOT.

The review involved a visit to both Christmas and Cocos (Keeling) Islands by two highly qualified and experienced senior consultants who consulted with the following groups of people:

  • On the Cocos (Keeling) Islands – 72 people (55 community members and 17 health care/administrative workers)
  • On Christmas Island – 76 people (61 community members and 15 health care/administrative workers).


As the majority of IOT citizens are Australians (70% on CI and 93.8% on C(K)I), aiming to maintain residents at home in Australia (preferably in the IOT) should be prioritised.

Key Finding 1: There is scope to better align the current health service model provided and the availability of community and aged care services with those provided in comparable remote Australian communities.

Key Finding 2: There is a need for community and aged care services that is currently not being met.  The lack of data collected and reported by the health service limits the ability to accurately quantify unmet need at this stage.

Key Finding 3: There is an opportunity to better utilise existing resources, staff and facilities to support the aged population in the IOT.

Key Finding 4: Communication between all levels of government, the IOTHS and the Administration could be enhanced to support more effective planning and provision of preventative, public health, community and aged care services.

The key findings illustrate the four main areas that need to be addressed to improve aged care in the IOT.  A new model for aged care service provision that is community based and person centred is needed in order to meet the current unmet needs of the older people in the IOT.  There are opportunities for existing resources to be utilised in different ways to more effectively deliver services.  Communication between all stakeholders is required to ensure effective planning and provision of a full range of services to support the needs of community members as they age.

The final report is available on the Department’s website.

As the majority of IOT residents are Australians citizens, aged care service delivery should prioritise maintaining residents at home in Australia, preferably in the IOT.