In a sunny room plastered with white wallpaper with pink roses, Yusra Yasser Alhattali types fast on the laptop resting on her knees as she lies in bed.
She wears a tiny golden watch and lime yellow bracelet, a hint of her penchant for shopping for clothes and accessories. Malls are her favourite hangouts and she has already been to the recently opened Yas Mall despite the crowd.
All in all, Ms Alhattali, 28, is the typical girl-next-door.
“I look younger, it’s good to look young,” she writes.
For that is the only way she can communicate as she is hooked up to a ventilator. Since the age of 12, she has been afflicted by muscular dystrophy, which has degenerated her muscles, led to respiratory failure and severely limited her mobility. The rasping gasps that the ventilator makes at regular intervals can throw a newcomer off-guard but she is well used to it.
Ms Alhattali is among the 75 in-patients at ProVita with whom nurses and care givers work around-the-clock to make sure they feel at home. She has been here from the early days of the facility, which opened four years ago. Its Al Ain branch opened a year ago.
The neat little compound in the sleepy suburb of Khalifa City A has six villas for patients – adults and children – who need constant ventilator support.
Long-term care is still an underserved market in this country as investments tend to focus on new hospitals and clinics. The market is gradually diversifying with some amount of private equity coming into the segment. However, investors and analysts say insurance for non-UAE nationals in this sector and regulating the supply of new long-term care facilities will help in the growth of this segment.
“The challenge has always been market size and affordability, including insurance coverage and disposable income,” says Imad Bokhari, the transaction advisory services healthcare leader for the Middle East and North Africa region for the accountancy EY.
In the expat-dominated landscape of the UAE, as in the wider Arabian Gulf, a smaller number of residents sought such care here in the past as many went home for treatment. While there is a need from UAE nationals, the numbers are still small.
That has started to change, Mr Bokhari says.
“Between 7 and 9 per cent of all expat households in Dubai, excluding low-income workers, require some form of long-term care, such as assisted living and physical therapy, although it usually includes looking after elderly patients, according to our current estimates,” he says.
“Home care is expected be the fastest-growing sub-sector of long term, as capital expenditure will be much lower as there is no need to build facilities, as most care is provided at the patient’s home.”
More complex cases, such as post-surgery or post-trauma rehabilitation, and respiratory diseases, are taken care of at tertiary hospitals’ critical care beds.
“Lack of leading players for private-public partnership, challenges to attract and retain appropriately trained personnel and lack of incentives to develop private-public partnerships in this sector” are among the challenges to the growth of the sector, according to Norbert Hueltenschmidt, a partner with Bain and Company in Zurich and a healthcare analyst for Europe, Africa and the Middle East.
But an ageing population, the presence of non-communicable diseases such as cardiovascular diseases, cancer, diabetes and mental health problems, are driving the need for such facilities in the region, Mr Hueltenschmidt says.
Oz Mondejar, a senior vice president for Spaulding Rehabilitation Network, says: “In the UAE, we see a tremendous need [for long-term rehabilitation facilities] because acute care hospitals do not have enough beds.”
The US company provides consultancy to Abu Dhabi’s ProVita International Medical Center, which takes care of patients placed under ventilation in any age group and who can stay there as long as they need. It caters to UAE nationals. The patients include those affected by debilitating vehicle accidents, neuro-muscular conditions or congenital diseases.
The ProVita officials cite quality of life as another factor in why private medical rehab facilities are needed. Their in-patients, such as Ms Alhattali, go to schools and universities, participate in art fairs, go to movies and beaches andalso visit families regularly.
“During Eid, 85 per cent of our patients went home to spend the two days with their parents and our drivers worked 15-hour days,” says Dr Aline Nassar, the director of health affairs at ProVita.
Ms Alhattali, for instance, is in the first year of Zayed University studying English and wants to study art.
Of the 835 patients treated at all the long-term care facilities in Abu Dhabi in 2011, the latest figures available, 391 had neuropsychiatric conditions, according to a 2012 Health Authority of Abu Dhabi (Haad) report. Those suffering from cardiovascular diseases and recovering from injuries formed the next major patient group.
A handful of private-equity companies such Gulf Capital and TVM Mena have invested in such facilities.
Currently, public hospitals are the major providers of long-term care. Privately managed institutions include ProVita, Cambridge Medical and Rehabilitation Center in Abu Dhabi and Al Ain for non acute long term care, Manzil Health Care Services for home care in which TVM Capital has invested, and Amana facilities in which Gulf Capital has invested.
“Because of current minimal investment as compared to the rest of the healthcare sector, any investor from the private sector is likely to have a first mover’s advantage; however, one must be careful as to not create excessive supply,” Mr Bokhari says.
“The elderly numbers are growing and we can even see people coming back from abroad after receiving major surgeries, getting rehabilitation services here.”
In Abu Dhabi, large public providers include Tawam Hospital and Abu Dhabi Rehabilitation Center.
Dubai-based Gulf Capital completed an investment in Amana Healthcare, a provider of long-term medical care and post-acute rehabilitation to UAE nationals, in December. It invested US$25 million.
Currently, Amana has two facilities with a total of 160 beds and two more with a similar number of beds are expected to come on stream in 2016.
“So far, we have been focused on UAE nationals and if we cater to non-UAE nationals we will see more demand,” says Walid Cherif, the managing director of Gulf Credit Partners, a part of the alternative asset manager Gulf Capital.
Access for non-UAE nationals to long-term care in the country is hinged upon the penetration of insurance, Mr Cherif says. About 80 per cent of the long-term care in Abu Dhabi is taken care of by the Thiqa payment plan for UAE nationals, according to Haad.
In the absence of more long-term care facilities, patients currently are being taken care of at critical care beds of hospitals or sent abroad.
The critical care beds in Abu Dhabi have occupancy rates between 95 and 100 per cent, according to the Haad report from 2012. That year the emirate had about 598 critical care beds, including 146 intensive care units (ICU).
In home health care, currently Abu Dhabi Health Services Company, known as Seha, provides the majority of the services in Abu Dhabi through Al Tawam Hospital, Venecia Medical Center For Rehabilitation and Sheikh Khalifa Medical City (SKMC). Both Seha and Haad have proposed increased privatization in the sector.
“The opportunity for growth is huge,” says Colin Sykes, the chief operating officer at Venecia. “We work with Tawam Hospital, Al Rahba Hospital and Sheikh Khalifa Medical City and they need to free up their intensive care beds. And patients want to be with their families.”
Venecia, which opened in 2007, was among the first of the private players in home care services. Currently, there are about 42 such providers in the emirate, Mr Sykes says.
Today, Venecia has more than 80 patients on its books on a 24-hour of 12-hour care periods.
“The demand is huge and we can’t keep up with it,” Mr Sykes says. “Currently some such patients are being sent abroad but as times goes on that will change as Dubai and Abu Dhabi are moving into medical tourism.”
One of the major challenges for the growth of the sector is recruitment.
It takes six to nine months to recruit a nurse, according to ProVita. It expects to open an education centre geared towards the sector in six months.
As of now, government facilities and funding from the Government will help patients such as Ms Alhattali to pursue her dreams of opening an art gallery one day.
“I don’t want to be lazy in any way,” she writes.
“I need to keep painting and make my family happy and proud.”
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