Question 14176 — personal services

Summary

Ms. Julie Delpech draws the attention of the Minister of Health, Families, Autonomy and People with Disabilities to the difficulties of implementing the reform of the mixed home help service in rural areas, as resulting from the LFSS 2026 and the decree establishing territorial social and medico-social groups (GTSMS). This reform, whose objective of coordination between nursing care and home help is shared, imposes a single entity model with a legal structure, a director and a budget which raises serious concerns among establishment directors. In rural areas, the forced merger between an SSIAD and a home help association can generate significant social tensions, linked to differences in collective agreements, statuses and professional cultures. Above all, it can lead to a loss of control over healthcare services by establishments which have neither the size nor the means to manage a restructuring of this magnitude. However, the model of reinforced agreement (contractual partnership between legally independent entities) has proven, in many territories, its capacity to ensure effective and flexible coordination between care and home help. Reduce it to a simple transitional stage doomed to disappear in favor of merger ignores the realities on the ground and weakens existing and proven cooperation. Exceptions to the principle of merger in the current form of the reform remain in practice inaccessible: their conditions of granting by the ARS remain insufficiently defined and their eligibility criteria difficult to read for the structures concerned. She therefore asks him, on the one hand, if the Government plans to recognize the reinforced agreement as a lasting and fully recognized method of organizing mixed SAD and not as a simple transitional phase and, on the other hand, if the reform were to continue in its current form, what precise instructions will be sent to regional health agencies to regulate the granting of exemptions in favor of small structures operating in rural areas, where the merger legal would impose disproportionate constraints with regard to local issues of continuity of care.

Machine translation from French. The official text remains authoritative.

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