Public Health Nurse Dementia Ireland: What the PHN Does and How to Prepare

The Public Health Nurse is the most important person in your parent's home care system — and the one most families underestimate. The PHN acts as the gatekeeper to HSE Home Support, community therapies, continence supplies, and referrals to specialist services. How well you prepare for their visit directly affects the care hours your parent receives.

What the PHN Does

Your local PHN is based at the HSE Primary Care Centre and coordinates community-level health services. For dementia families, the PHN's role includes:

• Leading/coordinating the Care Needs Assessment — the assessment that determines HSE Home Support eligibility and hours
• Prescribing continence supplies — free absorbent pads, pull-ups, and bed protection through the HSE
• Referring to community therapies — occupational therapy (home modifications, aids), physiotherapy (falls prevention, mobility), and speech and language therapy
• Coordinating with Community Intervention Teams (CITs) — rapid-response clinical nursing for acute situations
• Connecting with local services — day care, Meals on Wheels, transport options

How the Care Needs Assessment Works

When you apply for HSE Home Support, a healthcare professional—usually a PHN, though a physiotherapist or occupational therapist may also carry out the assessment—assesses your parent using the HSE care-needs assessment process. They evaluate:

• Physical mobility, balance, and fall risk
• Ability to perform daily activities (bathing, dressing, eating, toileting)
• Cognitive function and level of confusion
• Nutritional status and meal preparation ability
• Existing family support and where the gaps are
• Home environment safety

The timing of the assessment and approved care plan depends on local capacity and the assessment process; ask your local Home Support Office for the current estimate.

How to Prepare for the PHN Visit

The assessment captures a snapshot of one visit. If your parent has a "good day," the allocation may not reflect their actual needs. Preparation is essential.

Before the Visit

1. Keep a daily log for 2 weeks documenting incidents: falls, wandering, forgotten meals, medication errors, nighttime confusion, moments of distress
2. Note what you're doing — every task you handle (bathing, dressing, cooking, supervision, medication management) and how many hours it takes
3. List what's not getting done — tasks you can't cover because of work, your own health, or other family responsibilities
4. Gather medical documentation — recent GP letters, specialist reports, hospital discharge summaries

During the Visit

• Be honest about struggles — minimising difficulties leads to inadequate hours
• Describe the worst days, not the average ones
• Mention specific safety concerns: has your parent left the stove on? Wandered outside? Fallen?
• Ask the PHN directly: "Based on what you've seen, how many hours would you recommend?"

After the Visit

• If the allocated hours seem too low, write to your local HSE Home Support Office within 20 days of the decision letter, explaining why you are dissatisfied
• Ask your parent's GP to write a supporting letter if you believe the allocation doesn't match clinical need
• If your parent's needs later change, contact the local HSE Home Support Office to request a review

Requesting a PHN Visit

If your parent doesn't already have a PHN assigned, contact your local HSE Health Centre and ask how to request a visit. A GP or existing PHN can also advise on the referral route. The PHN can then:

• Assess for home support needs
• Arrange a continence assessment
• Refer for occupational therapy (for home safety modifications)
• Connect you with the local Alzheimer Society of Ireland Dementia Adviser

For families coordinating the full care pathway, our Dementia Care in Ireland guide includes a PHN Preparation Checklist with the exact questions and documentation to bring to maximise your parent's home support allocation.

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