Healthcare/Wellness

Jefferson Community Health and Life

September 9, 2022 by

Jefferson Community Health & Life was established in 1963 as Jefferson County Memorial Hospital and Nursing Home, the first hospital/nursing home combination in the state of Nebraska. The facility has grown over the years, adding a home health agency in 1984, a community wellness center in 1996, expanding outpatient services throughout the years, and adding the Fairbury Clinic in 2016, and opened the Plymouth Clinic in 2018. Through its 50-plus-year history, Jefferson Community Health & Life has been very active and involved in its community, and has worked to promote health and wellness. Currently 20 visiting specialists utilize this space each month, allowing area residents the opportunity to receive specialty care locally. JCHL operates two rural health clinics offering primary care services by 9 employed providers.

In Nebraska, nearly 30 percent of the state’s population resides in rural areas like Fairbury and its surrounding communities. JCH&L faces a unique combination of rural forces not faced by their urban healthcare peers, such as continuing health provider shortages, limited access to specialty care, disparate socioeconomic factors, and higher rates of obesity, hypertension, suicide, and death by serious injury.

In August of 2022, in partnership with Hampton Roads Ventures, and US Bank, Crescent closed on a $9M Federal NMTC/$9M Nebraska State NMTC twin financing for the expansion of the Jefferson Community Health and Life Critical Access Hospital..

The expansion includes 23 exams rooms, 2 special procedure rooms, a radiology room, and a specialty room for COVID and flu patients. JCH&L currently employs 192 FTEs and this expansion will create 10 new full-time jobs ranging from nursing to support staff as well as laboratory technicians. 65% of JCH&L’s patients are Medicare/Medicaid, and this addition is expected to grow Medicare/Medicaid services by nearly 10% from 2022-2026. Additionally, the subsidy from the transaction will enhance JCH&L’s liquidity in funding ongoing services for the hospital.

Biomedical Research Foundation – Center for Molecular Imaging and Therapy

June 24, 2021 by

The Biomedical Research Foundation of Northwest Louisiana (d/b/a BRF), a 501(c)(3) based in Shreveport, LA, was created in 1986 to serve as a cornerstone for a rebounding Shreveport economy. Shreveport had enjoyed a fairly robust expansion from the mid-1970’s to the early-80’s, driven in large part by a heavy dependence on the oil and gas industry. However, a sharp decline in the global price of oil in the mid-1980’s had a particularly devastating effect on Shreveport’s economy, forcing most of the city’s major employers to either close their doors or leave town.

In the wake of the oil glut, Shreveport’s Chamber of Commerce commissioned an economic study that focused on laying the foundation for a more diversified local economy. In 1986, the Biomedical Research Foundation was created to serve as one of the pillars of the new, multifaceted Shreveport economy. In 1994, BRF opened the $36M Virginia K. Shehee Biomedical Research Institute, the home of the state and region’s first Positron Emission Tomography (PET) Center. PET scans expedite the diagnosis and treatment for cancer patients, as well as advancing research on many other diseases. BRF also launched STEM education programs for local high school students to assist in educating future innovators and workers in the region.

In June. 2019, BRF engaged Crescent Growth Capital to pursue a New Markets Tax Credit financing for its $15M Center for Molecular Imaging and Therapy (CMIT), and in summer, 2021, the team closed on a $5M Louisiana State NMTC financing to purchase state-of-the-art PET and CT scanning equipment for the new CMIT facility.

The new CMIT center will serve as a platform to host advanced clinical trials and cutting-edge healthcare solutions, while providing research opportunities for scientists from around the country. CMIT is capable of producing and distributing radiopharmaceuticals for speedy detection of medical conditions, while expanding the molecular imaging program through its two main divisions:

The Radiopharmaceutical Division for expanded access to both existing and novel radio pharmaceuticals
The Imaging and Therapy Division for expanded access to diagnostic scans and novel therapies

CMIT has evolved to also provide access to unique diagnostic probes as advanced medical tools for the local population as well as researchers. For example, CMIT offers cancer patients image-guided treatment options, and state-of-the-art advanced medical care via targeted alpha therapy. Similarly, CMIT patients with neurodegenerative disorders have access to radiopharmaceuticals specific to their disease that can assist physicians in customizing therapy to the individual patients. Such options are currently available only at select academic centers across the nation.

The $14.8M CMIT facility is expected to increase total employment from 16 to 41 FTE’s, with the 25 new positions earning an average of $60,000 annually. CMIT serves a patient base that is comprised primarily of referrals from the former LSU hospital in Shreveport, one of Louisiana’s two main safety-net hospitals. As a result, 70% of CMIT patients rely on Medicare/Medicaid, and 15% are uninsured: since 1995, CMIT has conducted 46,000 PET scans, including 10,000 free scans to uninsured and indigent patients. Furthermore, CMIT has a financial hardship assistance program that provides for varying levels of payment assistance depending on the patient’s family size and need.

CommCare Natchitoches

May 25, 2021 by

CommCare Corporation has owned and operated skilled nursing and rehabilitation centers throughout Louisiana since 1994 and is currently the largest non-profit nursing home owner in Louisiana.

At the beginning of the COVID-19 outbreak, Louisiana’s nursing homes were disproportionately impacted: in the first year of the pandemic, of the roughly 4,000 deaths in Louisiana, approximately 41% occurred in nursing homes. This was largely due to the average age of the facilities, as the older homes were built with more communal space, making viral transmission more prevalent.

CommCare learned that their Household modelled facilities fared surprisingly well during the pandemic, as they were built to provide an adequate buffer between each resident’s living space, thus limiting the airborne and contact-related spread of COVID-19.

Specifically, CommCare noted four primary benefits of to Household model:

Having a private room eliminates the potential for airborne spread of the virus from patient to patient in close living and sleeping quarters;
Private baths eliminates the sharing of toilets, sinks, tooth brush holders, paper dispensers, etc. – all items that are touched when using;
The household (itself at 25 to 30 residents per household) acts as a separate unit, with separate dining and entertainment areas within the building thereby eliminating social contact spread commonly found in traditional common dining or a common activities room buildings
Consistent staffing, which is only found in a household model, prevents staff from traveling around the entire building

These four lessons were central to the design of the new Natchitoches facility. In the midst of the pandemic, CommCare found that traditional construction funding was growing ever more expensive. So in October, 2020, CommCare engaged Crescent Growth Capital (“CGC”) to pursue a New Markets Tax Credit financing to subsidize the development cost for the new facility.

In May, 2021, CGC and CommCare closed on a $5 million Louisiana State and $16.5 million Federal NMTC financing, utilizing allocation provided by AMCREF and HRV. The project will provide vital nursing, therapy, and pharmacy services to residents of the surrounding low-income community of Natchitoches. The project will also provide a cafeteria with a healthy, nutritious menu approved by a licensed dietician. Residents, employees, family, and community members are all welcome to dine at the facility. The roughly $20M facility is expected to increase total employment by 55 FTE’s, 74% of which are expected to be minorities, with all the new positions having access to career training and advancement opportunities in an economically distressed area.

Shelter Ministries of Dallas – Genesis Women’s Shelter & Support

January 8, 2021 by

Established by Shelter Ministries of Dallas (“SMD”) in 1985, Genesis Women’s Shelter & Support (‘Genesis”) offers the most comprehensive domestic violence (“DV”) recovery program in Dallas including an Emergency Shelter, a Transitional Housing Facility that includes on-site schooling, daycare, and afterschool programming, and a non-residential Outreach Counseling Center where clients have access to clinical counseling facilitated by licensed mental health professionals, advocacy services offering representation in legal proceedings, and legal services provided by licensed attorneys. The Genesis full continuum of care for women and children who are escaping DV is provided at no cost to the client and is delivered through a trauma-informed response that addresses the personalized needs of each and every individual.

The Genesis non-residential program has experienced a steady increase in clients since its inception, as well as a shift in needs and responses to DV that require careful application of evidence-based programs and technology. Genesis has outgrown its current Outreach Counseling Center, experiencing a 63% increase in counseling hours in 2018 (26,000 hours provided, versus 16,000 in 2017); additional space with expanded offerings is desperately needed. Current estimates also point to an additional increase in new clients of at least 20% but possibly as high as 40% in 2019 and in subsequent years, as the prior year-over-year increase was 40% (3,500 2018 vs. 2,500 2017). In all additional areas measured Genesis continually experiences increases year-over-year. The upward trend of need is anticipated to continue, and the staff, program and facility must expand to accommodate it.

In August 2019, SMD engaged Crescent to pursue NMTC financings for both the Genesis Street and Austin Street Centers. On January 8th, in partnership with Hampton Roads Ventures, Texas Mezzanine Fund and Capital One, Crescent and SMD closed on a $19M NMTC financing to construct the new Genesis Women’s Center.

Genesis’ new campus will encompass a 28,600 square-foot facility for non-residential counseling services plus accommodate the establishment of three evidence-based centers for treatment, advocacy and research-focused education: The Center for Child Trauma and Healing, The Legal Justice Center and Family Law Library, and The Genesis Institute for Training and Education. The center will also launch a dedicated 24/7 DV response initiative in the Genesis Technology Command Center. Firsts for the city of Dallas, these new initiatives will transform current approaches to DV response, treatment and prevention, supporting more positive outcomes for women and children.

The new Genesis Women’s Shelter will increase overall capacity by 40%, legal service provision by 100%, deployment of cutting-edge techniques targeting children traumatized by domestic violence, education opportunities for DV advocates and therapists, and will debut the Genesis Technology Command Center. The newly-completed Genesis Women’s Shelter will necessitate the hiring of between 40-70 new FTE’s.

Shelter Ministries of Dallas – Austin Street Center for Community Engagement

January 7, 2021 by

1717 Jeffries Street, Dallas, TX 75226

Founded by Shelter Ministries of Dallas (“SMD”) in 1983 and located on Austin Street south of downtown Dallas, the shelter moved to its current location on Hickory Street in 1992. Austin Street Shelter subsequently evolved into Austin Street Center, a 400-bed shelter and comprehensive care program for the homeless. More than just a meal and a bed, the Austin Street individualized model of service offers the homeless a comprehensive program that includes housing coordination and stabilization services, employment and education resources, benefits and ID assistance, mental health services on-site, spiritual, emotional, and addiction support, diversion, and transportation. Austin Street is also Dallas’ largest “low barrier” shelter, accepting people as they are, without imposing obstacles or “barriers” to entry, such as passing a drug test.

Despite an aging facility and space constraints, Austin Street has managed to support substantial increases in client volume over the past five years (1,569 in 2013 to 3,008 in 2018), while significantly enriching its program to better address needs. The center’s track record remains impressive; its programs have the highest success rate for housing transition in Dallas, with the lowest rate of recidivism. However, both the current facility and its staff have reached capacity; both require expansion, as homelessness in Dallas continues to increase. (The 2019 “Point in Time” count of the homeless population revealed 4,538 total individuals experiencing homelessness in Dallas, a 9% increase over 2018.) In response, Austin Street is planning a brand-new campus that spans approximately 2.3 acres and is located across the street from the current South Dallas facility.

On January 7, 2021, utilizing allocation provided by PeopleFund, Dallas Development Fund and Capital One, Crescent and SMD closed on a $17,500,000 NMTC financing to construct the new Austin Street Center.

The new 60,000 square-foot Austin Street Center for Community Engagement, a 24/7 client-focused facility dedicated to supporting and improving the health and wellness of Dallas’ most vulnerable homeless population.

The new Austin Street Center for Community Engagement will increase shelter capacity by 12%, meals served by 28%, bathroom stall availability by 400%, daytime access by 100%, case managers by 67%, respite care by 30 beds, and classroom space through the addition of three new classrooms – with all of this accomplished in the context of efficient, state-of-the-art facilities operated according to data-driven best practices.

Norfolk Medical Office Building

October 4, 2018 by

The new Fountain Point Medical Office Building (“SurgiCenter”) development in rural Norfolk, Nebraska will focus on an 83,493 square-foot medical office complex. The Medical Office Building will include physical therapy, pediatrics, family practice, internal medicine, imaging, lab, orthopedics, specialty clinic, surgical/oncology, pain, ambulatory surgical center and a YMCA/daycare. There are shared common areas for IT, waiting space, reception, and restrooms.

The Fountain Point development is located on 55 acres in southwest Norfolk and will be a gateway to the community, giving physicians the autonomy to advocate for their patients. The goal of this development and project is to provide a continuum of care to meet the needs of the internal and external community. This project will also be a regional hub for medical services under one roof and provide the same specialty service found in larger metropolitan communities.

The new Fountain Point MOB is the result of a group of Norfolk physicians attempting to combat the lack of local medical service providers, as well as the rising cost of medical care, by building one large facility to house a wide variety of medical services, using the lowest cost of capital available. The SurgiCenter physicians decided that lower-cost financing options such as TIF bonds and the NMTC program, while less straightforward than a conventional construction loan, would ultimately mean a lower cost to the medical service provider tenant, and therefore a lower cost of care to the end user.

In January of 2018, SurgiCenter’s management hired Crescent to pursue NMTCs in conjunction with its overall financing plan for the expansion. Having already secured bank loan commitments and TIF Financing totaling $8.6 million, Crescent worked to secure an investor commitment along with both Nebraska State NMTC allocation and Federal NMTC allocation. In October of 2018, Crescent and SurgiCenter closed on $10.0M of Nebraska State NMTCs provided by Brownfield Revitalization, and $5.3M of Federal NMTCs provided by Brownfield Revitalization, leveraging a NMTC equity investment made by US Bank.

Without the Nebraska State and Federal NMTC subsidies the SurgiCenter would not be able to continue to expand its patient base while holding to its commitment to keep surgery costs low. The new SurgiCenter will be a ‘one-stop-shop’ medical complex for the surrounding, medically-underserved census tract; moreover, the NMTC subsidy significantly reduces the high construction costs typically associated with this type of modern medical facility, and that savings will directly translate to a lower overall cost of care to the residents of this low-income community. Additionally, the NMTC financing allows the Project to pursue energy efficient elements such as LED fixtures, low-flow plumbing, and high efficiency mechanical systems including HVAC, lighting, and water heating/storage, lowering facility operating costs, which further .

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