New cases say fear and confusion about abortion bans in three states are causing doctors and hospitals to deny medically necessary abortions.
La grave escasez de camas pediátricas que azota a la nación este otoño es en parte producto de las decisiones financieras tomadas por los hospitales durante la última década, como cerrar las salas infantiles, que a menudo operan en números rojos, y ampliar la cantidad de camas disponibles para proyectos más rentables como reemplazos articulares y atención del cáncer.
Para hacer frente a la avalancha de niños enfermos por una convergencia radical de virus desagradables, especialmente el virus respiratorio sincitial (VRS), la influenza y el coronavirus, los centros médicos de todo el país han desplegado carpas de triage, retrasado cirugías electivas y trasladado fuera del estado a menores gravemente enfermos.
Un factor importante en la escasez de camas es una tendencia de muchos años entre los hospitales de eliminar las unidades pediátricas, que tienden a ser menos rentables que las de adultos, dijo Mark Wietecha, director ejecutivo de la Children’s Hospital Association.
Los hospitales optimizan los ingresos tratando de mantener sus camas llenas al 100 %, y llenas de pacientes con condiciones que las aseguradoras reembolsan bien.
“Realmente tiene que ver con los dólares”, dijo el doctor Scott Krugman, vicepresidente de pediatría del Hospital Pediátrico Herman and Walter Samuelson en Baltimore. “Los hospitales dependen de procedimientos de alto volumen y alto reembolso de seguros que paguen bien para ganar dinero”.
El número de unidades pediátricas para pacientes internados en los hospitales cayó un 19% entre 2008 y 2018, según un estudio publicado en 2021 en la revista Pediatrics. Solo este año, los hospitales han cerrado unidades pediátricas en Boston y Springfield, Massachusetts; Richmond, Virginia; y Tulsa, Oklahoma.
El aumento actual de enfermedades respiratorias peligrosas para los niños es otro ejemplo de cómo covid-19 ha alterado el sistema de atención médica. Los bloqueos y el aislamiento que marcaron los primeros años de la pandemia dejaron a los niños en gran medida sin exposición, y aún vulnerables, a virus distintos al covid durante dos inviernos, y los médicos ahora están tratando esencialmente enfermedades respiratorias de varios años.
La pandemia también aceleró los cambios en la industria de la atención de salud que han dejado a muchas comunidades con menos camas de hospital disponibles para niños gravemente enfermos, junto con menos médicos y enfermeras para atenderlos.
Cuando las unidades de cuidados intensivos se inundaron con pacientes mayores con covid en 2020, algunos hospitales comenzaron a usar camas infantiles para tratar a adultos. Muchas de esas camas pediátricas no se han repuesto, dijo el doctor Daniel Rauch, presidente del comité de atención hospitalaria de la Academia Estadounidense de Pediatría.
“Simplemente no hay suficiente espacio para todos los niños que necesitan camas”, dijo la doctora Megan Ranney, quien trabaja en varios departamentos de emergencia en Providence, Rhode Island, incluido el Hasbro Children’s Hospital. La cantidad de niños que buscaron atención de emergencia en las últimas semanas fue un 25% más alta que el récord anterior del hospital.
“Tenemos médicos que limpian las camas para que podamos acomodar a los niños más rápido”, dijo Ranney, vicedecana de la Escuela de Salud Pública de la Universidad Brown.
No hay mucho dinero en el tratamiento de niños. Alrededor del 40% de los niños estadounidenses están cubiertos por Medicaid, un programa federal y estatal conjunto para pacientes de bajos ingresos y personas con discapacidades. Las tarifas básicas de Medicaid suelen ser más de un 20% inferiores a las que paga Medicare, el programa de seguro del gobierno para adultos mayores, y son aún más bajas en comparación con los seguros privados.
Si bien la atención especializada para una variedad de procedimientos comunes para adultos, desde reemplazos de rodilla y cadera hasta cirugías cardíacas y tratamientos contra el cáncer, genera importantes ganancias para los centros médicos, los hospitales se quejan de que generalmente pierden dinero en la atención pediátrica de pacientes hospitalizados.
Cuando Tufts Children’s Hospital cerró 41 camas pediátricas este verano, los funcionarios del hospital aseguraron a los residentes que los pacientes jóvenes podrían recibir atención en el cercano Boston Children’s Hospital. Ahora, Boston Children’s está retrasando algunas cirugías electivas para dejar espacio a los niños que están gravemente enfermos.
Rauch señaló que los hospitales infantiles, que se especializan en el tratamiento de enfermedades raras y graves como el cáncer pediátrico, la fibrosis quística y los defectos cardíacos, simplemente no están diseñados para manejar la avalancha de niños gravemente enfermos de esta temporada con virus respiratorios.
Incluso antes de la trifecta viral del otoño, las unidades pediátricas se esforzaban por absorber un número creciente de jóvenes con angustia mental aguda.
Abundan las historias de niños en crisis mentales que se quedan en el limbo durante semanas en las salas de emergencia mientras esperan ser transferidos a una unidad psiquiátrica pediátrica. En un buen día, dijo Ranney, el 20% de las camas de la sala de emergencias pediátrica del Hasbro Children’s Hospital están ocupadas por niños que experimentan problemas de salud mental.
Con la esperanza de aumentar la capacidad pediátrica, el mes pasado, la Academia Estadounidense de Pediatría se unió a la Asociación de Hospitales Infantiles para pedir a la Casa Blanca que declare una emergencia nacional debido a infecciones respiratorias infantiles y proporcione recursos adicionales para ayudar a cubrir los costos de la atención.
La administración Biden ha dicho que la flexibilidad que se les ha dado a los sistemas hospitalarios y a los proveedores durante la pandemia para eludir ciertos requisitos de personal también se aplica al VRS y la gripe.
El Doernbecher Children’s Hospital de Oregon Health & Science University ha cambiado a “estándares de atención de crisis”, lo que permite que las enfermeras de cuidados intensivos traten a más pacientes de los que normalmente se les asignan. Mientras tanto, los hospitales en Atlanta, Pittsburgh y Aurora, Colorado, han recurrido al tratamiento de pacientes jóvenes en carpas desbordadas en estacionamientos.
El doctor Alex Kon, pediatra de cuidados intensivos en el Centro Médico Comunitario en Missoula, Montana, dijo que los proveedores han hecho planes para cuidar a los niños mayores en la unidad de cuidados intensivos para adultos y desviar las ambulancias a otras instalaciones cuando sea necesario. Con solo tres UCI pediátricas en el estado, eso significa que los pacientes jóvenes pueden volar hasta Seattle o Spokane, Washington o Idaho.
Hollis Lillard llevó a su hijo de 1 año, Calder, a un hospital del ejército en el norte de Virginia el mes pasado después de experimentar varios días de fiebre, tos y dificultad para respirar. Pasaron siete horas angustiosas en la sala de emergencias antes de que el hospital encontrara una cama abierta y los trasladaran en ambulancia al Centro Médico Militar Nacional Walter Reed en Maryland.
Con la terapia adecuada y las instrucciones para el cuidado en el hogar, el virus de Calder fue fácilmente tratable: se recuperó después de que le administraran oxígeno y lo trataran con esteroides, que combaten la inflamación, y albuterol, que controla los broncoespasmos. Fue dado de alta al día siguiente.
Aunque las hospitalizaciones por VRS están disminuyendo, las tasas se mantienen muy por encima de la media para esta época del año. Y es posible que los hospitales no tengan mucho alivio.
Las personas pueden infectarse con este virus más de una vez al año, y Krugman se preocupa por un resurgimiento en los próximos meses. Debido al coronavirus, que compite con otros virus, “el patrón estacional habitual de virus se ha ido por la ventana”, dijo.
Al igual que el VRS, la influenza llegó temprano esta temporada. Ambos virus suelen alcanzar su punto máximo alrededor de enero. Tres cepas de la gripe están circulando y han causado aproximadamente 8,7 millones de casos, 78,000 hospitalizaciones y 4,500 muertes, según los Centros para el Control y la Prevención de Enfermedades (CDC).
Krugman duda que la industria de la atención de salud aprenda lecciones rápidas de la crisis actual. “A menos que haya un cambio radical en la forma en que pagamos la atención hospitalaria pediátrica”, dijo Krugman, “la escasez de camas solo empeorará”.
A new federal program offers hefty payments to small hospitals at risk of closing. But it comes with a bewildering requirement: to end all inpatient care.
As the covid-19 pandemic worsened a mental health crisis among America’s young people, a small group of states quietly withdrew from the nation’s largest public effort to track concerning behaviors in high school students.
Colorado, Florida, and Idaho will not participate in a key part of the Centers for Disease Control and Prevention’s Youth Risk Behavior surveys that reaches more than 80,000 students. Over the past 30 years, the state-level surveys, conducted anonymously during each odd-numbered year, have helped elucidate the mental health stressors and safety risks for high school students.
Each state has its own rationale for opting out, but their withdrawal — when suicides and feelings of hopelessness are up — has caught the attention of school psychologists and federal and state health officials.
Some questions on the state-level surveys — which can also ask students about their sexual orientation, gender identity, sexual activity, and drug use — clash with laws that have been passed in conservative states. The intense political attention on teachers and school curriculums has led to a reluctance among educators to have students participate in what were once considered routine mental and behavioral health assessments, some experts worry.
The reduction in the number of states that participate in the state-level CDC survey will make it harder for those states to track the conditions and behaviors that signal poor mental health, like depression, drug and alcohol misuse, and suicidal ideation, experts said.
“Having that kind of data allows us to say ‘do this, not that’ in really important ways,” said Kathleen Ethier, director of the CDC’s Division of Adolescent and School Health, which oversees the series of health surveys known as the Youth Risk Behavior Surveillance System. “For any state to lose the ability to have that data and use that data to understand what’s happening with young people in their state is an enormous loss.”
The CDC developed the Youth Risk Behavior Surveillance System in 1990 to track the leading causes of death and injury among young people. It is made up of a nationally representative poll of students in grades nine through 12 and separate state and local school district-level questionnaires. The questions focus on behaviors that lead to unintentional injuries, violence, sexually transmitted infections, pregnancy, drug and alcohol misuse, physical inactivity, and more.
The decisions by Colorado, Florida, and Idaho not to participate in the state-level questionnaires will not affect the CDC’s national survey or the local school district surveys in the states that have them.
Part of what makes the survey a powerful tool is the diversity of information collected, said Norín Dollard, a senior analyst with the Florida Policy Institute, a nonprofit research and advocacy group. “It allows for the analysis of data by subgroups, including LGBTQ+ youth, so that the needs of these students, who are at a greater risk of depression, suicide, and substance abuse than their peers, are understood and can be supported by schools and community providers,” said Dollard, who is also director of Florida Kids Count, part of a national network of nonprofit programs focused on children in the United States.
The CDC is still processing the 2021 data and has not released the results because of pandemic-related delays, said Paul Fulton, an agency spokesperson. But trends from the 2009 to 2019 national surveys showed that the mental health of young people had deteriorated over the previous decade.
“So we started planning,” Ethier said. “When the pandemic hit, we were able to say, ‘Here are the things you should be looking out for.’”
The pandemic has further exacerbated the mental health problems young people face, said Angela Mann, president of the Florida Association of School Psychologists.
Nearly half of parents who responded to a recent KFF/CNN mental health survey said the pandemic had had a negative impact on their child’s mental health. Most said they were worried that issues like self-harm and loneliness stemming from the pandemic may affect teenagers.
But the CDC’s survey has shortcomings, said health officials from some states that pulled back from it. Not all high schools are included, for example. And the sample of students from each state is so small that some state officials said their schools received little actionable data despite decades of participation.
That was the case in Colorado, which decided not to participate next year, according to Emily Fine, school and youth survey manager at the Colorado health department. Instead, she said, the state will focus on improving a separate study called Healthy Kids Colorado, which includes questions similar to those in the CDC survey and Colorado-specific questions. The Colorado survey, which has been running for about a decade, covers about 100,000 students across the state — nearly 100 times the number that participated in the CDC’s state-level survey in 2019.
Minnesota, Oregon, Washington, and Wyoming, which also have their own youth surveys, either never participated or decided to skip the previous two CDC assessments. At least seven states will not participate in the 2023 state-level survey.
Fine said the state-run option is more beneficial because schools receive their own results.
In Leadville, a Colorado mountain town, a youth coalition used results from the Healthy Kids Colorado survey to conclude that the county had higher-than-average rates of substance use. They also learned that Hispanic students in particular didn’t feel comfortable sharing serious problems like suicidal thoughts with adults, suggesting that opportunities to flag issues early were being missed.
“I feel like most kids tell the truth on those surveys, so I feel like it’s a reliable source,” said high schooler Daisey Monge, who is part of the youth coalition, which proposed a policy to train adults in the community to make better connections with young people.
Education officials in Florida and Idaho said they plan to gather more state-specific data using newly created questionnaires. But neither state has designed a new survey, and what questions will be asked or what data will be captured is not clear.
Cassandra Palelis, a spokesperson for the Florida Department of Education, said in an email that Florida intends to assemble a “workgroup” to design its new system.
In recent years, Idaho officials cited the CDC survey data when they applied for and received $11 million in grants for a new youth suicide prevention program called the Idaho Lives Project. The data showed the share of high school students who had seriously considered attempting suicide increased from 15% in 2011 to 22% in 2019.
“That is concerning,” said Eric Studebaker, director of student engagement and safety coordination for the State Department of Education. Still, he said, the state is worried about taking up class time to survey students and about overstepping boundaries by asking questions that are not parent-approved.
Whatever the rationale, youth mental health advocates call opting out shortsighted and potentially harmful as the exodus erodes the national data collection. The pandemic exacerbated mental health stress for all high school students, especially those who are members of racial or ethnic minority groups and those who identify as LGBTQ+.
But since April, at least a dozen states have proposed bills that mirror Florida’s Parental Rights in Education law, which bans instruction about sexual orientation and gender identity in kindergarten through third grade.
The law, which critics call “Don’t Say Gay,” and the intense political attention it has focused on teachers and school curriculums are having a chilling effect on all age groups, said youth advocates like Mann, the Florida school psychologist. “Some of these discussions about schools indoctrinating kids has bled into discussions about mental health services in schools,” she said.
Since the law was adopted, some Florida school administrators have removed “safe space” stickers with the rainbow flag indicating support for LGBTQ+ students. Some teachers have resigned in protest of the law, while others have expressed confusion about what they’re allowed to discuss in the classroom.
With data showing that students need more mental health services, opting out of the state-level surveys now may do more harm than good, said Franci Crepeau-Hobson, a professor of school psychology at the University of Colorado-Denver, who has used the national youth risk behavior data to analyze trends.
“It’s going to make it more difficult to really get a handle on what’s happening nationally,” she said.
KHN Colorado correspondent Rae Ellen Bichell contributed to this report.
Voters in Kansas told the rest of the country this week that they don’t want their state to ban abortion. In a nearly 60%-40% split, voters turned back an effort by anti-abortion activists to amend the state constitution to remove its right to abortion, which would have allowed the legislature to ban the procedure.
Meanwhile, in Washington, Congress is in its pre-recess push to pass legislation. A bill to provide health benefits to veterans injured by breathing in toxic substances from military burn pits finally made it to President Joe Biden’s desk. But talks continue on the Democrats’ health care-climate-tax bill that would, among other things, allow Medicare to negotiate some prescription drug prices and extend expanded subsidies for insurance under the Affordable Care Act.
This week’s panelists are Julie Rovner of KHN, Tami Luhby of CNN, Sandhya Raman of CQ Roll Call, and Rachel Cohrs of Stat.
Among the takeaways from this week’s episode:
- At least four other states — California, Kentucky, Montana, and Vermont — will have abortion questions on their ballots in November. Michigan is likely to have one, too, but the petitions required are still being certified.
- The Department of Justice has sued Idaho, arguing that its nearly-total abortion ban — set to take effect later in August — conflicts with federal law guaranteeing patients access to emergency medical care. If the case were to be appealed all the way to the Supreme Court, it could endanger the emergency care law, which has not faced that sort of legal challenge before.
- Biden signed an executive order this week that among other things could allow Medicaid to cover the travel expenses of women seeking out-of-state abortion care if their state restricts it. But the White House did not provide many details about how such a program would work or be paid for. The so-called Hyde Amendment, named for abortion opponent Rep. Henry Hyde, who died in 2007, forbids federal funding of most abortions. Supporters of the president’s move suggested that restriction applies only to medical care and not transportation, but any effort by Medicaid to set up such a transportation program would likely be litigated.
- New data released this week by the Department of Health and Human Services finds that the number of uninsured Americans has fallen to an all-time low of 8%. That estimate comes as the Senate is considering funding to continue enhanced premium subsidies for people who buy insurance on the Affordable Care Act’s marketplaces. If that legislation falters, the number of people without insurance is expected to rise sharply, as premiums will become unaffordable for many.
- Biden’s rebound of covid-19 symptoms reminds the country that the standards on when a patient has recovered are not firm and raises questions about how patients should handle reentry after battling the disease.
Also this week, Rovner interviews KHN’s Bram Sable-Smith, who reported and wrote the latest KHN-NPR “Bill of the Month” installment about a single-car accident that resulted in three wildly different ambulance bills. If you have an enormous or outrageous medical bill you’d like to send us, you can do that here.
Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too:
Julie Rovner: KHN’s “They Lost Medicaid When Paperwork Was Sent to an Empty Field, Signaling the Mess to Come,” by Brett Kelman
Rachel Cohrs: The Washington Post’s “Thousands of Lives Depend on a Transplant Network in Need of ‘Vast Restructuring,’” by Joseph Menn and Lenny Bernstein
Tami Luhby: KHN’s “Hospices Have Become Big Business for Private Equity Firms, Raising Concerns About End-of-Life Care,” by Markian Hawryluk
Sandhya Raman: KHN’s “Nursing Homes Are Suing the Friends and Family of Residents to Collect Debts,” by Noam N. Levey
To hear all our podcasts, click here.
Stories about people trying something different in their lives have always inspired me. Now, the Times series It’s Never Too Late offers readers more examples.
Last year, mountain resorts were overrun by travelers in search of space and fresh air. The visitors are expected back, but now the towns have expanded activities and plans in place to deal with the crowds.
For their vacation this summer, Susan Tyler and her husband have booked a house in the small ski resort town of Red Lodge, Mont., with a group of friends. As they message daily about the trip, the anticipation grows, said Ms. Tyler, a performing arts administrator in Texarkana, Texas. “Being outside with friends is smart and renewing, and it feeds your soul,” she said.
True, but not when the trailhead is so packed you can’t find a place to park. Last summer, pandemic travelers, remote workers and an unprecedented number of new full-time residents descended on mountain towns in search of space and fresh air, prompting longtime locals to complain about overcrowding and quality-of-life concerns. This year promises more of the same.
The difference? Resort towns are prepared, with on-mountain activities back to operating at full capacity, programs in place to educate visitors on outdoors etiquette, plans to address overcrowding and new attractions that highlight the alpine environment.
A mid-May report from DestiMetrics, which tracks lodging in mountain resort destinations, describes bookings as “surging” for this summer, with July, August and September already well ahead of the same time period two years ago, which was itself a record-setting summer for resort visitation and revenue. At the same time, average daily hotel rates were 32 percent higher than they were in summer 2019.
“We’re seeing earlier demand than we’ve ever seen before and at higher levels,” said Anna Olson, the president and chief executive of the Jackson Hole Chamber of Commerce, who noted that lodges in nearby Grand Teton and Yellowstone national parks that had closed for most of last summer have reopened, increasing the number of rooms available near the Wyoming resort town; additionally, the Cloudveil, a new Autograph Collection hotel, has opened.
Not just for skiing
Of course, summering near ski resorts is nothing new. Some towns, like Jackson and Whitefish, Mont., have historically attracted warm-weather visitors because of their proximity to national parks. Others, like Colorado’s Aspen and Telluride, have drawn vacationers with longstanding cultural events, like the eight-week-long Aspen Music Festival and School and the Telluride Bluegrass Festival. And many ski areas have long offered scenic chairlift rides to hiking and biking trails. But now resorts are increasingly promoting themselves as warm-weather destinations and adding more outdoors-oriented activities like purpose-built bike parks, forest canopy tours, mountain coasters and via ferratas, a European-derived system that consists of permanent steps and ladders bolted into a rock face; users attach themselves with carabiners to steel cables to prevent big falls.
For one, there’s the desire to create more of a year-round — and less snow-dependent — economy. Additionally, passage of the Ski Area Recreational Opportunities Enhancement Act in 2011, and subsequent policy guidelines issued by the U.S. Forest Service in 2014, eliminated cumbersome aspects of the permitting processes on federal land, making it easier for many mountains to develop summer recreation.
Vail Resorts was one of the first to capitalize on the new legislation with its Epic Discovery summer program, introduced at Vail Mountain and Breckenridge in Colorado, and Heavenly in California, starting in 2016. Zip lines, alpine slides, ropes courses and more, along with educational components, aim to let visitors immerse themselves in the mountain environment. Since then, many other resorts have followed suit. This June, for example, Telluride, in southwestern Colorado, introduced its first canopy tour, with zip lines, aerial bridges and rappels.
The approach has been working. Some would even say too well. “Now at most mountain destinations in the West, and at many in the Northeast, the summer occupancy is as high or higher than during the winter months,” said Tom Foley, the senior vice president for business operations and analytics for Inntopia, a resort marketing and e-commerce firm. (He adds that lodging prices, however, still lag behind winter’s peak rates.)
Even resorts that long had infrastructure in place have benefited. Vermont’s Killington introduced its bike park (which sits on a combination of state and private land) 30 years ago. But from 2016 to 2018, visits surged to 30,000 from 12,000, said the resort spokeswoman, Courtney DiFiore. She attributed the growth to new beginner and intermediate trails, more programming for children and an all-season pass option.
This year, resorts expect summer visitation to ramp up several notches, in reaction to the pandemic. “It’s unreal how much demand there is for Jackson right now,” said the ski area spokeswoman, Anna Cole. “Jackson by nature is outdoors and pretty distanced, and people want to get in their cars and drive,” she said. “We fit the bill on all fronts.”
The ski area continues to expand its offerings. The Sweetwater gondola is running for the first time in summer, hauling riders and their bikes to new routes within a growing trail network, and last summer the mountain added to its guided via ferrata routes.
Other resorts, like California’s Mammoth Mountain, have also built via ferratas. For some ski areas with rugged winter reputations (including Jackson Hole), offering hikers the challenge and reward of safely ascending rock features is a fitting alternative to more passive experiences. “We’re not looking for zip lines or mountain coasters,” said David Norden, the chief executive of Taos Ski Valley in New Mexico, which added a via ferrata last August. “We want people to engage with the mountain and get that sense of accomplishment.” Colorado’s Arapahoe Basin delves into summer operations for the first time this year with its own via ferrata — topping out at 13,000 feet in elevation, it’s North America’s highest — along with an aerial adventure course.
Taos also introduced lift-served mountain biking last year, tapping into another summer growth area, as resorts across the country have introduced or expanded existing bike parks. Though these projects have taken at least a couple of years to plan and construct, they coincide fortuitously with the pandemic-inspired surge in cycling.
For instance, New Hampshire’s Cranmore Mountain Resort, near North Conway, opened a family-friendly bike park last year, while nearby Loon Mountain opened its version in fall 2019. In Idaho, lift-accessed mountain biking returns to Sun Valley’s extensive trail network after a year’s hiatus and Snowmass, Colo., continues to add trails to its park. Even Mammoth, which was the world’s first resort to offer lift-served mountain biking back in 1986 and now hosts California’s largest park, is still expanding, adding some e-bike-specific on-mountain trails last summer.
Goodbye to the slow season
But the increase in visitors has come at a cost, especially in summer, when recreation takes place across more outdoor venues with greater impact. The upsurge of people vying for space on trails and in restaurants in the summer months means resort towns never get a break. “Discussions about overtourism in mountain towns have been going on for a long time,” said Inntopia’s Mr. Foley, who also noted the scarcity of affordable housing for workers, especially given the recent run up in prices as new home buyers have sought refuge from the pandemic in the mountains. “Every problem that existed before the pandemic is still there and probably worse.”
Many longtime locals say the growing number of visitors, especially those who may not be familiar with low-impact outdoors practices is having a negative effect — and they are taking their objections public. Perhaps the most notorious instance took place in Lake Tahoe last August, as groups of residents, fed up by the onslaught of tourists and an avalanche of litter, staged protests at several busy intersections.
As a result, mountain towns are planning to greet this summer’s visitors with messages about how to encounter wildlife and engage with other people, especially given the ever-changing Covid regulations and staffing shortages in the hospitality industry. “We need the summer of courtesy and kindness,” said Rose Abello, the director of Snowmass Tourism.
Remember to be nice
Whitefish, home to a large ski area and a gateway to Glacier National Park, encourages visitors to Be a Friend of the Fish by limiting social media tagging on popular trails, staying calm in lines or traffic, packing out trash and keeping a safe distance from wildlife. Similarly, Sun Valley’s Mindfulness in the Mountains campaign asks visitors and newer residents to practice good environmental stewardship and adjust their pace and expectations to the area’s “modest, unpretentious, down-to-earth feel.” Jackson Hole’s Wild Rules tool kit provides expectation-managing emails and social media posts for businesses to share with guests, ideally before they arrive. And Breckenridge touts its new B Like Breckenridge program, which emphasizes respect for wildlife, using good trail etiquette, consuming less and walking more.
The town of Mammoth Lakes, home of Mammoth ski area, opted to fund a community host program, with both paid and volunteer ambassadors answering questions and handing out maps that show where dispersed camping is allowed and list important backcountry basics, like how to douse a campfire and bury or pack out human waste. At many resorts, hikers will be encouraged to cut down on trailhead crowding by going midweek or earlier or later in the day or by choosing less-frequented but still rewardingly scenic trails.
How travelers will respond and whether or not this new outreach will have a positive effect could go a long way toward decreasing friction between residents and tourists. “We’re a resort town but also a tight-knit community,” said Laura Soard, the marketing director for the Steamboat Springs Chamber, in Colorado. “It’s newer for us to be giving visitors behavior expectations, saying we want you to come visit us, but we want you to follow our rules and respect our community.”
The return of signature summer events, from outdoor concerts to food festivals, may mean fewer people all heading to the trail at the same time. Last summer, “we saw trailheads being stacked with cars, camping sites full and recreation stores sold out of gear,” said Ray Gadd of Visit Sun Valley. “This summer will have much more of a feeling of normalcy,” he said, mentioning annual gatherings like a multiday wellness festival and well-known writers’ conference that are once again on the schedule.
As for traffic, road trips will likely still be a popular form of travel this summer, but resorts hope to alleviate congestion by encouraging visitors to return to public buses and shuttles or to bike around town. New transportation options that make a rental car unnecessary have special appeal this summer, when cars are in short supply. Taos Ski Valley’s airline, Taos Air, offers new direct flights from Texas and California to a small nearby airport, and then shuttle service to the resort. Travelers to Breckenridge can book a United Airlines package that offers seamless transfer to the resort: They’ll board a 35-seat motor coach directly on the tarmac at Denver International Airport, along with their luggage, for the drive to their final destination.
Among the most important messages mountain towns hope to convey this summer: Plan and book well in advance, whether for lodging, restaurant reservations or guided outdoor activities. “Booking early helps us prepare and makes for a more relaxed experience for guests,” said Abe Pacharz, the owner of Colorado Adventure Guides in Breckenridge. You’ll get a spot on a trip, and perhaps advice on acclimating to the altitude, what gear you’ll need and what activities are the most appropriate.
“You have to have a reservation,” said Ms. Olson from the Jackson Hole Chamber. “The idea that you can come to national parks or ski area destinations and find somewhere to stay or camp is very limited. It may not be their vision of being on the open road and making last-minute decisions, but the reality of coming to these beautiful places with limited resources is that people have to be planners.”
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