Your parent needs help getting up, washing or preparing meals. You’re looking for someone reliable to provide support at home, but there are many options and job titles can be hard to make sense of. Choosing home care for a dependent older person comes down to three practical factors: their actual level of dependency, the legal framework of the service and how care providers coordinate day to day.
Home autonomy services: a reform that changes the landscape
Since the decree of 13 July 2023, former home help and nursing care services can merge to form a home autonomy service (SAD). This has a direct impact on the choices available to families.
A SAD can either provide home care itself or coordinate care with other healthcare professionals. In practice, this means a single point of contact can manage both the home care worker who helps your parent shower and the nurse who visits to change dressings or give injections.
Why does this matter when choosing a service? Because after a hospital stay or when a loss of independence worsens, coordination between home help and healthcare prevents gaps in care. Ask the service how it coordinates visits with independent healthcare professionals. A SAD that cannot answer this question has yet to embrace the purpose of the reform.
When looking for home care for a dependent older person, check whether the provider is a SAD or a traditional home help service. This distinction determines the level of overall support your loved one will receive.
Home care worker or housekeeper: choosing the right support
The two terms are often confused, even though they refer to very different roles.
A housekeeper helps with household tasks such as cleaning, shopping and ironing. This is suitable for someone who is still independent with everyday activities like washing, dressing and eating.
A social care worker supports people with essential daily activities. They can help with washing, moving between a bed and chair, and eating when someone can no longer manage on their own. This is the right type of support when someone has a significant level of dependency.
How to assess dependency before choosing
Start with the GIR assessment scale used by the department’s medico-social teams. People classified as GIR 1 to 4 may be eligible for APA (personalised autonomy allowance), which covers part of the cost of home care hours.
Make a list of the daily activities your parent struggles with:
- Washing, dressing and using the toilet: if your parent needs physical assistance, they need a trained home care worker
- Preparing meals and eating: someone who forgets to eat or can no longer cook needs regular support, not just meal delivery
- Moving around the home: the risk of falls increases as independence declines, and support from someone trained in safe handling can help reduce this risk
- Keeping track of medical treatment: a home care worker cannot provide medical care, but can remind someone to take their medication and raise the alarm if their condition changes
This practical assessment helps determine the number of hours needed each week and the right type of support. Insufficient support can put the person at risk.
Agency service, agency-assisted employment or direct employment: three legal arrangements to understand
The type of arrangement determines your responsibilities as a family, the actual cost and the continuity of care.
Agency service
The service directly employs the home care worker. It manages schedules, arranges cover when someone is absent and handles the administrative formalities. The family pays the service, which then pays the worker. This is the simplest arrangement for families, but also the most expensive per hour of care.
Agency-assisted employment
The family is the home care worker’s employer. The agency recruits, puts forward candidates and handles payslips. The hourly cost is lower, but the family takes on the responsibilities of an employer (dismissals, cover and leave).
Direct employment (private arrangement)
The family recruits and manages everything. Some people prefer this option because it gives them the freedom to choose their own care worker. CESU (universal service employment voucher) simplifies the reporting process. However, finding emergency cover is entirely the family’s responsibility.
For a highly dependent older person, using an agency offers the greatest security and continuity of care. The additional cost is partly offset by APA and tax relief.
Check the quality of the service before signing
Marketing brochures all look much the same. Here’s what really sets a reliable service apart.
Check the evaluation report in the official directory of services for older people. Some SADs are listed there with their latest quality report. This is a more reliable indicator than an online review.
At your first meeting, ask specific questions:
- What is the cover rate when the regular care worker is absent, and how quickly can a replacement be arranged?
- How does the service coordinate visits with the person’s GP or independent nurses?
- Does the proposed care worker have a recognised qualification (DEAVS, professional qualification in family care) or documented experience supporting people who have lost some of their independence?
A service that answers these three questions clearly has well-organised procedures. If it is vague about cover, you may be left to manage absences on your own.
Joint application form for APA and pension fund assistance
Before comparing services, clarify how the care will be funded. A form developed by Assurance retraite, CNSA and MSA lets you apply for assistance from a pension fund or for APA. Your application is directed to the relevant organisation based on your circumstances. Taking this step first helps you avoid choosing a number of care hours without knowing your actual out-of-pocket costs.
Choosing home care for a dependent older person is about more than finding someone who is available. The legal arrangement, the care worker’s training and the service’s ability to coordinate with healthcare professionals all affect the quality of support over time.
