HSE publishes cost of providing care in public residential services for older people

The HSE has today published the updated cost of providing care in its public residential care centres for older people. The information can be found on the HSE’s Fair Deal Scheme webpage at www.hse.ie/nhss

In 2019, there is a minor increase in the average cost of care from €1,592 in 2018 to €1,615 in 2019. This increase is caused by pay increases required under the Lansdowne Road Agreement (funded separately to NHSS funds allocated within the HSE Service Plan 2019).

These costs apply to the operating costs of providing care in these centres. They do not relate to the amount a person will pay towards their care under the Nursing Home Support Scheme (Fair Deal).  

A weekly price for the cost of care in a public nursing home is based on the actual costs of operating the public centres. The cost of running these centres ranges from a bed rate of €889 to €2,182 per week*.

It is acknowledged that there are variations in the cost of care for public and private nursing homes, with public nursing homes generally having a higher cost of care.  A number of factors contribute to this including:

Reductions in long-stay public beds numbers

Many public centres were required to reduce bed numbers since 2009/2010 to comply with health and safety, fire regulations and HIQA compliance with residential care standards. However, it has been more difficult to achieve a similar reduction in fixed costs e.g. lighting, heating, maintenance, staffing costs, etc.

Environmental implication on staffing levels

The need to modernise/replace many public centres and improve their environments in line with HIQA standards has seen substantial Capital Plan funding committed for 2016 – 2021. The current environment of many brings challenges to staffing levels due to the layout of bedrooms and shared areas. The planned capital development will support a modern fit-for-purpose environment.

Geographical provision of residential placements

The HSE provides residential care services in locations that are not viable for private providers e.g. in some rural areas, long stay beds are provided for geographical reasons in smaller centres which would not be profitable for a private provider to supply e.g. Achill Island, Donegal etc.

Higher nurse staffing ratios

Public nursing homes generally have higher nurse staffing ratios in place.  A review of NHSS published in 2015, recommended that a ‘Value for Money and Policy’ review be carried out by the Dept of Health. It is planned that this review will be completed in 2019.

Staffing cost of providing ‘Long Term Residential Care Services’

The cost of providing long term residential care services comprises in the main of staff pay costs (including nursing and other care staff). Public Long Stay Residential Centres are obliged to apply public service rates of pay and conditions of employment for all staff which includes paid sick leave, maternity leave etc.

Reliance on agency staffing

Due to the public sector recruitment moratorium which was in place for the last number of years, the public residential care sector has relied on agency staff to support adequate safe levels of service. However, this reliance is being replaced steadily.



*excluding centres undergoing variations in bed numbers due to refurbishments

Notes to editor

Under the NHSS, a person’s care needs are assessed to determine if they need long term residential care services. They will also have a 'Fair Deal' financial assessment to determine how much they will pay towards the total cost of their care. The HSE will pay the balance.  It is important to note that a person’s payment will be the same for voluntary, private or a public nursing home.

Cost of care

The National Treatment Purchase Fund (NTPF) agrees on the price with private and voluntary nursing homes for long term residential care services provided under the NHSS.  The NTPF notifies the HSE of the agreed prices, which are published on the HSE website.

Determining the cost of care under NHSS is based on the following criteria (the same for all providers):

  • Nursing and personal care appropriate to the person's level of care needs
  • Bed and board
  • Basic aids and appliances necessary to assist a person with daily living activities
  • Laundry services.

The following services are not funded under the NHSS Scheme:

  • All therapies                                                   
  • Ophthalmic and dental services
  • Social programmes                                         
  • Dry cleaning
  • Incontinence wear                                          
  • Specialised equipment
  • Chiropody                                                     
  • Transport
  • Hairdressing and other similar services
Last updated on: 05 / 06 / 2019