1.1 Definition of the market and the scope of the study
The term retirement home covers several types of medical and social establishments offering various housing solutions for the elderly. A retirement home can be public or private, medicalized or not, specialized or not, etc.
Medicalized retirement homes are divided into 2 main categories:
The EHPAD (Establishments for the Accommodation of Dependent Elderly Persons) which target dependent elderly persons for whom a permanent supervision by a medical team is necessary.
The USLD (Unité de Soins de Longue Durée - Long-term care unit) with permanent medical staff and reinforced medical equipment to ensure the total and constant care of seniors.
In Europe, the aging of the population is prompting European countries to invest in the construction of new medical residences for seniors, like Germany, which has invested 10.860 billion euros in this sector.
As EHPADs are by far the majority, this study will focus primarily on this category of medicalized retirement homes. In 2019, France had 7,519 EHPADs, which represented 70% of the total capacity for the elderly. USLDs, on the other hand, represented less than 5.51% of the accommodation capacity.
In 2018, EHPADs can be public (44% of establishments), private commercial (25%) or non-profit (31%). In 2019, 611,673 beds were offered in EHPADs and the average occupancy rate was 97%.
In France, the market for nursing homes is growing rapidly, driven by the aging population and the increase in elderly dependency. This increase is expected to accelerate further due to the arrival at 3ᵉ age of the post-war "baby boom" generation and the continued increase 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 creation of new facilities and the existing barriers to entry, lack of financing and recruitment difficulties are central issues.
For several years now, institutions have also been suffering from an image deficit. The players are therefore focusing on modernizing their structures and seeking to improve the quality of life of residents. In addition, the main players in the sector, such as Korian, Orpéa and DomusVi, are diversifying their offer, in particular by reinforcing their home care offer, by taking over the entire operation of nursing homes and by positioning themselves on alternative accommodation offers to nursing homes.
1.2 The European market
The demand for housing for seniors Europe, ****, in millions of people Source: ****
There is a certain increase in the number of people over ** years of age in a majority of European countries. Germany is the country with the largest number of seniors, with approximately ** million people, and it is estimated that ...
1.3 A French market struggling to meet growing demand
Medicalized retirement homes account for more than three quarters of the accommodation capacity for the elderly. In ****, EHPADs had in fact ***,*** places while in ****, they could accommodate ***,*** people, an increase of *.**%.
Capacity of residential facilities for the elderly and number of SSIAD places France, ****, in thousands Source: ****
Between **** and ****, the number ...
ANALYSIS OF THE DEMAND
2.1 The aging of the population and the increase in dependency of the elderly
Many countries, particularly in the West, are experiencing a structural trend of population aging 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 has been observed ...
2.2. Typical profile of the residents: a majority of women and GIR 2
Medicalized retirement homes are intended for individuals who are already dependent and therefore need permanent daily support.
The female population is largely represented, with approximately **% of senior residents being women.
The residents generally suffer from Alzheimer's disease (***)[***]
On average, the residents are ** years old. The majority (***) of nursing home residents are ...
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 the staff and the parent are the main criteria taken into account when choosing an EHPAD for a parent. These two criteria are cited by **% and **% of respondents respectively, and are cited first by **% and **% of ...
2.4 The poor image of nursing homes
Often referred to as "mouroirs" (***), medicalized retirement homes do not enjoy a good image in France. In ****, **% of respondents had a poor image of nursing homes and **% of nursing staff in nursing homes. Conversely, caregivers working in the homes of the elderly have a good image.
Perception of healthcare personnel/caregivers ...
3.1. A fragmented market divided between public and private sectors
Nursing home operators have one of three statuses:
Private non-profit (***). Private for-profit: Residences managed by non-profit associations (***), establishments belonging to foundations, mutualist groups, and congregations. Public: Establishments managed by the commune (***) or attached to a public hospital.
Moreover, the differences between the statuses have determining consequences in the choice of ...
3.2. Imbalances between supply and demand
Tensions between supply and demand
In France, there are approximately *.* million dependent persons, including *.* million beneficiaries of the APA (***) in ****, **% of whom are totally dependent. As analyzed in *.*, the number of elderly people is growing rapidly, as is their dependency.[***]
This growth is expected to accelerate even more in the coming ...
3.3 The main issues of the sector
The nursing home market is characterized by a number of challenges, the main ones being the following
The image deficit (***) The gap between supply and demand (***) Recruitment Financing Digitalization
The average distribution of staff in an EHPAD is illustrated by the graph below. A large part of the staff belongs ...
3.4 Economic model of an EHPAD
EHPAD managers are both property managers and service companies. They therefore have two activities: property management and operation of the EHPAD.
The operation of the EHPAD includes several activities, in particular the design of the residences, the management of the activity, i.e. the inflow and outflow, the monitoring of occupancy ...
ANALYSIS OF THE OFFER
4.1 Types of offers
The different types of nursing homes are the following:
Since the law of January *, ****, establishments with more than ** beds and a GMP (***). Consequently, the majority of MAPADs have become EHPADs. By abuse of language, no distinction is generally made between the two, the term EHPAD being used in both ...
4.2 The prices
In France, the median monthly cost of a single room in EHPAD in **** was **** euros.[***]
There are geographical disparities regarding the prices of medicalized retirement homes as shown in the map below. In particular, Ile-de-France, Corsica and Provence-Alpes-Côte-d'Azur are the most expensive regions, with a median price of over *,*** euros. ...
5.1 Current regulations
Law of January **, ****
Medicalized retirement homes are subject to the regulations for EHPAD 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 General Council of the Department as well as with the Departmental ...
POSITIONING OF THE ACTORS
The following segmentation of actors is used:
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