Selling or partnering your care home (EHPAD) or senior residence in France: a sector reshaping after the crisis of the large groups

In elderly accommodation, succession long followed a simple logic. The doctor, nurse or entrepreneurial couple who had created a retirement home in the 1980s or 1990s sold, when the time came, to Korian, Orpea, DomusVi or Colisée, which absorbed establishments of 60 to 100 beds all over France. That era ended in 2022: the Orpea scandal, then soaring interest rates and costs, led the large groups to sell rather than buy, and the state to inspect the entire stock.

The succession market has not disappeared. It has changed players, criteria and pace, and requires more serious preparation than before.

7,500 care homes, 615,000 places, and a commercial private sector dominated by five groups

According to the health ministry's statistics directorate DREES, France had around 7,500 EHPADs in 2022 offering nearly 615,000 places. ¹ The public sector runs 44%, the private non-profit sector 32% and the private commercial sector 24%, or 1,805 establishments and 23% of places. ¹ Within the commercial private sector, five groups, Clariane, Emeis, DomusVi, Domidep and Colisée, operate 1,017 establishments and 83,540 beds, or 56% of commercial EHPADs and 13% of the total. ¹ The rest, nearly 800 establishments, belong to regional groups and family operators. The large groups' occupancy rate, 89%, is lower than that of other commercial EHPADs, 93%, and well below the 98 to 100% of the non-profit and public sectors. ¹

The financial situation remains tight. According to the summary published by the public finance directorate DGFiP in January 2026, nearly 60% of autonomous public EHPADs were loss-making in 2024, after 70% in 2023, with a cumulative deficit of €145 million. ² Commercial operators do not publish aggregate data, but the accounts of listed groups and the liquidation of networks such as Philogeris show the same pressure. ³ Senior living residences, operated almost exclusively by private operators, grew very quickly until the peak of openings in 2023 and 2024, before experiencing, according to Xerfi, operator defaults, frozen projects and accelerated concentration. ⁴

The four drivers of restructuring

Demographics, the long-term driver. The national statistics institute Insee projects nearly 4 million dependent seniors in 2050, against 2.5 million in 2015, and more than 700,000 people living in establishments as early as 2030. ⁵ The need for places is not in question; it is the ability to operate them profitably and compliantly that distinguishes establishments.
Blanket inspection of the stock. Following the Orpea affair, the government launched a plan to inspect all EHPADs: by the end of 2024, 96% of the 7,500 establishments had been inspected on site or on documents, 55 had been placed under provisional administration or closed and 40 reports had been sent to the public prosecutor. ⁶ An independent establishment must now document its quality like a group, without a group's support functions.
The squeeze between regulated tariffs and costs. The care and dependency sections are funded by the health insurance fund and departments, the accommodation tariff for places approved for social assistance is set by the departmental council, and only non-approved places, 19% at the large groups and 25% at other commercial operators, follow the market. ¹ When salaries, energy and food rise faster than allocations, a standalone operator has only occupancy to absorb the shock, whereas a group pools its purchasing.
The large groups' deleveraging. Clariane launched a plan including €1 billion of asset disposals, among them the sale of the 17 Les Essentielles senior residences to the Duval group in 2024 and of Petits-fils to Crédit Agricole in 2025; Emeis sold its 16 senior living residences to the fund TwentyTwo Real Estate at the end of 2025; Colisée sold around a thousand beds abroad. ^7,3 The former buyers have become sellers, and the market has opened up to other acquirers.

Who buys care homes and senior residences today

Fund-backed mid-sized groups. Domidep, owned by I Squared Capital, took over three independent EHPADs in 2025, more than 230 beds, and Emera, backed by Ardian and Naxicap, continues to grow. ³ These groups of 50 to 150 establishments look for well-run homes with clear authorisations and property in good condition.
Family and regional groups. Iroise Bellevie, Oméris, IGH, Pavonis Santé or Sedna are among the top fifteen commercial operators with a few dozen establishments each; Iroise Bellevie took over three establishments from the Philogeris liquidation. ³ For a seller, these buyers have a culture close to their own.
Mutual, non-profit and banking players. Mutual insurers and social protection groups, the Caisse des Dépôts and the insurers in Emeis's capital, Crédit Agricole with its subsidiary Santé & Territoires, or non-profit operators take over establishments to secure a local offer. ³
Property investors and senior residence operators. In senior living residences, specialist property companies and growing operators, Stella Management, Domitys or Les Jardins d'Arcadie, take over residences or entire portfolios from care home groups and developers who are pulling out. ⁴

The capital of a company operating an EHPAD can be freely transferred, but the operating authorisation, issued jointly by the regional health agency (ARS) and the departmental council, cannot be transferred without formalities and requires their express consent. The multi-year objectives and resources contract (CPOM), approval for social assistance, recent inspection reports and, for senior residences, leases with investor co-owners are the first documents any buyer asks for.

What this changes for the owner of a care home or senior residence

A full sale suits an owner close to retirement, with a transition of six months to two years to reassure families, care teams and tariff-setting authorities.
A partnership with reinvestment is for an operator of several establishments who sells a majority or minority to a group, reinvests part of the price in the top holding and continues to grow with greater resources.
A combination between operators lets two or three independents in the same department form a group able to support a quality department and purchasing negotiations, without an outside investor.
Separating property and operations or a capital reorganisation such as an OBO lets the founder secure part of their wealth, keep control of operations and bring in their director.

Whatever the structure, buyers look at the same things. An establishment presenting clear accounts, an investment plan and tracked quality indicators sells far better. The criteria that come up in every file are the following.

Occupancy and waiting list. Actual occupancy over several years, depth of the waiting list and average time to re-let a room measure the establishment's attractiveness in its area.
Approved places and accommodation tariff. Split between places approved for social assistance and non-approved places, level of the accommodation tariff relative to the local market and possible room for increase.
Average dependency level and allocations. Dependency level of residents (weighted average GIR), care allocation, content of the CPOM and its renegotiation dates.
Inspections and quality. Conclusions of the latest ARS and departmental inspections, whether orders have been lifted, reported adverse events and a formalised quality approach.
The care team and use of agency staff. Stability of management, the coordinating doctor and nursing supervisors, absenteeism and the weight of agency staff in payroll.
The building and upcoming works. Condition of the building, fire safety and accessibility compliance, energy performance, double rooms to convert and a costed investment plan.
Property structure. Ownership of the building or lease, rent level, and for senior residences, the relationship with investor co-owners; these elements determine how the deal can be structured.

You are thinking of selling: is this the right moment for you?

This is the first question we ask, and the answer is not the same for everyone. The right moment is never automatically "right now", even in a market where the range of buyers has widened. It depends on two things: you, meaning your life plans, personal horizon and wealth objectives, and your establishment, meaning its ability to realise today all the value it holds. We encounter two situations.

Your establishment is almost ready. Occupancy is high, the last inspection made only recommendations, teams are stable, the building meets standards and margin holds up against rising costs. Or you want your establishment to become part of a larger project, that of a group, often under LBO, that brings the tools, expertise and resources to absorb the sector's new requirements, which is reassuring for you and for your teams. A few weeks of preparation are then enough to go to market, and today's diversity of buyers works in your favour.
Your establishment needs time. The inspection left orders unresolved, occupancy has dropped and last year's accounts show it, the building needs heavy, unfunded renovation, or dependence on agency staff weighs on payroll. Selling remains possible, but it means accepting a discount. We will then tell you frankly that it is better to spend several months, sometimes a few years, working on these points, and we can support you through that phase before launching the transaction when you are truly ready.

The workstreams that make the difference are well known: lift inspection orders and formalise the quality approach, rebuild occupancy and the waiting list, stabilise care supervisors, plan and finance works, clarify the relationship between property and operations and present readable accounts. Depending on your starting point, they take a few weeks or a few years.

The benefit of talking early, even without being sure you want to sell, is knowing which of these two situations you are in, and deciding with full knowledge rather than under the pressure of an unfavourable inspection or an unexpected approach.

Facing groups with development teams experienced in authorisation transfers, an owner negotiating alone is rarely on an equal footing. The value of an establishment is not just a headline figure: it depends on the buyer's plan, the price structure, the portion conditional on transfer of the authorisation and maintained occupancy, the treatment of property, warranties on past inspections and the future of the teams. Two offers at the same headline price can mean very different things.

The role of an independent M&A adviser is to value the establishment objectively, identify all relevant buyers, mid-sized groups, family operators, mutual players or property investors, put them in competition in a structured and confidential process, and negotiate terms beyond price alone. This competition protects the seller: it lets them compare genuinely different projects and choose the one that fits their objectives and their residents.

Frequently asked questions

Can you sell an EHPAD without the consent of the ARS and the departmental council?

The operating company's capital can be freely transferred, but the operating authorisation, issued jointly by the ARS and the departmental council, cannot be transferred without formalities and requires their express consent. The authorities examine the buyer's plan, the multi-year objectives and resources contract and the approval for social assistance. This step structures the timetable of any care home sale.

Do the large groups still buy independent care homes?

Far less than before 2022. The large listed or fund-backed groups are selling assets and deleveraging, and have become sellers rather than buyers. The market has opened up to other acquirers: fund-backed mid-sized groups, family and regional groups, mutual, non-profit and banking players, and property investors or specialist operators for senior living residences.

Can you sell your care home and remain the operator?

Yes. An operator of several establishments can sell a majority or minority to a group, reinvest part of the price in the top holding and continue to grow with greater resources. Separating property and operations, or a capital reorganisation such as an OBO, also lets the founder secure part of their wealth while keeping control of operations and bringing in their director.

Should you sell the building along with the operations?

Not necessarily. The building and operations can be sold together, separately or to two different buyers, for example a property investor for the building and an operator for the business, each paying for what it values best. The choice depends on the rent the operations can sustain, upcoming works and the seller's wealth objectives; it should be decided before approaching the market.

How long does it take to sell a care home or senior residence?

Allow nine to eighteen months between the first conversation and the effective transfer: preparing the file, confidentially approaching buyers, offers, financial, property and quality due diligence, negotiation, then review of the authorisation transfer by the ARS and the department. The seller then supports the transition for six months to two years with families, teams and tariff-setting authorities.

Who buys care homes and senior residences today?

Fund-backed mid-sized groups looking for well-run homes with clear authorisations, family and regional groups of a few dozen establishments, mutual insurers, social protection groups, banks and non-profit operators securing a local offer, and, for senior living residences, specialist property companies and growing operators.

When should you start preparing the sale of your establishment?

Two to three years before the target date, to have time to lift inspection orders and formalise the quality approach, rebuild occupancy and the waiting list, stabilise care supervisors, plan and finance works and clarify the relationship between property and operations.

Why put several buyers in competition to sell your care home?

Because a mid-sized group, a family operator, a mutual player and a property investor do not value the same things and do not offer the same project to residents and teams. A confidential process that puts them in competition allows you to compare genuinely different offers and negotiate beyond the headline price: treatment of property, the portion conditional on transfer of the authorisation, warranties on past inspections and the future of the teams.

Public sources consulted

DREES, Études et Résultats n° 1346 : Ehpad, un résident sur dix est accueilli dans un établissement géré par l'un des cinq grands groupes (septembre 2025) : https://drees.solidarites-sante.gouv.fr/sites/default/files/2025-09/ER1346-Grands%20groupes_MEL2.pdf (high reliability)
DGFiP, Synthèse : les EHPAD publics déficitaires en 2024 (janvier 2026) : https://www.impots.gouv.fr/sites/default/files/media/8_transverse/eps_esms/syntheses/2026-01_synthese_ehpad_deficitaires_2024.pdf (high reliability)
Planète Grise (Le Média Social), Top 15 des groupes privés commerciaux d'EHPAD 2026, données au 31 décembre 2025 (juin 2026) : https://www.lemediasocial.fr/hulkStatic/EL/ELI/2026/06/f71637af2-b9e2-4c69-b523-2521a6eede12/sharp_/ANX/top-15-ehpad-prives-2026.pdf (good reliability)
Xerfi, Le marché des résidences seniors, présentation de l'étude (mise à jour du 2 juin 2026) : https://www.xerfi.com/presentationetude/le-marche-des-residences-seniors_bat53 (high reliability)
Insee, Insee Première n° 1767 : 4 millions de seniors seraient en perte d'autonomie en 2050 (25 juillet 2019) : https://www.insee.fr/fr/statistiques/4196949 (high reliability)
Gouvernement, Bilan 2024 du contrôle des EHPAD (info.gouv.fr, 28 mars 2025) : https://www.info.gouv.fr/index.php/actualite/bilan-2024-du-controle-des-ehpad (high reliability)
CFNews, Clariane rétrocède ses résidences seniors (26 juin 2024) : https://www.cfnews.net/L-actualite/M-A-Corporate/Operations/100/Clariane-retrocede-ses-residences-seniors-490433 (good reliability)