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In France, the leading provider of long-term institutional care is the residential care home for the elderly or EHPAD [ établissement d’hébergement pour personnes âgées dépendantes]. In recent years the business model of these institutions has been called into question. However, knowledge about their method of functioning is incomplete. This article aims to study the management decisions of EHPAD directors and their determinants. A qualitative survey of 26 directors identified four defining lines in terms of care home organisation, staff composition, the fight against absenteeism, and the extent of modern management. Statistical analysis of an original survey of 460 managers was then used to study the determinants of directors’ practices in human resource management. This study shows that, for the three decision nodes studied, the strategies adopted by directors are highly correlated to their initial training. This result opens new perspectives in the tools that can be mobilised to adapt EHPADs to the future challenges of the sector.