Purpose - To cover the main trends in health care for the elderly and the issues regarding the competitiveness between public and private organizations that are mainly small to medium-sized enterprises. Design/methodology/approach - A three-dimensional longitudinal study: the social policy of public authorities; the ageing process of the French population; and the behavior of the elderly toward retirement homes. Findings - Provides a better understanding of the competition between different modes of accommodation for the elderly. Underlines the crucial role played by non-profit organizations in the French health sector, i.e. to act as a regulator and buffer between the public sector, which lacks flexibility, and the private sector, which gives a free hand to private interests. Research limitations/implications - This study is limited to France. It would benefit from being enlarged to cover larger geographical areas, e.g. Europe. Practical implications - For academics, this method could be replicated in different other fields and sectors. For public decision makers, this work shows how non-profit organizations could improve cohabitation between public and private organizations in the health-care system. For managers, this paper contributes toward a better understanding of the accommodation market for the elderly. Originality/value - This paper deals with the care of the elderly that is nowadays a world-wide problem. However, opportunities are emerging with a new market for the care for the elderly.