James G. Beierlein / James E. Van Horn
Professor of Agricultural Economics / Professor of Family Sociology
Agricultural Economics and Rural Sociology
Penn State University
Copyright/Access Information
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.
- Improves recruitment, employee morale, and workflow.
- Reduces absenteeism, relieves stress on parents.
- Enhances company image.
- 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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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).