Ilian Grigorov is the founder and CEO of Blocks Group. He is an executive with more than 10 years experience in healthcare and 15 years in private equity and M&A advisory. Mr. Grigorov has founded City Clinic, which in 7 years became the leading private healthcare operator in Bulgaria and among the top 5 operators in Eastern Europe Prior to that has led Bedminster Capital (formerly Soros Investment Capital) office in Bulgaria for 8 years He has experience in investing in various industries including cable, media, and healthcare.
The interview is for the City magazine.
– Mr. Grigorov, congratulations on the upcoming opening of the most modern rehabilitation and physiotherapy hospital in Southeast Europe!
– Thank you, we are really proud of this achievement. The project is one of the largest in South East Europe and will certainly be the most advanced in the region. We already have Authorization for use of the building No 16, issued by the state authorities for the building with two basement floors and 5 floors above ground, which will receive patients for inpatient and outpatient treatment, and the investment so far is over 30 million euros.
But I would also like to add here that the hospital complements the largest fully integrated elderly and post-acute care and rehabilitation center with our existing complex in operation for 2 years. It includes 9 family-type houses for the elderly with a capacity of 81 residents, the largest hospice in Bulgaria with 39 beds, a community center with a restaurant, cafe and newsstand, prosthetics center, park, etc.
The concept of family care has evolved in Western Europe and the United States to maximize the independence and individual experience of individuals. Each house, designed for 9 residents, has a spacious common ground floor of 200 square meters with various common areas and corners, laundry, kitchen and dining room, on the second floor there are 4 double rooms, on the attic floor – one single room. Daily care is provided for all residents by nurses and physicians and a night assistant. The Prosthetic Center operates with the best parts and a private med-tech lab, with vendors such as Otobok and with an excellent interface to connect the external prosthesis to the human body.
– Blocks collaborates with the most prestigious rehabilitation center in the world – Shirley Ryan Ability Lab – the number one rehabilitation hospital in the United States for the past 32 years?
– Indeed, our clinical partner for the past 3 years has been the renowned and reputable hospital and research facility, Shirley Ryan Ability Lab. The United States is the best place in the world for high-quality medicine and rehabilitation, and about 80% of research grants in the sector, such as exoskeletons, remote monitoring, etc., are absorbed right out of the Shirley Ryan Ability Lab. Their renowned hospital in downtown Chicago is 40 stories and serves adult and pediatric patients in the best possible way in the world. We can say that we will apply the best of the institute’s practices and innovations.
– The project was prepared by the world’s leading studio in the sector HKS? Tell us more about the building itself.
– Yes, HKS is a world leader in hospital design, having worked on the design for the Shirley Ryan Ability Lab hospital in Chicago, and the team is the same that prepared the conceptual design for our hospital. The Bulgarian partner is ProArch – a collective led by arch. Ilia Evrev, who developed the technical design for the building with a total area of 15 thousand square meters on a site of 11 acres. Apart from being beautiful, the building will also be quite functional and high-tech. There are about 130 points with the latest technologies, about 60% of which are unknown in Bulgaria, which we will show to journalists and the public as soon as we open the hospital. A 5-acre therapeutic park will be used for part of the warm season rehabilitation. There will also be an outdoor gym by a well-known Danish company leader in the sector, and a children’s inclusive playground for cases of functional deficit – for children in wheelchairs. In terms of implementation – our contract with Diana Commerce allows us to anticipate the price increase thanks to the fixed price for the rough construction and to carry out the construction in a short time with little cost overruns. We had small complications in places, such as our request for cantilever suspension of one block with a structure with 900 tons of iron embedded, and in the end we had to strengthen it with columns.
– What are the features of your home care model?
– Our great advantage is the integrated care complex after the acute phase of treatment, after discharge we can take people with any level – first in the hospital for rehabilitation, and if our patients are elderly, we can continue their care in a family-type home, if necessary to transfer the patient to hospice. In general, 60% of adult patients requiring the type of care we offer have neurological conditions following a stroke, and in children it is most often cerebral palsy. About 45% of people leaving hospitals for active treatment after therapy for neurological diseases, and stroke in particular, end up in a rehabilitation hospital. We view the care we offer as complementary to active inpatient treatment so that we can complete this episode and achieve optimal outcomes.
The main advantage of a care home over home care is the social element – a crucial factor in quality of life. Social isolation, inactivity and lack of physical activities is detrimental to the condition of elderly and sick people. We strive to create maximum physical activity for all residents, which is extremely useful for mastering cognitive difficulties – such as morning gymnastics, various forms of animation – activities such as drawing, painting, coloring, etc.
It is important that we are part of the city close to areas such as Dragalevtsi, Boyana and Vitosha Collar, which allows the elderly person to be closest to family, to the city, to preserve the frequency of relationships, relatives to come to visit after work and spend time together.
– How is the health and social services sector developing in the country and what are the biggest challenges?
– This is the first such complex in Bulgaria, but unfortunately the state does not take any part of the care for the elderly, except the minimum in the rehabilitation part. The main part of inpatient rehabilitation in developed countries are severe neurological patients after stroke, whose rehabilitation can last up to 1 year, and in our clinical pathway is 7 days. In comparison, in our similar and the largest rehabilitation hospital in Greece, the average stay per patient for rehabilitation and physiotherapy after a stroke is 28 to 45 days with the possibility of extending it by another 45 days. Care for people with stroke and severe cognitive and physical deficits in Bulgaria has been reduced to 7 days, and therefore there is not much investor interest in such complexes.
Historically, former sanatoriums in Bulgaria are now registered as rehabilitation hospitals. In Sofia there are 40 hospitals for active treatment and only 2 for rehabilitation, besides ours, and the former sanatoriums are territorially located far away – in Pomorie, Hisarya and throughout the country. Rehabilitation, however, has to take place in the big city – where the people, the patients, the doctors and nurses are, for whom there is a huge hunger.
In Bulgaria there is no differentiation for adult care and the deinstitutionalisation of the existing homes with 300-400 people is a complex and slow process.
– From your position as a leading operator in rehabilitation and elderly care in the Southeast Europe, do you foresee any expansion of the business?
– We can share our good experience in Greece, where we have a 175-bed hospital on 24 000 square meters on a 75-acre site in a neighborhood of Athens – the largest in Greece, which we acquired from an American investment fund – as well as 3 nursing homes in three neighborhoods in the capital with a total of 288 beds. We work with the Veterans Fund of Libya, we have veterans from the war in Ukraine, the Middle East, North Africa.
Our aspiration is to standardize the best in rehabilitation and elderly care in both countries, with the Bulgarian hospital gaining international recognition. During these 25-30 days of rehabilitation therapy, people can benefit from various activities, entertainment, recreation, food, especially when rehabilitating children, and not travel abroad for the same procedures.
Yes, we have an ambition to expand in Romania, Poland, Hungary.
– How do you assess the future of the sector?
– Given the global demographic trends, the long-term care sector will develop more and more actively with an increased demand for such services, also in Bulgaria, but with a large deficit of personnel who leave for Western Europe.
From an investment point of view, there is increased interest from large financial strategic investors in this type of rehabilitation services in the US and Western Europe, but not in Bulgaria, as I have already explained.
In 10 years, the industry will look different. There are two main trends in rehabilitation in the world – digitalization and service delivery, and the service is becoming hybrid – much of it is delivered physically and another part digitally in the home. The fastest growing sector is digital neurorehabilitation, and many services can be provided at home as augmented reality.
Another trend is so-called gamification – the services and technology themselves are migrating to simulated play, which addresses another problem – adherence to the therapeutic plan. The expectations are that in 5 years this will transform the service with a transition to more entertainment.
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