Health care ‘implosion’ threatens Greater Minnesota

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My mother dreamed of helicopters falling from the sky. In one crash, my uncle died. In another, her children. Again and again, the low thrum of helicopters tore her world apart.

These fitful dreams remain mom’s only memories from the month after she suffered a life-threatening stroke on Nov. 19, 2022. That night, just before midnight, a helicopter flew her safely from Hibbing to the University of Minnesota hospital in Minneapolis.

Mom spent almost three months in a hospital and four more in rehabilitative care. Known as “the baby whisperer,” my mom was only 62 when the stroke ended her long career as a child care provider. She spent most of her adult life years near poverty because she loved the work.

The last 18 months upended our family. We saw first hand the disparities in our health care system for people in small towns and rural areas.

The first challenge was diagnosis and treatment. An understaffed rural hospital, reeling from another COVID-19 outbreak, took almost five hours to properly diagnose mom’s stroke, which was in the brain stem outside the view of the first CT scan. She lost crucial hours of advanced stroke care.

Once mom stabilized at the U of M hospital, her long recovery began. Unlike about one million Minnesotans, my job allowed enough paid time off to wrangle mom’s paperwork and medical care. Living in a rural area adds hours of driving, hotel stays and meals, expenses many can’t afford.

As time wore on, mom needed more intensive physical, occupational and speech therapies to regain functions taken by the stroke. We spent months looking for a rehabilitation facility but couldn’t find one near home.

Professor Carrie Henning-Smith of the University of Minnesota Rural Health Care Research Center said our experience is typical of rural patients. She said rural providers struggle because of low patient volume, aging and impoverished demographics, and workforce shortages.

Fifteen Minnesota nursing homes closed in the past decade. More than half were in rural areas, according to the state Department of Health. During the same period, rural Minnesota counties lost beds for cardiac care and mental health. In the past 20 years, 25% fewer Minnesota hospitals offer birth services, again mostly in rural places.

State Rep. Natalie Zeleznikar, a Republican from Fredenberg Township north of Duluth, spent 30 years as a health care administrator before being elected to the legislature in 2022. The challenges of one job spilled into the next.

“These issues are just going to become a lot worse because we have an older population just as we start to see lower workforce participation,” Zeleznikar said. “It’s going to cause an implosion.”

She said the pressure on health care providers grew so great during COVID that many burned out. Now, it’s harder to find people willing to take on double shifts and more patients.

My mom’s fierce determination sustained her through several close calls. Despite the visible stress on their faces, nurses and doctors saved my mother’s life with kindness and respect. Today, she can walk, eat most foods, and live independently.

She’s a miracle. And yet, talking to experts only illustrates that she’s part of the financial deficit choking rural health care services. How can an industry full of people who care still fall short?

A few answers seem clear.

Congress must address Medicare and Medicaid reimbursement rates, which are too low to sustain rural ambulances and hospitals.

The state should incentivize a new generation of medical professionals to practice rural medicine.

Localities could welcome these professionals by improving access to housing and child care, key recruitment factors. Rural places can also grow talent from within.

“We know from research I’ve been involved that the biggest predictor of going into rural health care is growing up in a rural area,” Henning-Smith said.

She says encouraging young rural people to go into medicine is crucial.

Parts of our health care system work. Minnesota has some of the best hospitals in the world. And Henning-Smith is excited for the opening of a new medical school at the University of Minnesota’s CentraCare Regional Campus in St. Cloud.

“It creates hope beyond just new physicians,” she said, adding that the project would draw more kinds of medical professionals outside the Twin Cities.

Nowadays, mother and I travel 160 miles round-trip for her follow-up appointments in Duluth. Sometimes, we watch those spectral helicopters land on the roof of the hospital. The rotors chant psalms of change.

There goes another family into the great unknown. May they find peace. All Minnesotans deserve reasonable access to the best care. Where we live and how much we make should not matter.

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