Aim: To examine processes of aged-care needs assessment for Aboriginal people in remote central Australia to assist development of appropriate models of aged care. Method: A qualitative study involving 11 semistructured interviews with aged-care assessors and two focus groups with Aboriginal community members. Results: This paper reports four major themes concerning how needs assessments relate to realities of service delivery: cultural perspectives on aged care, context of service delivery, equity and access to services, and program (mis)alignments. Conclusion: Disparities exist between assessment recommendations and service availability, with a potential mismatch between Aboriginal understandings of needs, interpretations by individual assessment staff and program guidelines. Incorporating a conceptual framework, such as the International Classification of Functioning, Disability and Health, into service guidelines to ensure structured consideration of a person's holistic needs may assist, as will building the capacity of communities to provide the level and type of services required.