Framework decision of the Defender of Rights No. 2026-149 regarding the right to autonomy for people with disabilities receiving support at home

📜🔗LINK to the source

1. ANALYTICAL SUMMARY

A structural crisis in home human assistance documented by the associative referral

Referred by APF France Handicap and AFM-Téléthon at the end of 2023 for "endangerment of others' lives", the Defender of Rights has processed dozens of individual complaints from people with high dependency (p. 4). The investigation reveals a gap between formally recognised rights (CRPD, CASF) and their concrete implementation: insufficient supply of service providers, rates below actual costs, unfilled absences, untrained staff (p. 6-25). The consequences range from violations of dignity to a vital break in care.

An operational and legal framework decision

The document articulates the legal framework (CRPD, CASF, case law of the Court of Cassation and judicial courts), analyses structural barriers (funding, recruitment, rigidity of the PCH) and 17 specific recommendations addressed to the Minister of Health, to Departments of France and to the Ministry of Economy (p. 9-42). It provides field actors with mobilisable legal references (obligation of means vs results, qualification of abuse, notice periods) directly transposable into local advocacy or user support.

2. KEY POINTS OF THE DOCUMENT

1. A structurally insufficient floor rate undermines home assistance structures. Set at €25/hour on 1st January 2026, this rate remains, according to professional federations, "far below the actual cost price", threatening the cash flow of associations and thus the continuity of service for beneficiaries (p. 10-11).
2. The obligation to replace absent workers is only an obligation of means, not of results. A judicial court decision of 26th September 2024 confirms that a provider is not held responsible for numerous unfilled absences as long as they have "reasonably" attempted to address them — even for users at vital risk (p. 22-23).
3. The cancellation of interventions without a replacement solution can be classified as abuse. A decision from the Defender of Rights in March 2026 establishes this precedent, based on Article L. 119-1 of the CASF, opening a path for legal qualification that can be mobilised by field professionals (p. 37-38).
4. Users are experiencing a denial of their rights to compensation despite notified PCH hours. The Court of Auditors (December 2025) estimates the actual execution rate of aid plans to be between 50% and 80% depending on the departments, and two rulings from the Court of Cassation on 19th February 2026 allow departments to claim overpayments from users who have not consumed all of their hours — even when the impossibility is external to them (p. 28-29).
5. DGCCRF inspections reveal widespread misleading commercial practices. Of 360 operators inspected in 86 departments (May 2023-April 2024), 73% presented at least one anomaly, resulting in 141 warnings, 191 injunctions, and 13 criminal reports (p. 19, 26).

3. ACTION PATHS FOR LOCAL ACTORS

1. Mobilise the qualification of abuse (art. L. 119-1 CASF) in supporting users confronted with repeated cancellations without a replacement solution, relying on the decision of the Defender of Rights from March 2026 as a precedent (p. 37-38).
2. Systematically inform PCH beneficiaries of the risk of undue reimbursement in case of under-consumption of hours, and document in writing any impossibility of access to the service to anticipate potential litigation (p. 28-29).
3. Use the departmental fund for disability compensation to cap the remaining charge at 10% of net resources, checking with the departmental council the credits actually available, this capping not being guaranteed (p. 30-31).
4. Direct users to the mediation provided for in the welcome booklet and the operating regulations, a system that the Defender of Rights finds largely underused due to lack of information (p. 35).
5. Systematically report any adverse event to the competent authorities (ARS, departmental council, prosecutor), an obligation provided for by article L. 331-8-1 of the CASF, relying on the specifications of the SAD which now impose training and procedures for identifying abuse (p. 38-39).

Les 17 leviers d'actions

1. Minimum rate indexed to the actual cost of one hour of assistance
2. Development of a sufficient offer and evaluation of the reform of the SADs
3. Evaluation by 2027 of the additional allocation and funding for complex care
4. Compensation mechanism for departmental charges without increasing the out-of-pocket costs
5. Funding for the development of skills in home care professions
6. Clarification of the obligations for continuity of interventions in the specifications of the SADs
7. 24/7 telephone support and reflection on an operational on-call service
8. Clear and accessible information for users on the funding of human assistance hours
9. Strengthening of DGCCRF control over the financial transparency of the SADs
10. Mandatory minimum contribution to the departmental disability compensation fund
11. National information system on the pricing and consumption of care plans
12. Strengthening the CNSA's steering role in autonomy policy
13. Minimum notice period of one month in case of termination of home care
14. Obligation for effective continuity of nursing care before any notification of termination
15. Strengthened control plan on combating abuse and promoting good treatment
16. Definition of a true status for caregivers
17. Guarantee of respect for privacy and full social participation of supported individuals

4. ADDITIONAL REFERENCES

🔍➕ For more information, see the articles referenced by "Health Practices" on the topic of people with disabilities ➡️🔗 https://pratiquesensante.odoo.com/5-4-personnes-en-situation-de-handicap and on the topic of human rights ➡️🔗 https://www.pratiquesensante.com/blog/tag/droits-humains-269  AND on the topic of Home Help  ➡️🔗 https://pratiquesensante.odoo.com/blog/tag/aide-a-domicile-92

• CNSA, Annual report 2025 of the Autonomy branch (2025-2026) — Updated overview of the resources dedicated to home care, the deployment of the departmental public service for autonomy, and the attractiveness issues of home care professions.
  https://www.rapportannuel.cnsa.fr/2025/
• Ministry of Labour and Solidarity, Launch of the departmental public service for autonomy (SPDA) (2025) — Presentation of the system resulting from the Well-Aging law, directly complementary to recommendation no. 8 from the Defender of Rights on the readability of information for users.
  https://solidarites.gouv.fr/lancement-du-service-public-departemental-de-lautonomie-spda
• High Authority of Health, Guide "Good Treatment and Management of Signs of Abuse in Establishments" (October 2024) — Methodological tool for identifying and addressing situations of abuse, directly applicable to recommendations no. 14 and no. 15 of the framework decision.
  https://www.has-sante.fr/jcms/p_3549483/fr/bientraitance-et-gestion-des-signaux-de-maltraitance-en-etablissement-mise-en-oeuvre-en-milieu-sanitaire-medico-social-et-social-personnes-majeures

5. FREQUENTLY ASKED QUESTIONS (FAQ)

1. What is the PCH "human assistance" and how is its amount determined?
   The disability compensation benefit, human assistance component, is calculated based on the number of hours of required presence, based on an hourly rate set at €25 since 1 January 2026 in the case of using a service provider (p. 27).
2. Can a provider be held responsible if all my hours are not completed?
   According to the cited case law (judicial court, 26 September 2024), the provider is only bound by an obligation of means, not of result — unless there is a more protective contractual clause (p. 22-23).
3. Can I be pursued for overpayment if I have not used all my PCH hours?
   Yes: two rulings from the Court of Cassation on 19 February 2026 validate the possibility for the department to claim a reimbursement of undue payments even if the inability to access the service does not fall on the user (p. 29).
4. What is a “mixed SAD” and how does it differ from a classic SAD?
   A mixed SAD provides both assistance/support and care with salaried health professionals; other SADs must direct, by agreement, their users needing care to another service (p. 9).
5. Is there a cap on the remaining charge for the most vulnerable users?
   A departmental fund for disability compensation allows capping the remaining charge at 10% of net resources, but its application depends on available credits and is not guaranteed (p. 30-31).
6. What should be done if a service provider cancels an intervention without a replacement solution?
   This situation can be classified as mistreatment under Article L. 119-1 of the CASF if it is not accompanied by any effective alternative measures; a report to the ARS or the Defender of Rights is possible (p. 37-38).
7. What obligations rest on a SSIAD that wishes to end support?
   The ARS considers that continuity of care requires finding an effective alternative care solution before any termination; the Defender of Rights recommends including a minimum notice period of one month in the law (p. 34-35).

6. REWRITING IN EASY TO READ FRENCH

The problem

Many disabled people need help every day at home.

This help is called “human assistance.”

It is funded by the PCH.

The PCH is a financial aid from the State.

The Defender of Rights has received many testimonies.

Disabled people recount very difficult situations.

Sometimes, no one comes to help them for an entire day.

Some people have to sleep in their wheelchair.

Some people cannot eat or go to the toilet.

Why this situation occurs

There are not enough trained people to help at home.

Home care jobs are poorly paid.

Working conditions are difficult.

Many professionals change careers.

Care services often lack staff.

When a professional is absent, they are not always replaced.

The law states that the service must try to replace.

But the law does not say that they must always succeed.

The consequences for individuals

Some people can no longer go to the toilet alone.

Some people have no privacy anymore.

Families often have to replace absent professionals.

This greatly fatigues the family caregivers.

What the Defender of Rights is asking for

The Defender of Rights has made 17 recommendations.

They are asking to increase the rate paid to care services.

They are asking for better training for professionals.

They are asking to create a phone number available day and night.

They are asking to better protect the rights of the people being helped.

He calls for the creation of a true status for family caregivers.

7. CROSS-ANALYSIS — VALUES OF HEALTH PRACTICES

• Literacy : The document itself notes that the funding system is "particularly complex and opaque for users" (p. 25); it does not propose a FALC tool or simplified information, but recommends "clear and accessible" information (recommendation no. 8).
• Empowerment : The individuals supported are neither involved in the design nor in the evaluation of the systems; their participation is limited to the testimony collected during the processing of complaints.
• Participation : No co-construction mechanism is described; professional federations and the CNSA have been consulted, but not the users themselves or their representatives in the development of the recommendations.
• Community health : The collective dimension is absent; the approach remains focused on individual situations addressed on a case-by-case basis.
• Ethics : The document identifies structural biases (remuneration of predominantly female professions, disadvantaged rural and border territories) and cites the principle of "equal pay for work of equal value" (p. 17).
• Human rights : The anchoring is central and explicit: CRPD, European Social Charter, ECHR are referenced throughout the text to underpin each recommendation.
• Intersectorality : The document recommends enhanced coordination between the Ministry of Health, ARS, departmental councils, CNSA and the Ministry of Economy (recommendations no. 7, 9, 11, 12).
• Partnership : No model of formalised collaboration is proposed beyond the existing CPOMs, which the document itself highlights as heterogeneous and administratively burdensome (p. 15).
• Fight against discrimination : Discrimination based on disability is explicitly legally defined (law of 27 May 2008) and linked to observed situations of abuse (p. 37).

8. EVALUATION OF THE RELIABILITY OF THE RESOURCE

Scientific relevance : First-rate institutional source — independent administrative authority with a constitutional mandate to protect rights. Dense legal sourcing (CASF, CIDPH, jurisprudence of the Court of Cassation and judicial courts, CEDS decisions) and cross-referencing with external numerical data (Court of Auditors, IGAS, DGCCRF, UNA, FEDESAP). Limitation: the numerical data on the execution rates of aid plans (50-80%) come from a limited number of departments surveyed by the Court of Auditors, without affirmed national representativeness.

Operational relevance : Directly mobilisable by field professionals: precise legal references, illustrative testimonies and 17 recommendations formulated with identified recipients. The implementation timelines for the recommendations (reporting in 6 months for some, evaluation in 2027 for others) allow for concrete calendar tracking for local monitoring or advocacy work.