Skip to main content
CareMapIreland

Situation

When approved home support hours are not enough

How to request a review of HSE home support hours in Ireland, and what other options exist while you wait.

Last reviewed: 11 September 2026Verified

Approved hours are based on an assessment at a point in time. When needs increase, the assessment can be reviewed — but you generally have to ask, and it helps to be specific about what has changed.

While a review is under way, community services, carer supports and, if you can pay, private top-up hours are the practical options.

First steps

  1. Ask the local HSE Home Support Office for a review of the assessment of need, and put the request in writing
  2. Keep a short log for two weeks showing where the gaps fall
  3. Ask what the local process is if you disagree with the outcome
  4. Look at community services and carer supports to cover specific gaps

Who can help, and what each of them does

Ask for people by role. It is the quickest way past a general phone number.

The local HSE Home Support Office
The office that holds the current approval. A request for a review of the assessment of need goes here, and it is worth putting it in writing as well as by phone.
The person who carried out the assessment
Usually a public health nurse, physiotherapist or occupational therapist. They recorded what the person could and could not do, so new difficulties need to reach them.
Their GP or hospital team
A letter noting a change in health, a fall, weight loss or a hospital attendance since the last assessment is useful evidence of what has changed.
A Citizens Information centre
Independent help understanding a decision, and what your options are if you disagree with it.

What to have ready

None of this is a formal requirement we can promise on anyone's behalf — it is simply what tends to be asked for, and having it written down saves repeating yourself.

  • A two-week log showing exactly where the gaps fall — which days, which times, and what does not get done
  • What has changed since the last assessment, with dates: falls, hospital attendances, weight loss, missed medication, new incontinence, night-time needs
  • What family are currently covering, and specifically what is no longer sustainable
  • The current approved hours and the pattern of visits, so you can be precise about the shortfall
  • Any recent letter from a GP, hospital, physiotherapist or occupational therapist

Questions worth asking

Ask the local HSE Home Support Office

  • Can we request a review of the assessment of need, and what do you need from us?
  • Who will carry out the review, and roughly when?
  • Will we get the outcome and the reasons in writing?
  • If more hours are agreed, is the constraint the approval or the availability of a carer locally?
  • Is Consumer Directed Home Support an option in our situation?
  • What is the local process if we disagree with the outcome?

Ask about the gaps that are hurting most

  • Could a different pattern of the same hours help — two short visits instead of one long one?
  • Are day services or respite available locally to cover part of the week?
  • Is there anything at home — equipment or an adaptation — that would reduce the amount of help needed?

What can happen next

Possible paths, not predictions. Decisions about assessment, hours and timing are made by the HSE locally, and we never claim to know the outcome in advance.

  • The assessment is reviewedA review looks again at what the person can and cannot do. It can result in more hours, the same hours arranged differently, or no change — and the reasons should be given to you.
  • Approval and availability turn out to be different problemsSometimes hours are approved but cannot start or increase because of carer availability in the area. It is worth asking which of the two is holding things up, because the next step differs.
  • Other supports fill part of the gapDay services, respite, meals, community transport and carer supports run on separate processes and are often the faster route to relief for a specific part of the week.
  • There may be a waitAny published waiting figures we hold are aggregate figures for an area at a past date. They describe pressure on the system and cannot tell you when one person's hours will change.

What to do while you wait

  • Keep the log going and send updates in writing if things get worse — the record is what a review works from
  • Ask for a named contact for your case, and note the date of every call and what was said
  • Check carer supports, including respite, before the main carer is at breaking point
  • If you can pay for private hours, treat them as a top-up while the public request continues — do not withdraw the application
  • Ask about equipment or a small adaptation: sometimes the practical problem is the bathroom, not the hours

Support that often applies here

Relevant does not mean approved. Each of these has its own assessment or decision process, run by the HSE, a local authority or the Department of Social Protection.

Guides that help you prepare

Where the facts on this page come from

How the system works is taken from the official pages below. Everything else here is practical experience of dealing with that system, not official guidance — and none of it is clinical or legal advice.