The service offer for elderly people in France has been undergoing a profound restructuring for several years. Between the creation of the Home Autonomy Service (SAD), the “Aging Well” law of April 8, 2024, and the gradual expansion of the scope of home interventions, the landscape of senior support is changing shape without families always realizing its concrete implications.
Home Autonomy Service: a merger that redefines senior support
Decree No. 2023-608 of July 13, 2023, laid the groundwork for a major reorganization. The former SAAD (home assistance and support services), SSIAD (home nursing services), and SPASAD are gradually being grouped under a single category: the Home Autonomy Service (SAD). Two forms coexist: the SAD assistance and the mixed SAD, which combines human assistance and nursing care within a unified framework.
This merger aims to eliminate breaks in care between daily assistance and medical care. A senior who needs a home helper for bathing and a nursing visit for a dressing theoretically falls under a single point of contact, where previously two distinct structures had to be coordinated. The transition to this model is expected by 2026.
To accurately identify the services offered by Info Seniors, it may be useful to cross-reference these regulatory categories with the actual needs of the household, as administrative terminology often obscures very variable intervention realities from one department to another.
Interventions outside the home: what the July 2024 decree changes
A decree from July 7, 2024, has expanded the scope of authorized interventions. Until then, assistance focused on actions performed at home. The text now specifies that services can intervene “at home or from home”, which includes shopping, leisure activities, civic participation, and transportation, provided these activities are included in the notified assistance plan.
This evolution is not trivial. It recognizes that maintaining autonomy also involves mobility and social connections. Assistance to attend a community activity or do grocery shopping at the market falls within the service’s scope, without the family having to separately finance transportation or a companion.
Field feedback varies on this point: some departments apply this extension broadly, while others remain cautious in validating assistance plans that include regular outings. The practical implementation heavily depends on the local interpretation by departmental councils.
“Aging Well” law and administrative simplification for seniors
Law No. 2024-317 of April 8, 2024, known as the “Aging Well” law, complements this system. Among its measures, it facilitates the transformation of SSIAD into mixed SAD through a mechanism of administrative silence deemed acceptance after six months. This rule reduces transition times for structures wishing to expand their offerings.
The law also introduces provisions on combating the isolation of elderly people and strengthening the role of autonomy residences. These establishments, distinct from nursing homes (EHPAD), host seniors who are still autonomous in individual housing with shared spaces and services (catering, activities, coordination with health professionals).
Autonomy residence and home care: two complementary logics
The choice between staying at home with home services or moving into an autonomy residence depends on several factors that families sometimes underestimate. The autonomy residence is suitable for seniors who maintain their independence but wish to break isolation. Home care with a SAD remains appropriate when the housing is accessible and the assistance plan covers daily needs.
The available data do not allow for a conclusion that one option systematically offers a better quality of life/cost ratio than the other. It all depends on the level of GIR, the configuration of the housing, the presence of close caregivers, and the local service offerings.
Financial assistance and coordination: concrete bottlenecks
The Personalized Autonomy Allowance (APA) remains the primary funding lever for seniors experiencing loss of autonomy (GIR 1 to 4). The Retirement Insurance offers a support plan for autonomous but vulnerable retirees, subject to income conditions. This plan may include hours of home assistance, prevention advice, and housing adaptation solutions.
The recurring issue does not lie in the existence of these aids, but in their coordination. A senior may simultaneously qualify for the APA, assistance from their supplementary pension fund, a tax credit for home employment, and pre-funded CESU. Coordinating these systems requires administrative expertise that neither elderly individuals nor their caregivers always possess.
- The APA at home finances a personalized assistance plan assessed by a departmental medico-social team, with a variable out-of-pocket cost depending on income.
- The Retirement Insurance assistance plan targets retirees from the general scheme who are still autonomous, with prevention services (ergotherapy, memory workshops, assistance with transportation).
- The pre-funded CESU, offered by some mutual insurance companies and pension funds, simplifies the payment of caregivers but only covers part of the hourly cost.
The role of local information points
Local information points for elderly people and their families often serve as the first access to reliable guidance. They help identify available services in a given area and avoid overlaps between aids. Their coverage remains uneven across departments.
The reform of the SAD and the “Aging Well” law aim to simplify this landscape. The unification of assistance and care structures under a single label should ultimately reduce the number of contacts for families. The effective implementation of this simplification, department by department, remains the real challenge of the coming years.
