Visits to social and medico-social establishments (ESMS) in the field of autonomy

This text is immediately useful to the management of ESMS, health executives, quality referents, CVS, and ARS teams to legally secure the organisation of visits and any potential restrictions. It allows for a review of operational regulations, residency contracts, reception procedures, and inspection-control methods in light of the new fundamental right to visit enshrined in the law of 8 April 2024. It also equips ARS services to handle complaints, document shortcomings, and manage regional action plans via the SI‑ICEA.

Source: 📒 Visits to social and medico-social establishments (ESMS) in the field of autonomy

📜🔗LINK

Number of pages: 7

1. Analytical summary

Context, issues, and target audiences

The instruction is part of the continuation of law no. 2024-317 of 8 April 2024, which explicitly enshrines the right of residents in social and medico-social establishments (ESMS) for elderly people and people with disabilities to receive visitors, now integrated into article L. 311-5-2 of the CASF and article L. 1112-2-1 of the CSP for health establishments. It follows the report "Obstructed Places, Forbidden Goodbyes" by Laurent Frémont, which documented the harmful effects of visiting restrictions, particularly in the context of health crises, on residents of nursing homes and other establishments. The text primarily targets the regional health agencies (ARS), recipients of the instruction, but also engages the management of ESMS and the pricing and control authorities, including departmental councils. By reminding that ESMS must guarantee the possibility for each resident to receive any visitor of their choice every day, without prior notification, unless expressly requested by the person, the instruction positions this right as a component of respect for privacy and the fight against the isolation of vulnerable groups. It specifies the strict and regulated conditions under which a director may oppose a visit, only in cases of a threat to public order or a proven health risk assessed by a doctor, referring to the case law of the Council of State on the proportionality of restrictions.

Operational contributions for stakeholders

On an operational level, the instruction sets out five expected actions from the ARS: dissemination of the application modalities of the law to ESMS, enhanced vigilance, meetings with management in cases of unjustified restrictions, systematic integration of the respect for the right to visit in the 2026 inspection-control programmes, and informing the declarants with an annual report on complaints. It details the administrative (ARS, departmental council, Defender of Rights, future single complaints form, regional platforms) and judicial (administrative court for public managers, judicial court for private ones) avenues for appeal, specifying that service constraints or lack of staff cannot justify limitations on visits. The document clarifies the obligations of establishment directors: concrete organisation of visitor reception including outside administrative hours, integration of the right to visit in the operating regulations and the residency contract, informing residents, and providing written justification for any restrictions. The annex finally provides a step-by-step guide for coding in the SI-ICEA the injunctions related to non-compliance with the right to visit (theme "Care", sub-theme "Respect for the rights of individuals", mention "Non-compliance with the right to visit" in comments), in order to enable a consolidated national follow-up of the discrepancies observed.

2. Key points of the document 

1. The right to visit as an explicit fundamental right

   The instruction reminds that the law of 8 April 2024 introduced in article L. 311-5-2 of the CASF an explicit right for individuals accommodated in ESMS to receive any visitor of their choice every day, without prior information conditions, except at the request of the resident themselves, and that this right is in line with the respect for the privacy of individuals [file:1, p.1-3].

2. Strict framework for possible restrictions

   The text specifies that the management of establishments can no longer set restrictive visiting hours in the operating regulations or residency contracts, and that they can only restrict visits in exceptional, proportionate, justified, and time-limited cases, in the event of a threat to public order or a proven health risk, in accordance with the case law of the Council of State on the necessity, adaptation, and proportionality of measures [file:1, p.3‑4].

3. Clearly defined administrative and judicial appeal routes

   The instruction details the procedures for appeals and complaints in the event of non-application of the right to visit: referral to the pricing and control authorities (ARS, departmental council), the possibility of referring to the Defender of Rights, the use of the future single complaints form, and judicial recourse before the administrative or judicial court depending on the status of the manager [file:1, p.4].

4. Mandatory action plan for ARS and integration into inspection-control

   The document requires ARS to disseminate the application methods of the law, to ensure enhanced vigilance, to engage in dialogue with establishments in cases of unjustified restrictions, and to systematically include the theme of respect for the right to visit in the 2026 inspection-control programmes, documenting the discrepancies observed and using the SI-ICEA tool to report injunctions to the DGCS [file:1, p.1‑2, 4‑5].

5. SI-ICEA tool mobilised as a national steering support

   The annex proposes an operational guide for entering decisions regarding the "Non-compliance with the right to visit" into the SI-ICEA within the inspections-controls of ESMS for elderly and disabled persons, in order to enable comprehensive and consistent monitoring of breaches across the entire territory, including within the framework of ONIC [file:1, annex p.1-2].

3. Action points for local stakeholders 

1. Immediately revise contractual and informational documents

   The management of ESMS can initiate a rapid revision of operational regulations, welcome brochures, and residency contracts to clearly integrate the daily right to visit, without limiting hours, and the exceptional conditions for restrictions provided for by Article L. 311-5-2 of the CASF, in line with the recommendations of the DGCS [file:1, p.3-4].

2. Concretely organise the reception of visitors outside administrative hours

   Management teams and executives can adapt internal organisation (reception procedures, on-call duties, instructions to staff) to make evening, weekend, or care-time visits effective, ensuring that safety is maintained without using service constraints as a reason for restriction [file:1, p.3-4].

3. Train and equip teams and CVS on the right to visit

   Professionals (caregivers, educators, hospitality staff) and user representatives in CVS can benefit from information sessions focused on the new legal framework, the right of residents to refuse, the procedures for notifying restrictions, and appeals, supported by examples and legal reminders provided by the instruction [file:1, p.3-4].

4. Structure the processing of complaints and appeals at the regional level

   The ARS can establish a clear process for receiving, analysing, and following up on complaints related to the right to visit, by coordinating the regional platform "ARS complaint form", the future single complaint form, and inspections-controls, with annual data reporting and systematic information to reporters on the outcomes [file:1, p.1‑2, 4‑5].

5. Use the SI-ICEA as a lever for managing the quality of rights

   The inspection-control services of the ARS can systematise the coding of injunctions related to the non-compliance with the right to visit under the theme "Care" and the sub-theme "Respect for the rights of individuals", by adding the mention "Non-compliance with the right to visit" in the comments, in order to produce useful regional and national reports for improving practices [file:1, annex p.1‑2].

4. Additional references 

🔍➕ For more information, see the articles referenced by "Practices in Health" on the theme of ESSMS ➡️🔗https://pratiquesensante.odoo.com/medico-social-social-essms

1. Law No. 2024-317 of 8 April 2024 on measures to build a society for healthy ageing and autonomy, articles relating to the right to visit in social, medico-social, and health establishments.

   URL (accessible):https://www.legifrance.gouv.fr/jorf/article_jo/JORFARTI000049385899 

2. Public life – File "Law of 8 April 2024 Healthy ageing, old age and autonomy (EHPAD)" (online 2024, updated) presenting the main measures, including the strengthened right to visit in establishments.

   URL (accessible):https://www.vie-publique.fr/loi/291928-loi-du-8-avril-2024-bien-vieillir-grand-age-et-autonomie-ehpad 

5. Cross-sectional analysis — Values of Practices in Health

• Literacy: The text remains legal but clearly outlines rights and obligations, without specific simplification measures for low literacy audiences, apart from a concise summary on the cover page [file:1, p.1‑2].

• Empowerment: The document strengthens the agency of residents and their relatives by detailing their right to visit, the right to refuse visits, and the avenues for recourse, but does not offer participatory co-construction tools [file:1, p.3‑4].

• Participation: Participation is mainly mentioned through the possible mobilisation of the social life council (CVS) to relay information and discuss implementation modalities, without formalised co-decision mechanisms [file:1, p.4‑5].

• Community health: The collective dimension appears through the consideration of the effects of isolation on vulnerable groups and the organisation of daily visits, but the logic remains focused on individual rights rather than structured community dynamics [file:1, p.2‑4].

• Ethics: The document explicitly addresses the proportionality of restrictions and tensions between health protection, safety, psychological well-being, and respect for privacy, without delving deeply into cultural biases but reminding of the principle of non-discrimination by law [file:1, p.3‑4].

• Human rights: The instruction is in line with fundamental texts (Declaration of 1789, Constitution of 1946, law 2002-2) and affirms the right to visit as a fundamental enforceable right, reinforcing the principles of equity and inclusion for elderly and disabled individuals [file:1, p.2‑3].

• Intersectorality: The text clearly positions the ARS, departmental councils, Defender of Rights, and managers of ESMS, but does not describe partnerships beyond the health, social, and medico-social fields [file:1, p.1-2, 4-5].

• Partnership: The instruction mentions work with federations of establishments to support implementation, as well as the dialogue between ARS and ESMS management within the framework of inspections-controls, without formalising detailed partnership models [file:1, p.4-5].

• Combating discrimination: The document does not explicitly address targeted discrimination (gender, origin, sexual orientation, etc.), but the general, everyday, and unconditional nature of the right to visit helps to limit arbitrary or discriminatory restrictions [file:1, p.3-4].

Points of vigilance in facilitation

This instruction deals with a sensitive right (visits, end of life, isolation, experience of deprivation of liberty) but does not cover a theme typically classified as "gender-based and sexual violence, unaccompanied minors, disability in the activist sense, LGBTQI+, HIV/PrEP, chemsex" even though disabled individuals are concerned in terms of autonomy. The risks of emotional triggering mainly lie in the reactivation of experiences of prohibited visits, end of life without loved ones, or family-establishment conflicts implicitly mentioned through the report "Constrained Places, Forbidden Goodbyes" and the reminder of case law on abusive restrictions.

For training, it is therefore advisable to:

• Inform participants that situations of isolation, refusal of visits, and end of life will be addressed, allowing the possibility to withdraw if needed.

• Plan for periods of regulation, distancing, and, if possible, a referral to support services (occupational psychologist, supervision).

• Emphasise concrete levers for action (rights, procedures, SI-ICEA) to move away from a solely guilt-inducing or traumatic framework.

6. Assessment of the reliability of the resource

• Scientific and legal relevance:

  The instruction is a primary source from the competent ministry, validated by the National Steering Council and published in the Official Bulletin, which gives it high legal authority. It is based on explicit references, notably law no. 2024-317, the CASF, the CSP, and a decision from the Council of State, and does not present numerical data subject to rapid obsolescence.

• Operational relevance:

  The text is directly usable by the ARS and ESMS managers, with concrete actions, a deadline (31 December 2026) for the effective implementation of the right to visit, and precise follow-up procedures via SI-ICEA. It also describes the avenues for appeal and the responsibilities of the various actors, making it an immediately usable tool for management, control, and rights advocacy practices.

7. MCQ — 5 questions

Part 1 — Questions (without answers)

Question 1 (p.1-3):

What is the main contribution of article L. 311-5-2 of the CASF for residents of ESMS?

a) It limits visits to only family members.

b) It allows directors to freely set visiting hours.

c) It guarantees the right to receive any visitor of their choice every day.

d) It prohibits visits during a health crisis.

Question 2 (p.3‑4):

In what case can a director of an ESMS legally oppose a visit?

a) In the event of a lack of available staff for reception.

b) If the visit poses a threat to public order or health.

c) If the visit takes place during meal times.

d) When the resident is already receiving only one visit per week.

Question 3 (p.4):

What is the competent authority for a legal appeal against a public establishment in case of non-compliance with the right to visit?

a) The judicial court.

b) The departmental council.

c) The administrative court.

d) The Defender of Rights.

Question 4 (p.1‑2, 4‑5):

Which of the following actions is part of the five actions expected from the ARS according to the instruction?

a) Set a maximum quota of visits per resident.

b) Reduce the number of inspections-controls in ESMS.

c) Include the theme of respecting the right to visit in the 2026 inspection-control programme.

d) Fully delegate the monitoring of the right to visit to the federations of establishments.

Question 5 (annex p.1‑2):

How should the ARS code an injunction related to non-compliance with the right to visit in the SI-ICEA?

a) In the theme "Financial management" and the sub-theme "Budget".

b) In the theme "Care" and the sub-theme "Respect for the rights of individuals".

c) In the theme "Human Resources" and the sub-theme "Organisation of Work".

d) In the theme "Infrastructure" and the sub-theme "Fire Safety".

Part 2 — Commented Correction

Question 1 :

✅ Correct answer: c) It guarantees the right to receive any visitor of their choice every day.

📝 Explanation: Article L. 311-5-2 of the CASF, stemming from the law of 8 April 2024, requires establishments for elderly and disabled persons to guarantee the right for each resident to receive any visitor of their choice daily, without making this visit subject to prior information, unless requested by the resident [file:1, p.2-3]. The other proposals introduce restrictions not provided for by law.

Question 2 :

✅ Correct answer: b) If the visit poses a threat to public order or health.

📝 Explanation: The instruction reminds that the establishment director can oppose the right to visit only if the visit poses a threat to public order inside or around the establishment, or to the health of the resident, other residents, or professionals, as assessed by a doctor [file:1, p.3-4]. Lack of staff, meals, or visits deemed too frequent are not legal grounds for restriction.

Question 3 :

✅ Correct answer: c) The administrative court.

📝 Explanation: In the event of non-compliance with the right to visit, the competent jurisdiction depends on the status of the manager: for establishments under public law entities, it is the administrative court that is competent, while the judicial court is competent for private managers [file:1, p.4]. The departmental council and the Defender of Rights can be approached for appeals or complaints, but they are not courts of judgment.

Question 4:

✅ Correct answer: c) Include the theme of respect for the right to visit in the 2026 inspection-control programme.

📝 Explanation: Among the five actions expected from the ARS, the instruction explicitly mentions the inclusion of respect for the right to receive visits in the 2026 inspection-control programme, in order to identify situations of deficiency and to urge managers to remedy them [file:1, p.1-2, 4-5]. The other proposals contradict the spirit and content of the text.

Question 5:

✅ Correct answer: b) In the theme "Care" and the sub-theme "Respect for the rights of individuals".

📝 Explanation: The annex guide specifies that any injunction related to a failure to comply with the right to visit must be coded in the SI-ICEA under the control theme "Care" and the sub-theme "Respect for the rights of individuals", with the mention "Non-compliance with the right to visit" in the comments [file:1, annex p.1-2]. The other proposed themes do not correspond to the instructions of the DGCS.

8. Frequently Asked Questions (FAQ) 

1. Who is concerned by this instruction on the right to visit?

   The instruction is addressed directly to the regional health agencies (ARS), but it also concerns social and medico-social establishments for elderly and disabled people, whether public or private, as well as their pricing and control authorities [file:1, p.1‑2].

2. Does the right to visit apply only to the families of residents?

   No, the law provides that residents have the right to receive any visitor of their choice every day, which includes family, relatives, friends, or any other person chosen by the resident, without prior restriction [file:1, p.2‑3].

3. Can an establishment set limited visiting hours in its operating regulations?

   No, management is no longer allowed to set visiting hours in the operating regulations or residency contracts; they must instead organise to allow visits outside of administrative hours, including on weekends and during certain care or meal times, while respecting safety constraints [file:1, p.3‑4].

4. Can a resident refuse visits from certain relatives?

   Yes, the text specifies that the right to receive visits must primarily respect the wishes of the residents, who can refuse visits, including from family members, without having to provide justification [file:1, p.3‑4].

5. What can a relative do if the establishment refuses a visit without legal grounds?

   The relative or the person receiving care can file a complaint with the ARS, the departmental council, or the Defender of Rights, and bring the matter before the competent jurisdiction (administrative court for public establishments, judicial court for private structures) in case of persistent non-compliance [file:1, p.4].

6. How should the ARS use the SI-ICEA to monitor breaches of the right to visit?

   When a breach is identified during an inspection-control of ESMS with accommodation, the ARS must enter the injunction in the SI-ICEA under the theme "Care" and the sub-theme "Respect for the rights of individuals", adding in the comments the mention "Non-compliance with the right to visit" [file:1, annex p.1-2].

7. Is there a deadline for the effective implementation of the right to visit?

   Yes, the expected outcome is an effective implementation of the right to visit as provided for in Article 11 of the law of 8 April 2024, with a deadline set for 31 December 2026, which gives a clear timeframe to the ARS and the establishments [file:1, p.1-2].

9. Rewriting in Easy-to-Read Language 

Title

Right to visit in establishments: rules for elderly and disabled people.

Context and issues (Easy-to-Read Language)

Elderly and disabled people sometimes live in establishments.

During crises, visits were banned and this caused a lot of suffering for residents.

A law from 2024 now clearly states that everyone has the right to visits every day.

This instruction explains this right and reminds authorities and establishments of the rules.

The ARS must ensure that this right is respected everywhere.

Families and residents can use these rules to defend their rights.

Contributions for action (FALC)

Establishments must allow visits every day, even in the evening or at weekends.

The director can only refuse a visit if there is a real danger to safety or health.

The resident can say no to a visit, even if it is a family member.

If the right to visit is not respected, one can complain to the ARS or the departmental council.

The ARS must carry out checks and record problems in a special IT tool called SI-ICEA.

Everything must be in place by the end of 2026 for this right to be truly enforced.

Key points (FALC)

• New clear right: every resident has the right to a visit every day.

• No rigid hours: visits can take place outside of office hours.

• Limited refusals: the director can only refuse a visit in case of serious danger.

• Possible recourse: residents and relatives can make a complaint and take legal action.

• National monitoring: the ARS record problems in the SI-ICEA to track progress.