Financing Long-Term Care in Ireland: Public Funding, Private Contributions and the Balance Between Home and Residential Care

Two older people with similar levels of dependency can encounter very different financial arrangements depending on where their care is provided in Ireland. One may receive HSE-funded home support without a means test or direct charge for the service. Another who requires long-term nursing-home care may enter the Nursing Homes Support Scheme, commonly known as Fair Deal, where income and assets are assessed to determine how much they contribute and how much the State pays.

That contrast sits at the centre of Ireland’s long-term care financing debate. The Ireland Ageing, Long-Term Care & Community Support Knowledge Hub examines a system seeking to support more people at home while maintaining adequate residential capacity for those whose needs cannot safely or sustainably be met there. Financing determines how credible that ambition becomes.

Ireland does not operate one unified long-term care insurance fund through which all older-person support is financed. Instead, general taxation, HSE expenditure, individual contributions, private purchasing, voluntary-sector funding, housing investment and unpaid family care combine in different proportions across the pathway. This creates flexibility, but it also creates different levels of financial certainty. Fair Deal establishes a defined statutory mechanism for long-term nursing-home costs. Home support follows a different model in which the person is not currently charged for HSE-funded support but practical access remains dependent on assessment, available public resources and local delivery capacity.

The strategic question is therefore larger than how much Ireland spends. It is whether the way money flows through the system supports the outcomes Ireland says it wants: independence, ageing at home, equitable access, sustainable providers, supported carers and high-quality residential care when it is required.

Ireland finances long-term care through several different routes

The cost of supporting older people is spread across several parts of the State and across households themselves. Health expenditure funds hospital, community and HSE older-person services. The HSE funds home support and administers Fair Deal. The National Treatment Purchase Fund negotiates prices with participating private and voluntary nursing homes. Local-government and housing expenditure supports adaptations and other infrastructure that can help people remain independent. Social-protection payments provide income to older people and some carers.

Alongside that public expenditure sits substantial private and unpaid contribution. Some families purchase additional homecare directly. Nursing-home residents contribute according to the Fair Deal financial assessment. People may pay separately for services outside Fair Deal. Family carers provide many hours of assistance that never appear as expenditure in a health-service account.

A realistic financing model therefore has to recognise at least five forms of resource:

• general taxation funding HSE and wider public services;
• State payments for home, community and residential support;
• assessed personal contributions towards long-term nursing-home care;
• direct private spending by individuals and families; and
• unpaid family and community care with significant economic value even though no invoice is generated.

These resources are not interchangeable. A family cannot necessarily replace a professional home-support worker. Additional hospital spending cannot solve an inaccessible bathroom. More residential funding cannot achieve an ageing-at-home objective if community capacity remains constrained.

Home support is publicly funded and currently free to the person

The HSE Home Support Service for older people represents one of the clearest examples of Ireland’s tax-funded approach to community long-term care. A person’s needs are assessed and, where support is approved, HSE funding is allocated according to the level of care required.

Under current arrangements, the HSE Home Support Service is not means-tested and the person is not required to pay a charge or contribution towards the HSE-funded service. That is a significant feature of the Irish system.

It means that access to publicly funded home support is based primarily on assessed care need rather than an assessment of the person’s income and property. This differs substantially from Fair Deal, where financial assessment is central to determining the person’s residential-care contribution.

Home support can be delivered directly by HSE staff or through HSE-approved providers. Under Consumer Directed Home Support, an approved person receives a weekly funding allocation and can choose from approved providers, with the HSE paying the provider. The amount of actual support that allocation purchases may depend on provider rates and the timing of visits.

The absence of a direct client charge does not mean that home support is unlimited. It is a publicly funded service operating within available resources, workforce and local service capacity. The financial constraint therefore appears primarily through the quantity and availability of support rather than through an individual means test.

This distinction is important when examining homecare demand, capacity and waiting lists. A service can be free at the point of use while still being rationed through assessment, prioritisation and practical supply.

Budget 2026 shows the scale of the shift towards older-person services

Ireland’s 2026 health budget provides a useful indication of current policy direction. More than €3 billion was allocated to older-person services, with an additional €215 million compared with 2025.

Within that increase, €82 million in additional funding was allocated to home support. The intention is to support approximately 26.7 million home-support hours during 2026, including additional capacity aimed at persistent waiting lists in parts of the country. A proportion of new home-support hours is also being directed specifically towards people living with dementia.

At the same time, an additional €92 million was allocated to Fair Deal, including provision intended to support more people entering long-term residential care. Further investment has been directed towards community nursing units, transitional care, dementia support, meals on wheels and community services.

This matters because it demonstrates that current policy is not based on a simplistic transfer of funding from residential care to homecare. Ireland continues to need both.

An ageing population creates additional demand across the continuum. More home support may prevent or defer some nursing-home admissions, but it cannot remove residential need altogether. Likewise, additional nursing-home capacity does little to support people whose needs could be met more appropriately at home.

The financing challenge is therefore one of balance and sequencing: where investment produces the greatest improvement in independence, safety, flow and quality across the whole pathway.

Funding an hour does not guarantee that an hour can be delivered

An additional allocation for home support only becomes useful when a worker is available to deliver it. This creates a direct relationship between financial policy and workforce economics.

Consider a Health Region that receives additional resources to expand home support across several rural counties. The budget allows more packages to be approved, but approved providers struggle to recruit workers for geographically dispersed routes. Travel between visits reduces productive time, morning and evening demand is concentrated into narrow periods, and some packages remain difficult to fill.

The region has therefore increased financial capacity without increasing service capacity to the same extent.

The appropriate response is not simply to conclude that more funding has failed. Leaders need to examine what the funding model is asking providers and workers to do. Travel, scheduling, employment conditions, provider rates, recruitment and local housing costs may all influence whether funded hours can be delivered.

This is why homecare workforce and scheduling belong inside financing analysis. The true cost of care is not merely the wage attached to the minutes spent inside a person’s home. It includes the infrastructure required to make reliable delivery possible.

The Digital Twin Scenario Modeller can help organisations explore this type of relationship between demand, workforce, capacity and service stability. It is not designed to determine Irish public funding, but the scenario-planning discipline is useful: leaders need to understand what happens operationally when financial expansion runs ahead of workforce supply.

Private purchasing adds another layer to home-based care

Some older people and families purchase homecare privately, either because they are not receiving HSE-funded support, because they want additional hours, or because they wish to arrange particular forms of assistance outside their public package.

This private market increases overall system capacity but also introduces financial inequality. A household with substantial disposable income can buy additional support more readily than one dependent on a State pension.

The existence of private purchasing therefore needs careful interpretation. It can offer choice and flexibility, but it should not be confused with equitable public access.

There can also be an interaction between public and private provision. The same provider market may serve both HSE-funded and self-funded customers. Workforce constraints consequently affect both sectors, and differences in rates or terms can influence provider behaviour and worker deployment.

This makes provider sustainability an important financing consideration. If payment structures do not reflect the real cost of delivering high-quality support, nominal service availability can mask instability underneath.

A family combines public support with private spending

An 86-year-old woman living outside Kilkenny receives an HSE-funded home-support package following a decline in mobility. The package covers essential personal care on several mornings each week, but her family would also like additional evening assistance and more support at weekends.

The HSE package is not subject to a means test and no client contribution is charged for the approved service. However, the family decides to purchase additional hours privately from a homecare provider.

The resulting care arrangement therefore contains two different funding streams around the same person: publicly funded support based on assessed need and privately purchased support reflecting the family’s preferences and financial capacity.

For the woman, these are not two systems. They are one weekly routine. Coordination becomes important so that workers understand the plan, duplication is avoided and changes in need are communicated appropriately.

At policy level, cases like this raise a broader question. If privately purchased care becomes routinely necessary to achieve a level of support that families consider sustainable, public authorities need to understand what that means for equity. Private expenditure can complement public provision, but it should not become invisible evidence of unmet public need.

Fair Deal uses a fundamentally different financial model

Long-term nursing-home care is financed differently from HSE home support. The Nursing Homes Support Scheme, established under the Nursing Homes Support Scheme Act 2009 and commonly known as Fair Deal, creates a formal mechanism for sharing eligible nursing-home costs between the person and the State.

The HSE first determines whether the person requires long-term residential care through a care-needs assessment. A separate financial assessment then establishes the person’s contribution.

For a single person, the assessment generally takes account of up to 80% of assessable income and 7.5% per year of assessable assets. The first €36,000 of assets is disregarded. Where the applicant is part of a couple, the calculation generally uses 40% of combined assessable income and 3.75% of combined assets, with the first €72,000 disregarded.

The person’s principal residence receives particular treatment. Its value is included in the asset contribution for a maximum of three years, limiting that element to 22.5% of the relevant assessable property value for a single applicant or the corresponding half rate where the applicant is part of a couple. Qualifying farms and businesses may also benefit from the three-year cap where the statutory conditions are met.

The person pays the assessed contribution and the State pays the balance of the approved nursing-home cost. The contribution is therefore linked to means rather than simply to the price charged by the chosen participating nursing home.

This gives Fair Deal a fundamentally different financial character from home support. Residential care has a statutory, means-related cost-sharing mechanism. Public home support is currently delivered without a means test or direct client charge.

The three-year cap protects against unlimited exposure of the home

The treatment of a person’s home has always been one of the most politically and personally sensitive aspects of long-term care financing. Property may represent substantial wealth on paper while generating little usable income with which to pay weekly care costs.

The Fair Deal three-year cap addresses this by limiting the period for which the principal residence contributes through the asset assessment. After the relevant three-year period, that property is no longer included in the calculation in the same way.

The principle is significant. Ireland has not chosen either complete protection of housing wealth or unlimited reliance on it. Instead, the scheme seeks to balance personal contribution with protection against open-ended erosion of the value of the family home.

For families, however, the rules can still feel complex, particularly when a decision about care is being made during illness or hospitalisation. Financial information therefore needs to be explained clearly and separately from the clinical question of whether nursing-home care is appropriate.

This is also a rights issue. Financial complexity should not pressure a person towards or away from a care setting without proper understanding of alternatives, costs and consequences. The wider principles of co-production, choice and control remain relevant even where substantial financial assessments are required.

The nursing home loan addresses liquidity rather than affordability alone

A person may have sufficient property assets to generate a substantial assessed contribution but lack the cash income needed to pay that contribution each week. Fair Deal therefore includes an optional nursing home loan, sometimes described as ancillary State support.

The loan allows the property-related element of the contribution to be deferred. The State effectively advances that part of the cost, secured against relevant property, with repayment occurring later under the scheme’s rules, commonly from the person’s estate after death unless repaid earlier.

This mechanism distinguishes wealth from liquidity. A person can own a valuable house without having substantial cash available.

The loan does not remove the contribution. It changes its timing. That distinction is important because deferred payment is still personal financial responsibility.

For system design, the model allows Ireland to use housing wealth within residential-care financing without requiring every household to sell property immediately when a person enters nursing-home care.

A couple’s finances show why the rules need to protect the person remaining at home

Consider a married couple in Galway. One partner develops advanced frailty and requires permanent nursing-home care while the other continues living in the family home.

Fair Deal does not simply treat all household income and assets as though both people have entered care. The applicant’s assessed contribution is based on the couple rules, which effectively apply half the single-person income and asset rates to their combined means.

The family home can still form part of the assessment, but the three-year cap limits the duration of that property-based contribution. The spouse remaining at home therefore retains a substantial degree of financial protection.

If the couple have significant property but limited liquid savings, the nursing home loan may be considered so that the property-related element can be deferred rather than creating an immediate cash-flow problem.

The important operational point is that financial assessment and care planning need to remain distinct but coordinated. The need for nursing-home care should be determined by care needs. The financial system then establishes how eligible care is paid for.

For the spouse at home, this is not an abstract funding formula. It determines household income, financial security and confidence about remaining in their own home. Long-term care financing therefore has consequences for two lives even when only one person enters residential care.

The NTPF determines a critical part of the private and voluntary nursing-home funding model

The National Treatment Purchase Fund performs a defined statutory role within Fair Deal. It negotiates the maximum price for long-term residential care with participating private and voluntary nursing homes.

The NTPF considers matters including costs reasonably and prudently incurred, evidence of value for money, previous prices, local market prices and public budget constraints. The resulting price is recorded through a deed of agreement.

The HSE then uses those agreed prices within Fair Deal administration. The NTPF does not determine the resident’s care need, calculate the individual financial assessment or regulate nursing-home quality. HIQA holds the regulatory role, while the HSE administers the scheme.

This separation is important because price, quality and eligibility are related but different functions.

A viable long-term care market requires prices that are affordable to the State while allowing competent providers to meet workforce, property, clinical, regulatory and operational costs. If prices are too high, public expenditure becomes less sustainable. If they are too low relative to legitimate cost, capacity, quality or provider stability may be affected.

This places risk management and compliance alongside financial stewardship. The cheapest nominal unit price does not necessarily represent the lowest system cost if it contributes to provider exits, workforce instability or reduced capacity in locations where alternatives are limited.

Fair Deal does not cover every cost of living in a nursing home

Fair Deal covers defined components of long-term residential care. It does not mean that every service a resident might use is automatically included.

Short-term respite, convalescent care and day care sit outside the scheme. Nursing homes may also charge separately for additional goods or services outside the approved core cost, depending on their contract with the resident.

This matters for transparency. A family comparing nursing homes needs to understand both the approved Fair Deal price and any additional charges that could arise.

The financial assessment determines the resident’s contribution towards the approved nursing-home cost. It does not necessarily determine their total personal expenditure once optional or additional services are considered.

Strong provider governance therefore includes clear contracts, understandable charges and meaningful consent around extras. Financial transparency is part of quality because uncertainty about charges can undermine trust and place pressure on residents or families.

Public nursing homes sit within a different cost structure

Ireland also operates public community nursing units and other HSE residential facilities. These form an important part of long-term care capacity but do not operate through precisely the same provider-price negotiation mechanism as private and voluntary homes.

The NTPF’s Fair Deal pricing role applies to participating private and voluntary nursing homes. Public nursing-home costs are managed through HSE arrangements.

This creates an important analytical challenge when comparing expenditure. A weekly price is not necessarily directly comparable across sectors if cost components, capital funding, staffing arrangements or accounting treatment differ.

Policy therefore needs to distinguish between price and full economic cost. Public provision may carry infrastructure and employment costs differently from an independent provider. Private and voluntary providers may need to recover property, financing and other costs through the agreed price.

For decision-makers, value for money should ultimately combine cost, quality, capacity and outcomes rather than reducing comparison to the lowest visible weekly figure.

Provider viability is a system-level issue, not merely a commercial issue

Where a region depends heavily on independent nursing homes, closure or withdrawal of capacity affects far more than the business concerned. Residents may need to move, families may travel further, hospitals may experience longer discharge delays and remaining homes may face increased demand.

This does not mean that the State should protect every provider regardless of efficiency or quality. It does mean that provider-market intelligence belongs inside public long-term care planning.

The same principle applies to home-support organisations. A provider can appear replaceable in procurement terms while being operationally difficult to replace in a rural locality with a limited workforce.

Financial governance therefore needs to monitor not just expenditure but capacity, concentration, workforce and quality. The Quality Dashboard Builder can help organisations structure information on quality and performance alongside financial indicators. It is not an Irish funding tool, but it reflects the wider principle that cost should never be viewed without the outcomes and risks attached to it.

The real financing imbalance lies in certainty as much as expenditure

The debate about home versus residential care is sometimes reduced to which setting costs less. That is too simplistic.

Home care may be significantly less costly for a person requiring a modest amount of daily support. At very high levels of dependency, however, providing continuous support to one person at home can be expensive, particularly where overnight presence, complex clinical tasks or multiple workers are required.

Residential care can achieve economies through shared staffing and infrastructure, but it also carries substantial accommodation, workforce and regulatory costs. More importantly, cost should not determine setting independently of safety, preference and quality of life.

The deeper structural issue in Ireland is the difference in funding architecture. Fair Deal gives eligible people a defined statutory route to financial support for long-term nursing-home care. Home support has historically operated through a publicly funded service model without the same statutory individual entitlement.

This can affect decision-making even where policy strongly favours ageing at home. A residential funding route that is relatively clear can feel more certain than a community package dependent on local capacity and available hours.

The central policy challenge is therefore to align financial certainty more closely with policy intent. If Ireland wants home to be a realistic first option for more people, home-support infrastructure needs sufficient predictability, workforce and governance to make that option dependable.

Unpaid family care is one of Ireland’s largest hidden financing mechanisms

Any analysis that counts only public expenditure and personal fees significantly understates the resources sustaining Ireland’s long-term care system.

Family members provide substantial assistance with personal care, supervision, meals, household management, transport, medicines, appointments and emotional support. This care often allows a person to remain at home with a comparatively small formal package.

Its economic value is considerable, even though it does not appear as an HSE service cost. It also has costs for carers themselves.

A family member may reduce working hours, decline promotion, leave employment, use savings or experience poorer health. Women continue to carry a disproportionate share of unpaid caring responsibilities, creating implications for lifetime earnings and retirement income.

Carer’s Allowance, Carer’s Benefit, respite and other supports recognise part of this contribution, but they do not convert family care into a fully paid service.

The financing question is therefore not simply how much unpaid care saves the State. That framing risks treating families as a cost-containment mechanism. The more appropriate question is what level of informal contribution is sustainable and freely chosen.

The wider family partnership and carer support agenda is critical because formal and informal capacity are connected. If unpaid care collapses through exhaustion, the resulting public cost may emerge suddenly through hospital admission, emergency home support or residential care.

A low-cost care arrangement can conceal a high family cost

An 83-year-old man in Cork receives a modest HSE home-support package. His daughter visits before work each morning, prepares meals in the evening, manages appointments and stays overnight several times a week because his dementia has progressed.

Measured only through public expenditure, his care appears relatively inexpensive. The HSE funds a limited number of hours and no nursing-home payment is required.

Measured across the whole household, the picture is different. His daughter has reduced her employment, loses income and is increasingly exhausted. Her own health is beginning to deteriorate.

If the arrangement continues unchanged until she can no longer cope, the father may eventually require urgent residential placement. The apparent saving from maintaining a small formal package may therefore have transferred cost onto the family before creating a larger public cost later.

A more mature financing assessment asks whether the total care arrangement is sustainable. Additional formal home support, respite or dementia services may increase expenditure now while protecting the longer-term stability of the household.

This illustrates why prevention and early intervention need financial as well as clinical analysis. The least expensive intervention today is not always the lowest-cost pathway over time.

Housing investment is also long-term care investment

Housing expenditure sits outside much of the conventional health and long-term care budget, but it can materially change future care needs.

Ireland has significantly increased funding for Housing Adaptation Grants for Older People and Disabled People. These grants can support changes that make homes safer and more accessible, while local-authority contributions increase the overall resources available.

From a narrow accounting perspective, an adapted bathroom belongs to housing expenditure. From the person’s perspective, it may determine whether they can continue washing independently or require recurring personal care.

This is an important example of prevention crossing departmental boundaries. The organisation paying for an adaptation may not be the organisation that receives the direct financial benefit if formal care needs subsequently reduce.

Effective governance therefore needs to understand cross-system value. The same applies to falls prevention, rehabilitation, transport and community participation.

The principles within health inequalities, prevention and early intervention are relevant because upstream investment can affect both future expenditure and equitable access. Older people with fewer personal resources are less able to finance adaptations privately and may therefore be more dependent on effective public schemes.

Regional budgeting creates an opportunity to connect costs across pathways

The development of six HSE Health Regions creates a potentially important change in financial governance. Regional leadership increasingly has responsibility for deploying resources across defined populations rather than viewing every service solely through a national programme structure.

This creates an opportunity to examine expenditure across the pathway.

If a region experiences high levels of delayed discharge because people are waiting for home support, investment in community capacity may provide benefits within the acute hospital system. If insufficient rehabilitation leads to greater long-term dependency, expenditure in one service may increase costs elsewhere.

The challenge is that budget structures can encourage organisations to optimise their own line rather than the whole pathway. The service paying for prevention may not be the service recording the eventual saving.

Population-based regional planning can help address this by examining:

• hospital use and delayed discharge;
• home-support demand and unmet need;
• community rehabilitation and prevention;
• nursing-home utilisation and availability;
• workforce capacity across settings; and
• outcomes such as sustained independence and readmission.

The goal is not to create a crude financial formula assigning a monetary value to every outcome. It is to stop budget boundaries from obscuring obvious relationships between services.

Better data is essential if Ireland is to know whether funding is balanced

Financial sustainability cannot be judged through expenditure growth alone. Ireland needs to know what additional funding buys.

For home support, relevant measures include hours delivered, waiting, timing, continuity, unmet need, provider capacity and whether support helps people remain at home. For residential care, measures include access, occupancy, quality, resident outcomes, provider viability and geographical availability.

Hospital information adds another dimension. If community investment rises while delayed discharge and avoidable readmission also worsen, leaders need to understand why.

Cost and quality therefore need to be viewed together. The quality data, KPIs and performance metrics agenda becomes central to financing because activity alone cannot show value.

The stronger evidence model links resources to a chain of consequences: what was funded, what capacity was created, who received support, whether access was equitable, what changed for people and what happened elsewhere in the system.

For organisations trying to strengthen this link, the Social Value Report Builder offers a structured way to think about outcomes and evidence beyond immediate financial inputs. It does not calculate Irish long-term care budgets, but it can support the broader discipline of demonstrating social and community value alongside expenditure.

Future reform will need to address the relationship between entitlements

Ireland’s future long-term care financing model will be shaped by demographic growth, workforce costs, public expectations and the continuing policy preference for supporting people at home.

A central question is whether home support should have a more explicit statutory footing and how future entitlements should relate to residential support.

This does not automatically mean replicating Fair Deal at home. Residential and home-based care have different cost structures and operational realities. Nor does it necessarily mean introducing personal charges for home support.

It does mean that Ireland will increasingly need to decide how predictable access to community support should be, how needs are prioritised, how public expenditure should respond to rising demand and how the State should balance collective and individual financial responsibility.

The Commission on Care for Older People provides an important strategic context for that debate. Later in this series, its implications will be examined directly. The financing issue running underneath is whether current arrangements remain sufficiently coherent for a much larger and more diverse older population.

A financing system should follow need rather than push people towards a setting

The strongest long-term care financing models minimise incentives that distort care decisions.

An older person should not enter residential care merely because the funding pathway is more predictable. Equally, they should not remain at home with an unsafe or exhausting arrangement simply because residential care is perceived as too costly to the family.

Funding should support proportionate choice within clinically and practically realistic options.

This requires assessment to consider the whole situation: the person’s abilities and wishes, housing, carers, workforce availability, clinical needs, safety and likely trajectory. Financial arrangements then need to support the appropriate pathway rather than determine it in advance.

The principles within outcomes, independence and community inclusion are particularly relevant. The goal of public expenditure is not simply to purchase care units. It is to create conditions in which people can live safely and with as much independence, dignity and connection as possible.

What Ireland’s financing model offers internationally

Ireland’s combination of tax-funded home support, means-related residential contributions and substantial family care reflects its own legal and institutional history. It should not be treated as a model that other countries can simply reproduce.

Its experience nevertheless highlights several internationally important principles.

First, the financing architecture matters as much as the headline budget. Two services can receive substantial public funding while offering very different levels of certainty to individuals.

Second, ageing-at-home policy needs financial credibility. Expanding community care requires funding for workforce, travel, provider capacity, housing and coordination rather than simply an aspiration to reduce residential use.

Third, residential funding needs to balance affordability for individuals, value for the State and sustainable provider capacity. These objectives can conflict and require active governance.

Fourth, unpaid care should be visible in economic planning without being reduced to a source of savings. Carers have their own rights, incomes and limits.

Finally, long-term care expenditure should be analysed across organisational boundaries. Investment in housing, rehabilitation or home support can influence hospital and residential costs even when the financial benefit appears in another budget.

Conclusion

Ireland’s long-term care financing system combines substantial public responsibility with important personal and family contributions, but it does so through markedly different mechanisms depending on where care is delivered. HSE home support is currently funded without a means test or client charge, while Fair Deal uses a statutory financial assessment to divide eligible nursing-home costs between the resident and the State. Private purchasing, unpaid family care, housing investment and community services sit around both.

That mixture has enabled Ireland to support a wide range of care arrangements, but demographic change makes the balance increasingly important. Budget 2026 shows significant investment in both home support and Fair Deal, recognising that community and residential capacity need to grow together. The longer-term challenge is to ensure that financial certainty does not unintentionally favour one setting over another.

Sustainable reform will depend on more than increasing expenditure. Ireland needs to connect money with workforce, provider viability, housing, regional capacity, quality and outcomes. It also needs to recognise the substantial hidden contribution made by families without allowing unpaid care to become the default solution to gaps in formal provision.

The strongest financing system will be one in which funding follows assessed need and informed preference as far as possible, public investment is judged by what it enables people to achieve, and national resources can be redirected when local evidence shows that the balance is wrong. As Ireland’s older population grows, financial sustainability and person-centred care will not be competing objectives. Increasingly, each will depend on getting the other right.