La Cour des comptes, saisie par la commission des affaires sociales du S\u00e9nat, a publi\u00e9 le 8 juillet 2026 un rapport sur la r\u00e9forme des services autonomie \u00e0 domicile (SAD). Elle y rappelle que pr\u00e8s de 1,5 million de personnes avaient un besoin d\u2019aide \u00e0 l\u2019autonomie \u00e0 domicile en 2025, avec une augmentation attendue de 150 000 personnes suppl\u00e9mentaires d\u2019ici 2030 puis encore 200 000 d\u2019ici 2035. L\u2019augmentation pr\u00e9vue du nombre de personnes en perte d\u2019autonomie \u00e0 domicile d\u2019ici 2030 d\u00e9passe d\u00e9j\u00e0 le volume actuel de places dans les services de soins infirmiers \u00e0 domicile pour personnes \u00e2g\u00e9es (SSIAD), soit 127 073 places, ce qui met en \u00e9vidence une tension d\u00e9mographique forte.<\/p>\n
La r\u00e9forme des SAD vise \u00e0 coordonner les interventions des services d\u2019aide (SAAD) et des services de soins (SSIAD) \u00e0 domicile et \u00e0 rationaliser les territoires d\u2019intervention. Selon la Cour, le principe de cette r\u00e9forme fait consensus, mais ses modalit\u00e9s suscitent une opposition quasi unanime, notamment pour des raisons statutaires, malgr\u00e9 un assouplissement du calendrier par les pouvoirs publics. La Cour estime que la r\u00e9forme peut \u00eatre per\u00e7ue comme une double injonction, soit \u00e0 la privatisation de structures publiques, soit \u00e0 la nationalisation de structures priv\u00e9es, dans un contexte o\u00f9 les 2 000 gestionnaires de SSIAD sont majoritairement des acteurs priv\u00e9s \u00e0 but non lucratif, et secondairement publics, tandis que les 9 000 gestionnaires de SAAD sont principalement des op\u00e9rateurs priv\u00e9s commerciaux, puis des priv\u00e9s \u00e0 but non lucratif.<\/p>\n
Le rapport souligne la fragilit\u00e9 du mod\u00e8le \u00e9conomique des SAAD, caract\u00e9ris\u00e9 par un taux de d\u00e9faillances double de la moyenne des autres secteurs d\u2019activit\u00e9, alors que les SSIAD, historiquement plus solides financi\u00e8rement, doivent en parall\u00e8le absorber une r\u00e9forme de leur mode de tarification. La Cour constate que cette r\u00e9forme, jug\u00e9e importante et utile, entra\u00eene d\u00e9j\u00e0 des r\u00e9ductions de recettes pour certaines entit\u00e9s consid\u00e9r\u00e9es comme trop peu actives au regard des services rendus.<\/p>\n
Face \u00e0 cette situation, la Cour des comptes recommande un pilotage pragmatique de la r\u00e9forme, centr\u00e9 sur les r\u00e9sultats obtenus par les acteurs de terrain au service des usagers plut\u00f4t que sur la forme juridique de l\u2019int\u00e9gration des services. Elle propose que, pour l\u2019attribution des autorisations \u00e0 exercer, trois indicateurs de r\u00e9sultat deviennent d\u00e9terminants : le nombre de personnes prises en charge conjointement au titre de l\u2019aide et des soins, le recensement des \u00e9v\u00e9nements ind\u00e9sirables (refus ou ruptures de prise en charge) et le nombre d\u2019heures annuelles d\u2019aide r\u00e9alis\u00e9es. Ces orientations visent \u00e0 adapter la politique de l\u2019autonomie \u00e0 l\u2019urgence d\u00e9mographique et \u00e0 la crise du secteur de l\u2019aide \u00e0 domicile.\u00a0(contenu r\u00e9sum\u00e9 en fran\u00e7ais par l’IA)Lire la Suite<\/a><\/p>","protected":false},"excerpt":{"rendered":" La Cour des comptes, saisie par la commission des affaires sociales du S\u00e9nat, a publi\u00e9 le 8 juillet 2026 un rapport sur la r\u00e9forme des services autonomie \u00e0 domicile (SAD). […]<\/p>\n","protected":false},"author":1,"featured_media":9221,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[18],"tags":[192],"class_list":["post-13641","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-autonomie-et-age","tag-caisse-des-depots"],"_links":{"self":[{"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=\/wp\/v2\/posts\/13641","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=13641"}],"version-history":[{"count":1,"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=\/wp\/v2\/posts\/13641\/revisions"}],"predecessor-version":[{"id":14381,"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=\/wp\/v2\/posts\/13641\/revisions\/14381"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=\/wp\/v2\/media\/9221"}],"wp:attachment":[{"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=13641"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=13641"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=13641"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}