The legacy of institutional inertia that deprives the beneficiary of quality support and resources!
The source of the injustice lies in the historical adoption of the agencies’ commercial rate (€24.58/h) as the budgetary reference by the Departments. This mechanism, inherited from the structuring of the provider sector in the late 1990s, created the rate anchor that generates the disparity and costs everyone dearly, but especially the beneficiary and the efficiency of public spending.
Detailed Explanation of the Disparity-Creating Mechanism:
Fixed Commercial Reference: The rate of €24.58/h is adopted as the absolute norm by the pricing authorities. This amount includes all business costs (structure, margin, advertising).
MDPH Conversion: The AGGIR Grid (autonomy assessment) determines a theoretical number of hours. The MDPH or the Department immediately converts this need into a potential monetary envelope by multiplying the number of hours by the agency rate (€24.58/h).
The Funding Blockage: When the beneficiary opts for the flexibility of gré à gré, the Department only transfers a fraction of the envelope, corresponding to the salary (€12-17/h). The difference, which should fund coordination, is « saved » by the Department, preventing the beneficiary from securing their own aid model.
The Disproportionate Consequence for the Beneficiary: This financial imbalance hinders the adoption of secured gré à gré, which is nevertheless the most flexible model and best suited to the individualized needs of the beneficiary. For the same assessed need, the beneficiary in gré à gré ends up with a reduced envelope and unfunded administrative workload, directly impacting their quality of life.
Our Role as Autonomy Coordinator: We propose to break with this inertia by proving to the Department and the MDPH that professional coordination AND better pay for the care worker can be funded, all while remaining below the disparity ceiling (€24.58/h). We make the system equitable and efficient for the beneficiary.