Bemidji hospital unit closure will further reduce Minnesota's rehab supply

Sanford Bemidji Medical Center in Bemidji, Minn., is planning to close an acute rehabilitation unit, reducing post-hospital care options that are becoming increasingly scarce in the state.

The hospital intends to send patients elsewhere for rehab but couldn't justify keeping the unit open when insurance restrictions and other changes left it half-full, said Karla Eischens, chief executive of the regional hospital in northwest Minnesota.

"How we care for patients is more than just one unit or one facility," she said. "Closing the [acute rehabilitation unit] will allow us to reallocate scarce resources to other high-need areas within our hospital."

A state public hearing on Wednesday will review Sanford's plans to close the unit by April and convert it into more inpatient medical and surgical beds.

Inpatient rehab helps patients recover from strokes, traumatic injuries and surgeries when they aren't ready to go home but are strong enough to participate in three hours of daily therapy. It's a little-used level of care in Minnesota — only a dozen units statewide — that has been in decline over the past decade because of improved surgical techniques that have allowed more patients to recover at home.

Sanford had already reduced its unit from 14 beds to five, but its closure comes as other providers are trying to expand the level of care in response to emerging pressures on Minnesota's health care system.

Hospitals in Minnesota often relied on nursing homes to provide rehab treatment, but those facilities have closed 3,000 beds statewide since 2020 because of declining staffing and rising costs.

The loss of access has caused logjams in hospitals, which can't discharge patients in need of rehab until they find openings for them and can't free up their own beds for waiting patients. The overcrowding extends into emergency departments, where patients sometimes wait for hours or receive treatment in hallways or waiting rooms.

The pressure is greatest in the Twin Cities, where 99% of inpatient beds are full on any given day, according to state tracking data developed during the COVID-19 pandemic. But even rural hospitals see occupancy rates above 90% during peak times, such as flu season.

A Texas for-profit company has responded by seeking an exemption to Minnesota's hospital construction moratorium so it can build a 60-bed inpatient rehabilitation hospital in Roseville. Minneapolis-based Allina Health similarly submitted plans to open a rehab facility, but delayed them because the system won't be ready to seek legislative approval this year.

Eischens said patients qualifying for inpatient rehab after hospital stays in Bemidji will be transferred to Sanford's unit in Fargo. Sanford also renovated its small, critical access hospital in Bagley, Minn., which has federally designated "swing beds" that can be used either for inpatient care or for post-hospital rehab.

Patients with the greatest needs after surgeries or severe illnesses are placed in long-term acute care hospitals, though those facilities also are in short supply in Minnesota after M Health Fairview reduced the number of beds at Bethesda Hospital in St. Paul and relocated. For-profit Regency Hospital offers this care in Golden Valley and recently sought state permission to move 26 beds to St. Paul to increase access in the East Metro.

The pandemic reduced access to all levels of post-hospital care, including rehab units and nursing homes, said Toby Pearson, executive director of Care Providers of Minnesota, a lobbying group for nursing homes. Many workers burned out and quit, and didn't return to care facilities when the pandemic receded.

"It was no longer, 'Are there enough people to be in your beds?'" he said. "It was, 'Do you have enough staff to operate your beds?' So you started to see an access issue for folks."

Wednesday's hearing on the Sanford closure is the seventh since 2021, when the Legislature required them in order to inform the public about substantial changes within hospitals.

Prior hearings covered Allina's relocation of an inpatient adolescent mental health unit from St. Paul to Minneapolis, the closure of an addiction unit at New Ulm Medical Center and the relocation of the Astera Health hospital in Wadena, Minn.