Le d\u00e9bat sur la r\u00e9forme des services autonomie \u00e0 domicile (SAD) est relanc\u00e9 \u00e0 la suite d\u2019un rapport r\u00e9cent de la Cour des comptes qui remet en cause le principe de l\u2019int\u00e9gration de l\u2019aide et du soin au sein d\u2019une m\u00eame entit\u00e9 juridique. Dans un communiqu\u00e9 commun en date du 23 juillet 2026, plusieurs grands r\u00e9seaux du secteur de l\u2019aide et des soins \u00e0 domicile \u00e0 but non lucratif \u2013 Adedom, ADMR, FNAAFP, Nexem et UNA \u2013 contestent cette orientation et r\u00e9affirment leur soutien au mod\u00e8le de services int\u00e9gr\u00e9s, consid\u00e9rant que l\u2019abandon de l\u2019objectif d\u2019entit\u00e9 juridique unique constituerait une erreur strat\u00e9gique.<\/p>\n
Ces organisations soulignent que la transformation du secteur vers des services int\u00e9gr\u00e9s aide\/soin n\u00e9cessite du temps et repose d\u00e9j\u00e0 sur des d\u00e9marches engag\u00e9es dans de nombreux territoires, notamment des rapprochements entre structures publiques et priv\u00e9es. Elles jugent ces exp\u00e9riences r\u00e9ussies et estiment qu\u2019elles confirment la pertinence de l\u2019objectif poursuivi. Elles consid\u00e8rent que les coop\u00e9rations conventionnelles entre structures d\u2019aide et de soins ne doivent \u00eatre qu\u2019une \u00e9tape transitoire et plaident pour une int\u00e9gration plus forte des organisations, pr\u00e9sent\u00e9e comme favorable \u00e0 la fois \u00e0 la qualit\u00e9 des parcours des personnes accompagn\u00e9es et \u00e0 l\u2019am\u00e9lioration des parcours professionnels dans un secteur confront\u00e9 \u00e0 des enjeux d\u2019attractivit\u00e9. Selon elles, renoncer au principe de territoire d\u2019intervention unique entre l\u2019aide et le soin reviendrait \u00e0 ent\u00e9riner des faiblesses de la gouvernance territoriale.<\/p>\n
Le texte fait \u00e9cho \u00e0 une note d\u2019octobre 2025 du think tank Mati\u00e8res grises, dirig\u00e9 par Luc Broussy, qui relevait que la r\u00e9forme des SAD \u00e9tait globalement per\u00e7ue comme souhaitable par les services d\u2019aide \u00e0 domicile, notamment dans la perspective de b\u00e9n\u00e9ficier de la meilleure situation \u00e9conomique des services de soins. Les r\u00e9seaux \u00e0 but non lucratif, qui regroupent une majorit\u00e9 de services d\u2019aide et des services de soins, s\u2019opposent par ailleurs \u00e0 une autre recommandation de la Cour des comptes visant \u00e0 abandonner tout principe de tarification encadr\u00e9e des services d\u2019aide \u00e0 domicile au profit de r\u00e8gles nationales uniquement centr\u00e9es sur la limitation du reste \u00e0 charge pour les b\u00e9n\u00e9ficiaires.<\/p>\n
Ces acteurs d\u00e9fendent le maintien d\u2019un financement r\u00e9gul\u00e9 comme principale garantie de l\u2019\u00e9galit\u00e9 d\u2019acc\u00e8s aux services sur l\u2019ensemble du territoire national. Ils s\u2019appuient sur une d\u00e9cision r\u00e9cente du D\u00e9fenseur des droits allant dans ce sens et demandent, comme lui, un renforcement de la r\u00e9gulation nationale du secteur par la Caisse nationale de solidarit\u00e9 pour l\u2019autonomie (CNSA). Celle-ci devrait, selon eux, \u00eatre clairement investie d\u2019un r\u00f4le de garante de l\u2019\u00e9quit\u00e9 entre les territoires en mati\u00e8re d\u2019offre et de financement des services d\u2019aide et de soins \u00e0 domicile.\u00a0(contenu r\u00e9sum\u00e9 en fran\u00e7ais par l’IA)Lire la Suite<\/a><\/p>","protected":false},"excerpt":{"rendered":" Le d\u00e9bat sur la r\u00e9forme des services autonomie \u00e0 domicile (SAD) est relanc\u00e9 \u00e0 la suite d\u2019un rapport r\u00e9cent de la Cour des comptes qui remet en cause le principe […]<\/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":[2],"tags":[192],"class_list":["post-13658","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-sante-publique-et-systeme-de-soins","tag-caisse-des-depots"],"_links":{"self":[{"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=\/wp\/v2\/posts\/13658","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=13658"}],"version-history":[{"count":1,"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=\/wp\/v2\/posts\/13658\/revisions"}],"predecessor-version":[{"id":14252,"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=\/wp\/v2\/posts\/13658\/revisions\/14252"}],"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=13658"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=13658"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=13658"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}