Service Autonomie à Domicile (SAD): the reform explained

The Service Autonomie à Domicile (SAD) is France’s single legal category for home-care services, created by décret n° 2023-608 of 13 July 2023. It folds three older categories into one: the SAAD (services d’aide et d’accompagnement à domicile, home help), the SSIAD (services de soins infirmiers à domicile, home nursing), and the SPASAD (the polyvalent services that already combined both). If you run or build software for a French home-care organisation, this reform changes the box you sit in, and, for services that deliver both help and nursing, it changes how one record has to hold the whole picture.

This guide gives the operator’s view: what the SAD is, the two forms it comes in, the two deadlines you can’t conflate, and why a combined help-and-nursing service needs one coordinated record rather than two. It sits under our wider guide on how France assesses autonomy and funds home care. The reform is still in transition, so read the dates as “true when checked”, not settled.

What changes with the SAD reform?

The short version: three separate home-care statuses become one. Before the reform, a household needing both housekeeping help and nursing often dealt with two different services, each with its own paperwork, its own visits and its own record. The SAD reform is meant to end that split by putting help and nursing under a single service category.

The legal ground is décret n° 2023-608, which sets a national cahier des charges, a specification every SAD has to meet. It defines the missions of a SAD and the minimum conditions for how it’s organised and run. This is part of the wider “bien vieillir” wave of reforms rather than a standalone change; the accompanying LOI n° 2024-317 du 8 avril 2024 also created the SPDA (Service public départemental de l’autonomie), a single door per département for information and orientation, rolling out unevenly since 2025.

One thing the reform is not: it isn’t the long-promised loi grand âge or a full loi de programmation. That broader financing law is still stalled. The SAD merger is the concrete piece that has actually landed and is being applied on the ground.

The two SAD forms

A SAD comes in one of two forms, and which one you fall under depends on what you actually deliver.

The aide-only form covers help and accompaniment, the work a SAAD used to do. Housekeeping, personal help, support with daily life, but no nursing.

The aide-and-nursing form (often called the mixed SAD) delivers both help and care under a single service. This is the form that absorbs the old SPASAD logic and pulls SSIAD nursing into the same house as the aide arm. For a household, it means one service handles both the home-help hours and the nursing visits, instead of two services that never quite line up.

That distinction matters for planning. If you run an aide-only service, converging to the SAD specifications doesn’t force you to build a nursing arm. If you run a mixed service, the two arms are now meant to work as one, which is where the operational and software questions start.

Two deadlines you shouldn’t conflate

There are two dates here, and treating them as one is the most common mistake. They measure different things.

The first is convergence to the cahier des charges by the end of 2025. Existing services have to meet the new national specifications introduced by the decree. The original deadline was 30 June 2025, two years after the reform took effect, but the Ministère du Travail et des Solidarités extended it to 31 December 2025 given the difficulties services hit in practice. This is the “get your organisation compliant with the spec” step.

The second is legal consolidation of the category by 2028. This is the deeper step: the old SAAD, SSIAD and SPASAD statuses folding fully into the single SAD category. Meeting the specifications in 2025 is not the same as the category being legally consolidated. A service can be compliant with the cahier des charges well before the category itself is fully unified.

So: the end-of-2025 date is about your service meeting the spec; the 2028 date is about the legal architecture finishing the merger. Don’t let a supplier or a consultant blur the two.

Who governs and pays for all this?

The SAD sits inside the same financing structure as the rest of French home care. The system runs on the branche autonomie, the fifth branch of the Sécurité sociale, managed by the CNSA (Caisse nationale de solidarité pour l’autonomie). That branch is the financing backbone behind APA, the SAD reform and the digital-compliance programmes around them.

Day to day, the assessment and the money for home care still sit with the département, which scores the AGGIR grid and builds the plan d’aide (covered in the pillar guide, and in detail for the benefit itself in APA à domicile). The SAD reform doesn’t change that; it changes the shape of the service delivering the plan. For the current status of the reforms and the SPDA rollout, vie-publique.fr tracks where each piece stands.

Why one combined service needs one coordinated record

This is the operational core. If a mixed SAD is one service delivering both help and nursing, running those two arms on two disconnected systems reproduces exactly the split the merger was meant to remove.

A combined service needs one coordinated record: shared scheduling so the aide and soins visits are planned against the same person and the same week, clean handoffs between the home-help team and the nursing team, and shared context so a nurse sees what the auxiliaire de vie logged and vice versa. On top of that sit the same obligations any French home-care product carries: the plan d’aide, télégestion with contrôle d’effectivité, and a Ségur-referenced DUI handling the INS, MSSanté and the Mon espace santé feed. Those are covered in our guide on the ESMS numérique and Ségur DUI rules.

The failure mode is familiar: the help side runs on one package, the nursing side on another, and the two only meet in a spreadsheet or a phone call. That’s the friction the SAD reform is trying to design out. Software that treats a mixed SAD as one service, on one record, is what makes the merger real rather than paper-only.

Frequently asked questions

What is a Service Autonomie à Domicile (SAD)?

The SAD is France’s single legal category for home-care services, created by décret n° 2023-608. It folds the old SAAD (home help), SSIAD (home nursing) and SPASAD (both) into one. It comes in two forms: an aide-only form, and an aide-and-nursing form that delivers help and care under one service.

What are the SAD deadlines, and why are there two?

There are two dates you shouldn’t conflate. Existing services must meet the new national cahier des charges, the convergence step, by the end of 2025. The deeper legal consolidation of the category, folding the old statuses into the single SAD, is set for 2028. Meeting the specifications is not the same as the category being fully consolidated.

Does an aide-only SAAD have to become a mixed SAD?

No. The reform keeps an aide-only SAD form, so a home-help service can converge to the specifications without adding a nursing arm. The mixed aide-and-nursing form is for services that provide, or want to provide, both help and care under one roof. Which form you fall under depends on what you actually deliver.

What does the SAD merger mean for our software?

A mixed SAD runs help and nursing as one service, so it needs one coordinated record rather than two disconnected systems. Shared scheduling, handoffs and context across the aide and soins arms, on top of the same plan d’aide, télégestion and DUI obligations that apply to any French home-care product. Two systems that don’t talk is the friction the merger is meant to remove.

One service, one record

I’m a nurse by background, so the part of this reform that lands for me isn’t the legal architecture. It’s the household that used to get a home-help visit and a nursing visit from two services that never shared a note. The SAD is meant to make that one service. In software terms, that only works if help and nursing sit on one record: same schedule, same handoffs, same context, so the person doing the toilette in the morning and the nurse doing the pansement in the afternoon are working from the same page. When we built Domihome, the thing that took the most care was making the aide and soins sides share one record instead of two, so the plan d’aide, the télégestion log and the billing export all tell the same story. See what we did for Domihome, or book an intro call.

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This guide is informational and not legal, billing or medical advice. France’s home-care rules are evolving, and the SAD reform is still in transition; several dates are moving parts. Confirm current rules with the official sources, including Légifrance for the decree, the CNSA for the branche autonomie and the reform, and vie-publique.fr for the status of the reforms and the SPDA. Last verified 14 July 2026.