Community Services

Overview

Community care services are public health services delivered by or on behalf of the HSE in the community.  They may be provided by voluntary organizations with the support of the HSE.

Generally, Medical Card holders are entitled to community care services free of charge.  In some cases, non-Medical Card holders will also be entitled, in effect, to the service free of charge.  The entitlement to community care services is not as clearly defined as in respect of hospital services.  The level of service in particular areas varies throughout the country.

Community care services can embrace public health nursing services, home health, physiotherapy, occupational therapy, daycare, respite care, chiropody service and others. The rules for various types of services vary.  In respect of some services, the HSE has the discretion whether to make the service available or not.

Community services are provided in health centres and clinics.  Generally, a referral from a general practitioner, public health nurse or hospital is required.

Nurses may act as the point of access to other community services. In some areas, care assistants are employed as well as nurses.   They provide personal care services.

Childrens Services

Children qualified for medical services on the basis of parents’ entitlement.  If parents have a Medical Card, it generally extends to their dependent children.

There is a range of child-specific services that are provided for all children free of charge.  They are provided as part of maternity and infant welfare services.

Public Health Nurse

Public health nurse services are available free of charge to Medical Card holders.  Other categories may be entitled but may not obtain priority.

The public health nurse provides basic nursing and medical needs as well as specialist services in certain community care areas.  This may include night nursing, day nursing, weekend nursing, and twilight nursing.

Public health nurses provide a range of services in the community.  They are based out of local health offices and cover particular areas.  They may provide services in the home, health centres, schools and community centres.

Public health nurses provide basic nursing care and assistance as well as advice.  They may act as the principal point of contact between the patient,  community care and other health services.  They may liaise with family doctors, hospitals, hospices and other services to ensure that the needs of the patient are met.

Public health nurses generally provide health services to

• older persons living at home,
• chronically and acutely ill persons at home,
• infant welfare services to children,
• school health services,
• expectant mothers,
• persons with disabilities
• persons socially deprived and
• travellers.

Public health nurses visit mothers and newborn children in the first six weeks.  They may keep a register of older people and visit them.  They may provide a similar service in respect of disabled persons.

A public health palliative care service is available through GP references. Voluntary services may complement the public health service.

Social Workers

Social workers are registered with the Health and Social Care Professionals Council.

Social service works are provided to groups or individuals who experience social or emotional difficulty.  Social workers work with groups and families to improve their quality of life and achieve change.  They assist in identifying options and supports.

Most social workers are involved in child-related services.  They deal with children at risk. They also deal with adoption and fostering services.  They work with the criminal justice system in the context of juvenile offenders.

Some social workers are employed to deal with older people. Some social workers provide services to persons with addiction problems, persons with physical and mental disabilities, persons experiencing marital difficulties and single parents.

Aural Services

Aural services are provided for persons with hearing problems.  They are generally provided with the HSE’s own practitioner.  Occasionally they may be provided by private practitioners.

Persons are generally referred by a general practitioner to an audiologist or ENT specialist at the nearest health centre or clinic.  There is special emphasis on children and infants.  Corrective measures may be prescribed.  Persons with Medical Cards are entitled to obtain hearing aids free of charge.  In other cases, the clinics or centre may refer a patient to a private supplier, and the cost may be reimbursed under the Treatment Benefit Scheme or by private insurance.

The HSE provides aural services free of charge to Medical Card holders, persons with Hep-C, and dependent preschool children and primary school children referred from child health services or school health services examinations.

There are no charges for hearing tests at health centres, public hospitals and clinics, regardless of whether the person has or has not a Medical Card.

The Health Act obliges the HSE to provide free aural services to Medical Card holders and their dependents and national school children who are referred to the public health examination. Outside of the below, a person may qualify for treatment benefits or tax relief for medical expenses in relation to optical expenses.

Optical Services

Optometric and ophthalmology services are provided free of charge to eligible persons by optometrists, dispensing opticians and ophthalmologists.  The providers may be employed directly by the HSE, although most do so on a contract basis.

Optometrists, formerly ophthalmic opticians, examine eyes and diagnose problems.  They deal with eye health and may prescribe spectacles and contact lenses.

Dispensing opticians dispense glasses, contact lenses etc, based on prescriptions.  They may dispense or recommend other glasses and contact lenses based on particular requirements.

Ophthalmologists deal with eye diseases and injuries.  They may also prescribe glasses and contact lenses.  Doctors registered medical practitioners may also examine eyes and prescribe contact lenses.

The HSE provides free optical services to Medical Card holders and their dependants as well as their defendants as well to  Hep-C, qualified persons.

Preschool children and children referred under the child health service or the school health service examinations with sight problems are entitled to free services.  The treatment may be carried out at outpatient departments of public hospitals, free of charge, without public hospital charges.  Services may continue until the child is 16 years.

Physiotherapy Services

Physiotherapist services may be provided in hospitals on an in or out-patient basis.  Community physiotherapy services may be provided by the HSE in certain regions.

The HSE is not obliged to provide physiotherapy services but does so in some cases.

Physiotherapist services are provided free service to Medical Card holders.  A waiting list applies.

Dental Services

The HSE must provide free dental services to persons with Medical Cards, preschool children, and school children referred under state primary school and child healthcare references.

Dental service is provided to persons under the age of 16 who attend state services and who are referred from child and school health services in HSE clinics and primary schools.

Persons without Medical Cards may be able to obtain tax relief on specialized dental treatments.  Routine treatments, such as descaling,  filling of teeth, repairing of dentures, do not qualify for tax relief.  Certain services may qualify for social insurance treatment benefits.  See the separate sections in that regard.

In  2010 measures were introduced to protect access to emergency dental care for Medical Card holders,  provision for children with special needs, those at high risk and with exceptional care requirements.  Others require prior approval from a clinician in the HSE.

Where prior approval is required for specialized treatment, HSE  dental surgeons apply judgment in relation to priority.

Orthodontic services were restructured in order to deal with long waiting lists. Some HSE areas have engaged private practitioners to provide services to certain eligible persons in particularly children.  Children are classified in accordance with the severity of their needs.  The most severe are prioritized.  This may include persons with congenital abnormalities such as cleft pallets.

Chiopidy & Podiatry

The HSE is not obliged to provide chiropody and podiatry services but may do so directly or through voluntary organizations.  Where the service is available, it is free to Medical Card holders and persons with Hepatitis C cards.

Non-Medical Card holders may be entitled to tax relief if they are referred to as part of medical treatment.  Chiropodists and podiatrists are registered under the Health and Social Care Professional Council.  There are three professional bodies representing chiropodists and podiatrists.  Each represents both categories.

Services provided by the HSE vary.  Generally, priority is granted to persons with

• medical Cards over 66.
• persons with certain illnesses such as arthritis and diabetes.
• persons with disability.

Services may be provided at HSE clinics, health centres or, exceptionally, a home service. Persons are generally referred by their registered medical practitioner or public health nurse.

Occupational Therapists

Occupational therapists are employed by most health HSE offices.  Their services are generally provided free of charge to persons with Medical Cards.  Waiting lists are long and exceptional; persons may be referred to private practitioners by the HSE.

Occupational therapists are employed in most health areas.  They are available free of charge to Medical Card holders subject to a waiting list.

In principle, the services are available to all persons.  However, in practice, the waiting lists are long.  Persons with disability and older persons are prioritized.

An occupational therapist generally assesses the ability to function in relation to the normal requirements of living.  Home arrangements are assessed in relation to requirements for appliances such as wheelchairs, lifts, chair lifts, downstairs bathrooms etc.

The occupational therapist may arrange for the provision of mechanical aids and appliances by the HSE or may certify eligibility for a housing adaptation grant for persons with disabilities.

Speech and language services

Speech and language services may be provided by HSE in settings including health centres, hospitals and schools.  They deal with persons with speech, language, fluency, voice and swallowing issues.  They may be available through the HSE or voluntary services.

Services are provided free, and children are prioritized in most areas.  Service may be provided in schools.

Adults must generally be referred by general practitioners or public health nurses as part of combined care in public hospitals.  Priority is given to persons who have had strokes, accidents or progressive neurological disorders.

Home Help Services

The HSE has the discretion to provide home help services for persons who are ill, infirm or aged as substitutes for institutional care. Access to many services is by referral. The home help service may be provided by the HSE directly or through voluntary service.

They assist with regular household tasks and may give personal care.  A contribution towards costs may be required depending on local requirements.

Home help services need not be provided by the HSEs.  The HSE may provide home health services directly or under arrangements with voluntary organizations. The services are generally available free to Medical Card holders.  Others may be provided with services on the basis of making a contribution.

In principle, the service may be provided to any person. In practice, older persons, persons with families with small children or where a parent has died, who is seriously ill or persons with disabilities may be provided with the service.

Home helps assist with normal household tasks.  They may assist with personal care.  Persons with Medical Cards may be required to make a contribution. Where persons are not eligible, there may be an obligation to pay a greater portion of the costs.

The arrangements will be agreed upon between the beneficiary and the HSE.  The type of work would depend on the circumstances and needs.  Home help may be available when parents are dead or seriously ill.  Each application is considered on its merits. In practice, the service is largely confined to older people or where there is a deceased or very ill parent.

Residential Services

An ‘‘accommodation’’ as

• accommodation provided by or on behalf of the Health Service Executive or
• accommodation arranged to facilitate the provision of residential support services to a person whose ongoing costs of maintenance are met by or on behalf of the Health Service Executive;

‘‘costs of maintenance’’ is defined as a person’s essential ongoing daily living costs (other than ‘‘excluded costs’’) met by or on behalf of the Health Service Executive, including purchasing or paying for food or other essential household provisions and/or essential utilities;. ‘‘excluded costs’’ as accommodation costs and non-maintenance costs associated with the provision of health or personal social services;

‘Residential support services’’  are services — other than outpatient, acute in-patient or long-term residential care services (under the Nursing Homes Support Scheme Act) — provided by or on behalf of the Health Service Executive to a person residing in (or ancillary to) accommodation which is a hospital, convalescent home, nursing home or residential accommodation for persons with physical, sensory, mental health or intellectual disabilities.

The Minister may specify different maintenance and accommodation contribution amounts having regard to persons’ incomes and/or levels of dependence or independence. There is provision to reduce the level of contributions — for those maintained but not accommodated by or on behalf of the Health Service Executive — to reflect service users’ own net contributions towards their accommodation costs.

Nothing in legislation may authorise the payment ‘‘on the double’’ of a contribution towards maintenance and/or accommodation costs or may prohibit a person to whom section 67C is applicable from being required to pay such a contribution. The Health Service Executive, when deciding on the level of applicable waivers, to take account of the extent, if any, to which persons provide for their maintenance and/or accommodation.