Content of the study:
The nursing home market - France

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1.1 Market definition and scope of study

The term "retirement home" covers several types of medical-social establishments offering a variety of housing solutions for the elderly. Retirement homes can be public or private, medicalized or non-medicalized, specialized or non-specialized, etc.

Medicalized retirement homes fall into 2 main categories:

  • EHPADs (Etablissements d'Hébergement pour Personnes Âgées Dépendantes - accommodation establishments for dependent elderly people), which cater for dependent elderly people who require permanent supervision by a medical team.

  • USLDs (Unité de Soins de Longue Durée - Long-term care units), with permanent medical staff and enhanced medical equipment to ensure total, constant care for senior citizens.

In Europe, the aging of the population is prompting governments to invest in the construction of new medical residences for senior citizens, as is the case in Germany, which has invested 10.860 billion euros in this sector.

As EHPADs are by far the majority of retirement homes, this study will focus primarily on this category. In 2019, France was home to 7,519 EHPADs, representing 70% of the country's retirement home capacity . USLDs accounted for less than 5.51% of capacity.

In 2021, EHPADs may be public (45% of establishments), private commercial (24%) or not-for-profit (31%) [Les Echos]. In 2019, 611,673 beds were available in EHPAD, with an average occupancy rate of 97%.

In France, the market for nursing homes is growing rapidly, driven by an aging population and increasing dependency among the elderly [INSEE]. This increase is set to accelerate further due to the arrival at 3ᵉ age of the generation born of the post-war "baby boom" and the continuing rise in life expectancy.

However, with supply outstripping demand, the market has been characterized for several years by significant challenges. In particular, the slowdown in the number of new establishments, existing barriers to entry, lack of financing and recruitment difficulties are key issues.

Inaddition, for several years now, establishments have been suffering froman image deficit[Les Echos]. Players are therefore focusing on modernizing their structures and seeking to improve residents' quality of life. In addition, the main players in the sector, such as Korian, Orpéa and DomusVi, are diversifying their offering, notably by strengthening their homecare services, taking over the entire operation of nursing homes and positioning themselves in alternative accommodation offers to nursing homes.

1.2 The European market

Europe's population is aging. In ****, the over-**s will represent more than a fifth of the European population. By ****, this proportion is expected to rise to almost a third. The European population aged ** and over is expected to rise from *% in **** to over **% in ****.

Proportion of the population aged ** and over Europe ...

1.3 A French market struggling to meet growing demand

In ****, ***,*** people will be staying in retirement homes in France.

Medicalized retirement homes account for almost **% of accommodation capacity for the elderly , with ***,*** people in EHPAD in ****.

Elderly care facility capacity and number of SSIAD places France, ****, in thousands Source: ****

In ****, France will have **,*** nursing homes. Between **** and ****, the number of ...


2.1 The aging of the population and the rise in elderly dependency

Many countries, particularly in the western hemisphere, are experiencing a structural trend towards an ageing population, due to combined declines in mortality and birth rates. In France, not only is the number and proportion of elderly people increasing, but also the number and proportion of dependent elderly people. This phenomenon, which ...

2.2. Typical resident profile: a majority of women and GIR 2 residents

Medicalized retirement homes are designed for individuals who are already dependent on care and therefore need permanent day-to-day support.

The female population is largely represented, with around **.*% of senior women residents in ****. This can be explained by the fact that men die earlier, so the proportion of women increases with ...

2.3 Choosing a facility: quality of care and social ties as primary criteria

The quality of care and the quality of the social and emotional bond between staff and relatives are the main criteria taken into account when choosing an EHPAD for a relative. These two criteria are cited respectively by **% and **% of respondents, and are cited first by **% and **% of respondents.

The quality ...

2.4 The poor image of nursing homes

Often referred to as "mouroirs" (***), nursing homes do not enjoy a good image in France. The scandal that brought to light situations of neglect and mistreatment at the leading EHPAD, Orpéa, in the survey "Les Fossoyeurs" published by Victor Castanet in January ****, exacerbated this poor image.

An Ifop poll carried ...


3.1. A fragmented market divided between the public and private sectors

Retirement home operators have one of three statuses:

Private not-for-profit (***). Private for-profit: residences managed by non-profit associations (***), establishments belonging to foundations, mutual benefit groups and congregations. Public: Establishments managed by the commune (***) or attached to a public hospital.


Differences in status also have a decisive impact on customers' choice of ...

3.2. Imbalances between supply and demand

Tensions between supply and demand

In the coming years, the so-called "papy boom" phenomenon, a consequence of the "baby boom" that followed the Second World War, is set to accelerate the growth in the number of dependent elderly people. With an accelerated aging of the population, linked to the post-war baby-boom ...

3.3 The sector's main challenges

The nursing home market is characterized by a number of challenges, the most important of which are as follows:

Lack of image (***) Mismatch between supply and demand (***) Recruitment Financing Digitalization


According to the Drees survey, there will be ***,*** FTEs in all facilities for the elderly in **** , **% of whom will be ...

3.4 EHPAD business model

EHPAD managers are both property managers and service companies. They therefore have two activities: property management and EHPAD operations.

EHPAD operations encompass a number of activities, in particular residence design, activity management (***), occupancy rate monitoring, resident selection and care by the management team.lection and care of residents, for example; financing ...


4.1 Offer typology

The different types of nursing homes are as follows:

Source: ****

Under the French law of January *, ****, establishments with more than ** beds and a GMP (***). As a result, the majority of MAPADs have become EHPADs. By misuse of language, no distinction is generally made between the two, the term EHPAD being used ...

4.2 Prices

In France, the median monthly cost of a single room in EHPAD in **** is **** euros. The average cost is **** euros[***] According to the same source, it breaks down as follows:

An average daily accommodation rate : Single room: €**.** / day Double room: €**.** / day

Average daily care rate : GIR *-* : *.** € / day GIR *-* : **.** € / day DIR ...


5.1 Current regulations

Law of January **, ****

Medicalized retirement homes are subject to EHPAD regulations, and therefore to the law of January **, ****.

In order to obtain the official designation of nursing home, an establishment must sign a *-year tripartite agreement with the Conseil Général du Département and the Direction Départementale de ...


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