Disabled, vulnerable, abandoned. Enough is enough

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The scenes playing out inside emergency departments and other hospital units throughout Minnesota are some of the most horrifying we have seen in our combined 60-plus years of working in health care.

Children with developmental disabilities, often with behavioral challenges but no acute medical needs, are being abandoned in hospital emergency departments. In each case a biological parent, legal guardian, licensed group-home staff or county worker tells our hospitals they can no longer care for the child in their current setting, leaving hospitals responsible to care for them while an alternative placement is found.

The results are increased moral and physical injury to our staff and hundreds of children languishing inside hospitals that are not designed to provide residential care for days, weeks and sometimes months — all because of a completely broken social safety net. It is inhumane and it must stop.

We hoped the crisis would wane as stories of some of the most egregious cases became public last year: a 13-year-old with autism who heartbreakingly described the need for sun and air during a monthlong hospital confinement; the 15-year-old boy with intellectual disabilities whose story prompted an investigation by a local TV news station after he was kicked out of his group home; and the 10-year-old boy with severe aggression whose county guardian left him at a local hospital, then refused to pick him up.

Sadly, we have reached a new boiling point. What started as dozens of children being left in hospitals throughout Minnesota has now grown to hundreds. Since 2019, there has been a 140% increase in abandoned minors at M Health Fairview emergency rooms. In 2021, there were 109 children abandoned at our hospitals. In 2022, the number nearly doubled to 211. Half of the children are under the care of the state or counties.

At Allina Health, children boarding in our hospitals has resulted in hundreds of patients with acute mental health care needs who are not able to access care because our hospital beds are full, or we are forced to temporarily close entire units to accommodate the needs of boarding patients.

Vulnerable adults are sheltering in hospitals now, too. And like the children before them, they have no medical need to be there. Hospitals are neither designed nor well-suited to care for people without an acute medical need, especially those who need consistent, low-stimulating and complex behavioral support. In fact, loud, fast-paced emergency rooms are among the worst possible environments for supporting their needs.

Most of these abandoned children and adults struggle with autism or developmental delays. Normal daily conflicts with caregivers, combined with their social and cognitive challenges, lead them to act out their frustrations through repeated incidents of physical aggression. Over time, parents, guardians, group homes and even county case managers become frustrated and are no longer able or willing to care for the children and adults for whom they are legally responsible.

Contributing to the problem are the record number of group homes that have closed in recent years. According to the Association of Residential Resources in Minnesota, 173 group homes have shuttered since 2021.

The impacts are twofold: many of those displaced do not have a medical condition requiring hospital care. Yet over time, due to their circumstance of living inside a hospital, they develop one. This worsens the already growing mental health crisis in our community. It also strains the capacity of emergency departments across the state as we grapple with a commitment to care for every patient who comes to us, while not displacing patients with acute medical needs.

This crisis is playing out across the country. Some states have resorted to legal action to hold state and local agencies accountable for protecting children from unnecessary pain and suffering while others have passed legislation to hold governor's offices accountable for the growing crisis of children being housed in hospitals awaiting placement elsewhere.

Hospitals are playing an outsized role in finding solutions to this problem because we are the part of the system that is open 24/7/365 and cannot turn patients away from our emergency departments. But it is all of society's duty to ensure children living without parental care grow up in an environment that supports their physical, psychological, social and emotional development.

People with disabilities have the right to be treated in the least restrictive setting appropriate to their needs to prevent further deterioration. As a state and a community, we are not meeting our obligations for this vulnerable group of people. Health care providers will not abandon them, but we cannot do this alone.

Our caregivers experience very real physical and psychological harm as they strive to meet the complex needs of these patients with compassion. More than anyone, they see and experience the impacts of people being stuck in the wrong care settings.

Despite repeated calls and hundreds of meetings with state and county leaders, this situation has only worsened. Enough is enough: we need action. Those responsible must step up to address this crisis.

There is state legislation pending to provide funding for psychiatric residential facilities as well as community based mental health providers that needs to be passed by our lawmakers. It is not enough but it is a step in the right direction. Health systems, state agencies, counties and community organizations need to innovate and invest in opportunities for upstream prevention and downstream needs that we know make a difference. It is a complex challenge with few easy answers, yet we know as Minnesotans we can — and we must — do better.

Lewis Zeidner is vice president, Mental Health and Addiction Services, M Health Fairview. Mary Beth Lardizabal is vice president, Mental Health and Addiction Services, Allina Health.