“I think it’s the least bad option.” According to M Health Fairview, babies don’t belong in a hospital but they have nowhere else to go.
MINNEAPOLIS — For months, KARE11 has reported hospitals across Minnesota sounding the alarm as emergency departments struggle to care for children with a wide range of mental, emotional and behavioral issues being communicated by caregivers and county case workers.
Now, M Health Fairview Masonic Hospital for Children says the problem is so out of control that they’ve turned their ambulance garage into a temporary shelter for kids who need 24/7 care, but don’t belong in the hospital.
“I think it’s the least of the bad options,” said Lou Zeidner, director of clinical triage and transition services at M Health Fairview.
Over the past two weeks, Zeidner says, a team of nurses has been transferred to the converted ambulance garage, to supervise eight children, ages 10 to 17. Zeidner says the vast majority of children have not come to the emergency room because of a medical or mental health crisis, such as threats to self-harm. Instead, he says, most have faced lifelong developmental and behavioral disorders and ended up in the emergency room after criticizing their caregivers.
Lou Zeidner: “They have no reason to stay in the hospital, except that they are not safe to get out of the hospital. The traditional emergency room is relatively small. It rarely has a window, so we tried to make more space.”
Kent Erdal: “If you go (into the ambulance garage), what do you see?”
Zeidner: “Well, at one end of the room, you see three garage doors, and that creates some natural light for the space. The floor is concrete, the walls are concrete, and then spread all over are some beds and some chairs, which are a lot like a chair.”
Erdal: “Honestly, just thinking about those kids who are in crisis, who live in a garage, is hard to imagine and take in. Why wouldn’t it be somewhere else?”
Zeidner: “I think there are two answers to your question. The first is that we’re so full, so people say, ‘Why don’t you move them somewhere else? There’s nowhere else to move them. The second reason is that we didn’t expect – and don’t think it’s appropriate – that these kids are with us.’ abuse of hospitals.”
According to M Health Fairview, more than two-thirds of children in the emergency department who do not need medical care are in county care or in a group home. Since September 2021, the hospital system has reported seeing more than 145 patients in that group, spending an average of 15 days, with the longest being 97 days. The average before that was 1-2 patients per month.
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“This is a serious and serious concern for everyone in the state,” said Neerja Singh, MD, director of clinical behavioral health for the Minnesota Department of Human Services.
Part of the problem, Singh says, is the loss of licensed residential facilities for children. In 2019, there were 122 housing facilities across the state, and as of January this year there were only 106. On paper, that translates to 413 fewer beds, but Singh says the reality is that capacity is lower due to an ongoing shortage of workers.
Singh: “The manpower shortage is really hitting our residential providers, who don’t have staff who can provide supervision as well as treatment for these children.”
Erdal: “Should counties take children to the emergency room if they are not really suffering from a medical emergency?”
Singh: “No child should be placed in the emergency room if they do not have a medical need. This is not a healthy and ethical practice.”
In November 2021, DHS set up an intensive unit to address the problem at Freemasonry and other hospitals. Singh says they have received $2.5 million in temporary emergency funding from the governor’s office to try to tackle the problem in the short term.
“The state is working with our existing residential providers to provide funding to immediately begin accepting these children from emergency rooms,” Singh said.
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Zeidner says he hopes the coordination will lead to progress for the children currently staying in the ambulance garage, but he thinks it will take more effort.
Zeidner: “I’m not really seeing the evidence yet. But I’m really not looking for who’s at fault here. I’m really looking at a systematic problem.”
Erdal: “It’s like kids no one knows how to take care of, and so they move from place to place.”
Zeidner: “I agree, and I would say the most frustrating part about this is that we’re watching vulnerable kids get worse over time.”
Erdal: “Are there any things you find that indicate potential momentum?”
Zeidner: “In fairness, no, I think there’s been a lot of discussion about better methods, but this is a very long process and every day I walk into the emergency department and look into the eyes of a child who’s been there 46 or 47 days ago, and I’d say the process is very slow.”
Both Zeidner and Singh agree that it will likely require larger, longer-term investments in order to stabilize employment pain and close residential treatment centers.
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