Chartered accountant for nursing homes and EHPADs: three-tier funding, EPRD/ERRD budgets under CPOM, per-resident cost accounting, nursing payroll management. Paris-based firm.
Running an EHPAD (a French residential care home for dependent elderly people) or a nursing home is nothing like keeping the books of an ordinary company. Your income comes from three different funders, your costs are dominated by a very heavy nursing payroll, and your accounts often have to fit a budgetary framework imposed by the supervisory authorities (EPRD, ERRD, CPOM). A standard tax return is not enough: you need to read a budget by tariff section, track a care allocation paid by the regional health agency, and justify how public funding is used.
Cabinet Hayot Expertise (Paris 8th district, registered with the Île-de-France Chartered Accountants Board) supports directors and managers of elderly-care facilities on both fronts: accounting and tax on one side, medico-social and budgetary management on the other.
An EHPAD differs from an ordinary business in three structural ways: funding split across three tariff sections (care, dependency, accommodation), each with a different payer; a specific budgetary framework (a forecast EPRD and an actual ERRD) once the facility signs a CPOM with the regional health agency and the department; and per-resident, per-section cost accounting that matters more than the tax return alone. Management revolves around one dominant cost: nursing payroll. Unlike the healthcare sector funded on an activity basis (clinics' T2A), an EHPAD belongs to the medico-social field, managed through the EPRD and the CPOM.
This is the core specificity. A resident's daily rate breaks down into three blocks, each with its own logic and payer.
In practice, this means that a single euro of cost (a healthcare assistant's salary, for example) must be allocated across several sections using allocation keys. A misallocation can distort the care allocation or the accommodation tariff, with a direct impact on cash flow. It is one of the first things we put right in files we take over.
When an EHPAD signs a CPOM (multi-year objectives and resources contract), which replaced the former tripartite agreement, with the ARS and the department council, it moves into a budgetary logic specific to the medico-social sector, set out in the French Social Action and Families Code (CASF).
These frameworks sit alongside the usual accounting and tax obligations. A commercial EHPAD remains subject to corporation tax, which we handle through our business taxation team, and the general accounting plan; a public facility applies the M22 budgetary and accounting instruction; an association-run or non-profit EHPAD follows the non-profit-entity framework. In every case, the aim is to produce an EPRD/ERRD consistent with the general accounts and with the facility's analytical reality.
Our view. Many directors experience the EPRD as administrative red tape. Used well, it is in fact a negotiation tool with the authorities: a documented EPRD, backed by solid cost accounting, makes it possible to defend a care allocation that matches the facility's real workload.
Cost accounting is not a luxury here: it is the condition for managing an EHPAD. You need to answer questions the general accounts do not address: what is the real cost of a bed? What margin does the accommodation section generate once costs are allocated? Does the care allocation actually cover nursing staff?
We structure this analysis around cost allocation by section, occupancy-rate tracking, and reconciliation between income by funder and allocated costs. It is also what reveals, sometimes early, that one section is silently funding another's deficit.
The three-section model is changing. Since 1 July 2025, 23 departments have been piloting the merger of the care and dependency sections into a single global allocation, a scheme provided for by the 2024 social-security financing act and amended by the 2025 act. The law of 28 December 2015 on adapting society to ageing (the ASV law) remains the sector's underlying framework.
This is an ongoing pilot, not a general rollout. If your facility is in a department concerned, the budgetary organisation and the allocation keys between sections change, and the impact on both the EPRD presentation and cash flow must be anticipated. We follow this closely for the files we support.
Two operational points come up in almost every file.
Residents' security deposits are not income: they are third-party accounts. They must be recorded as liabilities towards the resident, tracked individually, and refunded under the applicable rules. Treating them as accommodation turnover is a common, easily corrected mistake.
Accommodation billing follows a monthly rhythm, with special situations (absences, hospital stays, mid-month arrivals and departures) that call for clear pro-rata rules.
On VAT, care and accommodation services for dependent elderly people largely fall under exemption regimes or specific treatments. The matter is handled case by case according to the facility's status and activity; we qualify it precisely rather than applying a default rate.
In an EHPAD, staff costs are by far the largest item, and nursing staff (healthcare assistants, state-registered nurses) make up the bulk of it. The sector's acute recruitment pressure translates into costly use of temporary staff, high absenteeism and turnover, and constant pressure on payroll.
Managing this payroll means tracking actual headcount against residents, distinguishing care-section staff from accommodation-section staff, and controlling the cost of temporary work. It is joint work between payroll and management control, which we coordinate through our social and payroll team.
| Indicator | What it measures | Why it matters |
|---|---|---|
| Occupancy rate | Occupied beds out of authorised beds | First lever of accommodation income; a lost occupancy point quickly weighs on the balance |
| GMP (weighted average dependency) | Average dependency level of residents | Measures dependency workload; influences allocation and tariff |
| PMP (weighted average care needs) | Average care-needs level | Measures care workload; influences the global care allocation |
| Payroll / income | Weight of staff costs | Central balance indicator in a payroll-heavy sector |
| Cost of temporary staff | Share of agency work in staff costs | Reveals recruitment pressure and its impact on the result |
| Result by section | Care / dependency / accommodation | Detects whether one section funds another's deficit |
A case representative of our files: an association-run EHPAD of around 80 beds, after two loss-making years, whose EPRD was produced every year but with no real cost accounting behind it. Cost allocation by section relied on old keys that had never been updated. By rebuilding the allocation of staff costs by section and isolating the real cost of temporary work, we showed that the care section was under-funded relative to the facility's actual workload, and that the accommodation section was silently making up the difference. This diagnosis became the basis for the management dialogue with the authorities. The exact figures remain confidential; what recurs from one file to the next is the gap between a formally produced EPRD and genuinely reliable cost accounting.
We cover the whole chain, from bookkeeping and accounts review to the production of the EPRD/ERRD, including social and payroll management and building your forecast budget. Our Paris 8th-district firm also supports other healthcare players, such as private clinics, medical biology laboratories and health centres, with the same rigour on the reliability of public funding.
Every facility is unique (status, size, with or without a CPOM, pilot department or not). This page is informative but does not replace a review of your situation: let us talk about your facility to set the most suitable financial management.
Updated 19 June 2026. Informative content reviewed by a chartered accountant registered with the Île-de-France Chartered Accountants Board. A decision specific to your facility requires a review of your documents and the regulations in force.
The elderly-care sector covers facilities that differ widely in legal status, size and funding model, but share a common logic: a multi-funder medico-social model, a heavy care workload, and a budgetary framework set by the authorities as soon as a CPOM is signed. Financial management relies as much on cost accounting as on general accounting.
Identify precisely who funds what: the ARS global care allocation, the department dependency allocation plus resident contribution, and accommodation payable by families. This is the foundation of all cost accounting.
Review the cost allocation keys, especially for nursing payroll, and keep them updated. Frozen allocation distorts both the care allocation and the accommodation tariff.
Build a documented EPRD, consistent with the general accounts and the per-section cost accounting, to turn it into a genuine management-dialogue tool with the authorities rather than red tape.
Monitor monthly the occupancy rate, the weight of payroll, the cost of temporary staff and the result by section, in line with the facility's GMP and PMP.
Check whether the facility is in a department piloting the global allocation, and prepare for the impact of the care-dependency merger on budgetary organisation and cash flow.
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Samuel Hayot is a French chartered accountant and statutory auditor registered with the Paris professional bodies.
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The EPRD (forecast statement of income and expenditure) is the start-of-year budget document: it sets out forecast income and expenditure and the expected result. The ERRD (actual statement of income and expenditure) is its year-end counterpart: it records what was actually received and spent. Both frameworks are mandatory for EHPADs that have signed a CPOM, under the French Social Action and Families Code.
Funding rests on three sections. The care section is funded by the social-security Autonomy branch through a global care allocation paid by the ARS. The dependency section is covered mainly by the department council through the APA allowance, with a resident contribution. The accommodation section remains payable by the resident and their family, with possible department social assistance where the facility is authorised.
Not necessarily. Since 1 July 2025, 23 departments have been piloting the merger of the care and dependency sections into a single global allocation, a scheme provided for by the 2024 social-security financing act and amended by the 2025 act. This is an ongoing pilot, not a general rollout. If your facility is in a department concerned, the budgetary organisation changes and the impact must be anticipated.
Security deposits are not turnover: they are third-party accounts, recorded as liabilities towards the resident, tracked individually and refunded under the applicable rules. Treating them as accommodation income is a common mistake that distorts both the result and the cash position.
GMP (weighted average dependency) measures residents' average dependency level and therefore the dependency workload. PMP (weighted average care needs) measures the average care-needs level and therefore the care workload. Both indicators influence the allocations paid to the facility: tracking them helps defend funding consistent with the real workload.
Yes, an EHPAD operated commercially is subject to corporation tax and the general accounting plan. A public facility applies the M22 budgetary and accounting instruction, and an association-run or non-profit EHPAD follows the non-profit-entity framework. Status determines the accounting and tax framework, but every facility under a CPOM produces an EPRD and an ERRD.
The key indicators are the occupancy rate, the GMP (weighted average dependency), the PMP (weighted average care needs), the payroll-to-income ratio, the cost of temporary staff and the result by section (care, dependency, accommodation). They make it possible to detect whether one section is silently funding another's deficit.
A public EHPAD applies the M22 budgetary and accounting instruction. A commercial EHPAD is subject to corporation tax and the general accounting plan, and an association-run or non-profit facility follows the non-profit-entity framework. Every facility under a CPOM produces an EPRD and an ERRD.
Chartered Accountant, registered with the Institute of Chartered Accountants.
Regulated French accounting and audit firm based in Paris 8, built to support companies across France with a digital and decision-oriented approach.
Official and operational sources cited for this page.