Editorial Roundup: Special session needed on care gap

Published 8:50 pm Friday, November 11, 2022

Kids and adults with behavioral or developmental conditions too often have sparse treatment options.

Minnesota’s high-needs kids and their families should have better options than an Airbnb rental when a crisis strikes.

Yet 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 himself and his younger siblings at home at risk.

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Faced with boarding Harrison at a hospital indefinitely until placement in a specialty care facility opened up, Tara Dobbelaere instead worked out a temporary arrangement with Dakota County to secure Airbnb accommodations. The boy would stay in the Airbnb while Tara and her husband took turns caring for him there.

While the arrangement proved beneficial, Dobbelaere’s ongoing frustrations are understandable and require urgent remedy. The Editorial Board’s recommendation: a special legislative session.

Minnesota may be home to world-class medical centers, but it has an unacceptable care gap that leaves families like Dobbelaere’s with sparse options. The gap also has Minnesota hospitals warning of capacity concerns.

Emergency rooms often are the provider of last resort when placements in group homes and other facilities for kids and adults with behavioral or developmental conditions are not available. That can leave these vulnerable patients stuck for weeks or even months in hospitals. A recent Star Tribune story amplified concerns about this, spotlighting a 10-year-old boy with “severe autism and aggression” who was confined to a Waconia hospital for seven months.

The winter virus season is fast approaching. Patients taking up a bed while waiting for residential or community care could reduce a hospital’s ability to respond to a bad flu season, a COVID surge or a mass trauma event, or to accept patients from other hospitals who require higher-level care.

Leaders at two respected Minnesota health care systems spoke out this week about the care gap and the downstream impact on capacity.

M Health Fairview’s Lewis Zeidner said the system averages about 10-12 patients a day who don’t require hospital-level care but are waiting for placement elsewhere. A little over a year ago, two was the average.

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

Waiting in a holding pattern at the hospital is not optimal. While kids are safe from outside dangers, a hospital is designed for acute care. This setting, particularly the converted ambulance bay that M Health Fairview set up earlier this year to shelter these patients, isn’t designed to provide broader educational, therapy and other interventions vital to manage ongoing conditions.

As the winter wears on, those beds will also be needed by kids who do require hospitalization.

Hennepin Healthcare’s Jennifer DeCubellis is worried about capacity, too, though her metro medical center generally has adults waiting for placement. “We’ve got an alarming problem. It’s not just a kid’s issue. It’s adults as well,” she said.

Demand for community and residential treatment has long outstripped the health care system’s ability to meet this need, particularly for kids with developmental and behavioral conditions. But the workforce shortages accompanying the COVID-19 pandemic years have created a crisis, which in turn limits patient placement.

It isn’t just a Minnesota problem. A recent Washington Post story highlighted a teen caught in “medical purgatory,” waiting in a Maryland emergency room for space to become available in a more appropriate care setting.

The workforce shortage and the hospital capacity concerns are compelling arguments for the Legislature to act before the end of the year.

An array of solutions is vital, but an obvious place to start is the workforce shortage, which is also plaguing long-term care centers. The state has an integral role because many of these patients get medical care through public programs, such as Medical Assistance. That means the state can raise payment rates, an obvious solution when there’s a large surplus.

Legislators tackled the health care workforce shortage in 2022. House and Senate leaders agreed to $1 billion over three years, but the bill stalled when negotiators couldn’t agree on how much of that amount to devote to pay raises for workers in long-term care, group home employees, personal care assistants and more, the Star Tribune reported.

In a statement this week, Gov. Tim Walz said that “there simply cannot be gaps in care” for kids and that Minnesota needs to do more. “If the Senate is willing to come back to the table, I remain ready to call legislators back to get it done.”

Vulnerable patients and the state’s health care systems are depending on lawmakers to rise to this challenge.

— Minneapolis Star Tribune, Nov. 5