Comparison of actual public costs:
- APA service provider: €21–22/hour on average (up to €28.58 depending on the department)
- PCH service provider: €24.58/hour
- PCH direct employment (“gré à gré”): €19.34/hour
- APA direct employment: Lower cost than with a PCH service provider
The savings are substantial — roughly 20–30% cheaper for public authorities.
For a beneficiary receiving 20 hours of assistance per week throughout the year, this represents several thousand euros in annual public savings.
Yet, direct employment is discouraged in many ways1. Deliberate administrative complexity
The elderly person becomes the legal employer and must handle all obligations:
registration with URSSAF, occupational health, leave management, replacement staff, pay slips, etc.
The administrative burden discourages most individuals.2. Lower financial support
Even though it costs less, departments reimburse less under the direct employment scheme than under the provider model — even when the exact same work is being done.3. Lack of communication
Departments heavily promote provider and intermediary services, but rarely mention the direct employment option. Many beneficiaries don’t even know it exists.4. Systematic steering toward providers
During home assessments, multidisciplinary teams almost always direct users toward approved providers, presented as “simpler” or “safer.”5. No structured support system
Unlike intermediary services, people employing directly are often left to manage alone, except for a few rare associations such as Gré à Gré Handicap that offer guidance.
Why this paradox?Unofficial reasons:
- Lobbying by major home-care corporations
The home-care sector is worth billions. Major companies (Korian, Domaliance, etc.) have every interest in maintaining a system that benefits them. - Control and traceability
Departments prefer dealing with licensed organizations that are easier to monitor than thousands of individual employers. - Corporatist logic
Professionals in the sector defend the provider model as a guarantee of “professionalism” and “quality.” - Legal complexity
In case of workplace accidents or disputes, responsibility is more diluted when a company acts as employer.
The absurdity for both workers and beneficiariesFor the care worker (auxiliaire de vie):
- Under direct employment (PCH) at €19.34/hour, the worker can earn €14–15 net/hour (depending on social contributions).
- Under a provider service at €24.58/hour, the same worker often earns only €11–12 net/hour, with the rest absorbed by administrative costs and company margins.
➡️ Direct employment allows the worker to earn more while costing less to taxpayers.For the disabled or elderly beneficiary:
- Direct relationship with their care worker
- More flexibility in scheduling
- Continuity of care (no staff turnover)
The unspoken political truthDirect employment exposes a fundamental flaw:
the system is expensive not because of human needs, but because of the structure chosen.Encouraging large-scale direct employment would mean:
- Questioning an entire economic sector,
- Admitting that intermediaries capture a large share of public funds,
- Accepting the need to train and support thousands of individual employers.
That’s why, despite its obvious economic efficiency, direct employment remains the poor cousin of home-care policies — trapped between the financial interests of provider companies and the administrative inertia of local authorities.