Question 14949 — personal services

Summary

Mr. Emmanuel Duplessy draws the attention of the Minister of Health, Families, Autonomy and People with Disabilities to the consequences of the 2023 reform relating to the structuring of home help and care services and their pricing. Presented as a tool for improving the coordination of the journeys of elderly people and those experiencing loss of autonomy, this reform aims to strengthen cooperation between home help and support services (SAAD) and home nursing care services (SSIAD). If this ambition for better articulation of interventions can be shared, its implementation today raises a certain number of questions from those involved in the field. Firstly, the structures concerned report organizational difficulties linked to the evolution of intervention frameworks and requirements news in terms of team coordination and qualification. These transformations, although guided by a quality objective, require significant adaptations in a context already marked by strong tensions on human resources. Secondly, professionals warn of persistent imbalances in financing methods. Home help services remain mainly financed on the basis of administered hourly rates, often considered insufficient in view of the evolution of costs, particularly salaries and logistics. Conversely, home care systems fall under distinct financing arrangements, which can create differences in care between structures working with similar populations. These differences in pricing call into question the overall clarity of the sector's economic model and may, in certain cases, making the management of support pathways more complex, even as the needs of elderly people tend to increase in intensity and complexity. More broadly, these developments take place in a context of strong budgetary tension, recruitment difficulties and the weakening of numerous associative structures, particularly in rural and peri-urban areas. This situation calls for a particular attention to guarantee the continuity and accessibility of home help and care services. Under these conditions, he asks how the Government intends to ensure sustainable and coherent financing of home services as part of the reform undertaken; what measures are being considered to reduce pricing differences between systems serving populations with similar needs; and how he plans to support structures in the organizational adaptations induced by this reform, in order to secure the continuity of the offer throughout the territory.

Machine translation from French. The official text remains authoritative.

Timeline

1. 5 May 2026

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• Emmanuel Duplessy · auteur

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