MINNEAPOLIS — For months, KARE11 has reported on hospitals across Minnesota sounding the alarm as their emergency departments struggle to care for children with a wide array of mental, emotional and behavioral issues who are being dropped off by caretakers and county case workers.
Now, the M Health Fairview Masonic Children's Hospital says the problem is so out of hand that they have converted an ambulance garage into a makeshift shelter for kids who need 24/7 care, but don't belong in the hospital.
"I think of it as the least of bad options," said Lou Zeidner, Director of Clinical Triage and Transition Services for M Health Fairview.
For the last two weeks, Zeidner says a team of nurses has been diverted to the converted ambulance garage to supervise eight kids who range from 10 to 17 years old. Zeidner says the vast majority of the children didn't come to the ER due to a medical or mental health crisis, such as threats of self-harm. Instead, he says most have faced life-long developmental disabilities and behavioral disorders and ended up at the ER after lashing out at caretakers.
Lew Zeidner: "They have no reason to be in the hospital, other than they are not safe to discharge. The traditional emergency department room is relatively small. Very rarely does it have a window, and so what we've tried to do is create more space."
Kent Erdahl: "If you walk in (to 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 throughout are some beds and also some chairs, which are more like recliners."
Erdahl: "Frankly, just the thought of these kids in crisis, living in a garage, is hard to imagine and stomach. Why not somewhere else?"
Zeidner: "I think there are two answers to your question. The first is that we are very full, so folks say, why don't you move them somewhere else? There isn't another place to move them. The second reason is, we didn't anticipate - nor do we think it's appropriate — that these kids are with us. The hospitals are being misused."
According to M Health Fairview, more than two-thirds of the children in the emergency department who do not need medical care are under the care of the counties or a group home. Since September of 2021, the hospital system reports seeing over 145 patients in that group, with each spending an average of 15 days (the longest being 97 days). The average prior to that was 1-2 such patients a month.
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"That is a matter of serious, grave concern for everybody at the state," said Neerja Singh, Clinical Behavioral Health Director for the Minnesota Department of Human Services.
Singh says the loss of licensed children's residential facilities is part of the problem. In 2019 there were 122 residential facilities throughout the state, and by January of this year there were just 106. On paper, that has translated to 413 fewer beds, but Singh says the reality is that capacity is even less because of an ongoing worker shortage.
Singh: "The workforce shortage is really hitting our residential providers, who do not have staff who can provide supervision as well as treatment to these children."
Erdahl: "Should counties be dropping children off at the Emergency Room if they are not really struggling with a medical emergency?"
Singh: "No child should be dropped at an Emergency Room if they do not have a medical need. That is just not a healthy, ethical practice."
In November 2021, DHS did create an intensive unit to address the problem at Masonic and other hospitals. Singh says they have received $2.5 million in temporary emergency funding from the governor's office to try to address the problem in the short term.
"The state is working with our current residential providers to provide funding to immediately start accepting these children from emergency rooms," Singh said.
Zeidner says he is hopeful the coordination will lead to progress for the kids currently staying in the ambulance garage, but he believes it will take a bigger effort.
Zeidner: "I'm not frankly seeing the evidence yet. But I'm really not looking for who is at fault here. I'm really looking at a systemic problem."
Erdahl: "It feels like kids that nobody knows how to take care of, and so they're getting shuffled around."
Zeidner: "I would agree, and I would say the most frustrating part of this is that we watch vulnerable children get worse over time."
Erdahl: "Are there any things that you're finding that are signs of potential momentum?"
Zeidner: "In fairness, No. I think there has been a lot of discussion about better ways, but that's a very long process and every day I walk into the emergency department and I look into the eyes of a child who has been there for 46 or 47 days, and I say that process is too slow."
Both Zeidner and Singh agree that it will likely require a larger, more long term investment in order to stabilize the staffing struggles and closures of residential treatment centers.
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