One of Minnesota's largest hospital systems is closing Twin Cities clinics that specialize in the care of older adults, disrupting care for hundreds of senior patients and exacerbating a statewide shortage of geriatric specialists.

Hennepin Healthcare has notified 700 patients who receive care at its Augustana and Parkside senior care clinics, both in Minneapolis, that they will be closing at the end of February.

Patients who wish to stay with Hennepin Healthcare, which operates HCMC, the large public hospital in downtown Minneapolis, can transition to one of the system's eight neighborhood clinics or to its large, new clinic and specialty care center in downtown Minneapolis, officials said.

The Hennepin Healthcare clinics have long employed doctors, nurses and social workers who specialize in the complex health needs of seniors, and their closure comes amid growing concerns that such specialty care is failing to keep pace with the aging population, both nationally and in Minnesota.

The United States has only 6,952 geriatricians (of whom about half are full time), and the nation will need 33,200 such specialists by 2025 to keep pace with rising demand, according to a 2017 federal study. More than half of Minnesota's counties have no certified geriatricians, according to the state association of geriatricians.

Geriatric clinics play a key role in treating the many complex ailments and disabilities associated with aging. Elderly patients often have multiple chronic conditions, from memory loss to macular degeneration and heart disease; which means physicians must understand and monitor how various medications interact. Research has found geriatricians generate savings over time by reducing costly hospitalizations and stays in skilled nursing facilities.

Geriatricians "are trained to be attuned to elders' wishes and preferences, and to see care from more of a holistic perspective," said Eilon Caspi, a gerontologist and adjunct faculty member at the University of Minnesota's School of Nursing. "These closings will almost certainly create instability for hundreds of people with complex health conditions."

Dr. John Cumming, interim CEO at Hennepin Healthcare, said the clinic closings are part of a broader restructuring designed to achieve cost savings, but he said they do not reflect a pullback from overall senior medical care. The geriatricians and interdisciplinary teams that worked in the clinics will be offered the opportunity to work elsewhere in the county-run system and their services will continue in more modern facilities, he said.

Officials at Hennepin Healthcare said the system will also continue to provide geriatric care to patients living in about 20 nursing homes in the Twin Cities through its extended care program. The hospital system also will maintain home nursing services for seniors through its provider, MVNA, and hospice care for people diagnosed with terminal illnesses.

"We are absolutely 100% committed to continuing to provide services to the seniors in our community," Cumming said. "I completely understand that this is a vulnerable and a fragile patient population and we do need to do this very, very carefully."

Minnesota has 146 certified geriatricians, but they are spread across a variety of settings, such as nursing homes and assisted-living facilities, which means there are broad swaths of the state where geriatric services are not available to seniors who live at home, according to elder care specialists.

'A punch to the gut'

Dr. Jane Pederson, a geriatrician from Woodbury, said she struggled for years to find a geriatric clinic for her 94-year-old mother, who has advanced dementia. Like many, she wanted a specialist who could monitor her mother over time and who could balance the often-difficult choices that seniors have to make — between medications and safety and quality of life, for example.

"There just aren't enough [geriatricians], and we are spread far too thin," she said.

Jennifer Wright, an elder law attorney who lives in Roseville, learned of the closures this week when she called one of Hennepin Healthcare's geriatric clinics to make an appointment for her 84-year-old mother, who has diabetes and high blood pressure. "It was like a punch to the gut," Wright said.

Wright said the availability of geriatric services at Hennepin Healthcare clinics was among the reasons she felt excited about moving her aging mother to the Twin Cities from a town in Oklahoma.

After her mother was diagnosed with a chronic illness a year ago, Wright said she looked forward to the availability of a specialty team of doctors, nurses and social workers all under one roof. Hennepin Healthcare, she said, had the only clinic where the doctors understood aging and how to coordinate her mother's various medications. One of the clinic's specialty physicians took Wright's mother off a blood-pressure prescription with potentially serious side effects, which helped improve her cognition and awareness, Wright said.

"It really felt like this clinic would extend and improve the quality of my mother's life," she said. "They combined cutting-edge medical expertise with a personal touch, and you just don't see that much anymore."