Home help, life assistant, caregiver, housekeeper: the terms used to refer to the person who assists an elderly relative vary according to the level of dependency, the professional’s qualifications, and the legal framework of the intervention. Since 2023, the reorganization of structures under the name “home autonomy service” (SAD) has further changed the administrative vocabulary, without always clarifying things for families.
Home help, life assistant, AVS: comparative table of titles
The confusion between the different job titles stems from a historical accumulation of diplomas and collective agreements. Each title corresponds to a level of qualification and a specific scope of intervention.
| Title | Qualification Level | Scope of Intervention |
|---|---|---|
| Housekeeper | No diploma required | Household maintenance, shopping, simple meal preparation |
| Home help | Sanitary and social BEP or equivalent | Daily living activities: cleaning, meals, accompanying outings |
| Social life assistant (AVS) | DEAVS (replaced by DEAES) | Assistance with daily living activities including bathing, dressing, getting up and going to bed |
| Life assistant (ADVF title) | ADVF professional title | Similar missions to the AVS, including for people with disabilities |
The use of a home help for elderly people thus depends on the degree of loss of autonomy assessed by the AGGIR grid. A person classified as GIR 5 or 6, still largely autonomous, will rather require a housekeeper. A person classified as GIR 1 to 4 will need a life assistant trained in physical assistance gestures.
The DEAES diploma has replaced the DEAVS and now unifies the training of professionals working with both elderly people and people with disabilities. This merger simplifies the qualification process, but it has not eliminated the old titles in common language.
Home autonomy service (SAD): what the 2023 reform changes
Before 2023, three types of structures coexisted: SAAD (home help and support services), SSIAD (home nursing services), and SPASAD (multi-purpose help and care services). The SAD merges these categories into a single structure, authorized to combine daily assistance and care under one administrative roof.
In practice, two configurations of SAD exist. The “help” SAD employs life assistants for cleaning, meals, shopping, and daily support. The “help and care” SAD adds nursing and caregiver interventions, coordinated by the same service.
This reform is part of the Departmental Public Service of Autonomy, created by the law of April 8, 2024. The Retirement Insurance, CNSA, and MSA have developed a common form allowing simultaneous requests for both retirement fund assistance and APA, reducing the number of steps for families.
Concrete impact on the choice of professional
For the elderly person or their family, the reform does not change the face of the caregiver. However, it changes the administrative contact: a single service now coordinates all services, where previously one had to juggle between two or three distinct organizations.
Direct employment, intermediary, or service provider: three statuses, three responsibilities
The choice of intervention mode determines who is the employer of the home help, and therefore who bears the legal and financial responsibility.
- Service provider mode: the organization (SAD, association, company) employs the life assistant, manages payroll and replacements. The elderly person pays a total bill to the service.
- Intermediary mode: the elderly person is the legal employer, but an organization manages the administrative formalities (contract, pay slips, declarations). Management fees are lower compared to the service provider mode.
- Direct employment: the elderly person recruits, employs, and pays the caregiver directly via Cesu or an equivalent system. They assume all employer obligations.
The service provider mode remains the most common for situations of high dependency, as it guarantees continuity of service in case of the usual caregiver’s absence. Direct employment is more suitable for occasional or light needs (a few hours of cleaning per week).
Exemption from employer contributions in direct employment
The automatic exemption from employer contributions for private employers has been refocused on individuals aged 80 and over. Since July 2026, this exemption requires a specific declaration. Employers under 80 years old retain access to the tax credit for employing a domestic worker, but no longer benefit from the automatic exemption.
APA and retirement fund assistance: what funding according to the profile
The funding for home help depends on the level of loss of autonomy. Two main systems coexist.
The personalized autonomy allowance (APA) is aimed at individuals classified as GIR 1 to 4. Paid by the department, it finances a personalized assistance plan that can include hours of life assistance, meal delivery, or teleassistance. The APA is not subject to resource conditions for its allocation, but the amount of out-of-pocket expenses varies according to income.
Individuals still autonomous (GIR 5 and 6) are not entitled to the APA. They can request assistance from their retirement fund (housekeeping help, assistance for returning home after hospitalization) or, subject to resource conditions, the department’s housekeeping assistance.
The common form developed by the Retirement Insurance, CNSA, and MSA now allows simultaneous requests for these different aids, preventing families from having to submit multiple applications to distinct contacts. This consolidation of procedures facilitates access to rights, especially for caregivers managing files remotely.
The term that designates the person intervening in the home of an elderly relative ultimately depends on three parameters: the level of dependency (GIR), the qualification of the professional (DEAES, ADVF title, no diploma), and the legal status of the intervention (service provider, intermediary, direct employment). Knowing these distinctions allows for the correct request to be made to the right contact and access to appropriate funding.
