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The transformation of the medico-social offer initiated for several years, marks the change of era in accommodation facilities for adults with disabilities. Thus, this transition from the era of institutional support to the inclusive era, where the user’s project is now developed from the angle of self-determination, has disrupted the models of organization, management and medico-social support implemented so far in institutions. In this context of profound change in the sector, the in-depth study of the perceptions, effects and impacts of this transformation makes sense, and makes it possible to project oneself on the necessary adjustments to be made to organizations and their actors, with the aim of calmly and effectively apprehending this overall transition. Focused on accommodation structures for adults with disabilities, this research aims to determine the stakes of these global developments, to analyze the mechanisms inherent in these multiple changes and ultimately to propose some areas for further analysis and tools that can be mobilized in this changing context by professionals.