Public health services provided in the community in Ireland are sometimes referred to as community care services. They are generally provided by the Health Service Executive (HSE). Community care services may also be provided by voluntary organisations in conjunction with, or on behalf of the HSE.
Entitlement to community care services is not as clear cut as entitlement to hospital services. There is also wide variation in the level of services available in different parts of the country.
In general, medical card holders are entitled to community care services free of charge. Non-medical card holders may also be entitled but it is not always possible to actually get the services.
Community care services can include the public health nursing service, home help service, physiotherapy, occupational therapy, chiropody service, day care and respite care service.
The rules about which community care services must be provided, differ in accordance with the different services. In some cases, the HSE is obliged to provide services while, in others, the HSE has discretion about whether to make the service available or not. One of the reasons for this is that the health services provided by the HSE reflects the population in the area in which you live.
The HSE is obliged to provide a free nursing service to medical card holders. The service is not necessarily confined to medical card holders, although they get priority as they have a legal entitlement.
Public health nurses supply many basic nursing and medical needs and a number of special services are provided in some community care areas. These include night nursing, day nursing, weekend nursing and twilight nursing. The services provided by the public health nurses vary from area to area and they frequently act as a point of access for other community care services.
Some Local Health Offices employ care assistants as a back-up to the public health nursing service. The role of the care assistant is to provide personal care rather than domestic services, but there is some overlap between what they do and what home helps do.
The Health Service Executive may make arrangements (but is not obliged to do so) to help maintain at home sick or infirm people. They may also make arrangements for people who would otherwise need institutional care. The usual way they do this is by providing a home help service.
Home helps may be employed either by the HSE or by voluntary organisations. They usually help with normal household tasks although they may also help with personal care. If you get a home help, you may have to make a contribution towards the cost, but this practice varies greatly from area to area.
Some Local Health Offices also provide a limited home help respite service for carers.
Physiotherapy services are generally provided in the community and are generally free to medical card holders. Waiting lists operate in many areas. Home services are only available in a small number of cases.
Occupational Therapists are employed by most Local Health Offices. Their services are generally available free to medical card holders. Waiting lists operate in most community care areas for these services.
Chiropody services are available free to medical card holders in most community care areas.
The HSE is obliged to provide medical and surgical aids and appliances such as wheelchairs and walking aids free of charge to medical card holders. If you do not have a medical card, you may get such aids and appliances free if they are part of hospital treatment. In practice, in other cases, the HSE may provide some help with the costs.
If you have private health insurance, you may be covered for some or all of the costs.
Respite care or temporary care may be based in the community or in an institution. In practice, respite care is provided to a varying degree at a number of locations around the country – in some cases by HSE and in others by voluntary organisations.
Day centres include centres that provide day activities such as recreational, sport and leisure facilities and specialised clinic facilities that provide a combination of medical and vocational rehabilitation services. Day centres are provided on a variable basis throughout the country, some being funded by the HSE and others funded by voluntary organisations. Day centres providing medical care are less widely available and are funded by the HSE. Access to day centres is by referral and the eligibility conditions vary from area to area with means tests applying in some cases.
Meals services are generally provided by a mixture of voluntary and statutory bodies. The ways in which these are provided vary from area to area. Access to meals services is generally by referral. You may be asked to contribute towards the cost of meals services. Eligibility conditions vary from area to area.
Transport services are provided by the HSE on a varying basis throughout the country. These services include access to day hospitals and day centres and access to outpatient departments and other hospital services.
Other community care services include social workers (there is a small number of specialist social workers for older people), speech therapists and dieticians.
If you have a question relating to this topic you can contact the Citizens Information Phone Service on 0761 07 4000 (Monday to Friday, 9am to 8pm) or you can visit your local Citizens Information Centre.