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Residential Care
Domiciliary Care
2
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• Milharado (20 min
from Lisbon)
Location
• 20 people assisted
residency
• 5 people day center
Capacity
Accommodations
=HH5G
Amenities
• Double or triple rooms with
– alarm connected with main desk
– personal telephone
– TV
– central heat
•
•
•
•
• 1.180 per month
(assisted residency)
Prices
Services
TV and living room
Dining room
Gardens
Chapel
• Social services
– hygiene and comfort
– housekeeping and laundry
– meals
• Occupational activities
– intellectual (i.e. reading, music, TV )
• Shared bathrooms with technical aids
• Medical services including ....
– general practitioner and nurse
·
*
85
Location
1
• Carregado (20 min
from Lisbon)
F
Capacity
Accommodations
9::5G
• 40 people
Amenities
• Single, double or triple rooms with
– ergonomic furniture
– articulated beds
– alarm connected with main desk
– personal telephone
– TV
– central heat
•
•
•
•
•
TV and living room
Dining room
Gardens
Rehabilitation room
Estheticism salon
• Occupational activities
– physical (i.e. exercises, walking)
– intellectual (i.e. internet, reading,
painting, movie sessions)
• Medical services including ....
– General practitioner and nurse
– Physical therapy and massages
– Psychological help
– Assistance in convalescence/
recovery and to patients with
Alzheimer and Parkinson
– ·
Source: Website
*
6
.
[: 8M
F= <M) = EM
Services
• Social services
– hygiene and comfort
– housekeeping and laundry
– meals
• Shared bathrooms with...
– full accessibility (namely for people
with disabilities)
– technical aids
(
• 1250 per month
Prices
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Share of private residential centers
(2007)
Index coverage (2007)
Aveiro
Beja
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Bragança
Castelo Branco
Coimbra
Évora
Faro
Guarda
Leiria
Lisboa
Portalegre
Porto
Santarém
Setúbal
Viana do Castelo
Vila Real
Viseu
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0.1
0.1
0.2
0.2
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Beja
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Bragança
Castelo Branco
Coimbra
Évora
Faro
Guarda
Leiria
Lisboa
Portalegre
Porto
Santarém
Setúbal
Viana do Castelo
Vila Real
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0.6
0.4
0.7
1.3
0.9
0.2
0.4
0.7
1.8
0.2
0.2
0.2
0
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10.1
11.4
7.8
26.2
25.4
2.9
15.4
18.3
40.6
7.0
6.2
7.1
0
10
20
30
40
50
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Average
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800
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Total Costs
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380
600
400
300
200
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Montepio Residências
Avós e Companhia
NorteCare
Viver Renascer
Gerações
Viseu
Resivida
Lisbon
Leiria
Montepio Residências
Fikemcasa
Humanidomus
Companhia Feliz
Sem Idade
Pluriapoio
Ajuda de Vida
Condomínio D.Dinis
Domus Augusta
Flôr da Serra
Baby Sénior
Setúbal
Três Gerações
Serhogarsystem
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is a small domiciliary support firm ...
Concept
Provision of social and medical domiciliary
support both to the elderly and to people with
disability
Differentiation
factor
Qualification of HR that provide the social and
medical support
(U
... providing both social and medical services
Social services
Social services providers
• Europ Assistance
Partnerships
Medical service providers
• Alerta Médico (Medical services provider)
• Ensaio Mágico (Physical Therapy)
• Fisiotaj (Rehabilitation clinic)
• Cardioteste (Cardiovascular clinic)
Nursing homes and IPSS
• Fátima park
• Apoio Social N. Sra das Neves (Manique)
National
coverage
Medical services
Greater Lisbon: Lisbon, Cascais, Oeiras, Sintra,
Amadora, Loures, Montijo, Almada, Barreiro
•
•
•
•
•
•
Medical consultations
Medical urgencies
Nurse or medical auxiliary assistance
Exams and clinical analysis
Assistance in convalescence/recovery
Assistance to patients with special needs:
Alzheimer, Parkinson, strokes, diabetes
Continuous care
Physical, speech and respiratory therapy
Therapeutic, relaxing and shiatsu massages
Acupuncture
•
•
•
Other services
Source: Website
Psychosocial assistance
Personal hygiene and comfort services
Housekeeping
Company and conversation
Assistance in outings and visits
Meals preparation and assistance
Medication administration
Occupation activities
Grocery shopping
Bills payment (i.e. utilities, telephone)
IRS submit and payment
Hairdresser, manicure, pedicure
•
•
•
•
Algarve: Loulé, Albufeira and Faro
Target
segment
•
•
•
•
•
•
•
•
•
•
•
•
Medium-high and high income seniors
• Independent and dependent
Sale and rental of geriatric equipment
Selection of "value for money" nursing home
Studies for definition of adaptation of spaces
for elderly with physical and psychological
conditions
*
1
9
=IH
&$D . $$%#
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;= 7 (
is a franchise of an American firm ...
... that provides 2 types of social services
Provision of social (or non clinical) domiciliary
support to the elderly and dependent people
Concept
•
•
•
•
• International experience
– won best social support franchise in 2007
• HR recruitment process
– 3 interviews and requirement of 6
recommendation letters
• 18 months training to employees
Differentiation
factor
•
Companionship
•
•
•
•
•
•
Social
services
700 offices in 11 countries
•
•
International
coverage
National
coverage
11 offices covering 6 districts
• Lisbon, Setúbal, Leiria, Santarém, Açores,
Madeira
Target
segment
Medium-high and high income seniors
• Independent and dependent (specially
Alzheimer patients)
•
Personal hygiene and comfort services
Assistance in housekeeping tasks (i.e.
change beds, assistance to pets)
Laundry and ironing (punctually)
Take the garbage out
Grocery shopping
Take and pick clothes from laundry
Go to pharmacy
Meal preparation
Company in appointments, visits,
lunches/dinners, concerts, religious
services, sports events
Airport assistance
*
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36
3
3
3
0
(
•
•
•
•
•
•
•
Assistance
(Note: does
not substitute
housekeeping
services)
Source: Website
=II 0
Conversation and company
Book or religious reading
Medication, anniversary and
commitments reminder
Meal planning, assistance in
preparation and diet monitoring
Clothes planning and cleaning
assistance
Company in walks, visits to friends
Writing of letters and mail organization
Planning of activities
Shop planning and delivery supervision
Acquisition of newspapers/magazines
Renting of movies
(
( 2
1
%
V
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TV, high speed internet
Amenities
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• Library
• Movie room
• Gardens
• Bars and restaurants
• Pool
• Tennis court
• Gymnasium and spa
• Convenient shop
• Para-pharmacy
• Meditation room
• Transport to beach and golf
Services
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customers
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Assisted residencies and apartments
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assistance, phone assistance, and rental and
sale of mobility and comfort equipment
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• Gaia
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country in the future
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capacity. Operations will start until 2009
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# of people
2,959,957
3,000,000
2,809,938
+1%
2,472,380
2,136,411
2,000,000
1,878,459
1,810,100
1,000,000
0
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2010
2020
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2040
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Long term
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120
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500
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Senior Living 3
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Yes
"Social welfare"
scenario
"Privatization
and expansion"
scenario
"Continuity"
scenario
"Privatization"
scenario
Government increases
coverage of public
elderly care services ?
No
No
Yes
Government promotes the
participation of for-profit players?
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Private
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Income
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High
Informal
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Large players
Individuals
Small players
Medium-High
Medium
Public
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Medium-Low
NGOs
IPSS
Misericórdias
Low
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Impact on current role of major actors
"Continuity"
scenario
Elderly care provider
"Privatization and
expansion"
scenario
"Privatization"
scenario
"Social
welfare"
scenario
Public sector
NGO
Informal
Small
scale
Private
sector
Large
scale
Increase with
small impact
Source: BCG analysis
Increase
None
Decrease
17
249307-00-ScenariosRevisto-26Nov07-RS-cg-LIS
+ ,
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Scenario
(
Probability
Yes
"Social welfare"
scenario
"Privatization
and expansion"
scenario
"Social welfare"
scenario
Government
increases
coverage
of public
funded
services?
"Continuity"
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Projection Senior Population in Germany 2006 - 2030
25
Seniors in Million
20
15
10
5
2030
2029
2028
2027
2026
2025
2014
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
0
Year
age 55-74
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USA
185000
Netherlands
133000
Greece
126000
Portugal
96000
Turkey
81000
Hungary
74000
Austria
67000
Denm ark
67000
Sweden
63000
others
160000
0
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Portugal
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Portfolio of services provided
Market value
and ownership
Focus
• 1,4 B
• Listed in NYSE
• Founders: 11%
• 1,3 B
• Listed NYSE
• Controlled by PE
(Fortress)
• Residential care
– Independent
living
– Assisted living
– Alzheimer
care
– Hospice care
– Rehabilitation
care
• 3,6 B
• Listed NYSE
• 1 B in 2006
• Controlled by PE
(Filmore partners)
• 0,6B in 2006
• Listed in NYSE
• Hospital and
pharmacies
management
/
3
Geographic
presence
Other
• Domiciliary care
• USA, Canada, UK
and Germany
• --
• USA (35 states)
•
•
•
•
• USA
Domiciliary care
Out-patient t
Rehabilitation
Pharmacy
services
• --
• USA
• Residential care:
assisted living
• Rehabilitation
• USA
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People
400,000
305,801
298,870
300,000
239,761
199,058
197,306
200,000
112,797
100,000
1999
2002
2006
0
Domiciliary care
Capacity 2006/
Capacity 1999
1
Residential care
2.7
0
1.5
? %
(
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4.00
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3.34
3
2
2.95
2.75
1.67
1
1999
2002
2006
0
Domiciliary care
1
0
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Capacity
'000
400
~76%
216
289
Private
Total
300
200
100
73
0
Public
1 #% .
(
(
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%
40
27
21
20
18
0
1999
2002
2006
1 #% .
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2,000
1,839
1,680
1,549
Average
commercial price
shared room
1,627
1,500
1,252
1,239
1,148
1,320
Aragón Asturias Baleares Castilla Castilla Cataluña
C.
ValenY León
La
ciana
Mancha
Galicia
1,346
1,305
964
1,000
1,316
1,110
500
0
Andalucía
$
C.
Navarra Guipúz- Vizcaya
Madrid
coa
) 9::8
14
)
(
(4
(
9::8 1
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(
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) 9::8 F G
'000
240
179
198
Other
Total
180
120
~10%
60
5
4
4
2
6
Ballesol
Sanitas
SAR
Sanyres
Mapfre
0
1 #% .?
=:<
? /
(
(4
) 9::8 F G
Comparison of average nursing home capacity (2006)
# beds
200
192
180
170
155
150
142
100
49
50
0
Ballesol
Grupo SAR
Mapfre
Adavir
Sanyres
Average Spain
/
1
;
98:
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(
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9::;39::H F G
# places
8,000
1,827
6,777
In construction
Total
6,000
4,950
4,000
2,000
0
In operation
35
# centers
11
+
==: ,
%
46
/
*
) 9::;3
9::;39::H F G
# places
5,000
535
4,565
In construction
Total
4,030
2,500
0
In operation
# centers
26
5
,
)
( (
F*
+
(
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31
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# places
~69%
6,000
612
5,423
1,760
4,000
502
2,549
2,000
0
In operation
In construction
In operation
In construction
Total
22
5
12
4
43
# centers
/
(4
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F
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(4
Investment
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Whole cycle players
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Location
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customers
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provides specialized care ...
... either in specialized units or homes
Regency Care Center
• 25 independent elderly
(long or respite stays)
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with palliative care needs
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break from home or who want to
experiment living in a home
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symptoms
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Physical
conditions
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disabilities who need fully
accessible facilities and, in some
cases, rehabilitation therapy
Long
term
Specialized
units
Priory Park
• 10 independent elderly
• 8 dependent elderly
• 23 elderly with dementia
or physical disabilities
The Retreat
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Specialized
homes
Knowsley Manor
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mental disabilities
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30
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2000
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1985
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1990
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Domiciliary care
6.0
5.4
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3.6
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1993
1994
4.2
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1995
1996
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1998
1999
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