After a medical crisis, an Iron Range journalist is speaking out about systemic rural health care issues

CATHY WURZER: Having a health crisis in your family is tough no matter where you live. But in rural areas, far from hospitals, the experience can be especially taxing. Preventable death rates tend to be higher in rural areas. So do insurance premiums. And then there's the extra cost of travel to doctors' visits.

Our next guest has had a front row seat to the problems with health care in rural Minnesota since his mom suffered a stroke back in 2022. He wrote about their experience in a recent column for Minnesota Reformer. That's the news website. Aaron Brown is an author and instructor at Minnesota North College in Hibbing. And he's on the line. Hey, welcome back, Aaron.

AARON BROWN: Hi, Cathy. Good to be here.

CATHY WURZER: Thank you. Thanks for taking the time. Now, I know your mom had a stroke in November of 2022. How is she doing?

AARON BROWN: She's doing well. I'm sure she's sewing and/or reading right now. That's what she normally does. And she's living on her own and doing a lot better now than she was on November 19 of '22.

CATHY WURZER: Oh, I'm so happy because what, of course, happened to her has happened to so many other people. She had a major stroke. I know you got her to the Hibbing Hospital, right? What kind of care did she get there?

AARON BROWN: Well, it was as good as it could be for the situation. There was a COVID outbreak. If you remember, that was going on. And it was difficult for us to be with her inside of the diagnostic area. And as a result, there was, I think, a misdiagnosis at first. And part of that was she had a very unique kind of stroke, a basilar stroke in the back of her head. The initial CT scan didn't show that.

So we lingered for a few hours until another doctor figured out the problem. And that's when things kicked into a higher gear. But at that point, she had already suffered the stroke. So that was the first challenge. And then from that point, she was on a helicopter to Minneapolis. And our whole lives were upturned as we headed down to support her.

CATHY WURZER: Not unusual, of course, to be medevacked around rural Minnesota. It's expensive, though. I'm surprised she didn't go to Duluth.

AARON BROWN: There was an option. And the neurologist at the university said given the-- it was a very serious stroke. And every doctor we've talked to since says she's lucky to be alive. And so at the time, the belief was she'd get the care she needed, the more advanced care she'd needed at the university hospital in Minneapolis. So that was why that choice was made.

CATHY WURZER: Sure. But again, as I say, helicopters play a really big role in rural health care in Minnesota.

AARON BROWN: Yes, yeah. No, and they're very expensive. I mean, it was covered by her insurance. But the thing about our health care system is that just because it's covered by insurance doesn't mean it's not terribly expensive and that those expenses don't have effects on availability of care. Because if the company is providing the services can't afford it, they'll eliminate the services. And we've run into a lot of that in her rehabilitation process, things not being available close to home, having to travel for certain kinds of care.

CATHY WURZER: Oh, I can only imagine trying to get rehabilitation services for your mom, try to find a facility that has room and staff.

AARON BROWN: Yeah, that was the big trouble. She was at an in-between kind of hospital, an advanced care hospital, for a number of months. And she could have left sooner, but there was no place for her at that time. It took a certain kind of nursing facility that could handle some of the things she had going on at that time.

And ultimately, the only place we could get her after a couple of months was Duluth, which is closer than Minneapolis to Hibbing and that area, but still a very regular drive. Fortunately, I have a sister who lives in Duluth. So that helped. But nevertheless, I was her power of attorney and taking care of a lot of her affairs. And it was a real challenge to-- we had a period there where every weekend was the trip to Duluth to see Mom and Grandma. So I wasn't aware.

And the thing of it is, I was not the only person going through this. It just opened my eyes in a way I hadn't seen before to what a lot of people go through, strokes, heart problems, cancer treatments, things that affect every family at some point. But in a rural area, a lot fewer services are available, even compared to before. And that's the thing I've noticed.

CATHY WURZER: You talked to a state lawmaker-- I thought this was interesting-- in your Minnesota Reformer piece who said the rural health care system is on track to implode. Wow. What did they mean by that?

AARON BROWN: Yeah, that was Natalie Zeleznikar. She's a Republican from Fredenburg, just outside Duluth. And the reason I talked to her is she, prior to being elected, spent decades as a health care administrator. She ran nursing homes. And so given that experience, I wanted to talk to her. And her experience as a leader in health care was just the opposite-- the very same problems we were noticing, she was having to deal with. How do you pay for people who have high needs but have low reimbursement rates from their insurance, or especially those like my mother who are on public health insurance?

My mom was very low income as a child care provider. So she had public health care. And those are more common. Whether you're talking about Medicare for older people or Minnesota Care for working people, you're dealing with a lower reimbursement rate. And so as that population gets bigger-- and it is, it's getting bigger-- health care facilities, hospitals, but also nursing homes are figuring out ways to keep providing the same level of care when they have less money to work with. And that's just one of the problems they're running into.

The other that she indicated was a very big problem was staffing. And this is another thing we've dealt with especially since COVID. But it predated COVID. Getting enough people to work these high demand jobs in health care, whether it's CNAs and personal care attendants all the way up to registered nurses and doctors and specialists, there just aren't enough people right now. And I think anyone in health care is nodding their head. They know because they're working double shifts. They're trying to take care of themselves while providing this care.

But that was a very big problem that fed in to some of the challenges we faced with my mother, in particular OT therapists, physical therapists. Finding in our local town, they had a vacancy for a number of months while they waited for a new therapist to come in and work with people again. And they did eventually find somebody. But that caused us to have to drive to other towns for a long period of time.

And of course, my mother can't drive because of the stroke. So one of us, usually me, but one of my siblings or public transportation provided by her health care, which is very expensive, had to be used to get her just to basic therapy appointments. So that's, again, not new. But the cost of it, it made me realize that my mother, my, dear mother, was one of the most expensive people in the state. And she's not the only one like that.

And that's the thing we have to think about, as I conclude, as Minnesotans, as citizens of a society is, how do we provide the level of care all across the state so that these organizations can stay open and providing their care? People want to provide the care. They just don't know how to afford it. And that's the problem in the whole industry right now.

CATHY WURZER: And how do you see the state potentially stepping in to possibly help?

AARON BROWN: Yeah, there's state federal, and local things that can be done. The state can address Minnesota Care reimbursements, anything state ordained. Encouraging more people into health care fields is another. That's what Natalie Zeleznikar talked about. I also talked to a professor at the University of Minnesota, Carrie Henning-Smith, who was very encouraged by the new [University of Minnesota medical school campus in St. Cloud] helping to make up the gap with physicians and special providers.

But really, it's going to take a long-term investment, planting the seeds of getting more young people into health care, into advanced health care, taking the hard classes and going on for the more challenging, whether it's registered nurse on up to physicians. Those are challenging fields. I work at a college, and we have a nursing school. It's very challenging. The people who come through and are providing that care, they've worked very hard to get there. And so we have to help them get there because all of us count on that.

CATHY WURZER: And of course, as you and I are both rapidly aging, there's--

AARON BROWN: As are we all.

CATHY WURZER: I know there's more of us coming down the pike that are going to need some care. Aaron Brown, I always appreciate talking to you. Thank you for the thoughtful article.

AARON BROWN: Thanks, Cathy. Thanks for having me.

CATHY WURZER: We've been talking to Aaron Brown, author and instructor at Minnesota North College in Hibbing. You can find his writing about life, politics, and history on the Iron Range at minnesotabrown.com.