SICK CHILD CARE

James G. Beierlein / James E. Van Horn
Professor of Agricultural Economics / Professor of Family Sociology
Agricultural Economics and Rural Sociology
Penn State University

Sick child care programs provide care for children who are mildly ill or recovering from a health problem. An employer saves the cost of a replacement or lost worktime when an employee uses a sick child care program rather than staying home with a child.

In most states, ill children are not allowed to attend regular child care programs. Several program models for the care of sick children have developed across the country in recent years. Although programs for sick children may not serve parents for all the days a child is sick, they can provide an alternative for days when a child is mildly ill. Almost all models exclude children with a high fever or serious illness, and most group programs exclude children with infectious diarrhea and highly contagious diseases such as chicken pox. Because of the high cost involved ($6 to $7 an hour), many companies subsidize sick child care provided in the employee's home.

The various models of sick child care include: (l) a center that cares only for sick children, (2) a program within a hospital, (3) care in a "sick bay" at a regular child care center, (4) a family day care home, and (5) in-home care or visiting nurse service. Programs vary on what childhood
illness or symptoms of illnesses they will admit or exclude from a program.

The following factors distinguish various types of programs for mildly ill children from regular child care programs:

- Sanitation policies and procedures are more stringent.

- The ratios of caregivers to children should be higher than in well care.

- Providers must be trained in caring for ill children since these children may need to rest and may have restrictions on the activities in which they can be engaged.

Record keeping procedures are more complex. When the child arrives, a health check must be conducted by the provider with the parent; the health check serves as a screening for exclusion purposes and gives information to be used in providing appropriate care to the child.

Center-based programs are similar to those of regular child care centers. An entire center may be developed solely as a sick care program, or a sick care program may be a part of a regular center. The latter is called a sick bay and consists of rooms in a regular center set up to care for ill children. Children who are excluded from the center because of illness may be moved into the sick bay.

Hospital-based programs usually operate independently from the pediatric ward of the hospital. Hospital-based programs for ill children should not be confused with hospital-based onsite programs for hospital employees.

Family day care network programs operate similarly to regular family day care.

Visiting nurse or in-home programs send caregivers into the child's home on an as-needed basis when the child is ill. The qualifications of the caregiver vary from program to program, but most do not require a nursing license. The program administrator maintains a list of caregivers who have been screened and trained and are supervised by the administrator. Parents usually must preregister their child. When the child becomes ill, the parents call the program to request a caregiver. Further arrangements sometimes are then made between the caregiver and parent.


ADVANTAGES/DISADVANTAGES

ADVANTAGES:

- Improves recruitment, employee morale, and workflow.

- Reduces absenteeism, relieves stress on parents.

- Enhances company image.


DISADVANTAGES:

- Monitoring quality control may be difficult in a visiting nurse program.

- Caregiver/surroundings may be unfamiliar to the child.

- Recruiting/retaining qualified staff may be difficult.

- Usage may be low due to unfamiliarity with the concept.


STEPS IN DEVELOPING A SICK CHILD CARE PROGRAM

1. CONDUCT A NEEDS ASSESSMENT

A needs assessment should be conducted among employees to determine the interest in this type of assistance. A sample needs assessment with suggested questions can be found in this file under "Questionnaire." This questionnaire may be copied and distributed among employees as it is
written, or changes may be made to reflect the needs and interests of a business.

2. CONSIDER ESTABLISHING A MANAGEMENT-EMPLOYEE COMMITTEE TO HELP PLAN THE PROGRAM OR SERVICE

A joint management-employee committee may be useful in developing the program. It can foster a sense of program ownership among employees and provide a forum for them to give input into design features of the program or service.

3. DETERMINE WHAT SICK CHILD CARE PROGRAMS EXIST IN THE COMMUNITY

The concept of sick child care is relatively new. A small percentage of parents use the program in the beginning. Repeat usage is high and additional parents use the service because of user recommendation. Your local extension home economist could be helpful in determining theexistence of programs in the community.

4. DETERMINE LICENSING REQUIREMENTS

Your state may not provide regulations or guidelines specifically for sick child care programs. Stringent standards should be established by the company before developing the program.

5. DECIDE WHETHER SICK CHILD CARE SERVICES SHOULD BE PROVIDED IN-HOUSE OR CONTRACTED OUT

There are advantages and disadvantages to contracting out. If an employer wishes to do so and if there are no local services interested in providing such a program, he/she may consider providing the seed money to establish a nonprofit agency with the primary function of operating such a program for the company, or the employer may explore the possibility of joining with other companies in the locality.

6. DETERMINE PROGRAM FEATURES

The following areas must be addressed in designing a sick child care program:

- Exclusion policies on what childhood illnesses will be admitted or excluded.

- Infection control procedures.

- Curriculum of activities for ill children.

- Staff training on childhood illnesses and in caring for ill children, including sanitation practices, giving medications, and taking temperatures.

Hospital-based programs may be developed by hospitals or other employers. The steps to be taken in designing a hospital-based program (in addition to those mentioned above) include:

- Determining the specific location of the program.

- Determining if the program will serve the community as well as employees.

- Purchasing materials and equipment.

- Establishing meal service, possibly through the dietary department.

- Determining staffing arrangements, including who will be the program manager and other caregivers or assistants.

- Working with the marketing department to promote the program.

Visiting nurse programs require the following additional steps:

- Involving the employee benefits manager.

- Hiring an administrator to operate the program.

- Screening and training caregivers.

- Recruiting parents to preregister for the program.

- Supervising the caregivers.

7. MAKE FINANCIAL PROJECTIONS

The cost of a sick child care program will vary depending on the type and size of the program, the facility, type of staff hired, insurance coverage, and geographic location. The basic budget items to consider include:

Personnel:
- director
- teachers and caregivers

Other Costs:
- insurance
- marketing
- equipment/Supplies
- telephone
- space
- postage

The least expensive programs to develop are the hospital-based and visiting nurse programs because development of facilities is minimal.

Most employer-supported sick child care programs require some level of operating support from the company in order to maintain reasonable fees. In the case of sick care, this subsidy is especially important because parents pay a double child care fee when their child is ill - to the regular center (even though the child is absent) and also to the sick care program. Additionally, sick care fees are higher because the service is labor-intensive.

A cost-benefit analysis should be conducted that compares short-term start-up costs and long-term operating costs with the productivity, absenteeism, and turnover advantages that sick child care assistance will provide. A child care benefits specialist can assist in this analysis.

8. PLAN THE MARKETING STRATEGY

Publicity and marketing of the program can be accomplished through lunchtime seminars or meetings, information flyers, notices on bulletin boards, or articles in employee newsletters. The employer should also ensure that company benefits personnel are expert enough on the program to answer questions.

9. DEVELOP AN EVALUATION MECHANISM

Once the program is in place, a mechanism should be developed so that the employer can evaluate the adequacy and usefulness of the program. An evaluation may include monthly review of the budget versus cost reports, usage figures, quality control standards and measures, and an annual
program review.


TECHNICAL ASSISTANCE NEEDED

A health consultant should assist in developing the policies and procedures. A health consultant can be a health care professional who works for the local health department, a physician, or a nurse (either registered nurse or nurse practitioner).

You may want to consult with your local Cooperative Extension Service to help determine child care needs. The Cooperative Extension Service could also present educational programs on child care, parenting, and other work/family-related concerns.

Other people in your community may be consulted in planning a child care assistance option. You should consider: nursery school teachers, director or staff of day care centers, child care Resource and Referral agencies, local Cooperative Extension 4-H agents, retired persons with child development backgrounds, vocational technical schools with child care curriculum, community colleges, and local child care sponsoring agencies (such as a child care council or community action agency).

Reprinted with permission from the National Network for Child Care - NNCC.
Beierlein, J. G., & Van Horn, J. E. (1991). Child care options for the
90s. University Park, PA: Penn State University.