Helena was the most active member of the royal family, carrying out an extensive programme of royal engagements. She was also an active patron of charities, and was one of the founding members of the British Red Cross. She was founding president of the Royal School of Needlework, and president of the Workhouse Infirmary Nursing Association and the Royal British Nurses' Association. As president of the latter, she was a strong supporter of nurse registration against the advice of Florence Nightingale. In 1916 she became the first member of her family to celebrate her 50th wedding anniversary, but her husband died a year later. Helena outlived him by six years, dying aged 77 on 9 June 1923.