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

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1. ANALYTICAL SUMMARY

A structural gap between recognised rights and actual effectiveness. Seized by APF France Handicap and the AFM-Téléthon (p. 4), the Defender of Rights analyses the violations of the right to autonomy of people with disabilities supported by a home service provider. The central finding: a persistent gap between the rights formally guaranteed (CRPD, CASF, PCH) and their concrete implementation methods (p. 5). The targeted groups are individuals with high dependency, often in a state of isolation, whose daily life — getting up, eating, hydrating, going to bed — entirely depends on the continuity of interventions. The document attributes these difficulties to two main causes: the functioning and funding of services (part 2) and the rigidity of the benefits system (part 3).

A tool for legal qualification and advocacy. Beyond the finding, the framework decision provides field actors with an opposable analysis grid. It documents that the cancellation of interventions without a replacement solution may constitute abuse under Article L. 119-1 of the CASF (p. 37) and represent discrimination based on disability (p. 37). It incorporates the 2026 case law (Court of Cassation on undue PCH, p. 29) and 17 recommendations primarily addressed to the minister responsible for autonomy, the Departments of France, and the CNSA (p. 44-46). It is a normative document from an independent authority, with guiding value, non-binding in law but usable as a reference.

2. KEY POINTS OF THE DOCUMENT

1. The notified PCH hours are not executed, due to a lack of available providers. The departments surveyed by the Court of Auditors indicate an execution rate of human aid plans varying between 50 and 80 %; testimonies quantify the gap (258 hours notified / 210 completed; 575 hours / 550 hours; 301 hours / 220 hours) (p. 28). Major cause: insufficient trained and available staff, exacerbated in rural and border areas (p. 13, 28).
2. The double penalty of undue PCH established by the Court of Cassation. In two rulings on 19 February 2026, the Court of Cassation adopts a strict reading of the "real cost" as the only regulatory rate, which allows for the reimbursement of undue payments to beneficiaries who have not consumed all their hours — even though they were unable to access a provider (p. 29). Non-consumption can also lead to a reduction in the volume of hours upon renewal (p. 29).
3. The obligation of continuity is merely an obligation of means. A judicial court (26 September 2024) ruled that non-performed services, even with a "quasi-vital" stake, did not constitute a breach of contract, the provider being bound only to an obligation of means (p. 22-23). The specifications of the SAD do not clearly define the obligation of replacement (p. 24).
4. The cancellation of interventions without a solution can be classified as abuse and discrimination. On the basis of Article L. 119-1 of the CASF (p. 36) and the law of 27 May 2008 (p. 37), the Defender of Rights establishes that an unfilled absence, without alternative measures, constitutes abuse and amounts to discrimination based on disability (decision no. 2026-032 of 2 March 2026, p. 38). Many users refrain from claiming for fear of reprisals (p. 37).
5. Out-of-pocket expenses and "de-tarification" penalise the most vulnerable. The minimum rate (€25/hour as of 1 January 2026) remains below the cost price (p. 10-11); services are renouncing their accreditation to set a free rate, generating out-of-pocket expenses of €700 to €800/month (p. 30). The price control rate (2% in 2026 compared to 3.84% in 2025) financially weakens the SADs (p. 32).

3. ACTION PATHS FOR LOCAL ACTORS

1. Document the gap between notified hours / actual hours for each person supported, relying on the execution rate data (50-80%) and the personalised compensation plan (p. 27-28), in order to objectify a request for re-evaluation or to contest a reduction in hours upon renewal (p. 29).
2. Challenge the undue PCH by providing proof of the impossibility of access. The Court of Cassation requires that the beneficiary justifies "not having been able to find a provider" at the regulatory rate (p. 29): keeping refusals, excessive quotes, and unsuccessful searches becomes a central defensive issue.
3. Systematically check the termination and replacement clauses of individual care documents (article D. 311 of the CASF, p. 21-22, 34). Report the absence of a one-month notice period and the lack of care relay guarantees before any termination (recommendations 13 and 14, p. 34-36).
4. Mobilise the qualification of abuse and discrimination in cases of repeated unfilled absences without a solution, based on article L. 119-1 of the CASF and the 2008 law (p. 36-38), and remind of the obligation to report without delay (article L. 331-8-1 of the CASF, p. 39).
5. Raise awareness and activate the underused avenues of appeal : qualified person, consumer mediator, external authority (p. 35). The document highlights the low use of mediation due to lack of information — a direct area for associative action.
6. Request the departmental compensation fund to cap the remaining charge at 10% of net resources (article L. 146-5 of the CASF, p. 30-31), while documenting its random nature (non-binding contribution) to support local advocacy. Identified unmet need : the absence of mandatory contribution makes this capping uncertain (recommendation 10, p. 31).

4. ADDITIONAL REFERENCES

1. Court of Auditors, The disability compensation benefit: an increasing cost, a coherence to strengthen, December 2025 — delves into the execution rates of aid plans and the opacity of CNSA contributions (source cited p. 28 of the document). https://www.ccomptes.fr/sites/default/files/2025-12/20251203-Prestation-de-compensation-du-handicap-PCH.pdf
2. CNSA, Annual report 2025 (Autonomy branch) — updated data on home care, territorial inequalities and effective access to rights. https://www.cnsa.fr/publications/rapport-annuel
3. CNSA – Scientific Council, Opinion on informal caregivers, June 2025 — sheds light on the unitary status vs enhanced rights debate, directly useful for recommendations 16 and 17. https://www.cnsa.fr/sites/default/files/2025-06/PUB-CS_avisCOG2_aidants_VF-accessible.pdf

5. FREQUENTLY ASKED QUESTIONS (FAQ)

1. What is a SAD since the 2023 reform? Since 30 June 2023, the SAAD, SPASAD and SSIAD have been merged into "home autonomy services", a single entry point. Two categories coexist: SAD "mixed" (help + care) and SAD limited to help and support, required to direct by agreement to a care service (p. 8-9).
2. What is the minimum rate for an hour of home help? 25 € per hour as of 1 January 2026, indexed annually — but deemed very low compared to the actual cost by the federations (p. 10-11).
3. Can a user deemed "too heavy" be refused? In practice, some services refuse complex care (severe disability, night, endotracheal aspirations) due to a lack of qualified personnel, which hinders the free choice guaranteed by article D. 312-1 of the CASF (p. 14).
4. Is the provider obliged to replace an absent worker? They are only required to a duty of means, not a result (judgment of 26 September 2024, p. 22-23). The specifications only impose a telephone availability during service hours (p. 24).
5. Why can a refund be claimed from a beneficiary who has not used all their hours? According to the Court of Cassation (19 February 2026), if they have consumed the amount without completing all the hours and do not justify the impossibility of finding a provider at the regulated rate, an undue payment may be noted (p. 29).
6. Can an unfilled absence be considered mistreatment? Yes: the cancellation of interventions without a replacement solution or alternative measure may constitute mistreatment (article L. 119-1 of the CASF) and discrimination based on disability (p. 36-38).
7. What remedies are available in case of a dispute with a service provider? Referral to a qualified person, an external authority or a consumer mediator — provisions exist but are little known and rarely used (p. 35). Reporting possible to the ARS, the departmental council, the prefect or the prosecutor (p. 39).

6. REWRITING IN EASY TO READ LANGUAGE

What is this document about?

This document is about disabled people who live at home.

They need help every day.

For example, to get up, eat or wash.

The main problem

People help at home. They are called life assistants.

But there are often not enough life assistants.

So disabled people wait a long time.

Sometimes, no one comes.

Financial aid

The State provides assistance to pay for these hours. This assistance is called PCH.

One hour of help costs at least 25 euros since January 2026.

But this price is too low for the services.

So the services have financial problems.

What is not fair

A number of hours is allocated to each person.

But often, not all the hours are used.

It is not the person's fault.

It is because there is a lack of staff.

Sometimes, the person is asked to return money.

They are told that they did not use all their hours.

This is unfair. They could not find someone to come.

What the Defender of Rights says

Leaving a person alone without a solution is abuse.

The Defender of Rights requests 17 changes.

He wants to protect the rights of disabled people at home.

7. CROSS-ANALYSIS — VALUES OF HEALTH PRACTICES

• Literacy : the document highlights the opacity of the pricing system for users and recommends clear and accessible information on the funding of hours (p. 25-26).
• Empowerment : it acknowledges the freedom of choice of the provider (article D. 312-1) but notes that it remains theoretical due to lack of supply, limiting the ability of individuals to act (p. 12).
• Participation : co-construction is underdeveloped; the document mainly relies on collected testimonies, without a described formalised participatory mechanism.
• Community health : the collective dimension appears through family caregivers and the territorial coordination of providers (recommendation 7, p. 25), but remains secondary.
• Ethics : biases are addressed from the perspective of informed consent (article L. 311-3) and the fear of reprisals that silences users (p. 37).
• Human rights : the guiding thread is equity and inclusion, with an explicit anchoring in the CRPD (article 19) and the European Social Charter (p. 5-6).
• Intersectorality : the document articulates health, medico-social, social and justice, and recommends coordination between ARS / departmental councils / providers (p. 25).
• Partnership : conventional models are described (SAD-care conventions, CPOM), with their limits (heterogeneity, administrative burden) (p. 9, 15).
• Fight against discrimination : central — acts based on disability are expressly qualified as discrimination under the law of 27 May 2008 (p. 37).

8. EVALUATION OF THE RELIABILITY OF THE RESOURCE

Scientific relevance : high. Institutional source of independent authority, rigorous note apparatus (98 notes), precise legal references (CASF, CIDPH, jurisprudence Court of Cassation 2026, Court of Auditors 2025, IGAS, DGCCRF). The data is current and cross-referenced with external sources. The method combines individual complaints, interviews with federations (UNA, FEDESAP, ADMR), CNSA and immersion day (p. 4-5).

Operational relevance : strong. The document is directly usable: enforceable legal qualifications, precise articles, targeted recommendations. Usage limit to note: it is a framework decision with guiding value (non-binding recommendations), not a binding normative text. Its scope is deliberately restricted to the provider mode (p. 4), to be distinguished from direct employment and the agent.

No major internal inconsistencies noted (dates, figures and references consistent). A minor editorial point of vigilance: “DGCCRFF” written with an extra F p. 24 (typo without impact).

10. STRATEGIC HASHTAGS

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