Dubai Rehabilitation Center

Transcription

1 Dubai Rehabilitation Center Planning Assumptions Health Policy, Planning and Strategy Policy & Strategy Department Policy and Strategy Sector April 2010

2 Dubai Rehabilitation Center s Updated Planning Assumptions Table of Contents Executive Summary 3 Introduction 4 Overview of the Project 4 Demographic profile and future projections of Target Population 5 Estimated Demand for acute rehabilitation beds for Nationals 60+ in Dubai year 2010 Estimated In-patient yearly demand for acute rehab services for Nationals 60+ in Dubai on different scenarios for years Estimated In-patient Capacity at Dubai Rehab Center Estimated yearly Capacity of rehabilitation procedures at Dubai Rehab center Estimated yearly Demand for rehabilitation procedures for National patients 60+ admitted in Dubai Rehab center 13 Estimated yearly demand for out-patient services for Nationals patients 60+ admitted at Dubai Rehab Center Estimated In-patient demand for acute rehab beds for Nationals above 20 years in Dubai Estimated yearly demand for out-patient services for Nationals admitted at Dubai Rehab Center General comments and recommendations 19 Brief Building Description of Dubai Elderly Rehab Center based on site visit Annex (1) on 7/12/2009 Population Projections of Nationals 60+ in Dubai up to 2025 Annex (2) References used for Diseases incidence and ALOS calculations for Dubai Annex (3) Elderly Rehab Center References used for setting type and number of staff required to run the Annex (4) rehab center and rehab community services Elderly Care & Rehabilitation Centre Dubai New Project by Dr. Salwa Annex (5) AlSuwaidi, Specialist Registrar Geriatrician, Project Manager Team Worked on and/or Consulted in This Study Annex (6)

3 Dubai Rehabilitation Center: Updated Planning Assumptions Executive Summary DHA Policy and Strategy was asked to review planning assumptions for the Dubai Elderly Rehabilitation Center as a basis for the development of an operator contract PPP. Our original planning assumptions document summarized our analysis and findings based on a review of the current and future demand for elderly rehabilitation services (Nationals 60+) and international experience from relevant comparator nations. This document amends and expands the earlier analysis to include the demand for rehabilitation services for all nationals above 20 years with specific medical disorders as requested by His Excellency Qadhi Saeed Al Murooshid, Director General of the Dubai Health Authority. Key findings and recommendations of the report include the following: Dubai Rehabilitation Center (DRC) s current bed and outpatient profile is sufficient to meet current needs for elderly rehabilitation services among nationals over 60 years and those above 20 years with Stroke, Parkinson disease and Multiple Sclerosis subject to explicit criteria for admission namely that admission will be restricted to those with particular acute rehabilitation needs and not long-stay or other social cases and subject to the center operating at international benchmark levels for Average Length of Stay (i.e. moderately shorter stays than are currently the case in Dubai). Inclusion of outreach and home-based services is essential and has been accounted for in our analysis of staffing requirements. Assuming that DRC is opened on time it will immediately operate at 85% bed occupancy rate. As such, we project that a second center will be required in the Deira area by 2015 to ensure better access and a more even geographic distribution of services and avoid overcrowding and customer dissatisfaction at DRC as demand for its services expands. Planning for this center should begin in The current geriatric facilities at DHA are largely occupied by long-stay patients. This shifts acute rehabilitation cases into acute medical wards and in some cases the community (e.g. patients who return home without adequate rehabilitation). Dubai Rehab Center is an excellent medium for delivering acute rehabilitation services and should remain strictly focused on these services. Long-stay or social admissions should be strictly prevented to avoid progressive failure of the rehabilitation model. Director, Strategy and Policy 3

4 Introduction: Currently, most of Dubai UAE Nationals are sent abroad, mostly to Germany and USA, after receiving acute management of their medical conditions to continue the required extensive rehabilitation services when needed. The reason behind that is the lack of proper acute rehabilitation services in Dubai and the whole UAE. This is affecting patients health, as they end up with limited social and psychological support essential for better prognosis. On top of that, this is causing unbearable additional financial burden on Dubai Government. The scenario becomes worse with elderly who face further psychological and physical problems in travelling abroad. From here came the idea of establishing an acute rehabilitation center to provide post acute treatment rehabilitation services primarily for patients suffering from common acute medical conditions such as stroke, parkinsonism, arthritis etc. with priority being for the elderly patients. Overview of the Project: Basic facts about the Center: The center is located at Dubai 2 area in Bur Dubai; The construction started on 1 st April 2008 and expected to finish by end of 2009; Total Land area is 7011 sq. meter and build in area is 5494 sq. meter; Consists of out-patients area as well as two in-patient wards one for males and the other for females with 15 single rooms each; Space planning standards - room sizes, types of rooms and grossing factors are planned according to DHA standards influenced by European/ German Standard and comply with AIA standards and contemporary guidelines; to ensure all standards of design and care are met. The main purposes of Dubai Rehab Center are: To help UAE patients, especially elderly, regain their physical independency after specific disorders; Maximize the physical independency of those who still have it, by helping them in their activities of daily living (ADL) and instrumental activities of daily living (IADL); Re-integrate patients, especially elderly, back into their communities; Improve quality of life for these patients; Liaise with hospitals to facilitate early discharge management. The Admission Criteria are as follows: U.A.E citizen patients; The priority is for 60 years and above With a medical problem that is amenable for rehabilitation initially limited to Stroke, Knee and Hip replacement, fracture femur/hip, Parkinson s disease and Arthritis (these medical conditions are chosen on the base of common occurrence and most benefit from acute medical rehabilitation); Patients should be accepted following extensive social assessment to avoid problems of long-stay 4

5 The Services the Center will be providing are as follows: Medical assessment and treatment Individually created rehabilitation plan and program Physiotherapy (6 stations), Occupational Therapy (10 stations) and Gym (9 stations); Hydrotherapy ( swimming pool activity 4 at a time, treadmill pool 1, and water bed massage 1); Speech Therapy (single station); Psychology and Social Services (one consultation room each) Foot Care (single station) Geriatric Services (two clinics) Community Services Demographic profile and future projections of Nationals 60 + in Dubai: Until eighties, the percentage of 60 years old and above among UAE Nationals was way below 2%. However, with the steady increase of life expectancy at birth and the improvement of all other determinants of long living, the percentage of Nationals 60 and above in Dubai has increased dramatically and is expected to reach 11% in year 2025 as illustrated in table (1) below. Table (1): Projected Number and Percentage of 60+ in Dubai by Age group (Nationals only) Year Age Group Number % of Total National (N) Pop Number % of Total N Pop Number % of Total N Pop Number % of Total N Pop , , , , , , , , , , , , , , , Total 8, , , , Note: These projections are based on 2008 National population estimate from Dubai Statistic Center, The following factors were taken into consideration: Crude Birth Rate of Dubai, Male to Female Ratio in UAE/Dubai, Age Specific Mortality rate of UAE /Dubai. This increase is factual for both genders as shown in table (2) and figure (1) below. Table (2): Projected Number of 60+ Nationals in Dubai by age group and gender Age Group Males Females ,653 2,635 4,148 5,801 1,366 2,617 4,326 6, ,126 1,860 2,990 4, ,758 3,075 4, ,317 2,133 3, ,169 2,141 3, ,069 2,343 4,164 6, ,905 3,777 6,743 Total 4,682 8,155 13,435 20,298 3,737 7,449 13,319 20,685 5

6 Graph (1): Projected Number of 60+ Nationals in Dubai by age group and gender ,000 20,000 Age Group 15, ,000 Males Females , The availability of patients support at home to help support the elderly financially and physically is expected to affect the workload of Dubai Rehab Center (e.g. patients with proper support could be discharged early and have the rest of rehabilitation as out-patient or homecare services). Table (3) below reveals dependency ratio of Dubai s 60+ nationals in five years intervals for the period 2010 to Table (3): Projected old age (Nationals 60 and above) dependency ratio from 2010 to 2025 Year Nationals aged supporting one female Nationals aged supporting one male Total Nationals 60+ dependency ratio The ratio of Nationals to 60+ Nationals in Dubai (financial and/ or physical dependency) Estimated Demand for acute rehabilitation services for Nationals 60+ in Dubai: As its well known, rehabilitation services will mostly benefit patients who have just recovered from acute medical condition that necessitate extensive rehabilitation such as stroke and knee or hip replacement. Therefore, what is needed for demand calculation is the incidence and not prevalence of relevant medical disorders. With current health information system in Dubai, it is impossible to get incidence of the related medical disorders. Taking this into consideration, we have chosen to apply the incidence rate of the specified diseases in 60+ groups in US, Australia and UK to the same groups in Dubai National population (Benchmark rates). Table (4) shows projected rehabilitation bed 6

7 required in Dubai in 2010 based on the incidence of the relevant medical disorders and ALOS in the benchmarked countries, while table (5) shows the same when applying ALOS in Dubai. Table (4): Projected Rehabilitation-Bed Requirement in 2010(for top 6 medical conditions and restricting to age 60+ as admission criteria), Based on ALOS in benchmarked countries Medical Disorders No. Of Patients ALOS at Rehab Rehab Days Stroke Arthritis Fracture Femur Hip replacement Knee Replacement Parkinson Disease Total Equivalent beds at 80% occupancy 16 Beds Required with 30% extra capacity to account for higher osteoporosis, diabetes*, etc in Dubai 21 Note: The no. of patients in this table is not based on actual data. They have been calculated applying the incidence rate of the specified diseases in 60+ groups in US, Australia and UK to the same groups in Dubai National population (Benchmark rates). Average LOS for these specific diseases has also been benchmarked to Canada, Australia and US. * These diseases could lead to higher demand for rehabilitation services for elderly as osteoporoses could cause more fractures and diabetes would lead to more cardiovascular disorders. Table (5): Projected Rehabilitation-Bed Requirement in 2010 (for top 6 medical conditions and restricting to age 60+ as admission criteria), Based on ALOS in Dubai Medical Disorders No. Of Patients ALOS at Rehab Rehab Days Stroke Arthritis Fracture Femur Hip replacement Knee Replacement Parkinson Disease Total Equivalent beds at 80% occupancy 21 Beds Required with 30% extra capacity to account for higher osteoporosis, diabetes, etc in Dubai 27 ALOS for these specific diseases in Dubai is given by Dr. Suad Trebinjac, Head of Physical Medicine & Rehabilitation Department, Rashid Hospital with DHA-Planning Team s calculations From observing pattern of diseases of elderly worldwide in general and in Dubai in particular, there are four other medical disorders that could highly benefit from acute rehabilitation services and will require additional number of beds. Table (6) below shows projected rehabilitation bed required in 7

8 Dubai in 2010 for the top 10 medical disorders based on the incidence of these disorders and ALOS in the benchmarked countries, while table (7) shows the same when applying ALOS in Dubai. Table (6): Projected Rehabilitation-Bed Requirement in 2010 when all other chronic conditions of elderly that can benefit from rehabilitation are included (top 10 medical disorders and restricting to age60+) (Based on ALOS in benchmarked countries) Medical Disorders No. of Patients ALOS in Rehab Rehab days Stroke Arthritis Fracture Femur Hip replacement Knee Replacement Parkinson Disease Amputation Traumatic Brain Injury Disability(Multiple Trauma and Complex Medical Conditions) Chronic Pain (Spinal Stenosis and Diabetic Neuropathy) Total Equivalent beds at 80% occupancy 33 Beds Required with 30% extra capacity to account for higher osteoporosis, diabetes, etc in Dubai 42 Note: Some medical conditions such as chronic pain & disability can result from spinal cord dysfunction, complex medical/ orthopedics diseases( e.g diabetes with osteoporosis) etc. Table (7): Projected Rehabilitation-Bed Requirement in 2010 when all other chronic conditions of elderly that can benefit from rehabilitation are included (top 10 medical disorders and restricting to age60+) (Based on ALOS in Dubai) Medical Disorders No. of Patients ALOS in Rehab Rehab days Stroke Arthritis Fracture Femur Hip replacement Knee Replacement Parkinson Disease Amputation Traumatic Brain Injury Disability(Multiple Trauma and Complex Medical Conditions) Chronic Pain (Spinal Stenosis and Diabetic Neuropathy) Total Equivalent beds at 80% occupancy 45 Beds Required with 30% extra capacity to account for higher osteoporosis, diabetes, etc in Dubai 58 8

9 1. 1- Estimated In-patient demand for acute rehab services for National 60+ in Dubai on different scenarios are illustrated in tables (8) to (10) Table (8) Estimated in-patient demand for acute rehabilitation services for Nationals 60+ in Dubai Base Case Scenario Ratios UAE Nationals 60+ in Dubai 8,419 11,548 15,604 20,682 Based on ALOS in benchmark countries for top 6 medical disorders Care days 4,650 6,386 8,629 11,437 Occupancy Rate 80% Beds Required with 30% extra capacity to account for higher osteoporosis, diabetes*, etc in Dubai Based on ALOS in Dubai for top 6 medical disorders Care days 5,996 8,245 11,141 14,767 Occupancy Rate 80% Beds Required with 30% extra capacity to account for higher osteoporosis, diabetes*, etc in Dubai Based on ALOS in benchmark countries for top 10 medical disorders Care days ,026 17,601 23,329 Occupancy Rate 80% Beds Required with 30% extra capacity to account for higher osteoporosis, diabetes*, etc in Dubai Based on ALOS in Dubai for top 10 medical disorders Care days Occupancy Rate 80% Beds Required with 30% extra capacity to account for higher osteoporosis, diabetes*, etc in Dubai Based on ALOS in benchmark countries (top 6) Based on ALOS in Dubai (top 6) Based on ALOS in benchmark countries (top 10) Based on ALOS in Dubai (top 10) * These diseases could lead to higher demand for rehabilitation services for elderly as osteoporoses could cause more fractures and diabetes would lead to more cardiovascular disorders. 9

10 Table (9) Estimated in-patient demand for acute rehabilitation services for Nationals 60+ in Dubai Optimistic Scenario (Mortality rate decreases and Crude Birth Rate Increases) Ratios UAE Nationals 60+ in Dubai ,650 16,003 21,670 Based on ALOS in benchmark countries for top 6 medical disorders Care days 4,658 6,442 8,850 11,984 Occupancy Rate 80% Beds Required with 30% extra capacity to account for higher osteoporosis, diabetes, etc in Dubai Based on ALOS in Dubai for top 6 medical disorders Care days 6,014 8,318 11,426 15,472 Occupancy Rate 80% Beds Required with 30% extra capacity to account for higher osteoporosis, diabetes, etc in Dubai Based on ALOS in benchmark countries for top 10 medical disorders Care days 9,501 13,141 18,051 24,444 Occupancy Rate 80% Beds Required with 30% extra capacity to account for higher osteoporosis, diabetes, etc in Dubai Based on ALOS in Dubai for top 10 medical disorders Care days Occupancy Rate 80% Beds Required with 30% extra capacity to account for higher osteoporosis, diabetes, etc in Dubai Based on ALOS in benchmark countries (top 6) Based on ALOS in Dubai (top 6) Based on ALOS in benchmark countries (top 10) Based on ALOS in Dubai (top 10) 10

11 Table (10) Estimated in-patient demand for acute rehabilitation services for Nationals 60+ in Dubai Pessimistic Scenario (Mortality rate increases and Crude Birth rate decreases) Ratios UAE Nationals 60+ in Dubai ,313 14,768 18,825 Based on ALOS in benchmark countries for top 6 medical disorders Care days ,256 8,167 10,410 Occupancy Rate 80% Beds Required with 30% extra capacity to account for higher osteoporosis, diabetes, etc in Dubai Based on ALOS in Dubai for top 6 medical disorders Care days 5,994 8,077 10,544 13,441 Occupancy Rate 80% Beds Required with 30% extra capacity to account for higher osteoporosis, diabetes, etc in Dubai Based on ALOS in benchmark countries for top 10 medical disorders Care days ,761 16,658 21,235 Occupancy Rate 80% Beds Required with 30% extra capacity to account for higher osteoporosis, diabetes, etc in Dubai Based on ALOS in Dubai for top 10 medical disorders Care days Occupancy Rate 80% Beds Required with 30% extra capacity to account for higher osteoporosis, diabetes, etc in Dubai Based on ALOS in benchmark countries (top 6) Based on ALOS in Dubai (top 6) Based on ALOS in benchmark countries (top 10) Based on ALOS in Dubai (top 10) 11

12 1. 2- Estimated In-patient capacity at Dubai Elderly Rehab Center (according to USA, Australia and UK benchmarks) are illustrated in table (11) below: Table (11) In-patient Capacity of Dubai Rehab Center (based on the admission criteria of top 6 medical disorders and patient s age as 60+) Medical disorder # of Beds Days/ Year ALOS (Days) Bed Occup. Rate Capacity (# of Patients) /year/ room Total Capacity (all rooms) Surplus Capacity Stroke Arthritis Fracture femur Knee & hip replacement % Parkinson's disease Total Note: The number of beds by medical disorder is based on incidence these disorders in 60+ groups in US, Australia and UK. Average LOS for these specific diseases has also been benchmarked to Canada, Australia and US. Points to be taken into consideration: Comparing the estimated demand for beds for elderly at the launch of Dubai Rehab Center with the maximum in-patient capacity, there is an evidence of the presence of surplus capacity. This surplus capacity could be utilized by nationals above 20 years with specific medical conditions namely Stroke, Parkinson disease and Multiple Sclerosis. However,once operating we might experience a latent demand that will narrow the above mentioned surplus; After thorough discussions with rehabilitation and geriatric consultants in Dubai and with the availability of patient support at residence for most of UAE nationals, part of the rehabilitation process could be carried out either on an out-patient basis or through homecare programs. This will open door for accommodating larger numbers as per the above point. 12

13 Estimated Capacity of rehabilitation procedures at Dubai Rehab center is illustrated in table (12) bellow Table (12) Rehab Procedures Capacity Calculations of Dubai Rehab Center Rehab Type # of Stations Minutes per Procedure Hours/ Day Days/ Year Efficiency Capacity /year/ Station Total Capacity (all stations) physiotherapy ,920 occupational therapy ,400 speech therapy gym activity ,880 electrotherapy ,960 swimming pool activity hrs % ,520 Treadmill Pool Water bed massage Individual Treatment Room Out-door exercise Machines ,880 Source: Dr. Salwa Abdulla Alsuwaidi, Project Manager of Dubai Elderly Rehab Center and Ms. Ismat Bakir Omar, Assistant Project Manager of Dubai Elderly Rehab Center with DHA-Planning Team calculations Estimated yearly demand for rehabilitation procedures for National patients 60+ admitted in Dubai Rehab center for top 6 medical disorders is illustrated in table (13) bellow Table (13) Estimated total yearly demand for rehab procedures (top 6 disorders and restricting to age 60+) As taken from table 4 above (Post acute hospital treatment rehab) Rehab Type Stroke Knee & Hip Fracture Parkinson s Arthritis Total Surplus Replacement Femur Disease Sessions Capacity physiotherapy ,509 occupational therapy ,755 speech therapy ,810 gym activity ,274 electrotherapy ,092 swimming pool activity ,200 Treadmill Pool ,460 Water bed massage ,320 Individual Treatment 8, Room Out-door exercise 38, Machines Source: Dr. Suad Trebinjac, Head of Physical Medicine & Rehabilitation Department, Rashid Hospital with DHA-Planning Team s calculations Points to be taken into consideration: 13

14 Looking at the above figures, its clear that the capacity of all rehab procedures at Dubai Rehab Center far exceeds the maximum in-patient demand for elderly nationals; thus, allowing for the accommodation of other population segments and illnesses, including mild cases on out-patient basis, as profit generation practice; The availability of individual treatment rooms, water bed massage and Podiatrist will allow for taking care of other type of cases such as caring for diabetic patients and people in need for different types of therapeutic massage; Estimated Capacity of out-patient services/clinics at Dubai Rehab center is illustrated in table (14) bellow Table (14) Out-patient clinics Capacity of Dubai Rehab Center Type Scenarios # of Clinics # of Patients/ Hour Hours/ Day Days/ Year Efficiency Capacity/ Year/clinic Geriatrics A Clinic B C Rehab Clinic A B C Social work 8 hrs 80% One Only 1 1 Consultation Room (R) Podiatrist treatment One Only Neurology on visiting basis One only Clinical Psychology on 96 One Only 1 1 visiting basis 614 Source: Dr. Salwa Abdulla Alsuwaidi, Project Manager of Dubai Elderly Rehab Center and Ms. Ismat Bakir Omar, Assistant Project Manager of Dubai Elderly Rehab Center with DHA-Planning Team calculations Estimated yearly demand for out-patient services for National patients 60+ admitted at Dubai Rehab Center is illustrated in table (15) bellow Table (15) yearly demand for out-patient services for Nationals patient 60+ admitted At Dubai Rehab Center Type of Consultation Geriatrics Estimated Number of Yearly Consultations 1508 Surplus Capacity on different scenarios Rehab Social worker Clinical Psychology Podiatrist Neurology Assumptions: Average number of consultations per in-patient is: 9 Geriatrics, 1 Rehab, 0.5 Social Work, 0.75 Clinical Psychology, 3 Podiatrist and 4 Neurology consultations. Points to be taken into consideration: 14

15 Looking at the above figures, its also clear that the capacity of all rehab out-patient clinics at Dubai Center far exceeds the maximum demand for admitted nationals 60+, allowing for the accommodation of many more geriatric and rehab cases on out-patient basis as profit generation practice; The center can easily accommodate the younger UAE nationals (20 to 59 years old) presenting with the diagnosis of Stroke, Parkinson disease and Multiple Sclerosis on inpatient and out-patient basis; The rest of this document will demonstrate calculations, analysis and general recommendations on Dubai Rehab Services when adding nationals above 20 with Stroke, Parkinson and Multiple Sclerosis to nationals 60+ tackled previously in details Estimated Demand for acute rehabilitation beds for Nationals in Dubai: Table (16) below illustrates the rehab bed requirement when the admission to rehab center is not restricted to those above age of 60 but will be open to all UAE national patients above age of 20 years presenting with Stroke, Arthritis, Fracture Femur, Hip and Knee Replacement, Parkinson Disease and Multiple Sclerosis. It is clear from the figures below that Dubai Rehab center alone will not be able to fulfill the demand for rehab services if opened to all national patients above the age of 20, as around 50 beds will be then needed based on the ALOS in benchmarked countries only. Table (16): Projected Rehabilitation-Bed Requirement in 2010 (For All Nationals above 20 years with the 7 medical conditions mentioned above) (Based on ALOS in benchmarked countries) Medical Disorders No. Of Patients ALOS at Rehab Rehab Days Stroke Arthritis Fracture Femur Hip replacement Knee Replacement Parkinson Disease Multiple Sclerosis Total Equivalent beds at 80% occupancy 43 With 30% extra capacity 56 Note: The no. of patients in this table is not based on actual data. They have been calculated applying the incidence rate of the specified diseases in US, Australia and UK to the same groups in Dubai National population (Benchmark rates). Average LOS for these specific diseases has also been benchmarked to Canada, Australia and US. If Dubai Rehab Center plans to accommodate, on top of nationals 60+, only young nationals presenting with Stroke, Parkinson disease and Multiple sclerosis, the number of bed required will be 30 beds at occupancy rate of 85% as illustrated in Table (17) below. Table (17): Projected Rehabilitation-Bed Requirement in 2010 (Adding Nationals above 20 with Stroke, Parkinson and Multiple Sclerosis) (Based on ALOS in benchmarked countries) 15

16 Medical Disorders No. Of Patients ALOS at Rehab Rehab Days Stroke Arthritis Fracture Femur Hip replacement Knee Replacement Parkinson Disease Multiple Sclerosis Total Equivalent beds at 85% occupancy 30 With 30% extra capacity 39 Estimated yearly demand for out-patient services when adding nationals with Stroke, Parkinson and Multiple Sclerosis admitted at Dubai is illustrated in table (18) bellow Table (18) yearly demand for out-patient services for admitted Nationals (Adding Nationals above 20 with Stroke, Parkinson and Multiple Sclerosis) Type of Consultation Estimated Number of Yearly Consultations Surplus Capacity on different scenarios 480 Geriatrics/ General 2592 physician Rehab Social work Clinical Psychology Podiatrist Neurology Assumptions: Average number of consultations per in-patient is: 9 Geriatrics/ General Physician, 1 Rehab, 0.5 Social Work, 0.75 Clinical Psychology, 3 Podiatrist, 4 Neurology except MS patients whom require up to 15 consultations per inpatient depending upon the severity of condition. Points to be taken into consideration: Looking at the above figures (except for geriatrics/ general physician consultations), the capacity of all rehab out-patient clinics at Dubai Center far exceeds the maximum demand for admitted patients allowing for the accommodation of many more rehab cases on out-patient basis as profit generation practice; This surplus capacity persists even when the out-patient load increases due to young UAE nationals with Stroke, Parkinson and Multiple Sclerosis are accommodated; Estimated yearly demand for Rehab Procedures when adding nationals with Stroke, Parkinson and Multiple Sclerosis admitted at Dubai is illustrated in table (19) bellow 16

17 Table (19) Estimated total yearly demand for rehab procedures (Adding Nationals above 20 with Stroke, Parkinson and Multiple Sclerosis) Rehab Type Stroke Knee & Hip Replacement Fracture Femur Parkinson s Disease Arthritis Multiple Sclerosis Total Sessions Surplus Capacity physiotherapy ,820 occupational , therapy 90 speech therapy gym activity ,070 electrotherapy ,410 swimming pool , activity - Treadmill Pool ,040 Water bed 4, massage Individual 8, Treatment Room Out-door exercise 38, Machines Source: Dr. Suad Trebinjac, Head of Physical Medicine & Rehabilitation Department, Rashid Hospital with DHA-Planning Team s calculations Points to be taken into consideration: Looking at the above figures, its still clear that the capacity of most of rehab procedures at Dubai Rehab Center far exceeds the maximum in-patient demand; thus, allowing for the accommodation of other population segments and illnesses, including mild cases on out-patient basis, as profit generation practice; The availability of individual treatment rooms, water bed massage and Podiatrist will allow for taking care of other type of cases such as caring for diabetic patients and people in need for different types of therapeutic massage; Table (20) Estimated Staff required to run Dubai Rehabilitation Center based on British Society of Rehabilitation Medicine (BSRM) Standards Amended as per Dubai s Need (Additional Requirements) 17

18 Type of staff # to run 30 beds * Additional Requirements Director of the Center 1 Assistant Director 1 Geriatrician 1 Consultant in Geriatrics Consultant accredited in rehabilitation medicine 1 Doctor with experience in Rehab Medicine/Geriatric Medicine 2 SR (Senior Registrar) Physiotherapists 6 Physiotherapists Aid 6 Speech and Language Therapists 1 Preferably an Arabic Speaking Hydro therapists 2 Hydro therapists Aid 2 Preferably an Arabic Speaking Clinical Psychologist/Counselor 1 Visiting Basis Neurologist 1 Social Worker and Activity Coordinator 2 +1 Social Worker Aid 2 Dietician 1 Clerical Staff (Receptionist+ Secretary+ Medical Record Staff+ 8 Visiting Basis( 2-3 times a week depending on case-mix and patient load) Minimum 80% of all these positions should be filled with Nationals. Ward Clark) Occupational Therapists 2 Occupational Therapists Aid 2 Preferably an Arabic Speaking Podiatrist 1 Messenger 5 Staff Nurses 15 With at least 1/3 with specific rehab training and remaining with experience of geriatric care Mix of Males & Females Assistant Nurses 33 Minimum 80% staff should be Arabic speaking Mix of Males & Females 18

19 General comments and recommendations: Dubai Rehabilitation center is designed up to a very high standard in healthcare facility construction and technology; the first is expected to give the center a very long lifespan. However, several points should be considered by the future management team of this center: This facility should serve solely and exclusively as an acute rehabilitation center. Long-term patients should not be admitted as the block of a single bed will affect the capacity and service provision to a great extent; The Flower Shop and Staff Canteen should be rented to external parties to operate e.g. subcontractors to a main private operator (with DHA holding right of no objection); The availability of surplus capacity especially in out-patient services provided should be properly and fully utilized towards serving different population segments in need for rehab services in Dubai taking into consideration the following points: o o o o Priority should always be given to the main target population i.e. UAE nationals 60 years and above, and their needs should be fully met before opening door for serving others; The availability of surplus capacity should also be taken as an opportunity to minimize sending people abroad to receive the service and possibly also to generate additional revenue through utilization of out-patient services after working hours; The existence of latent demand which will only be seen once the center begins operating may substantially narrow this surplus; Good management and segregation of the two age-groups (60+ vs. below 60) according to needs would be important especially for in-patient services; To be able to serve the unmet needs for rehab services in Dubai to the optimum level possible, the center should establish a good homecare program especially in physiotherapy and occupational therapy services; Once opened, DRC will immediately operate at 85% bed occupancy rate. We project that a second center will be required in the Deira area, where over 50% of UAE nationals in Dubai are residing, by 2015 to ensure better access and a more even geographic distribution of services and to avoid overcrowding and customer dissatisfaction at DRC as demand for its services expands. Planning for this center should begin in

20 Annex (1) Brief Building Description of Dubai Rehab Center Based on site visit on 7/12/

21 Brief Building Description of Dubai Rehab Center Based on site visit on 7/12/2009 Dubai Rehabilitation Center is located at Dubai 2 area in Bur Dubai. It s a double storey building on total land area of 7011 sq. meter with build in area of 5494 sq. meter. The main entrance of the building leads to a reception with medical record behind and a gift shop on the left side of the entrance. The rest of the ground floor consists mainly of: Administration Section (Director s room, Secretary room, Meeting room on one side and Assistant director room, social worker room, BMS room on the other); Facility Support Section (Kitchen, Staff Canteen, Staff Rest Rooms, Dietitian room, Laundry, General Store and Supply room); Therapy section : o 3 clinics, o 3 individual treatment rooms (one of them is for water bed massage), o 2 electrotherapy rooms, o 1 resuscitation room, o 1 podiatrist room, o 1 speech therapy room, o 1 gym (14.1m*6.0 m = ), o 2 hydrotherapy rooms (one for hydrotherapy pool (7.7m*7.0m = ) and other for tread mill pool (7.0m*3.4 m = )) with attached changing rooms (2), shower rooms (2) and toilets (2). o Physiotherapy room (12.5m*6.0m = 75 2 ) with attached changing rooms (2). Note: There is a separate entrance for outpatient clinics and therapy rooms. The first floor comprises of: Two inpatient wards one for males and the other for females with 15 single rooms each; Each ward has a close observation room, TV room, dining room, changing room for staff and assisted bath tub; In between these two wards, there is a large occupational therapy room (6.6m*17.2m = ), psychologist room and a resuscitation room. 21

22 Annex (2) Population Projections of Nationals 60+ in Dubai 22

23 Population Projections of Nationals 60+ in Dubai Projected Number and Percentage of Older persons by Age (Nationals only) Year Age Group Number % of Total Pop Number % of Total Pop Number % of Total Pop Number % of Total Pop Number % of Total Pop Number % of Total Pop Number % of Total Pop , , , , , , , , , , , , , , , , , , , , , , , , , , , Total 8, , , , , , , Note: These projections are based on 2008 National population estimate from Dubai Statistic Center; the following factors were taken into consideration: Crude Birth Rate of Dubai, Male to Female Ratio in UAE/Dubai & Age Specific Mortality rate of UAE /Dubai. Projected old age (Nationals 60 and above) dependency ratio from 2011 to 2040 Year Female 60+ as percentage of total pop aged Male 60+ as percentage of total pop aged Total Old age dependency ratio The ratio of 60 and above to the Nationals in Dubai (financial and physical dependency) Projected Number of 60+ Nationals in Dubai by age group and gender

24 Age Group Male Female ,653 2,635 4,148 5,801 1,366 2,617 4,326 6, ,126 1,860 2,990 4, ,758 3,075 4, ,317 2,133 3, ,169 2,141 3, ,069 2,343 4,164 6, ,905 3,777 6,743 25,000 20,000 Age Group 15,000 10,000 Male Female , Projected Rehabilitation-Bed Requirement in 2010 (ALOS in benchmarked countries) 24

25 Medical Disabilities No. Of Patients Average LOS in Rehab Rehab Days Stroke Arthritis Fracture Femur Hip replacement Knee Replacement Parkinson Disease Total Equivalent beds at 80% occupancy 16 With 30% extra capacity 21 Note: The no. of patients in this table is not based on actual data. They have been calculated applying the incidence rate of the specific diseases in 60+ groups in US, Australia and UK to the same groups in Dubai National population (Benchmark rates) Average LOS for these specific diseases has also been benchmarked to Canada, Australia and US. Year Rehab-Bed Required Projected Bed Requirements 2011 to 2025 Beds@ 80% occupancy With 30% extra capacity Total Rehab- Bed Required Source: calculated applying the incidence rate of the specific diseases in 60+ groups in US, Australia and UK to the same groups in Dubai National population (Benchmark rates) Average LOS for these specific diseases has also been benchmarked to Canada, Australia and US. Projected Rehabilitation-Bed Requirement in 2010 (ALOS in Dubai) 25

26 Medical Disabilities No. Of Patients Average LOS in Rehab Stroke Arthritis Fracture Femur Hip replacement Knee Replacement Parkinson Disease Total Equivalent beds at 80% occupancy 21 With 30% extra capacity 27 Note: The no. of patients in this table is not based on actual data. They have been calculated applying the incidence rate of the specific diseases in 60+ groups in US, Australia and UK to the same groups in Dubai National population (Benchmark rates) ALOS for these specific diseases in Dubai is given by Dr. Suad Trebinjac, Head of Physical Medicine & Rehabilitation Department, Rashid Hospital, with DHA-Planning Team calculations Rehab Days Year Rehab-Bed Required Total Rehab- Bed Required Projected Bed Requirements 2011 to 2025 based on ALOS in Dubai Beds@ 80% occupancy With 30% extra capacity Source: ALOS of Nationals in Dubai provided by Dr. Suad Trebinjac, Head of Physical Medicine & Rehabilitation Department, Rashid Hospital with DHA-Planning Team calculations 26

27 Average acute rehabilitation period and number of sessions for common diseases/ procedures affecting elderly nationals in Dubai Table (1) Typical Rehab Procedures for patients 60+ years with Stroke (Post acute hospital treatment rehab) Rehab Type # of Weekly Sessions for the first two rehabilitation weeks # of Weekly Sessions for next 10 rehabilitation weeks Average Total Rehabilitation Average # of Average Length of Average # of Average Length of Sessions required weekly sessions session by minutes weekly sessions session by minutes Physiotherapy Occupational therapy Speech therapy Gym activity Electrotherapy (For 3 weeks) Source: Dr. Suad Trebinjac, Head of Physical Medicine & Rehabilitation Department, Rashid Hospital with DHA-Planning Team calculations Table (2) Typical Rehab Procedures for patients 60+ years with Knee or Hip Replacement (Post acute hospital treatment rehab) Rehab Type # of Weekly Sessions for the first 4 rehabilitation weeks (inpatient) # of Weekly Sessions in outpatient clinic for next 4 weeks Average Total Rehabilitation Average # of Average Length of Average # of Average Length of Sessions required weekly sessions session by minutes weekly sessions session by minutes Physiotherapy Gym activity Swimming pool activity Source: Dr. Suad Trebinjac, Head of Physical Medicine & Rehabilitation Department, Rashid Hospital with DHA-Planning Team calculations Table (3) Typical Rehab Procedures for patients 60+ years with Fracture Femur (Post acute hospital treatment rehab) Rehab Type # of Weekly Sessions for the first 4 rehabilitation weeks (inpatient) # of Weekly Sessions in outpatient clinic for next 4 weeks Average Total Rehabilitation Average # of Average Length of Average # of Average Length of Sessions required weekly sessions session by minutes weekly sessions session by minutes Physiotherapy Occupational therapy Source: Dr. Suad Trebinjac, Head of Physical Medicine & Rehabilitation Department, Rashid Hospital with DHA-Planning Team calculations Table (4) Typical Rehab Procedures for patients 60+ years with Parkinson s disease

28 (Post acute hospital treatment rehab) Rehab Type # of Weekly Sessions for the first 4 rehabilitation weeks (inpatient) # of Weekly Sessions in outpatient clinic for next 4 weeks Average Total Rehabilitation Average # of Average Length of Average # of Average Length of Sessions required weekly sessions session by minutes weekly sessions session by minutes Physiotherapy Occupational therapy Gym activity Treadmill Pool Source: Dr. Suad Trebinjac, Head of Physical Medicine & Rehabilitation Department, Rashid Hospital with DHA-Planning Team calculations Table (5) Typical Rehab Procedures for patients 60+ years with Arthritis (Post acute hospital treatment rehab) Rehab Type # of Weekly Sessions for the first 4 rehabilitation weeks(inpatient) # of Weekly Sessions in outpatient clinic for next 4 weeks Average Total Rehabilitation Average # of Average Length of Average # of Average Length of Sessions required weekly sessions session by minutes weekly sessions session by minutes Physiotherapy Electrotherapy Gym activity Hydrotherapy Source: Dr. Suad Trebinjac, Head of Physical Medicine & Rehabilitation Department, Rashid Hospital with DHA-Planning Team calculations Important note: The number of rehabilitation sessions required for the patient can vary depending on the severity of the disease and presence of other co-morbid conditions. 28

29 Annex (3) References used for Diseases incidence, ALOS calculations and Benchmarking for Dubai Rehab Center References used for Diseases incidence, ALOS calculations and Benchmarking for Dubai Rehab Center 29

30 Incidence of Diseases/Medical Conditions Stroke Department of Epidemiology and Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands. Article: Incidence, risk, and case fatality of first ever stroke in the elderly population. The Rotterdam Study J Neurology, Neurosurgery Psychiatry MDRCh; 74(3): Table 1: Age and Gender Specific Incidence rate of Stroke in the elderly. In USA: approx 1 in 453 or 600,000 annually (CDC) people suffer from stroke. Arthritis AIHW (Australian Institute of Health and Welfare): Mathers C & Penm R (1999), Health System Costs of injury, poisoning and musculoskeletal disorders in Australia The incidence among female aged is 14 per 1000 and male aged 75 and over is 9 per Fracture hip/ Femur Endocrinology ReseDRCh Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran Article: Incidence of hip fracture in Shiraz, Iran- Osteoporosis International-Volume 16, No.11/ Nov.2005 The age-adjusted incidence rates of hip fracture standardized to the 1989 US white population were /100,000 for men and /100,000 for women. Hip and Knee Replacement Hip and Knee replacement report (Canadian Joint Replacement Registry) Table 2 and 3- International Comparison of Hip and Knee Replacement Crude rate (per 100,000 populations) Incidence of hip and knee replacement = 1/1000 Parkinsonism Article: Incidence of Parkinson diseases - variation by age, gender and race/ethnicity American Journal of Epidemiology, Van Den Eeden et al. Vol.157 Table 3 and 4: Age Specific and age-adjusted annual incidence rate of Parkinson s disease by gender and race/ethnicity, Kaiser Permanente, Reference: McGraw-Hill's Access Medicine 30

31 Incidence Rate of Amputation = 0.02%, Traumatic Brain Injury = 0.25%, Disability = 0.5%, Chronic Pain = 2% ALOS in Rehab for specific diseases/medical conditions Stroke: 5 to 6 weeks Arthritis: 3 to 4 weeks Fracture Hip/Femur: 3 weeks Parkinson Disease: 3 to 4 weeks Quick reference guide- Exploring the hip fracture and joint replacement landscape in changing context: Implications and Recommendations Hip Replacement: 19 days Knee Replacement: 15 days Center for Health Service Development - CHSD Rehabilitation Services in Tasmania P Milne and K. Eagar ALOS in Rehab: Amputation: 25 days Traumatic Brain Injury: 35 days Disability: 20 days Chronic Pain: 20 days Reference: Dr. Suad Trebinjac, Consultant in Physical Medicine & Rehabilitation, Head of PM &Rehabilitation Department, Rashid Hospital ALOS in Rehab for Stroke: 90days, Arthritis: 21days, Fracture Femur: 28days, Hip Replacement: 35days, Knee Replacement: 30 days, Parkinson Disease: 30 days, Amputation: 3weeks, TBI: 3months, Chronic Pain (Spinal Stenosis and Diabetic Neuropathy): 3-4 weeks, Disability (Multiple Trauma and Complex Medical Conditions): 1 month 31

32 Annex (4) References used for setting type and number of staff required to run the rehab center and rehab community services References used for setting type and number of staff required to run the rehab center and rehab community services 32

33 According to BSRM standards all specialist rehabilitation services should be supported by dedicated sessions from a consultant specialist in rehabilitation medicine. A minimum of 6 FTE consultant specialists in rehabilitation medicine (RM) per million populations including: o 3.6 FTE for specialist inpatient rehabilitation services and their associated out- reach activities. o 2.4 FTE for specialist community rehabilitation services. (These figures assume additional contributions from other specialties to support local rehabilitation in the context of Stroke Medicine and Care of the Elderly settings). No RM consultant should work single - handedly. Staffing based on Number of Rehab Beds (UK Standards): BSRM(British Society of Rehabilitation Medicine) Standards for Rehabilitation Services Minimum Staffing provision for a in-patient rehabilitation services For every 20 beds: 1.2 WTE Consultant accredited in rehabilitation medicine, 2-3 WTE training grades and/or 1.5 WTE Trust Grade Medical Staff doctors Nurses Physiotherapists Occupational Therapists WTE (varies with dependency, but at least 1/3 should have specific rehab training) 4 WTE 4 WTE Speech and Language Therapists Clinical Psychologist/Counselor Social Worker Dietitian Clerical Staff WTE ( depending on whether patients with tracheostomy are accepted) WTE ( depending on whether patients with severe behavioral problems are accepted) 1.5 WTE WTE (depending on the proportion of patients on entral feeding) 3.0 WTE, but dependent on caseload and throughput Note: These staffing levels support both the inpatient activity and associated out-reach work including assessments home-visits, follow-up, case-conferences etc. Additional resources are required if the services also offers community rehabilitation services. WTE: Whole Time Equivalent Note: Complex specialized services, taking patients with more complex needs are likely to require higher staffing levels and an adjusted skill mix to cater for the specific group of patients they serve e.g. a patient of traumatic brain injury/cognitive behavioral rehabilitation services would require a higher proportion of counseling staff Consultant neuropsychiatric support A sufficient staffing level to provide a safe environment for high risk patients, including 1:1 supervision when needed. Minimum staffing provision for community specialist rehabilitation services to support people with LTNC (population 1 million) Team Leader/coordinator* 2 Nurse specialists** 8 Physiotherapists 6 33

34 Occupational therapists 10 Speech and Language therapists 4 Clinical psychologists 4 Specialist Social Workers 8 Dietitian 2 Technical instructors 8 Generic assistants 8 Consultant accredited in Rehabilitation Medicine 2.4 * Team leader/coordinator may be from any clinical background, but should have at least half of their time designated for co-ordination and team management, including staff appraisal, audit etc. ** Nurse-specialist to cover the common neurological conditions e.g. stroke, acquired brain injury, parkinsonism and related conditions LTNC- Long Term Neurological Conditions Reference: BSRM Standards for Rehabilitation Services Mapped on to the National Service Framework for Long-Term Conditions Lynne Turner-Stokes and Christopher Ward Reference: Australasian Faculty of Rehabilitation Medicine- Standards 2005 (Adult Rehabilitation Medicine Services in Public and Private Hospitals 34

35 Annex (5) Elderly Care & Rehabilitation Centre Dubai New Project By: Dr. Salwa AlSuwaidi Specialist Registrar Geriatric Project Manager Dubai Health Authority (DHA) Elderly Care & Rehabilitation Centre 35

36 Dubai New Project By: Dr. Salwa AlSuwaidi Specialist Registrar Geriatric Project Manager Elderly Population of UAE: UAE is a country with a relatively young population. According to DHA statistics in the year 2005, the percentage of people 60+ years old in Dubai was 1.5%. A study done in Faculty of Medicine and Health Sciences (FHMS), UAE University from 1998 till 2002 showed that elderly population is growing at a rate of 10.3% annually. (The Highest in the World). This represents a great challenge to UAE being able to provide medical & social services to this group of people. Current Elderly Medical Services at DHA: Elderly people are getting services for their acute medical problems in the 2 main hospitals of DHA; Dubai & Rashid Hospitals. A great percentage of them do stay for long time as in patients, even when their acute medical problem is over. The reasons behind this are mainly social issues related to the family not being able to take care of them at home. This is usually either due to lack of resources, or lack of knowledge of how to deal with them. At the present time the only premise in Dubai that delivers nursing care to elderly patients is the Community Centre For the Elderly (CCFE) at Al Mamzar. This was established in 1993 in order to provide medical & social services for elderly people of Dubai and it was meant to be a day centre not a nursing home. The centre has a limited capacity of around 40 beds, and is occupied almost all the time. Only patients with special social circumstances are allowed to stay, i.e. patients who do not have some one to take care of them. 36

37 The Need for the Project: Being in Dubai which is a modern busy city with a great number of expatriates, the general hospitals of DHA are mainly focusing at delivering care to patients with acute medical problems. There is always a problem of bed shortages due to a great percentage of "bed blockers". A great number of them are the elderly patients who unfortunately turned to be bed ridden due to lack of proper rehabilitation of their initial acute medical problems. This critical situation requires a well studied solution. How the idea came up: It was after the visit of His Highness Sheikh Mohammed Bin Rashid Al Maktoum, Vice President & Prime Minister of the UAE, and the Ruler of Dubai to the (CCFE) centre in 2004, when he gave his instructions to build another elderly centre in BurDubai area. DHA started working on the project, and it was designed to be a nursing home. In 2005 I came back from Malta after getting a Post Graduate Diploma of Gerontology & Geriatrics from the University of Malta, and I was chosen by the Director General of DHA to be the chairperson of this project. I was able to convince the Director General that it would have been a better project if it turned to be a rehabilitation centre for the elderly instead of a nursing home. By doing so we can have a good solution for the above mentioned problem of "bed blockers" due to improper rehabilitation. The Process of Preparation: Since the initial project was designed to be a nursing home with a limited space for rehabilitation, we had to work again on the drawings and design in order to use the space to the maximum and to fit all the rehabilitation services. We had a few visits to countries in Europe with good experiences in elderly care & rehabilitation like Germany, France & Italy in order to look at their centers, and study them in terms of designs and services delivered. Project Details: The centre will be located at Dubai 2 area in BurDubai. The construction started on 1 st April Expected to be ready by the end of Total project cost is estimated to be 56 Million Dirhams. Total land area is 7011 sq. meter. 37

38 Build in area is 5494 sq. meter. The Aims of the Project: 1. Help elderly patients to regain their independence. 2. Maximize the independence of those who still have it by helping them in their activities of daily living (ADL) and instrumental activities of daily living (IADL). 3. Re-integrate elderly patients back into their communities. 4. Preserve patients' autonomy. 5. Improve quality of life of elderly patients. 6. Help to give patients the feeling of usefulness. 7. Help to decrease the load on care givers to minimize their stress. This can be done by applying the concept of "Respite Care". 8. Liaise with hospitals to facilitate early discharge. Admission Criteria: 1. U.A.E. citizen patients 2. Age: more than 60 years 3. With a medical problem that is amenable for rehabilitation. e.g. Stroke, knee and hip replacement, fracture femur/hip, Parkinson's disease, and osteoarthritis. 4. Patients to be admitted after an extensive social study in order to avoid the problems of long-stay. Services Delivered: The centre will provide the following services: Medical assessment and treatment Individually created rehabilitation plan and program Physiotherapy: The centre will have a large physiotherapy hall equipped with the basic physiotherapy equipments to help elderly patients with their mobilization, gait training, and pain relief measures. There will be a large gym equipped with the basic fitness equipments like 38

39 cycles and treadmills. Moreover, there will be 2 rooms for electrotherapy, and 3 rooms for individual treatment like manual and water massage. Occupational Therapy: This service mainly aims at restoring the basic functions of elderly patients, or the basic activities of daily living. This will be done by helping patients to regain their independence while eating, dressing, toileting, bathing, and operating simple daily equipments like T.V, radio, and telephone. This will be practiced in a semi-home like environment, as well as a large area for hand crafts activities. Hydrotherapy: This will work by the effect of water on carrying the weight of the patients, and thus making exercise easier. Water also promotes the blood circulation, and eases the pain of joints and muscles. The massage effect stimulates the skin and the internal organs, and warm water can help to prevent decubital ulcers. Speech Therapy: This will focus on improving the speech of elderly patients after getting stroke, or Parkinson's disease. It will also assess the swallowing ability for these patients. Psychology & Social Services: This will focus on alleviating the psychological disturbances that happen with old age, as well as helping elderly patients and their relatives to adjust to these changes. It aims at linking the elderly patients to their communities. Foot Care: This will be a special service delivered by a podiatrist who should carefully examine feet of elderly patients looking for signs of peripheral vascular diseases and diabetes mellitus, to avoid their complications. 39

40 Geriatric Services: - This will be delivered by specialized geriatricians who should be able to deal with the problems of old age, and to work closely to avoid their complications. Community Services: This means providing patients with nursing and rehabilitation services at their homes, and having the patients in close contact with the centre even after discharge. List of employee needed for the elderly care & rehabilitation centre Dubai Job Title No. of staff المسمى الوظيفي Director of the centre 1 مدير المرآز Assistant Director 1 مساعد مدير المرآز SSR Geriatrician 2 أخصاي ي أول طب المسنين SSR Rehabilitation Physician 1 أخصاي ي أول إعادة تا هيل Speech Therapist 1 معالج نطق Podiatrist 1 أخصاي ي العناية بالقدم Psychologist 1 أخصاي ي نفسي Physiotherapist 6 معالج علاج طبيعي Physiotherapist Aid 6 مساعد معالج علاج طبيعي Occupational Therapist 1 معالج مهني Occupational Therapist Aid 2 مساعد معالج مهني Social Worker 2 أخصاي ي اجتماعي Social Worker Aid 2 مساعد أخصاي ي اجتماعي Dietician 1 أخصاي ي تغذية Receptionist 2 موظفة استقبال Secretary 1 سكرتيرة Medical Record Staff 2 مسي ول ملفات طبية Ward Clark 3 آاتب Hydro-Therapist 2 معالج ماي ي Hydro-Therapist Aid 2 مساعد معالج ماي ي Messenger 5 مراسل Nursing Staff for Rehabilitation Center for Elderly Dubai SUMMARY OF STAFFING PER SHIFT AFTERNOON SHIFT 3 STAFF NURSES 8 ASSISTANT NURSES NIGHT MORNING

41 Reliever 3 4 TOTAL DETAILS OF STAFFING PER SHIFT SHIFT STAFF NURSES ASSISTANT NURSES MORNING 1 Clinical Facilitator 2 Staff Nurses ( 1-Male & 2-Females ) 6 Male Assistant Nurses 6 Female Assistant Nurses 1 Female Assistant Nurses For escorting of patients AFTERNOON 1 Shift In Charge 2 Staff Nurses ( 1-Male & 1-Female ) 4 Male Assistant Nurses 4 Female Assistant Nurses NIGHT 2 Staff Nurses ( 1-Male & 1-Female ) 4 Male Assistant Nurses 4 Female Assistant Nurses For Reference: Dr. Salwa Al Suwaidi Project Manager Ext Miss. Ismat Bakir Assistant Project Manager Ext Annex (6) Team Worked on and/or Consulted in This Study 41

42 Main DHA Policy and Strategy Department s Staff who worked on Dubai Elderly Rehab Center Revision Name Organization Job Title Dr. Awatif Abuhaliga DHA-Sector Facing Head of Policy, Planning and Strategy, Policy and Strategy Sector Dr. Meenu Mahak Sodhi DHA-Sector Facing Health Policy and Planning Specialist,, Policy and Strategy Sector Ms. Sara Mirza Al Taher DHA-Sector Facing Project Manager, Policy and Strategy Sector Ms. Shivani Gulati DHA-Sector Facing Senior Policy and Strategy Analyst, Policy and Strategy Sector Team Consulted in Dubai Elderly Rehab Center Revision Name Organization Job Title Dr. Suad Trebinjac Rashid Hospital Head of Physical Medicine & Rehabilitation Department, Rashid Hospital Dr. Salwa Abdulla Alsuwaidi Head Quarters Specialist Registrar- Geriatric, Project Manager, Dubai Elderly Rehab Center Ms. Ismat Bakir Omar Head Quarters Assistant Project Manager, Dubai Elderly Rehab Center 42