Domiciliary Care Northern Ireland: Free Home Care, Direct Payments, and How to Access Support

Your parent has dementia but wants to stay at home. The good news: domiciliary care in Northern Ireland is generally free at the point of delivery, unlike in England where home care is means-tested. The bad news: accessing it requires navigating the HSC Trust assessment process, and the care package you get depends on what the Trust deems appropriate.

What Domiciliary Care Covers

Domiciliary care means support delivered in your parent's home by a Trust-arranged carer. This can include personal care (help with washing, dressing, toileting), medication prompts, meal preparation, and getting in and out of bed. The care workers visit at scheduled times, typically two to four times a day depending on need.

Although HSC Trusts have the statutory power to charge for non-residential services, they historically do not charge for core personal care. The main exception is flat-rate services like meals on wheels.

This is a significant difference from England, where home care is means-tested just like residential care. In Northern Ireland, the shift from free domiciliary care to fully means-tested residential care catches many families off guard.

How to Request a Care Package

Contact your parent's local HSC Trust and request a formal Needs Assessment. A multidisciplinary team — usually led by a social worker or occupational therapist — will assess your parent using the Northern Ireland Single Assessment Tool (NISAT). This evaluates physical abilities, cognitive function, safety risks (including wandering), and daily living needs.

The outcome is a care plan specifying the type and frequency of support. If domiciliary care is recommended, the Trust arranges the service and reviews it periodically.

The five HSC Trusts in Northern Ireland are Belfast, Northern, Southern, South Eastern, and Western. Your parent's Trust is determined by their home address.

Direct Payments: Managing Your Own Care

If your parent (or you as their representative) would rather hire carers directly instead of using the Trust's arranged service, you can apply for direct payments under the Carers and Direct Payments Act (Northern Ireland) 2002. The Trust gives you a cash payment equivalent to the cost of the care package, and you use it to employ carers, buy services, or arrange respite.

Direct payments give more control over who provides care, when they come, and how the care is delivered. The trade-off is administrative responsibility: you become an employer, handling payroll, insurance, and managing the relationship with the carer.

Direct payments cannot be used to pay a close relative who lives with your parent, unless the Trust agrees there are exceptional circumstances.

When Home Care Is No Longer Enough

If your parent's dementia progresses to the point where domiciliary care visits cannot keep them safe — particularly if wandering, night-time confusion, or falls become frequent — the Trust may reassess and recommend residential or nursing home placement. At that point, the free care model ends and the CRAG means test applies.

The Northern Ireland Dementia Care Guide covers the full domiciliary care process, including how to request a NISAT assessment, what to do if the care package is insufficient, and how direct payments work in practice.

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