Give Us Your Sick

Children at the Huggs and Kisses day care center in Birmingham, Ala., may have a cold or strep throat or an ear infection, but their parents won’t get phone calls at work asking them to remove their children from the facility. At Huggs and Kisses, owned and operated by pediatrician Jacqueline Stewart, all of the children are a little ill.

Huggs and Kisses is a special type of facility—one that offers day care for mildly ill children whose parents are unable to rearrange their work schedules at the last minute to stay home with them.

Maintaining productivity is one reason some companies subsidize the cost of these backup day care centers for their employees. About 14 percent of organizations—usually companies with 500 or more employees—offer some sort of emergency or sick-child care benefit, according to the Society for Human Resource Management’s 2006 Benefits Survey Report; the figure is up from 6 percent the previous year.

“It is a benefit that can have a very positive impact for employees who have small children and … need some kind of backup care,” says Michele Pawlik, R.N., director of health, lifeworks and the employee assistance program at Birmingham, Ala.-based Protective Life Insurance Co., which has offered sick-child day care since 1997 as a component of its health and wellness benefits. The company pays the bulk of the costs for employees who use Stewart’s sick-child facility. Employees are charged a small co-pay.

Sick-child day care, proponents say, offers not only some peace of mind for working parents but also certain advantages for employers. Stewart, president of the nonprofit National Association for Sick Child Daycare (NASCD), says that “for every dollar spent” for such day care, “there is a $2.50 return” in the form of avoided costs for, among other things, paid sick leave, lost productivity, temporary staffing services and turnover. It’s a benefit that helps with retention, she says, and it is “also an excellent recruitment tool” for those of childbearing age who lack options such as an extended family nearby to help out with a sick child. The NASCD says there are sick-child day care centers in about 33 states.

A U-Turn in the Morning

Sick-child day care is an outgrowth of the separate areas, or “sick bays,” that some traditional day care centers set up years ago to keep mildly ill children apart from the others in the facilities. One of the first day care centers strictly for sick children was established in Minnesota in the 1980s, Stewart says.

Today, Stewart continues, such centers exist in various forms. Several, like hers, are stand-alone facilities, and others are sick bays in conventional day care centers. Some are based at hospitals, as is one run by the Mayo Clinic in Rochester, Minn. Its services, for example, are provided free to the hospital’s employees. Hospital-based centers are subject to the regulations that apply to their sponsoring hospitals, she says.

Sick-child day care centers may accept children as young as 6 weeks or as old as 15 years, but the age range for most centers is 2 months to 4 years, Stewart says. The children generally are those who become ill at traditional day care and must stay away for at least 24 hours, or those who become ill during the night and whose parents can’t rearrange their work schedules.

“Sometimes parents are in a bind,” says Stewart, who has operated her facility since 1990. “We’ve had [parents] on the way to day care and the child throws up in the car, and [the parents] make a U-turn and come to us” before heading to work.

Children arriving at Stewart’s center are placed in one of four rooms, based on their illness or condition:

• Upper respiratory illnesses such as colds, runny noses, strep throat and ear infections.
• Gastrointestinal illnesses such as diarrhea and vomiting.
• Noncontagious illnesses such as broken bones and dental problems.
• Contagious illnesses requiring isolation until the child can be seen by a physician.

Sick-child day care centers are not substitutes for medical care, Stewart emphasizes. The children “still go to the doctor, and we require some of them to go to the doctor before we see them,” she says. “We don’t prescribe treatment. We just carry out the treatment as it’s been prescribed” by the child’s physician. Her center also requires a copy of each child’s immunization records.

Centers that are not overseen by a physician are typically staffed by a registered nurse or a licensed practical nurse, with a doctor available for consultation, Stewart says. The nurse administers prescribed medications, observes vital signs, feeds the children and consoles them.

Sign of the Times

Another employer-sponsored center is the one set up in 1994 by Blue Cross and Blue Shield (BCBS) of Alabama at its headquarters in Birmingham. The organization took that step as the workforce was changing. As more women of childbearing age were entering the workforce and as it was becoming more common for two parents to work outside the home, “it seemed logical that providing a sick-child care facility would help reduce lost work time,” says Tina Works, R.N., corporate associate health nurse manager. “For every day a child with a minor illness spends at [the on-site facility], there is a decrease in lost work time.”

The organization converted its smokers’ lounge into a sick-child facility after its campus became smoke-free. Blue Cross has a contract with Stewart to run the center, called Huggs and Kisses/The Caring Corner. As in Stewart’s center, rooms are designated for illness categories; the customized facility can accommodate 55 children.

The BCBS center is open every day the company is open for business, and it is available to employees not only at headquarters but also at its other offices in the area. Parents are encouraged to preregister their children to save time, Works says. “An up-to-date blue immunization form must be on file at the center in order for the child to stay,” and additional paperwork must be completed daily as the child’s needs change, such as when the child starts taking a new medication.

Employees pay a nominal fee for each day of use, and BCBS pays the rest—about 60 percent to 70 percent of the cost, according to Works.

Although opening its own center meant “substantial start-up costs,” liability insurance costs and ongoing operating costs for BCBS, Works says, “the return on investment in terms of the reduction of lost work time is remarkable. … This results in satisfied associates and improved customer satisfaction, as company business is conducted without interruption.”

In addition, Works says, “we have found that the parents are overwhelmingly satisfied with the care their children receive, and the children enjoy the opportunity of going to work with their parents and receiving periodic visits from them throughout the day.”

The children also can receive a care-specific lunch, ordered by their parents from a menu and catered by the corporate dining center. In addition, parents receive e-mails throughout the day on their children’s health status.

Looking at the Numbers

While there seems to be a need for sick-child day care—the NASCD estimates that every day more than 350,000 children of working parents are ill—the number of centers remains small. Some don’t survive because they lack “support from the corporate community,” Stewart says.

Companies may “pay part of the cost” of maintaining a center, she says, but often that’s not enough to keep a center afloat. When usage slides, center operators must dip into their own pockets to keep the centers running, as Stewart has done in the past. Her 2,300-square-foot facility can accommodate 33 children, but “we very seldom reach that capacity,” she says.

As many as 71 of the 1,300 employees at Protective’s headquarters have signed up in a particular year to make use of the benefit, while in other years as few as two have done so, Pawlik says. She notes that sick-child day care is not a benefit that all parents want to use. “There’s a large number of people who would just not use it,” she says, because if a child of theirs becomes sick, they want to be home to care for the child.

From her company’s perspective, Pawlik says, the benefit is not complicated. “It requires no set-up investment other than someone paying [the care provider’s bill], putting correct information on the intranet and explaining the service” to employees.

Photos and information about the center are available to employees on Protective’s intranet site, as is a form that a parent must complete concerning the child’s known allergies and the name of the child’s physician. The parent then files the form with Huggs and Kisses. Immunization certificates are required by all schools and day care facilities, Pawlik explains.

Huggs and Kisses “is not overrun with children,” Pawlik says of Stewart’s facility. “There may be only one or two children there” at a time, “so they get a lot of attention. It’s been very positive for people who’ve used it.”

Kathy Gurchiek is associate editor for HR News, SHRMs online news provider.