Improving resident activity levels in the aged care facility on Norfolk Island

Published 5 December 2018. Last updated 13 December 2018.

We worked closely with the community, staff, residents, and families of those living in the aged care facility on Norfolk Island to address their most pressing issue; the activity levels of the residents.

View a poster from the Centre for Healthcare Redesign graduation, December 2018.


By July 2019 all 14 permanent residents within the residential aged care facility on Norfolk Island will receive individual ability/interest assessments and recreation and leisure care plans. This will increase activity levels of at least 75% of the residents by 50% from baseline by 31 August 2019.



  • Improved physical and mental health
  • Improved experience of care
  • Improved quality of life
  • Decreased use of medication
  • Decreased challenging behaviours


  • Improved staff morale


  • Decreased cost of care


In July 2016 the Commonwealth took responsibility of Norfolk Island, a previously self-governing external territory. South Eastern Sydney Local Health District was tasked with assisting the local health service, Norfolk Island Health and Aged Care Service (NIHRACS), to support and enhance service delivery in line with other jurisdictions on the mainland.

NIHRACS is a multipurpose service, housing acute care facilities, aged care facilities, and the island’s only general practice. Staff work across different departments, depending on the identified needs.
Interviews, monitoring and direct observation indicated that residents living in NIHRACS experienced low levels of activity. There were limited individualised assessments, no goals around activity levels, and no processes supporting enrichment activities. The diversional therapist role was new and had not received mentorship or training. The residents, staff, and community were not happy with the breadth and amount of activities being offered to the residents, as well as the uptake of such activities.


  • Training and mentorship for the diversional therapist
    The diversional therapist was offered training in the form of a Cert IV in Leisure and Health. This has been delayed due to staffing issues. Mentorship via telehealth was organised with a senior diversional therapist in the LHD, and final sign off on this is expected by the end of November 2018.
  • Policy
    A policy was developed outlining the expectations and values of the multipurpose service with regards to resident activity, as well as processes for back-filling. This was completed by November 2018.
  • Assessment
    A process and related resources were developed to facilitate the assessment of all residents in the facility in terms of ability and interests around activities. This was completed in November 2018, with assessments underway.
  • Planning
    A process and related resources are being developed to plan and track activity levels, based on the assessments.
  • Equipment
    The purchase of appropriate equipment was facilitated by creating networks and formal linkages with a large, well resourced,, aged care facility on the mainland who are able to provide advice on up-to-date best practice. Equipment has been purchased, and this relationship is ongoing.


Implementation – The project is ready for implementation or is currently being implemented, piloted or tested.


  • Project start: 8 February 2018
  • Policy complete: October 2018
  • Assessment process complete: October 2018
  • Planning process complete: October 2018
  • Assessments complete: October 2018
  • Completion of and implementation of planning: ongoing
  • Training: due to begin in January 2019
  • Mentorship: started November 2018

Implementation sites

Aged Care Unit of the Norfolk Island Health and Aged Care Service, NIHRACS


  • Norfolk Island Health and Aged Care Service, NIHRACS
  • The Department of Infrastructure, Regional Development and Cities (Commonwealth)
  • NSW Ministry of Health
  • Department of Premier and Cabinet (NSW)


  • Mentorship
    Formal approval is due shortly and mentorship will begin once this is received.
  • Policy
    The policy was completed on time and has been implemented.
  • Assessment process and resident assessments
    This is complete, with all assessments undertaken and recorded.
  • Activity planning processes and resident activities
    Ongoing, with the process being developed.
  • Equipment
    The purchase of equipment has not yet been evaluated.

Lessons learnt

  • Significant difficulties can arise when working with a system that does not fall under the jurisdiction of NSW. Involvement and buy in from stakeholders at all points is essential.
  • Clearly defining the project scope can mean that the focus of the project changes significantly over time. Following the wishes of those actually implementing the change is essential to obtain buy-in.
  • Extra time is required when working within a healthcare environment in which systemic approaches common to NSW Health are new.


Jocelyn Hickson
Phone: 02 9540 8506


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Aged healthSouth Eastern SydneyMetropolitanCentre for Healthcare Redesign
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