Dáil Éireann Debate, Tuesday - 24 February 2026
879. Deputy Robert O'Donoghue asked the Minister for Children, Disability and Equality the steps being taken to move away from institutional and congregated models of care, including the ongoing placement of younger adults with intellectual disabilities in nursing homes, towards community-based housing models with flexible, onsite supports; and if she will make a statement on the matter. [14533/26]
Amharc ar fhreagra880. Deputy Robert O'Donoghue asked the Minister for Children, Disability and Equality if her Department or the HSE has examined whether current nursing homes support payment structures create a financial incentive for the admission of persons aged under 65 years to nursing homes, rather than to community-based alternatives; and if no such examination has been undertaken, whether the she will commission this research; and if she will make a statement on the matter. [14537/26]
Amharc ar fhreagraI propose to take Questions Nos. 879 and 880 together.
This Government recognises that disabled people have a right to have access to a range of in-home, residential, and other community support services to enable living and inclusion in the community in line with Article 19 of the United Nations Convention on the Rights of Persons with Disabilities.
In the Programme for Government, this Government commits to develop a multi-year capital plan for investment in residential and independent living options for both adults and children, while continuing to implement the Time to Move on from Congregated Settings Strategy.
Additionally, the Programme for Government commits to continue to work to end the practice of placing young people with disabilities in nursing homes.
‘Time to Move on from Congregated Settings – A Strategy for Community Inclusion’ was established under the Transforming Lives Programme. It is a model of support where people with disabilities are supported to move from congregated settings, often large institutions to their own homes in the community, with the supports they need. The Report identified that in 2008 approximately 4,000 individuals with disabilities lived in congregated type settings, defined as where ten or more people reside in a single living unit or are campus based.
At the end of April 2025, there were 1,335 individuals remaining in the HSE tracked congregated settings, From 2020 to 2025, 454 individuals moved from congregated settings to homes in the community.
In 2026, the HSE National Service Plan allocates €3m to support the transition of 58 people from congregated settings to more appropriate homes in the community. Decongregation is progressing and continues to demonstrate very positive results for service users who have transitioned to living in homes in community settings.
In 2021, The office of the Ombudsman published “Wasted Lives: Time for a better future for younger people in Nursing Homes,” which outlines that for majority of people under the age of 65, nursing homes are not an appropriate placement and alternative, more sustainable supported living solutions are needed to give them greater independence and choice in their daily lives.
Data from the HSE indicates that as of December 2025, there are 1,209 people under 65s in Nursing Homes. 86% of these residents are over the age of 50. As of December 2025, A total of 121 people have transitioned to homes of their choosing in the community since the start of the programme in 2021.
Additionally, over 300 individuals have received additional enhanced quality of life supports (EQLS), while they are currently continuing their placement in a Nursing Home.
In 2026, The HSE National Service Plan allocated a record €10m to the under 65s work programme. €8m of this funding will enable 45 people who are inappropriately placed in a nursing home to transition to more appropriate living arrangements.
In some cases, a nursing home is an appropriate care option for a person under the age of 65, and a cohort of individuals may remain in their nursing home placement on an ongoing basis. The remaining €2m will provide EQLS to those who remain in nursing home settings. In addition, the U65 programme has also been awarded Dormant Account Funding for 2026 of €736k. This funding will be directed towards once off funding for EQLS.
EQLS are aimed at improving an individual’s quality of daily life in a nursing home, increasing social access and where appropriate, to support the pre-transition work, to help individuals prepare for a move back into the community.
Specifically, these EQLS supports range from iPads, Laptops, Audio Books & Head Phones, TV in own room, Motorised Wheelchairs, Mobility deceives, Communication devices, Exercise Bikes, PA (until year end), Therapeutic Supports, Allied supports e.g. Dentistry, Transport, Support Chairs etc.
Based on data from the U65 Operational Tracker, for the majority of those continuing a NH placement, the reason given is due to their current personal will and preference. Disability services recognise that will and preference is changeable; reviews are carried out regularly to ensure that the nursing home placement remains the most appropriate choice for the individual.
A further cohort will remain due to their assessment of needs requirements. Such complex medical and social care needs may require intensive nursing and medical care that cannot be provided in a home setting or by family members.
While the HSE are working on a targeted programme for transitioning those inappropriately placed in nursing homes into more appropriate care options in the community, this Government acknowledges that there have been admissions of people under the age of 65 into nursing homes.
The main source of admissions of people under the age of under 65 in to nursing homes is discharges from acute hospital settings where the individual has a complex medical need such as an acquired brain injury.
Preventing entry to nursing home facilities requires a model of service that supports the changing needs of individuals and allows them to continue to live a life of their choosing in the community. HSE data shows the impact that wider policies have on the numbers of U65s in Nursing Homes, with particular focus on the Acute Hospital winter discharge programme and its sustained focus on increased discharge rates and turnaround times from Acute hospitals.
Due to the work of the Under 65s Integrated Steering Committee and project team, there is a greater awareness across HSE Acutes, Older Persons and Disability services of the need to prevent people under the age of 65 from being placed in Nursing Homes.
Measures which among other things can prevent young persons from entering nursing homes continue to be supported through a range of services including Personal Assistants, peer supports, respite, day services, home supports, Advocacy and Digital and Assistive Technology.
The Nursing Homes Support Scheme (Fair Deal) is a scheme of financial support available to those deemed to require long term residential care at registered Nursing Homes. The Scheme requires a care needs assessment to establish that the applicant requires long-term residential care services and a financial assessment to calculate their client contribution. In this context, the HSE advise that there is no evidence to suggest that operation of the scheme could be considered to provide a financial incentive for the admission of persons aged under 65 years to nursing homes, rather than to community-based alternatives.
The National Clinical Programme for People with a Disability (NCPPD) is in the early stages of developing A Place to Call Home and its associated Guidance Notes - a rights-based model for all adults with a disability, supporting people of any age to live, age and thrive in their own communities. Together, this work will set out, in a clear and practical way, the full range of community-based alternatives to nursing home admission for people under 65.
Grounded in the Programme’s commitment to preventing unnecessary institutionalisation and enabling adults with a disability to exercise their right to live in the community rather than in long-term residential care, in accordance with their will and preference, the Programme is identifying the key supports, pathways and services required to uphold this right. This includes personalised supports, appropriate and accessible housing, enhanced home support, personal assistance, rehabilitation pathways and strengthened cross-sector collaboration — all central elements of the emerging model.
As the work progresses, the Programme will bring together research, data, stakeholder input and alignment with National reforms across health, disability, housing and social care to produce a clear, evidence-informed picture of the community options needed to ensure that adults with a disability can live independently and participate fully in society.
