Legal and Ethical Issues Related to Psychiatric EmergenciesT.docxLaticiaGrissomzz
Legal and Ethical Issues Related to Psychiatric Emergencies
The diagnosis of psychiatric emergencies can include a wide range of problems—from serious drug reactions to abuse and suicidal ideation/behaviors. Regardless of care setting, the PMHNP must know how to address emergencies, coordinate care with other members of the health care team and law enforcement officials (when indicated), and effectively communicate with family members who are often overwhelmed in emergency situations. In their role, PMHNPs can ensure a smooth transition from emergency mental health care to follow-up care, and also bridge the physical–mental health divide in healthcare.
In this week’s Assignment, you explore legal and ethical issues surrounding psychiatric emergencies, and identify evidence-based suicide and violence risk assessments.
To Prepare
· Review this week’s Learning Resources and consider the insights they provide about psychiatric emergencies and the ethical and legal issues surrounding these events.
The Assignment
In 2–3 pages, address the following:
· Explain your state laws for involuntary psychiatric holds for child and adult psychiatric emergencies. Include who can hold a patient and for how long, who can release the emergency hold, and who can pick up the patient after a hold is released.
· Explain the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state.
· Explain the difference between capacity and competency in mental health contexts.
· Select one of the following topics, and explain one legal issue and one ethical issue related to this topic that may apply within the context of treating psychiatric emergencies: patient autonomy, EMTALA, confidentiality, HIPAA privacy rule, HIPAA security rule, protected information, legal gun ownership, career obstacles (security clearances/background checks), and payer source.
· Identify one evidence-based suicide risk assessment that you could use to screen patients.
· Identify one evidence-based violence risk assessment that you could use to screen patients.
Attach copies of or links to the suicide and violence risk assessments you selected.
NOTE: MY STATE IS ILLINOIS
2
Final Project : Policy Research and Organizational Analysis Report
Precious Teasley
Southern New Hampshire University
IHP-620-Q1591 Economic Principles- healthcare 22TW1
Dr. Scott
October 20, 2022
Introduction
The purpose of this report is to focus on economic principles and how they apply to the field of healthcare. Healthcare facilities need to make economic decisions because they need financial resources to run. They need economic consultants that will help in making strategic economic decisions that will guide healthcare facilities on where and how to spend their money (Hicks, 2020). This ensures that they are wise in their undertakings. This report focuses on Jackson Memorial Hospital, a facility that has more than 1,500 li.
Discussion assignment & Instructions Below I need a mi.docxelinoraudley582231
Discussion assignment & Instructions
Below I need a minimum 100- word initial response to the Assignment question. Then, I need a
minimum of 50-word responses to TWO peers per their comments to the question below. Required a
minimum of 2 scholarly reference, one is the eBook attached. If you use any outside reference, cite APA
format. No plagiarism and 100% original work.
Assignment question: Describe and differentiate the roles of hospitals and nursing homes in providing long-
term care? Minimum 100- word initial response
Peer#1 Minimum of 50 words
Nursing homes are facilities that are licensed to provide that of short and long-term care to patients."
They are facilities that are specialized in caring for people that are not able to care for themselves such
as basic personal hygiene on there own, as well as Medicare pays substantially more for these services."
(Green, 2015, p. 27). Nursing homes usually specialize in caring for the elderly but there are cases when
a younger age group is cared for within a nursing home. A nursing home has nurses that are there to
treat the patients on a round the clock basis but doctors do not make rounds everyday in a nursing
home." Long-term care hospitals are facilities that patients are usually transferred to from a critical care
or an intensive care unit." (Green, 2015, p.30). These hospitals specialize in treating people who usually
have more than one or more serious conditions or that they need a hospital level of care for an
extended time but that the patient is expected to improve within a period of time are will be able to
then return home. "Also a requirement for Medicare reimbursement in a long-term hospital the
impatient length of stay has to be greater than that of 25 days but the average length of stay is right
around 30 days." (Competty & Rosenberg, 2016, p.12).
References:
Competty, Brad & Rosenberg, Jessica (2016). A Guide To Care Facilities. Retrieved from: https://www.a-
guide-to-care-facilities.com
Green, L.E. (2015). Nursing Home vs Long-Term Care. Retrieved from: https://www.lingtermcarelink.net
Peer#2 Minimum of 50 words
Hospitals may provide a wide variety of long-term care, ranging from skilled nursing and rehabilitation
services to less intensive long-term care. Hospital’s main focus has been acute care and health
education. Skilled nursing care involves medical and skilled nursing care, therapy, and social services
under the supervision of a licensed registered nurse on a 24-hour basis. Physical rehabilitation services
encompass a comprehensive array of restoration services for the disabled and all support services
necessary to help patients attain their maximum functional capacity. However, various types of hospital
specialize in long-term care, including categories of psychiatric, rehabilitation. Chronic disease,
orthopedics, and long term defined as an average length of stay of 23 days or more (Williams & Torrens,
2008).
Refe.
United Healthcare's business model is deepening and widening. Originally a managed care plan, it encompasses a PBM, medical group practices, a data analytics unit, a national ACO and more to come...
The healthcare market is evolving throughout the United States as well as globally. UHC is competing against Aetna, Cigna, Humana, Kaiser as well as Blue Cross Blue Shield plans and other healthcare plans ---and now healthcare provider organizations as well!
... Healthcare Marketing Leader: Pharmaceutical, Medical Device, RPA, SaaS, Digital Marketing Strategy, Managed Care, Market Access - John G. Baresky
In the coming years the United States will find themselves going through a number of changes within the Social Security Administration which will affect the Health Care Industry as we know it “Hospital size has long been an area of discussion and debate in the U.S. healthcare industry. Questions have consistently focused on cost management or efficiency in large versus small hospitals. A persistent question among researchers is whether efficiencies are associated with larger facilities through economies of scale, or if there are alternate scenarios that play a significant part in hospital cost and efficiency” (2009, JHM). Since the Affordable Health Care Act was established it made obtaining health care much more affordable and accessible, but at the same time there has to be some cut back.
Legal and Ethical Issues Related to Psychiatric EmergenciesT.docxLaticiaGrissomzz
Legal and Ethical Issues Related to Psychiatric Emergencies
The diagnosis of psychiatric emergencies can include a wide range of problems—from serious drug reactions to abuse and suicidal ideation/behaviors. Regardless of care setting, the PMHNP must know how to address emergencies, coordinate care with other members of the health care team and law enforcement officials (when indicated), and effectively communicate with family members who are often overwhelmed in emergency situations. In their role, PMHNPs can ensure a smooth transition from emergency mental health care to follow-up care, and also bridge the physical–mental health divide in healthcare.
In this week’s Assignment, you explore legal and ethical issues surrounding psychiatric emergencies, and identify evidence-based suicide and violence risk assessments.
To Prepare
· Review this week’s Learning Resources and consider the insights they provide about psychiatric emergencies and the ethical and legal issues surrounding these events.
The Assignment
In 2–3 pages, address the following:
· Explain your state laws for involuntary psychiatric holds for child and adult psychiatric emergencies. Include who can hold a patient and for how long, who can release the emergency hold, and who can pick up the patient after a hold is released.
· Explain the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state.
· Explain the difference between capacity and competency in mental health contexts.
· Select one of the following topics, and explain one legal issue and one ethical issue related to this topic that may apply within the context of treating psychiatric emergencies: patient autonomy, EMTALA, confidentiality, HIPAA privacy rule, HIPAA security rule, protected information, legal gun ownership, career obstacles (security clearances/background checks), and payer source.
· Identify one evidence-based suicide risk assessment that you could use to screen patients.
· Identify one evidence-based violence risk assessment that you could use to screen patients.
Attach copies of or links to the suicide and violence risk assessments you selected.
NOTE: MY STATE IS ILLINOIS
2
Final Project : Policy Research and Organizational Analysis Report
Precious Teasley
Southern New Hampshire University
IHP-620-Q1591 Economic Principles- healthcare 22TW1
Dr. Scott
October 20, 2022
Introduction
The purpose of this report is to focus on economic principles and how they apply to the field of healthcare. Healthcare facilities need to make economic decisions because they need financial resources to run. They need economic consultants that will help in making strategic economic decisions that will guide healthcare facilities on where and how to spend their money (Hicks, 2020). This ensures that they are wise in their undertakings. This report focuses on Jackson Memorial Hospital, a facility that has more than 1,500 li.
Discussion assignment & Instructions Below I need a mi.docxelinoraudley582231
Discussion assignment & Instructions
Below I need a minimum 100- word initial response to the Assignment question. Then, I need a
minimum of 50-word responses to TWO peers per their comments to the question below. Required a
minimum of 2 scholarly reference, one is the eBook attached. If you use any outside reference, cite APA
format. No plagiarism and 100% original work.
Assignment question: Describe and differentiate the roles of hospitals and nursing homes in providing long-
term care? Minimum 100- word initial response
Peer#1 Minimum of 50 words
Nursing homes are facilities that are licensed to provide that of short and long-term care to patients."
They are facilities that are specialized in caring for people that are not able to care for themselves such
as basic personal hygiene on there own, as well as Medicare pays substantially more for these services."
(Green, 2015, p. 27). Nursing homes usually specialize in caring for the elderly but there are cases when
a younger age group is cared for within a nursing home. A nursing home has nurses that are there to
treat the patients on a round the clock basis but doctors do not make rounds everyday in a nursing
home." Long-term care hospitals are facilities that patients are usually transferred to from a critical care
or an intensive care unit." (Green, 2015, p.30). These hospitals specialize in treating people who usually
have more than one or more serious conditions or that they need a hospital level of care for an
extended time but that the patient is expected to improve within a period of time are will be able to
then return home. "Also a requirement for Medicare reimbursement in a long-term hospital the
impatient length of stay has to be greater than that of 25 days but the average length of stay is right
around 30 days." (Competty & Rosenberg, 2016, p.12).
References:
Competty, Brad & Rosenberg, Jessica (2016). A Guide To Care Facilities. Retrieved from: https://www.a-
guide-to-care-facilities.com
Green, L.E. (2015). Nursing Home vs Long-Term Care. Retrieved from: https://www.lingtermcarelink.net
Peer#2 Minimum of 50 words
Hospitals may provide a wide variety of long-term care, ranging from skilled nursing and rehabilitation
services to less intensive long-term care. Hospital’s main focus has been acute care and health
education. Skilled nursing care involves medical and skilled nursing care, therapy, and social services
under the supervision of a licensed registered nurse on a 24-hour basis. Physical rehabilitation services
encompass a comprehensive array of restoration services for the disabled and all support services
necessary to help patients attain their maximum functional capacity. However, various types of hospital
specialize in long-term care, including categories of psychiatric, rehabilitation. Chronic disease,
orthopedics, and long term defined as an average length of stay of 23 days or more (Williams & Torrens,
2008).
Refe.
United Healthcare's business model is deepening and widening. Originally a managed care plan, it encompasses a PBM, medical group practices, a data analytics unit, a national ACO and more to come...
The healthcare market is evolving throughout the United States as well as globally. UHC is competing against Aetna, Cigna, Humana, Kaiser as well as Blue Cross Blue Shield plans and other healthcare plans ---and now healthcare provider organizations as well!
... Healthcare Marketing Leader: Pharmaceutical, Medical Device, RPA, SaaS, Digital Marketing Strategy, Managed Care, Market Access - John G. Baresky
In the coming years the United States will find themselves going through a number of changes within the Social Security Administration which will affect the Health Care Industry as we know it “Hospital size has long been an area of discussion and debate in the U.S. healthcare industry. Questions have consistently focused on cost management or efficiency in large versus small hospitals. A persistent question among researchers is whether efficiencies are associated with larger facilities through economies of scale, or if there are alternate scenarios that play a significant part in hospital cost and efficiency” (2009, JHM). Since the Affordable Health Care Act was established it made obtaining health care much more affordable and accessible, but at the same time there has to be some cut back.
HORIZON TOWER
520,094 RSF
17-story medical + biomedical space
13-level parking garage; 2,700 stalls
Under Construction and
On-Schedule for 4Q2023 Delivery
Simpolo Tiles & Bathware
Tile ho,
toh Simpolo.
Since the first steps were taken in 1977, Simpolo Ceramics has carved its niche as a consistently growing organisation with unparalleled innovation and passion rooted in simplicity.
We endure gratification for every experience we offer, created to share something meaningful. It may not resonate with the majority, but that makes us a class apart. If only a handful were to understand the purpose of our existence, we would be proud to have found our believers. Rather, people with whom we can share our beliefs.
VISUALIZER
Design your space in your style with our very own Visualizer. Now, you can choose the tiles of your liking from our wide selection and see how they would look in a space. Select the tile from the multiple options and the visualiser will replace the surfaces in the image with the selected tiles. This way, instead of just your imagination, you can choose the tiles for your place by getting an actual picture of how they would look in a space. So, design your space the way you desire digitally and implement it in real life to get the best results!
You can also share this visualiser with others to help them design their space.
Committed to delighting customers with world-class ceramic products and services. Make Simpolo synonymous with the best quality and set new benchmarks of excellence for all stakeholders. Pursue best business practices with utmost integrity to make Simpolo an exciting organisation to work with, for vendors, channel partners, investors and employees alike.
Gain worldwide recognition in the field of ceramic building products through Research and Innovation and bring an enhanced lifestyle within reach for every household.
Sense Levent Kagithane Catalog - Listing TurkeyListing Turkey
Sense Levent offers a luxurious living experience in the heart of Istanbul’s vibrant Levent district.
This cutting-edge development seamlessly integrates modern design with natural elements, featuring live evergreen plants maintained by an advanced irrigation system, ensuring lush greenery year-round.
The building’s elegant ceramic balconies are both stylish and durable, enhancing the overall aesthetic and functionality. Residents can enjoy the 700m Sky Lounge, which provides breathtaking views of Istanbul and a perfect space to relax and unwind.
Sense Levent promotes a healthy and active lifestyle with a full gym, swimming pool, sauna, and steam room, all available in the building. The interiors are crafted with high-quality materials, ensuring a luxurious and inviting living space.
Designed with young professionals in mind, Sense Levent features 1+1 and 2+1 units with smart floor plans and balconies. The project promises high investment returns, with an expected annual return of 6.5-7%, significantly above Istanbul’s average ROI.
Located in the rapidly growing and highly desirable Levent area, the development benefits from ongoing urban regeneration projects. Its prime location offers proximity to shopping malls, municipal buildings, universities, and public transportation, adding immense value to your investment.
Early investors can take advantage of discounted units during the construction phase, with an expected capital appreciation of +45% USD upon completion. Property Turkey provides comprehensive rental management services, ensuring a seamless and profitable investment experience.
Additionally, robust legal support and significant tax advantages are available through Property Turkey’s licensed Real Estate Investment Fund. Levent is a dynamic urban hub, ideal for young professionals with its numerous corporate headquarters and shopping malls.
Sense Levent is more than just a residence; it’s a place where dreams and opportunities come to life. Contact us today to secure your place in this exclusive development and experience the best of Istanbul living. Sense Levent: Sense the Opportunity. Live the Dream.
https://listingturkey.com/property/sense-levent/
Investing In The US As A Canadian… And How To Do It RIGHT!! (feat. Erwin Szet...Volition Properties
=== Investing In The US As A Canadian… And How To Do It RIGHT!! (feat. Erwin Szeto) ===
Ever been curious about Real Estate Investing in the US?? At Volition, for the past 14 years, we have been focused on helping investors invest in over $250M of real estate and generate $100M of wealth in the Toronto market, but we are always open to learning more about other business models and learning from other investors.
The US has always been an intriguing market to invest in. But the US is a big place… if you’re interested in investing in the US, you probably have a lot of questions, like:
☑️ Specifically WHERE should you invest?
☑️ What are the best markets to invest in and why?
☑️ How much are property prices there?
☑️ What are the returns like?
☑️ What is cashflow like?
☑️ Compared to investing in Toronto or other cities in Ontario, what are the benefits / tradeoffs?
☑️ What ownership structure should I use?
☑️ What are the tax implications?
☑️ Can I get financing?
☑️ What are tenants like?
Enter Erwin Szeto, a longtime friend of Volition. Since 2005, Erwin Szeto and his team have navigated the challenging landscape of being landlords in Ontario. Now, they are shifting their focus and guiding their clients' investments toward the more landlord-friendly environment of the USA. This decision comes after assisting Canadian clients in transacting over $440,000,000 in income properties. Faced with issues like affordability constraints, tenant-friendly laws, rent control, and rental licensing in Canada, Erwin sees a clear opportunity in the U.S. Here, there is a significant influx of investments leading to the creation of high-paying manufacturing jobs. Erwin and his clients are poised to capitalize on these opportunities where landlord rights are stronger and there is no rent control.
To facilitate this transition, Erwin has partnered with and become a client of SHARE, a one-stop-shop U.S. Asset Manager. Founded by Canadians for Canadians, SHARE enables as passive an ownership experience as possible for landlords in the U.S., while still maintaining direct, 100% ownership.
Erwin is “Making Real Estate Investing Great Again”!!
Website: https://www.infinitywealth.ca/
Facebook: https://www.facebook.com/iwinrealestate and https://www.facebook.com/ErwinSzetoOfficial
Podcast: https://www.truthaboutrealestateinvesting.ca/
Instagram: https://www.instagram.com/iwinrealestate/ and https://www.instagram.com/erwinszeto/
Omaxe Sports City Dwarka stands out as a premier residential and recreational destination, offering a blend of luxury and sports-centric living. Located in the thriving area of Dwarka, this project by Omaxe Limited is designed to cater to modern lifestyle needs while promoting a healthy, active living environment.
Total Environment Tangled Up In The Green - Residential Plots Where Nature an...JagadishKR1
Embark on a journey where lush landscapes and contemporary living converge at Total Environment's Tangled Up In The Green Residential Plots in Devanahalli, Bangalore. Surrounded by verdant expanses, these plots offer an idyllic setting for your dream home. Immerse yourself in the serenity of nature while enjoying the finest amenities and design, where every moment is a harmonious blend of luxury and tranquility.
One FNG by Group 108 Sector 142 Noida Construction UpdateOne FNG
One FNG by Group 108 is launching a new commercial project in Sector 142 Noida. Office space and high street retail shops on the FNG and Noida Expressway. For more information visit the website https://www.onefng.com/
Elegant Evergreen Homes - Luxury Apartments Redefining Comfort in Yelahanka, ...JagadishKR1
Experience unmatched luxury at Elegant Evergreen Homes, offering exquisite 2, 3, and 4 BHK apartments in the serene locality of Yelahanka, Bangalore. These meticulously crafted homes blend modern design with timeless elegance, providing a harmonious living environment. Enjoy top-tier amenities and a prime location, making Elegant Evergreen Homes the ideal choice for discerning homeowners.
Referans Bahcesehir which is being constructed, in the center of the most regional destination as Bahçeşehir, shines out with its central location and unique landscape including social facilities such as a fitness center, sauna, sports facilities, children’s playground and recreational areas.
Not only drawing attention for immediate surroundings including commercial centers and private schools but also providing the easily accessible location with closeness to Tem Highway and connection roads, ongoing construction of 3rd Bridge Connection roads and Metro Projects
Bahcesehir is a rising value in the great city of Istanbul… Located at a new transportation junction in the northwest of the City… Located at such a spot that the access roads for the 3rd bridge and for the 3rd Airport will reach the region in 2016. The Marmaray and the Subway will extend all the way to Referans Bahcesehir respectively in 2018 and 2019.
465 flats and 34 stores are designed with an outstanding approach and arranged with a unique perspective offering the following options: 1 plus 1, 2 plus 1, 3 plus 1, 3.5 plus 1, 4 plus 1, and 4.5 plus 1. It is planned so as to safeguard you and your loved ones based upon a modern, technological safety approach. As you experience the joy and luxury here, you will be content and feet at ease.
It is worth seeing both inside and outside with heart-warming cafes, tasty restaurants and elegant stores… And it is ready to offer a vivacious social life with a warm and cozy space design.
A folding swimming pool and indoor swimming pools, playgrounds, Turkish bath, sauna… It has them all. Everything you need for your well-being and for having a pleasant time will be at your service. You simply need to align the rhythm of life with the rhythm of Referans Bahcesehir.
https://listingturkey.com/property/referans-bahcesehir/
Rams Garden Bahcelievler - Istanbul - ListingTurkeyListing Turkey
Implemented by Rams Global in Bahcelievler, the Rams Garden Bahcelievler Apartments includes 796 residences of different types from 2+1 to 5+1.
Next to the project, which will have 33 thousand square meters of green area, there will be 42 thousand 300 square meters of woodland. There will also be a 210-meter-long pond in the landscape of the project. There are 94.5 square meters of green space per flat.
Rams Garden Bahcelievler Apartments, which has 8 times more green space than the average of Istanbul with its 33 thousand square meters of green area located within a total of 75 thousand square meters, offers various housing options from 2+1 to 5+1.RAMS Garden has brought a lifeline to the construction industry.
Rams Global, which has signed projects in many places from Dubai to Phuket and delivered more than 20 thousand residences, is now starting new projects in Istanbul.
Rams Garden Bahcelievler is located 9 minutes from Metroport AVM, 5 minutes from Marmara Forum AVM, 12 minutes from Kazlıçeşme beach, 9 minutes from Yıldız Technical University, 7 minutes from Istinye University, 9 minutes from Ramada Hotel and Medicana Hospital.
https://listingturkey.com/property/rams-garden-bahcelievler-apartments/
Dynamics 365 Bid Management for Construction ProjectsDynamic Netsoft
This PDF provides a straightforward guide to using Dynamics 365 for efficient bid management in construction projects. Learn how to streamline processes, improve accuracy, and enhance productivity with practical tips and step-by-step instructions.
https://dnetsoft.com/dynamics-365-bid-management-software
500 acres of brilliance await you here at Riverview City which offers modern living, effortless convenience, and a beautiful natural setting. It is a mega township by Magarpatta City in Loni Kalbhor, Pune. Enjoy easy access to work, schools, and fun while experiencing a perfect work-life balance.
Visit - magarpattacity.developerprojects.in
Torun Center Residences Istanbul - Listing TurkeyListing Turkey
THERE IS LIFE IN ITS CENTER!
The most energetic spot of the city that will add utterly different pleasures to your life, with a park that will make Istanbul breathe, delighting indoor and outdoor bistros, cafes, restaurants, the brand-new Food Hall concept, where dozens of unique tastes are served together, market area, cinema, theater, fitness club, SPA and event venue...
All the pleasures that will enrich your lives are awaiting you on the most beautiful side of the city, at Torun Center Residences. In Mecidiyeköy, where the heart of Istanbul beats, business, life and entertainment opportunities are located at the exact center, at Torun Center, the most beautiful side of the city.
Penthouse apartments and different styles of flats from 1 + 1 to 4 + 1, from 100 to 425 square meters in a 42-story residence tower, have been designed for those who want to live in the center of magnificence. Torun Center is the redefinition of a better life with specially landscaped floor gardens, apartment options with private balconies, and automatic glass systems equipped with Trickle Ventilation that offers clean air comfort.
Business and life in the same place
Excellent service
Torun Center has many delightful details, from a swimming pool to sunbathing and resting terrace. With 24/7 concierge services, 24/7 security, valet, technical service, closed-circuit camera system (CCTV), central heating and cooling system, it makes your life easier.
Delightful details
The two-story Torun Center Lounge, with its indoor and outdoor seating areas, children's playroom, private dining and TV lounge, promises unforgettable memories to you and your loved ones with its unique Istanbul view.
Neighboring to the most pleasant square of Istanbul
A few steps from the Torun Center Residences, you can reach the city's most modern city square and open the doors of a quality city life. Torun Center Residences brings together on the same project the long-awaited city life for Istanbul and gourmet restaurants, cafes, gym and SPA, and state-of-the-art cinema and Artı Stage, hosting the most famous plays of the season.
Located at the intersection of alternative public transportation options such as the metro and Metrobus, Torun Center comes to the fore as the most accessible office for both sides of Istanbul. With a central location and rich transportation lines, Torun Center offices make life easier for employees and increase productivity.
Lixin Azarmehr, a Los Angeles-based real estate development trailblazer, co-founded JL Real Estate Development (JL RED) in 2015 and serves as its CEO. Her expertise has propelled the firm to specialize in luxury residential and mixed-use commercial projects, with a portfolio that features upscale retail spaces and sophisticated care facilities.
Brigade Insignia offers meticulously designed apartments with modern architecture and premium finishes. The project features spacious 3,3.5,4 and 5 BHK units, each thoughtfully planned to provide maximum comfort, natural light, and ventilation.
https://www.newprojectbangalore.com/brigade-insignia-yelahanka-bangalore.html
The SVN® organization shares a portion of their new weekly listings via their SVN Live® Weekly Property Broadcast. Visit https://svn.com/svn-live/ if you would like to attend our weekly call, which we open up to the brokerage community.
2. HEALTHCARE MARKET COMMENTARY | YEAR-END 2014 | COLLIERS INTERNATIONAL HOUSTON
COLLIERS INTERNATIONAL | P. 2
Everything is bigger in Texas, including
healthcare, and the Houston area will
continue leading those statistics. Harris
County, home of Houston, has 80
hospitals – and it appears that isn’t
enough. We need more medical real
estate.
Several health systems are expanding
their hospitals and constructing in
additional locations. Houston Methodist,
CHI St. Luke’s and Texas Children’s
Hospital (“TCH”) are some that have
purchased prime land for the
expansions. The Texas Medical Center
(“TMC”) is working on an expansion of
640,000 square feet. Memorial
Hermann is expanding with a $650
million project in the TMC and its
hospitals are expanding in Katy and
Sugarland. They have purchased a 32-
acre site in the Cypress area for an 80-
bed acute care hospital, community care
medical office building (“MOB”) and an
emergency center. They are also
opening a new 100K SF MOB in Pearland
the first quarter of 2015.
Texas has 375 primary care Health
Professional Shortage Area designations,
demonstrating a serious need for
primary care physicians. Because of the
long wait to see primary care physicians,
and because emergency rooms are so
expensive and overcrowded, urgent care
centers are rapidly growing. Late in
2014, there were 26 UCAA-certified
urgent care centers in Texas – not
enough.
Suburban office and retail properties are
filling up with general practitioners and
family practice providers, while more
specialists stay on or closer to the
hospital campuses. Multi-specialty
properties are continuing to be a trend
where a patient can see a primary care
provider or be admitted into an
emergency department, then go down
the hall to a specialist, an imaging center,
or a pharmacy, and then have a bite to
eat at a restaurant or deli in the building
while waiting for x-rays or a
prescription. Efficiency and economy
are the guiding forces behind the current
trends.
Houston still has the same challenge for
investors that other cities do. There are
more investors for healthcare real estate
than there are properties for sale. No
matter what type of healthcare property
goes on the market, if it is well leased
with good-credit tenants on reasonably
long-term leases, the competition is
fierce. Cap rates are holding at low
levels for better properties.
Property investors and opportunities are
clearly divided into categories. For each
opportunity, it seems like a small and
specialized world. Most investors are
very specific about the types of
properties they want to purchase.
Medical office buildings, surgery centers,
dialysis clinics, hospitals, etc. each have
their own set of investors. Some
buyers are guided by location and
specific submarkets. The Woodlands
couldn’t get much hotter, and just a few
miles south, the FM-1960 submarket is
still struggling. REITs seemed to control
the class A purchases in past years, but
more recently, they have lost
opportunities to bigger investors – the
institutional buyers. High-quality
opportunities like on-campus, MOB
portfolios being offered by health
systems that would lease the properties
back are rarely even seen by private
investors. Even REITs have found it
difficult to compete for those trophies
recently.
Private investors still have the largest
piece of the pie when you look at
healthcare property sales statistics for
2014. In Houston, most purchases over
10,000 square feet were made by
private investors. However, a notable
sale involved CNL Healthcare Properties,
a real estate investment trust (REIT)
focused on senior housing and
healthcare facilities, which purchased
the Houston Orthopedic and Spine
Hospital and the attached MOB for an
estimated $76 million, making it the
largest single-property investment in its
portfolio.
Other hospital sales included the Humble
Surgical Hospital, a 30,000 square foot
property, built in 2000 and renovated in
2012, sold for just under $12 million or
$399 per square foot. The 23,300
square foot Victory Surgical Hospital in
East Houston, and the 105,000 square
foot Pristine Hospital in Pasadena (also
the east side of Houston) represented
the extreme differences in values of
hospitals with the former selling for
around $500 per square foot, and the
latter selling for less than $50 per
square foot.
The Berkeley Eye Center, a 100%
occupied, 16,250 SF single-tenant facility
was sold for $357 per square foot and
leased back to the seller. 9551 Fannin,
one of two buildings sold in a portfolio,
was also 100% occupied and is
estimated to have brought $471 per
square foot.
At the time of this writing, Memorial
Hermann Health System has decided to
market for sale an 11-building, one-
million square foot, on-campus medical
office portfolio totaling more than one
million square feet of net rentable area
throughout the Greater Houston area. It
will be interesting to see who is given
the opportunity to be their new landlord.
With a portfolio like that, the health
system can practically choose whom
they want for a landlord.
Overall, the largest individual owners of
healthcare real estate are hospitals and
healthcare systems, not REITs. Public
REITs own about 12 to 15 percent of the
real estate. So 85 to 88 percent is
owned by other owners and investors,
including the hospitals, health systems
and private investors.
Leasing and Investment Trends
BY BETH YOUNG
3. HEALTHCARE MARKET COMMENTARY | YEAR-END 2014 | COLLIERS INTERNATIONAL HOUSTON
COLLIERS INTERNATIONAL | P. 3
Houston is know as the energy capital of
the world and its reputation as an oil and
gas town is well documented. What
many outside of the region don’t know is
that Houston is a major healthcare hub
and home to one of the largest medical
complexes in the world, The Texas
Medical Center.
While the energy industry has been
primarily responsible for Houston’s
stellar job growth, robust economy and
hot commercial real estate market,
healthcare expansion and job growth
was more than significant in Houston in
2014.
While the recent plummet of energy
prices is expected to halt job growth in
the energy sector and cool off the
Houston commercial real estate market,
the healthcare sector in Houston is
showing no signs of slowing down as
hospital systems implement strategies to
respond to the Affordable Care Act and
meet demand in Houston’s rapidly
expanding population. All you have to do
is scan the recent headlines of the
Houston Chronicle or Houston Business
Journal and you will see many headlines
detailing major hospital system
expansions, new construction and
merger and acquisition activity.
Here is a look back at recent trends and
highlights in Houston Healthcare real
estate for 2014.
The Continued Push into the Suburbs
Several of Houston’s major health
systems implemented aggressive
strategies of expanding their reach out to
suburban Houston to expand market
share and respond to an increase in
healthcare services demand for
Houston’s rapidly growing population.
Houston Methodist Hospital, Memorial
Hermann Health System, CHI St. Luke’s
and Texas Children’s Hospital all
acquired land for new facilities or
initiated expansion of existing facilities in
suburban areas such as The Woodlands,
Sugar Land and Cypress in 2014.
In addition, Houston Methodist entered
the Clear Lake market and expanded it’s
West Houston footprint with the
acquisition of the Christus-St John
Hospital in Nassau Bay and the Christus-
St. Catherine campus in Katy.
Construction Accelerates in the Texas
Medical Center
As the largest medical complex in the
world, the Texas Medical Center (TMC) is
an internationally recognized community
of healing, learning and discovery.
Several of the TMC institutions initiated
major capital improvement and
expansion projects in the Texas Medical
Center in 2014.
Some of the projects announced,
underway or completed in 2014 include:
The Methodist Hospital will build a $300
million patient tower and a $70 million
adult outpatient clinic to consolidate
services.
Memorial Hermann Medical Plaza, the
largest medical office building in the
Texas Medical Center, is a 1.5 million
square foot, 30-story tower representing
a capital investment of $157.5 million.
CHI-St. Luke’s Episcopal Hospital is
undertaking a $200 million expansion
project that includes demolishing its
original 50-year-old hospital and
erecting a 10-story patient care center.
Baylor College of Medicine is building the
$1 billion Baylor Clinic and Hospital on a
35-acre tract of land located in the
Texas Medical Center’s mid-campus.
M.D. Anderson’s addition of nine floors
atop its 12-story Albert B. and Margaret
M. Alkek Hospital is expected to cost
about $293 million. This expansion will
add 478,000 square feet to the hospital’s
current 755,764 square feet.
Texas Children’s Hospital’s approved
plans to build a 19-story tower on top of
a six-story facility next to the Texas
Children’s Pavilion for Women in the
Texas Medical Center. The 25-floor
tower is expected to be complete in
2018.
The Proliferation of Free-Standing
Emergency Facilities
The Affordable Care Act has spurred an
initiative among health systems to extend
their reach beyond the hospital campus
and more health systems are turning to a
satellite network of freestanding
emergency departments (FEDs) to
provide enhanced services in the
outlying suburbs to capture additional
market share, reduce ER overcrowding
and wait times.
The strategy of locating in highly visible,
well traveled and convenient locations
with attractive demographics where
potential patients already frequent retail
establishments, these free-standing
emergency facilities provide a
convenient alternative to hospital
emergency rooms.
Free-standing emergency departments
are staffed by emergency physicians and
nurses and operate round-the-clock.
They are capable of handling most
emergencies as well as stabilizing
patients who need to be transferred to a
hospital.
Healthcare System Real Estate Trends
BY COY DAVIDSON
4. HEALTHCARE MARKET COMMENTARY | YEAR-END 2014 | COLLIERS INTERNATIONAL HOUSTON
COLLIERS INTERNATIONAL | P. 4
VACANCY & AVAILABILITY
Houston’s medical office market
occupancy decreased slightly during
the second half of 2014 with the
citywide average vacancy rate
increasing 10 basis points to 11.0%
from 10.9% in Q2 2014.
Sublease space has not had a
significant impact on current
vacancy rates, remaining at 0.2%.
Of the 3.2M SF of vacant space on
the market, only 52,500 SF is
sublease space.
Disciplined medical office
development activity has helped
prevent major upheavals in current
vacancy levels. There were nine
new buildings (353,315 SF) added
to the market during the second half
of 2014. Currently, there are six
medical office buildings totaling
371,797 SF under construction.
The largest medical office building
currently under construction is the
150,000-SF Class A Springwoods
Village Medical Office Building
located in The Woodlands
submarket. The 6-story building is
33.3% pre-leased and is expected
to deliver in September 2015.
ABSORPTION & DEMAND
Houston’s medical office market
recorded 284,394 SF of positive net
absorption in the second half of
2014, bringing the year-end 2014
total to 705,775 SF.
By property class, Class A posted
the largest amount of positive net
absorption in the second half of
2014, with 194,670 SF, followed by
Class B properties posting 84,000
SF of positive net absorption.
RENTAL RATES
Quoted full-service rental rates for
all medical office property classes
averaged $24.29 per SF in Q4
2014, an increase of 3.1% from
$23.57 per SF in Q2 2014.
By property class, on a bi-annual
basis, the average Class A rental
rate increased by 1.2% from $27.82
per SF in Q2 2014 to $28.15 per
SF, Class B increased 3.4% from
$23.45 per SF to $24.25 per SF,
and the average Class C rental rate
increased 3.1% from $17.77 per SF
to $18.32 per SF.
SALES ACTIVITY
Transaction activity remained
steady between mid-year and year-
end 2014, with 13 properties
changing hands since July 1, 2014.
The majority of the sales that
occurred were patient medical
centers and the average sales price
was $340 per SF and the average
cap rate was 5.95%.
Currently, there are 64 properties
listed for sale and 3 pending
transactions.
LEASING ACTIVITY
Houston’s medical office leasing
activity, which includes renewals,
reached 378,675 SF in the second
half of 2014. By property class,
Class B product led the market with
256,175 SF leased.
MEDICAL OFFICE
CLASS A & B VACANCY VS. RENTS
$10
$15
$20
$25
$30
$35
4%
6%
8%
10%
12%
14%
16%
18%
Q1-12
Q2-12
Q3-12
Q4-12
Q1-13
Q2-13
Q3-13
Q4-13
Q1-14
Q2-14
Q3-14
Q4-14
Class A Vacancy Class B Vacancy
Class A Rents Class B Rents
Class A
7,707,794
26.3%
Class B
16,517,172
56.2%
Class C
5,140,254
17.5%
Class A
Class B
Class C
(100,000)
0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
Q1-12
Q2-12
Q3-12
Q4-12
Q1-13
Q2-13
Q3-13
Q4-13
Q1-14
Q2-14
Q3-14
Q4-14
Class A Class B Class C
MEDICAL OFFICE
NET ABSORPTION BY CLASS
MEDICAL OFFICE
EXISTING INVENTORY BY CLASS
5. HEALTHCARE MARKET COMMENTARY | YEAR-END 2014 | COLLIERS INTERNATIONAL HOUSTON
COLLIERS INTERNATIONAL | P. 5
The Texas Medical Center (TMC) – the world’s largest medical center – represents one of Houston’s major
economic drivers and core industries with an estimated regional annual economic impact of $15 billion. TMC is
also one of Houston’s largest employers with 106,000 employees, including physicians, scientists, researchers and
other advanced degree professionals in the life sciences.
The internationally-renowned, 1,345-acre TMC is the world’s largest medical complex with 54 member institutions,
including leading medical, academic and research institutions, all of which are non-profit and dedicated to the
highest standards of research, education and patient and preventive care. Over 50,000 students – including more
than 20,000 international students – are affiliated with TMC, including high school, college and health profession
graduate programs. More than 7.2 million patients visit TMC each year, including approximately 16,000
international patient visits.
In addition to the medical facilities and institutions of higher learning, TMC is also home to more than 290
professional buildings. Overall, the complex covers over 18 miles of public and private streets and roadways, with
45.8M SF of existing patient, education, and research space. TMC has continued to grow and expand over the past
several decades with the majority of growth occurring in the past ten years. The Center is located in the 110-acre
University of Texas Research Park, a joint effort between the University of Texas Health Science Center, M.D.
Anderson and General Electric Healthcare. TMC spends billions of dollars on research and charity care annually.
TMC PATIENT CARE INSTITUTIONS
DePelchin Children’s Center
The Menninger Clinic
The University of Texas M.D. Anderson Cancer
Center
Texas Children’s Hospital
Memorial Hermann Hospital System
The Methodist Hospital
St. Luke’s Episcopal Hospital
Lyndon B. Johnson General Hospital
Quentin Mease Community Hospital
Ben Taub General Hospital
The Institute for Rehabilitation and Research
The Hospice at the Texas Medical Center
Texas Heart Institute
Shriners Hospitals for Children – Houston
Veterans Affairs Medical Center in Houston
TMC ACADEMIC AND RESEARCH INSTITUTIONS
Sabin Vaccine Institute
The University of Houston – Victoria School of Nursing
Texas Children’s Hospital Neurological Research
Institute
Baylor College of Medicine
The University of Texas Health Science Center at
Houston
The University of Texas M.D. Anderson Cancer Center
University of Houston College of Pharmacy
Rice University
Texas A&M University Health Science Center
Prairie View A&M University College of Nursing
Texas Woman’s University Institute of Health Sciences
Texas Southern University College of Pharmacy and
Health Sciences
Harris County Psychiatric Center
Houston Academy of Medicine
TEXAS MEDICAL CENTER
The University of Texas M.D. Anderson Cancer Center in the Texas Medical Center, ranked #2 in
U.S. News & World Reports “Americas Best Hospitals 2014-2015” for cancer care.
6. HEALTHCARE MARKET COMMENTARY | YEAR-END 2014 | COLLIERS INTERNATIONAL HOUSTON
COLLIERS INTERNATIONAL | P. 6
HOUSTON AREA HOSPITAL LOCATIONS
TEXAS MEDICAL CENTER MAP
Texas Medical Center
World’s Largest Medical Complex
(1,345 Acres)
54 Member Institutions
7.2M Visits Per Year
106,000 Employees
5,000 Physicians
50,000 Life Science Students
$960M in Charity Care
Houston MSA Health Care
115 Hospitals
19,830 Hospital Beds
13,360 Physicians
299,600 Health Care
& Social Assistance Jobs
3.5% Annual Employment Growth
7. HEALTHCARE MARKET COMMENTARY | YEAR-END 2014 | COLLIERS INTERNATIONAL HOUSTON
COLLIERS INTERNATIONAL | P. 7
Accelerating success.
COLLIERS INTERNATIONAL
1233 W. Loop South, Suite 900
Houston, Texas 77027
Main +1 713 222 2111
LISA R. BRIDGES
Director of Market Research | Houston
Direct +1 713 830 2125
lisa.bridges@colliers.com
The Colliers Advantage
ENTERPRISING CULTURE
Colliers International is a leader in global real estate services,
defined by our spirit of enterprise. Through a culture of service
excellence and a shared sense of initiative, we integrate the
resources of real estate specialists worldwide to accelerate the
success of our partners.
When you choose to work with Colliers, you choose to work with
the best. In addition to being highly skilled experts in their field, our
people are passionate about what they do. And they know we are
invested in their success just as much as we are in our clients’
success.
This is evident throughout our platform—from Colliers University, our proprietary education and professional development platform, to our client
engagement strategy that encourages cross-functional service integration, to our culture of caring.
We connect through a shared set of values that shape a collaborative environment throughout our organization that is unsurpassed in the industry.
That’s why we attract top recruits and have one of the highest retention rates in the industry. Colliers International has also been recognized as one of
the “best places to work” by top business organizations in many of our markets across the globe.
Colliers International offers a comprehensive portfolio of real estate services to occupiers, owners and investors on a local, regional, national and
international basis.
*Information herein has been obtained from sources deemed reliable, however its accuracy cannot be guaranteed.
BETH H. YOUNG, CCIM, LEED AP
Senior Vice President | Houston
Direct +1 713 830 2166
beth.young@colliers.com
Coy Davidson
Senior Vice President | Houston
Direct +1 713 830 2128
coy.davidson@colliers.com