Health and social affairs COCOM: bi-communal investments frozen

COCOM: a key institution for social affairs in Brussels

The Joint Community Commission (COCOM), known in Dutch as the Gemeenschappelijke Gemeenschapscommissie (GGC), is the bi-communal institution responsible for personal assistance and health matters in Brussels. It covers so-called "bi-personal" matters: those that fall under neither the French Community nor the Flemish Community exclusively, but address all Brussels residents regardless of their linguistic affiliation.

Its scope of action is broad:

• Nursing homes and care homes (MRS)
• Home care for the elderly and dependent persons
• Outpatient mental health services
• Homelessness policy and emergency shelter
• Early childhood care (bi-communal component)
• Services for people with disabilities
• Bi-communal hospitals

Since June 2024, COCOM has been operating under a caretaker government and its budget is managed through provisional twelfths. Its executive arm, Iriscare, continues its core missions but cannot commit any significant new expenditure.

The freeze on accreditations: the door is closed

The accreditation mechanism

Accreditation is the act by which COCOM recognises that a care facility or service meets the required quality and safety standards. It determines access to public funding and, in most cases, is a legal requirement to operate.

Since June 2024: zero new accreditations

Under a caretaker government, COCOM cannot issue any new accreditation. The consequences are direct:

• No new nursing homes despite the ageing of the Brussels population. The number of people over 80 in Brussels increases each year, but the supply of residential care is frozen.
• No new day centres for elderly or disabled persons
• No new accredited home care services
• No capacity extensions for existing facilities that are saturated

Facilities that submitted accreditation applications before June 2024 see their files on indefinite hold. Some have invested in premises, recruited staff and find themselves without official recognition.

Source: Iriscare, annual report 2024.

Iriscare agreements: funding under pressure

The role of agreements

Iriscare, the public interest body that implements COCOM policy, funds care providers and facilities through multi-year agreements. These agreements define the missions, resources and quality objectives for each accredited service.

The refinancing blockage

Several multi-year agreements have expired since June 2024. Under a caretaker government, Iriscare cannot:

• Renew expired agreements under updated conditions
• Revalue rates to account for inflation and rising costs
• Adapt agreements to evolving needs (ageing, mental health, precariousness)
• Fund new pilot projects or experiments

Care providers continue to operate on the basis of tacit renewals under previous conditions. The gap between actual costs and funding widens each month.

Provisional twelfths

COCOM's budget is managed through provisional twelfths: each month, one twelfth of the previous year's budget is released. This mechanism guarantees continuity of operations but prohibits:

• Any budget increase, even to cover indexation
• Any new investment in infrastructure or equipment
• Any new policy, even if it responds to a documented urgent need

Homelessness policy: the permanent emergency

The figures

The count carried out by Bruss'Help in November 2024 recorded 7,134 homeless or without-a-home people in Brussels. This figure has been rising steadily:

• 2018: 4,187 people
• 2020: 5,313 people
• 2022: 6,496 people
• 2024: 7,134 people

The increase is 70% in six years. It affects all profiles: single people, families with children, young adults, elderly people, migrants in transit.

Source: Bruss'Help, count reports 2018-2024.

What works

• The winter emergency scheme: each year, additional emergency shelter places are opened during the winter period (November to March). This scheme is recurrent and funded from existing budgets.
• Bruss'Help: the coordinating organisation for the homelessness sector continues its missions of counting, referral and coordination between stakeholders.
• Existing reception centres: facilities accredited and funded before June 2024 remain operational.

What is blocked

The structural plan to combat homelessness requires political decisions that the caretaker government cannot take:

• Housing First: the programme, whose effectiveness is demonstrated by the scientific literature, cannot be extended to new cohorts of beneficiaries
• Permanent shelter places: making emergency shelter places permanent beyond the winter scheme requires multi-year budget commitments
• Transit housing: no new agreements between COCOM and municipalities to create transitional housing
• Multidisciplinary support: no reinforcement of field teams (social workers, mediators, psychologists)

Mental health: needs without answers

A structural crisis

Mental health needs in Brussels have been rising structurally since the COVID-19 pandemic. Outpatient mental health services (Services de Sante Mentale -- SSM) face waiting lists of several months for a first consultation.

The most affected populations:

• Young people (18-25): anxiety, depression, social isolation
• People in precarious situations: precariousness is a major determinant of mental health
• Isolated elderly people: loneliness aggravates cognitive and depressive disorders
• Migrants and asylum seekers: trauma, post-migration stress, language barriers

What is blocked

Under a caretaker government, COCOM cannot launch any new mental health initiative:

• No new mobile crisis teams despite the saturation of existing services
• No new community mental health centres
• No targeted prevention programmes (youth, elderly, precarious environments)
• No reinforcement of existing SSMs whose teams are understaffed
• No new agreements with hospitals for psychiatric emergencies

Existing teams continue to work, but they are absorbing growing demand with constant resources.

Source: Brussels mental health network; Observatory of Health and Social Affairs.

Nursing homes: an ignored demographic challenge

The demographic reality

The ageing of the Brussels population is an established fact. The number of people over 80 increases each year, resulting in growing demand for places in nursing homes and care facilities.

The frozen supply

Under a caretaker government:

• No new accreditations for nursing homes
• No capacity extensions for existing facilities
• No refinancing to improve the quality of care
• No pricing policy adapted to residents' purchasing power

Nursing home staff face difficult working conditions: heavy workloads, salaries under pressure, high turnover. The freeze on investments worsens this situation.

What continues to function

Despite the blockages, the system has not collapsed:

• Iriscare handles day-to-day management: payments to providers, file processing, quality inspections
• Accredited services continue to operate within the limits of their current resources
• Bruss'Help coordinates the homelessness sector with an operational winter scheme
• The Observatory of Health and Social Affairs continues to produce data and analyses
• Existing mobile teams in mental health continue their interventions

Conclusion: a social health system under strain

COCOM/GGC is the institution that covers the most fundamental needs of Brussels residents: health, assistance for the elderly, homelessness policy, mental health. The freeze on its investment and decision-making capacity has direct consequences for the most vulnerable populations.

Each month under a caretaker government:

• Waiting lists grow longer
• Existing facilities are stretched thinner
• Unmet needs accumulate
• The social debt deepens

Resolving the crisis would require a fully empowered government capable of adopting a multi-year budget, renewing agreements with providers, accrediting new facilities and launching the structural plans that the situation demands.

Main sources: Iriscare, annual report 2024; Bruss'Help, count November 2024; Observatory of Health and Social Affairs, Social Barometer 2025; COCOM, budget on provisional twelfths.