Special session needed on care gap

Opinion editor's note: Editorials represent the opinions of the Star Tribune Editorial Board, which operates independently from the newsroom.

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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.

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.

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.

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.

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."