Comparing support services for seniors requires knowing what to measure. Since the reform of Home Autonomy Services (SAD) initiated in 2023, the former SAAD, SSIAD, and SPASAD are gradually merging into two models: “assistance” only or “assistance and care”.
This structural change alters the framework of understanding. A service that truly coordinates home nursing care does not provide the same level of support as a service limited to connecting with personal caregivers.
SAD assistance only or assistance and care: what the reform changes for families
Decree No. 2023-608 of July 13, 2023, established the framework for this transformation. Before the reform, a family had to juggle between a SAAD for housekeeping and a SSIAD for nursing care, with two distinct contacts and no guarantee of coordination.
With the SAD “assistance and care”, a single contact coordinates personal caregivers and nurses. The continuity of care relies on a shared communication log, documented transmissions between professionals, and reporting obligations in case of serious dysfunction.
In contrast, a SAD “assistance” only does not cover the care aspect. For someone whose health condition requires regular nursing interventions, this distinction is not trivial. Before signing, it is essential to explicitly ask how communications between caregivers and the family are organized, and if the provider indeed has the “assistance and care” accreditation.
Several organizations detail the services on astelos-senior.com according to a similar logic, distinguishing between daily assistance services and those that include a medical or paramedical component.
| Criterion | SAD “assistance” | SAD “assistance and care” |
|---|---|---|
| Daily assistance (cleaning, meals, shopping) | Yes | Yes |
| Nursing care coordination | No | Yes |
| Shared communication log | Variable depending on the provider | Mandatory |
| Single contact for the family | Partial | Yes |
| Reporting serious dysfunction | General obligation | Strengthened obligation |
Documentary follow-up: the invisible criterion in senior comparisons
Online comparisons list services (meal delivery, teleassistance, personal care) without addressing the quality of documentary follow-up. This is a blind spot that weighs heavily in the daily lives of families.
A poorly maintained communication log creates gaps in care. When the morning caregiver is unaware that the evening nurse has modified a protocol, the risk of error increases. Three points help evaluate the rigor of a service:
- Is the communication log digital or paper, and how frequently is it updated by each caregiver?
- Are transmissions between caregivers and nurses systematic with each shift change, or only in case of an incident?
- Does the family have direct access to follow-up notes, or must they go through a coordinator?
Asking these questions during the first meeting with a provider gives a quick idea of their internal organization. A service that hesitates about its transmission procedures has probably not formalized its follow-up.
Home respite care: an underutilized solution
Respite platforms, day care, and temporary accommodation in nursing homes are the most cited solutions to relieve caregivers. Home respite care remains less visible, even though its regulatory framework has been expanded.
The principle: a professional replaces the primary caregiver directly at the senior’s home, for several hours or consecutive days. The elderly person does not change their environment, which reduces disorientation, particularly for those with cognitive disorders.
Respite care allows for extended absences of the caregiver without moving the senior. For a caregiver who needs to leave for a few days for professional or personal reasons, it is a concrete alternative to temporary accommodation.
The difference with simple night care or occasional presence lies in continuity. The respite caregiver takes care of all the usual tasks (meals, companionship, night watch) for a sufficient duration so that the caregiver can genuinely rest.
How to identify a reliable respite care provider
Respite care requires specific skills. A personal caregiver accustomed to two-hour interventions may not necessarily have the experience of continuous presence over several days. Two elements to check:
- Does the provider train its caregivers for long-term respite care, with preparation for night situations and behavioral disorders?
- Is there a handover protocol planned between the usual caregiver and the respite caregiver, including the senior’s habits, treatments, and daily references?
- Does the rate include night hours, or are they billed separately, sometimes significantly higher?
Home care or nursing home: what support services shift in the equation
The question of maintaining home care versus entering a nursing home is not a binary choice. The quality of the support service determines the viable duration of home care.
A well-coordinated SAD “assistance and care”, combined with a teleassistance system and occasional respite for the caregiver, can postpone the moment when entering an institution becomes the only option. Conversely, fragmented support among several uncoordinated providers accelerates caregiver burnout and incidents at home.
The real indicator is the residual burden on the family caregiver. If, despite the services in place, the caregiver still spends several hours a day filling gaps in care, the system is insufficient. Measuring this residual burden, rather than counting the number of subscribed services, provides a more accurate picture of the situation.
The reform of SAD offers a lever to improve this coordination, provided that families verify the exact model of the chosen service and the reality of its follow-up procedures.
