Consumer Directed Home Support Ireland: How CDHS Lets You Choose Your Own Carer

What CDHS Actually Changes

Under the traditional HSE Home Support allocation, the HSE decides which provider delivers your parent's approved care hours. The family has limited say over scheduling, and caregiver consistency depends on local staffing. Consumer Directed Home Support flips this: the HSE still funds the hours, but the family chooses which approved provider delivers them.

Select CDHS on the application form if you want this pathway. When your parent is approved for home support hours after the interRAI care needs assessment, the HSE issues a formal decision letter with the weekly allocation and then a confirmation letter stating the monetary equivalent of the approved hours. If you need to change the delivery preference later, confirm the process with your local HSE Home Support Office. You contract directly with an approved provider from the HSE's Authorisation Scheme list, and the HSE pays that provider at the negotiated standard rate. No cash passes to the family.

Why Families Choose CDHS Over Traditional Allocation

The main advantage is control. Under CDHS, you pick the agency, negotiate the schedule, and can request specific carers. If your parent has dementia and responds badly to unfamiliar faces, this continuity matters enormously. Under traditional allocation, the HSE or its contracted agency rotates staff based on availability, and a parent might see three different carers in a week.

CDHS also gives families a direct provider relationship. If an agency is underperforming — carers arrive late, skip tasks, or fail to follow the care plan — raise the issue with the provider and ask the HSE how a change of approved provider would work. Under traditional allocation, the HSE manages the relationship with the provider, and families often feel stuck.

The trade-off is administrative. Under CDHS, the family takes on more coordination: finding a suitable provider from the approved list, managing the agreement, and flagging any issues directly. For families already overwhelmed by the care burden, this extra layer can feel like one more thing to manage.

How to Select an Approved Provider

The HSE maintains a regional directory of approved providers who have been vetted under the HSE Authorisation Scheme. You can access this through your local Home Support Office or on hse.ie. Under the Health (Amendment) (Home Support Providers) Act 2026, all home support providers within the Act's scope will eventually need to be registered with HIQA, adding a further layer of quality assurance.

When comparing agencies, ask about carer continuity guarantees, what happens when a carer calls in sick, whether they provide weekend and evening cover, and their policy on manual handling and medication prompting. Also confirm that they operate at the standard HSE-negotiated hourly rate — under CDHS, the provider cannot charge the family above what the HSE pays. If your parent's needs exceed the approved hours, you can top up privately at the agency's commercial rate, but that cost is separate from the CDHS arrangement.

CDHS Limitations to Know About

CDHS does not let you hire an independent carer directly and have the HSE reimburse you. The funding must flow through an approved provider. If you want to hire a neighbour or family friend as a paid carer, that is a separate private arrangement — and it makes you a legal employer under Irish law, with PAYE, PRSI, and USC obligations.

The hourly rate the HSE pays approved providers is set through negotiated standard rates. In areas with severe workforce shortages — particularly rural counties — some approved providers may not have capacity to take new CDHS clients, limiting your real choices. The family may need to supplement with privately funded hours from the same or a different agency.

CDHS availability can also vary by HSE Health Region. While it is a nationally available option, the practicalities of local staffing and provider density mean families in some areas have more genuine choice than others.

For a step-by-step guide to the full HSE Home Support process — including how to optimise the interRAI assessment, compare traditional vs CDHS allocation, and handle appeals when hours are cut — the Home Support Scheme Ireland guide covers everything from application to service mobilisation.

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