Special meeting required on care gap

Editor’s note: editorial represent the opinions of the Star Tribune Editorial Board, which operates independently of the newsroom.

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Minnesota’s needy children and their families should have better options than an Airbnb rental when a crisis hits.

But for a West St. Paul family this year, the hotel alternative was one of the few options available to help their 13-year-old son Harrison, who has autism and whose aggression temporarily put him and his younger siblings at risk at home.

Faced with Harrison having to be hospitalized indefinitely until placement at a specialty care facility became available, Tara Dobbelaere instead worked out a temporary agreement with Dakota County to secure Airbnb accommodations. The boy would stay at the Airbnb while Tara and her husband took turns caring for him there.

While the agreement has proven beneficial, Dobbelaere’s ongoing frustrations are understandable and urgently require remedial action. Editor’s recommendation: special legislation.

While Minnesota has world-class medical centers, there is an unacceptable gap in care, leaving families like Dobbelaere’s with few options. The gap has also prompted Minnesota hospitals to warn of capacity issues.

Emergency departments are often the last resort when places in group homes and other facilities for children and adults with behavioral or developmental disabilities are unavailable. This can leave these vulnerable patients stuck in hospitals for weeks or even months. A recent Star Tribune story heightened concerns about this, shedding light on a 10-year-old boy with “severe autism and aggression” who was incarcerated in a Waconia hospital for seven months.

The winter virus season is fast approaching. Patients making a bed while awaiting inpatient or community care could impact a hospital’s ability to respond to a severe flu season, COVID surge, or mass trauma event, or to admit patients from other hospitals who need higher levels of care.

Executives from two respected Minnesota health systems spoke this week about the supply gap and the downstream impact on capacity.

M Health Fairview’s Lewis Zeidner said the system has an average of around 10-12 patients per day who do not require hospital-level care but are awaiting placement elsewhere. A little over a year ago, two was the average.

Most of the waiting patients are children under the age of 18, said Zeidner, who serves as M Health Fairview’s executive director for triage and transition services.

Waiting in a hospital queue is not optimal. While children are safe from outside dangers, a hospital is designed for acute care. This environment, particularly the converted ambulance bay that M Health Fairview established earlier this year to house these patients, is not designed to provide the broader educational, therapeutic and other interventions essential to managing ongoing illness.

As the winter progresses, these beds are also needed by children who require hospitalization.

Hennepin Healthcare’s Jennifer DeCuberlis is also concerned about capacity, although her Metro medical center generally has adults waiting for placement. “We have an alarming problem. It’s not just a children’s problem. It affects adults too,” she said.

Demand for community and residential care has long exceeded the health system’s ability to meet these needs, particularly for children with developmental and behavioral problems. But the labor shortage that has accompanied the years of the COVID-19 pandemic has created a crisis, which in turn is limiting patient accommodation.

It’s not just a Minnesota problem. A recent Washington Post story showed a teenager trapped in “medical purgatory” waiting in a Maryland emergency room for a place in a more appropriate care environment to open up.

The labor shortage and concerns about hospital capacity are compelling arguments for lawmakers to act before the end of the year.

A number of solutions are critical, but an obvious starting point is the labor shortage that is also plaguing long-term care centers. The state plays an essential role as many of these patients receive medical care through public programs such as Medical Assistance. This means that the state can increase payment rates, which is an obvious solution when there is a large surplus.

Lawmakers have addressed the healthcare workforce shortage in 2022. House and Senate leaders agreed on $1 billion over three years, but the law stalled when negotiators couldn’t agree on how much of that amount should go to pay increases for long-term care workers , group home workers, personal care assistants and more, the Star Tribune reported.

In a statement this week, Gov. Tim Walz said that “there just can’t be gaps in the care of children” and that Minnesota needs to do more. “If the Senate is ready to return to the table, I stand ready to call lawmakers back to get this done.”

Vulnerable patients and government healthcare systems depend on legislators to meet this challenge.

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