Healthcare, Nutrition, Pressure Ulcers and Oral Health in Irish Designated Centres

This guide covers Ireland. For the UK equivalent, see our guide: Pressure Ulcer Prevention in Care Homes: Meeting CQC Regulation 12.

If you run a designated centre for older people in Dublin or anywhere else in Ireland, healthcare, food and nutrition, pressure ulcer prevention and oral health sit on the same inspection thread: the resident's assessment and care plan. This guide sets out what the Irish Regulations actually say, which HIQA Standards line up with them, and where HSE guidance fills gaps the Regulations leave open. It covers registered care settings for older people under the Health Act 2007 and S.I. 415 of 2013. It is not legal advice.

Healthcare delivery depends heavily on medicines and on trained staff, so it helps to read this alongside our guides to medication management training for healthcare staff and HIQA inspections and staff training.

Where the rules sit

The Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013 (S.I. 415 of 2013) are published on irishstatutebook.ie. The version published there is the Regulations as made. The later amending instruments include S.I. 293 of 2016, S.I. 428 of 2017, S.I. 628 of 2022 and S.I. 98 of 2025 (which, according to its page, revokes S.I. 1 of 2025). According to their published pages, none of them amends Regulations 5, 6, 15, 16 or 18, or Schedule 3. So the wording below is the wording in force for those provisions according to those pages. The Department of Health also publishes an informal consolidation, but its page carries a disclaimer that no responsibility is accepted for accuracy or currency, so check the legal text itself before relying on any quotation.

HIQA is the regulator. The Standards referred to are the National Standards for Residential Care Settings for Older People in Ireland (2016). For how inspectors approach each regulation, this guide draws on HIQA's Assessment-judgment framework for designated centres for older people (version 4.1, May 2025). If you want the wider picture of HIQA's role first, see what HIQA is and what it does.

Healthcare: Regulation 6 and the care plan

Regulation 6(1) requires the registered provider, having regard to the care plan, to provide appropriate medical and health care, including a high standard of evidence-based nursing care, in accordance with professional nursing guidelines. The Regulations as made name An Bord Altranais agus Cnáimhseachais; HIQA's 2025 framework refers to the Nursing and Midwifery Board of Ireland.

Regulation 6(2) places duties on the person in charge. So far as reasonably practical, they must make available to each resident:

• a medical practitioner chosen by or acceptable to the resident;
• any recommended treatment, where the resident agrees to it; and
• access to further treatment where the care needs additional professional expertise.

The care plan itself comes from Regulation 5. A comprehensive assessment by an appropriate health care professional is required, the care plan is due no later than 48 hours after admission, and it must be formally reviewed at intervals not exceeding 4 months. HIQA's framework links Regulation 5 to Standard 2.1 and Regulation 6 to Standard 4.1.

Standard 4.1 covers health and wellbeing and access to services. Its features include timely access to a GP or doctor of the resident's choice, timely referral to health and social care professionals, and access to screening and community services, including dental, optical and aural services. Beyond naming the medical practitioner in Regulation 6(2), the Regulations do not list the other professions that should be involved, so the Standards and the resident's assessed needs do the work of defining who should be involved.

Food and nutrition: Regulation 18

Regulation 18 is short and specific. The person in charge must ensure that each resident:

• has access to a safe supply of fresh drinking water at all times;
• is offered choice at mealtimes; and
• is provided with adequate quantities of food and drink that are properly and safely prepared, cooked and served, are wholesome and nutritious, and meet dietary needs prescribed by health care or dietetic staff, based on nutritional assessment in the individual care plan.

Regulation 18 also requires meals, refreshments and snacks to be provided at all reasonable times, and an adequate number of staff to be available to assist residents at meals and when other refreshments are served. HIQA's framework maps this regulation to Standard 2.2.

Standard 2.2 adds expectations the Regulation does not spell out. Its features include nutritional assessment on admission and regularly afterwards, a clear referral pathway to nutrition and dietetics services, staff vigilance in monitoring food and fluid intake, unhurried mealtimes and assistance offered discreetly and individually. Standard 3.4 on medicines also lists drug-nutrient interaction among the matters to consider in medication reviews.

The Regulations do not name a screening tool, a weighing frequency or a dietitian-to-resident ratio, and HIQA's framework does not name any either. Standard 2.2 refers to assessing nutritional status on admission and regularly thereafter, and its supporting text refers to a validated nutritional screening assessment tool, but it does not name one, so choosing and documenting the approach is a clinical decision for your team. For texture-modified food and thickened drinks, the HSE has published a short page on the International Dysphagia Diet Standardisation Initiative (IDDSI), with new terminology from September 2019. The page is undated and does not mention nursing homes, so we treat it as background, not a rule for your centre. Standard 2.2 also expects a clear pathway for referral to nutrition and dietetics services and speech and language services.

Schedule 5 also lists "monitoring and documentation of nutritional intake" among the written policies the provider must have. Regulation 4 requires those policies to be reviewed at intervals not exceeding 3 years.

Pressure ulcers: what the Regulations say and what they leave to guidance

Pressure ulcers are not the subject of a dedicated regulation. They appear in Schedule 3, which sets out resident records: paragraph 4 requires a record of any incident of pressure ulcers and of the treatment provided, and a record of falls and treatment. In our reading, prevention therefore falls under Regulation 6 (appropriate health care and evidence-based nursing care) and the care plan.

For the clinical detail, the HSE National Wound Management Guidelines 2018 apply to all care settings. Section 3 on pressure ulcers is built around the SSKIN bundle, and its good practice points include not relying on a risk assessment tool alone, and distinguishing blanching from non-blanching redness when documenting skin changes. The guidelines use four stages plus suspected deep tissue injury, and say stable heel eschar should be documented as at least Stage III until proven otherwise.

The HSE's October 2022 guide, Pressure Ulcers: A Practical Guide for Review, is written for HSE and HSE-funded services. It says pressure ulcers present on admission are recorded in the health record and care plan rather than reported by the receiving service. It also states that residential services must notify HIQA of pressure ulcers at Stage II or higher in quarterly notifications. Whether its internal incident-reporting steps apply to your centre depends on whether you are an HSE or HSE-funded service, so confirm that before adopting them.

The notification point

The notification schedule in the Regulations as made does not list pressure ulcers by name. HIQA nonetheless publishes form NF39E, the quarterly notification of incidents for designated centres for older people (version 2.1, effective from July 2025). It asks for any pressure ulcer of category II or higher sustained by a resident, with the category, whether medical or hospital treatment was needed and where it was sustained. The form cites no regulation, and refers providers to the Chief Inspector's notification guidance. Notification rules were also amended in 2025, so check HIQA's current notification guidance rather than relying on a summary like this one.

Oral health

The Regulations do not mention oral health or dental care. The Standards do touch it: Standard 4.1 refers to access to dental services, and Standard 2.2 to nutrition, which oral problems can affect.

The detailed reference is the HSE National Oral Care Guideline (Supporting Smiles) for health and social care teams supporting daily oral care for adults who require assistance. The HSE page gives its effective date as 13 October 2025. The full document says it covers adults in older person residential settings among others, with next review due 13 October 2028. Its key recommendations include:

• assessing oral health on admission using the Oral Health Assessment Tool (OHAT) and reviewing at least every 6 months, or sooner if needs change;
• an individualised oral care plan based on that assessment;
• oral care at least twice daily, with a soft toothbrush and 1450 ppm fluoride toothpaste;
• dentures cleaned and brushed twice daily, removed overnight and stored dry in a labelled, lidded container;
• referral to a dentist, medical team or speech and language therapist for conditions rated high risk, and documenting each delivery of daily oral care and any persistent refusal of it.

This is a HSE guideline, not a statutory requirement for your centre. Our suggestion: use it as the benchmark for your own oral care policy and care plan wording, and record how you chose to apply it.

A practical approach for providers

These steps are our suggestions, not legal requirements.

• Check that each care plan links nutrition, skin integrity and oral care to the assessment, not generic wording.
• Make sure staffing at mealtimes is visible on rosters, because Regulation 18 refers to enough staff to assist. Regulation 15 requires the number and skill mix of staff to suit residents' needs, and Regulation 16 requires access to appropriate training and appropriate supervision.
• Audit the records Schedule 3 requires, including pressure ulcer and falls records.
• Keep a note of which HSE guidelines you follow, and the date you last reviewed them.
• Reconcile your quarterly returns with your internal pressure ulcer register before each submission.

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

Is there a Regulation specifically about pressure ulcers?

Not in the Regulations as made. Pressure ulcers appear in the Schedule 3 resident records requirement, while prevention sits under healthcare and the care plan.

Does Regulation 18 require a dietitian?

It requires food and drink to meet dietary needs prescribed by health care or dietetic staff, based on nutritional assessment. It does not say that every centre must employ a dietitian.

How often must a care plan be reviewed?

Regulation 5 says at intervals not exceeding 4 months. The plan is due no later than 48 hours after admission.

Are the HSE oral care and wound guidelines mandatory for private nursing homes?

Check the current text of the HSE guidelines for whether they apply to private nursing homes. They are HSE guidelines for health and social care teams. We suggest treating them as strong good practice and documenting how you apply them.

Check each source's date before you update policies, and ask your own legal adviser if you are unsure how a provision applies to your centre.