End-of-Life Care in Irish Designated Centres: HIQA Regulations Guide

This guide covers Ireland. For the UK equivalent, see our guide: End of Life Care and Advance Care Planning: What CQC Expects From Care Homes.

If you run a designated centre for older people in Ireland, end-of-life care is covered by a specific regulation, by two standards in HIQA's national standards, and by a written policy you must have in place. This guide sets out what each says, where advance care planning fits, and what the sources do not specify, for providers, persons in charge and the managers who support them. For background on the regulator, see our guide to what HIQA is and what it does.

The legal basis: Regulation 13 of S.I. 415 of 2013

The Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013 (S.I. No. 415 of 2013) came into effect on 1 July 2014, according to the Irish Statute Book. Regulation 13 is headed "End of life care". Note that the duty in Regulation 13 is placed on the person in charge, not on the registered provider.

Under Regulation 13(1), where a resident is approaching the end of his or her life, the person in charge must ensure that:

• Care and comfort: the resident receives appropriate care and comfort that addresses physical, emotional, social, psychological and spiritual needs.
• Religious and cultural needs: these are met in so far as is reasonably practicable.
• Family: with the resident's consent, family are informed of the resident's condition, and suitable facilities are available for them to be with the resident.
• Location preference: where the resident indicates a preference about where they are, for example returning home or having a private room, that preference is facilitated in so far as is reasonably practicable.

Regulation 13(2) covers the time after death. The person in charge must ensure that appropriate arrangements are made, in accordance with the resident's wishes in so far as those wishes are known, and where reasonably practicable.

The Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) (Amendment) Regulations 2025 (S.I. No. 1 of 2025), made on 6 November 2024 and taking effect on 31 March 2025, amend the 2013 Regulations in many places. Its only change to Regulation 13 is to delete the words "and friends" in paragraph (1)(c). Check the current consolidated wording before you rely on a specific phrase in a policy.

What "reasonably practicable" means for your practice

Several limbs of Regulation 13 are qualified by "reasonably practicable" or "reasonably practical". The Regulations do not define those words or list what a provider may treat as impracticable. Our suggestion: where you cannot meet a stated wish, such as a private room, record what the wish was, why it could not be met, who discussed this with the resident or family, and what you did instead. This is not a legal requirement.

The related regulations that touch end of life

End-of-life care does not sit in Regulation 13 alone. These other provisions are relevant, according to the Regulations:

• Regulation 4 and Schedule 5: the provider must prepare in writing, adopt and implement the policies and procedures listed in Schedule 5. "End of life care" is one of the listed policy areas. Regulation 4 also requires them to be reviewed as often as the Chief Inspector may require, and at intervals not exceeding 3 years (as made).
• Regulation 5: the care plan must be prepared within 48 hours of admission, and formally reviewed at intervals not exceeding 4 months, after consultation with the resident and, where appropriate, the resident's family.
• Regulation 6: the provider must provide appropriate medical and health care, including a high standard of evidence-based nursing care, and make available a medical practitioner chosen by or acceptable to the resident, with access to additional professional expertise where required.
• Regulation 31 and Schedule 4: notification of incidents to the Chief Inspector. The 2025 replacement Schedule 4 lists the unexpected death of any resident, including a death following transfer to hospital from the centre, as an event to be notified within 2 days, with the circumstances and cause of death once established. Other deaths, including cause of death, are listed for the quarterly report. Timing is covered in the notifications section below.

The Regulations do not use the words "palliative care". That term appears in HIQA's national standards, covered next. For how inspectors use these documents together, see our overview of HIQA inspections and staff training.

What the National Standards add

HIQA's National Standards for Residential Care Settings for Older People in Ireland (2016) took effect on 1 July 2016. End-of-life matters sit in Theme 2, Effective Services, in two standards.

Standard 2.4

The standard states that each resident receives palliative care based on their assessed needs, which maintains and enhances their quality of life and respects their dignity. Feature 2.4.2 says that assessment of palliative care need is an ongoing process for those with a life-limiting condition. Feature 2.4.6 concerns staff providing palliative care being appropriately educated and having the knowledge to do so.

Standard 2.5: end of life

This standard states that each resident continues to receive care at the end of their life that respects their dignity and autonomy and meets their physical, emotional, social and spiritual needs. Features listed in the standard include:

• 2.5.1: residents receive timely assistance, if they want or need it, to discuss and plan for the end of life.
• 2.5.2: each resident is given the opportunity to obtain information on end-of-life care planning, and the feature refers to wishes in relation to advance care planning.
• 2.5.3: if a resident has difficulty in making or communicating decisions, all reasonable steps are taken to maximise their ability to participate in the decision-making process.
• 2.5.7: arrangements so that a resident is not unnecessarily transferred to an acute setting except for specific medical reasons.
• 2.5.8: every effort is made to ensure that the resident's choice as to place of death is identified and respected.
• 2.5.10: a written procedure for staff to follow after the death of a resident.
• 2.5.15: following a death, notification of the date, time and certified cause of death.

The standard also has features on staff training in end-of-life care, support for families and bereavement, and respectful handling of the deceased resident's body and belongings. Read those features directly in the Standards. The Standards also say that advance care planning provides residents with the opportunity to plan ahead for changes in circumstances.

Advance care planning and advance healthcare directives

The Regulations do not use the term "advance care planning". The Standards do, and the HSE's National Clinical Programme for Palliative Care Model of Care (approved 23 April 2018, published 25 April 2019) defines it as a process of discussion and reflection about goals, values and preferences for future treatment. It says people with life-limiting or life-threatening conditions should have regular, timely and supported opportunities to take part if they wish.

It helps to keep two things apart:

• Recording wishes: the HSE page on recording wishes for your care (last reviewed 6 December 2025) says anyone can share their care wishes in case they cannot make decisions in future, and that an informal document can record wishes not covered by law. Wishes about where someone wants care are not legally binding.
• Advance healthcare directive: Citizens Information (page last edited 4 December 2025) describes a written statement of the treatment someone wants or does not want if they later cannot decide. It must be made in writing and signed in the presence of 2 witnesses, and the person must be 18 or over. It is governed by the Assisted Decision-Making (Capacity) Act 2015. A refusal of treatment can be legally binding if the person loses capacity and the situation matches what the directive describes. A request for treatment is not binding but must be taken into consideration.

Check the current Regulations, National Standards and HIQA guidance for a centre-specific procedure on how a designated centre should store, check or act on a directive; the documents cited in this guide do not set one out. Do not treat a general note in a care plan as the same thing as a valid directive. Our suggestion: record in the resident's file whether a directive exists, where the original is, who the resident has named to be contacted, and when it was last discussed with them.

Palliative care input from outside the centre

The HSE page on palliative care (last reviewed 6 December 2025) says that you do not have to be dying to get palliative care, that all healthcare professionals can provide it, and that specialist palliative care teams exist. The Model of Care describes three levels: a palliative care approach practised by all professionals, general palliative care, and specialist palliative care. It also says residential care teams should feel empowered to access relevant specialist palliative care services appropriately. Referral routes and response times for a particular area are not set out in the sources, so check locally.

Notifications: timing changed in 2025

The timing changed in 2025. The 2013 text as made refers to notice "within 3 working days" in Regulation 31(1) and "within 3 days" in Schedule 4. S.I. No. 1 of 2025 amends Regulation 31(1) to read "2 working days", and its replacement Schedule 4 says the Chief Inspector is to be notified of the listed events "within 2 days of such occurrence". Check the current consolidated Regulation 31 and Schedule 4 before setting an internal deadline. If a death raises a safeguarding concern, see our guide to safeguarding vulnerable adults training.

A practical checklist for the person in charge

These are our suggestions, built from the sources above, and not legal requirements.

• Check that your end-of-life care policy exists, is in line with Schedule 5, is within its review period and matches what staff actually do.
• Check that each care plan records the resident's wishes on location, religious and cultural needs, who may be informed, and arrangements after death.
• Make sure staff know where the written procedure to follow after a death is kept.
• Agree who is responsible for contacting family, the GP and any specialist palliative care service, and record when you did.
• Review each death afterwards and record whether wishes were met.
• Set a training plan by role.

What the sources do not set

The Regulations as made and the Standards cited in this guide do not set a required form for an end-of-life plan, a named training course or a fixed number of staff hours for dying residents. Our suggestion: a clear written rationale shows how you reached a decision; it is not a requirement set out in the sources.

Learnsignal's offices are off Baggot Street in Dublin, and we offer in-person training from there. For current details, see our CPD pages.

Frequently asked questions

Which regulation covers end-of-life care in an Irish nursing home?

Regulation 13 of the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013 (S.I. 415 of 2013), headed "End of life care". The duty sits with the person in charge.

Is an advance care plan the same as an advance healthcare directive?

No. Citizens Information describes an advance healthcare directive as a written statement signed in the presence of 2 witnesses, and the HSE describes it as a legal document. The HSE says wishes about where someone wants care are not legally binding.

Does the 2025 amendment change end-of-life duties?

Its only change to Regulation 13 is deleting the words "and friends" from paragraph (1)(c). It also amended Regulation 31(1) to "2 working days" and replaced Schedule 4 on notifications, which includes deaths.

Review your end-of-life policy against Regulation 13 and Standards 2.4 and 2.5 this quarter, and keep the evidence on file.