One way to retain health care workers: offer child care

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Since the pandemic began, thousands of child care locations have closed, exacerbating an already acute shortage.

But health care worker Jada Carter was lucky. Her two children went to Hospitots, one of the few places to stay open during the early days of the pandemic, when, by one estimate, two-thirds of child care centers closed.

Hospitots is one of the three child care centers connected to the Ballad Health System in Johnson City, Tenn., where health care workers can send their kids at a discount. Having reliable child care while much of the country was struggling made her job possible for Carter. “At a time when the world was falling apart, child care was never something I had to worry about,” Carter said. Ballad Health is in the process of expanding to include 11 more child care sites throughout Northeast Tennessee and Southwest Virginia. “The number one reason for doing this is recruitment and retention of staff,” said Paula Masters, vice president of health programs and population health at Ballad.

The lack of federal child care infrastructure means that the health care industry is stepping in to create its own child care systems. Hospitals and health care systems are facing a staff recruitment and retention crisis that is particularly acute for nurses, who are overwhelmingly women and who resigned from hospital work in huge numbers during the first two years of the pandemic.

Polls consistently show that Americans want quality affordable child care options — and the health systems that do provide this understand what a powerful recruiting incentive the on-site systems provide. Leah Andrews is a recruiter for Wellstar Health based in Marietta, Ga., and she also has two children attending Wellstar’s Learning Academy, one of the system’s three on-site child care centers. When she talks to providers about joining the hospital, they’re very interested in the child care center, especially because of its extended hours.

Staff members who used the child care center at Wellstar Health had the lowest turnover rate — only 1.5% — among staff, according to an internal study which analyzed turnover and benefits.

“Basically no one leaves that utilizes the child care center,” said Penny Ferrell, the executive director for employee wellness and services at Wellstar.

There are other prominent health systems with on-site child care options: BJC HealthCare in St. Louis has two Child Development Centers — one at Christian Hospital and one on the academic medical campus, which comprises Barnes-Jewish Hospital, St. Louis Children’s Hospital, and the Washington University School of Medicine. Tampa General Hospital in Florida has an on-site child care center managed by Bright Horizons Family Solutions with extended hours.

Mass General Brigham in Boston has four on-site child care centers and a backup care option, and has advocated to the U.S. Senate Committee on Health, Education, Labor and Pensions for “more affordable child care options with flexible hours to support the 24/7 nature of healthcare workers and healthcare students while they study to enter the field,” a spokesperson said in an email to STAT.

Many of the hospital systems provide a subsidy or discount for the employees who utilize the child care center, but that’s still cheaper than having to keep hiring replacement staff. Reduced turnover and absenteeism enables hospitals and health systems to be fully staffed and cuts re-training costs. Hospitals lose an average of about $46,000 each time a bedside nurse resigns, which amounted to about $7 million in nursing turnover costs for the average hospital in 2021. The nation’s infant-toddler child care crisis now costs $122 billion in lost earnings, productivity, and revenue every year.

On-site child care has a unique benefit for working mothers, who are often forced to step back or step out of the workforce when reliable care isn’t available. Women make up 77.6% of health care workers and nearly half of mothers working in the health care sector cite caregiving responsibilities as a barrier to changing jobs. The child care crisis is most acutely affecting families of color and other disadvantaged groups, who are disproportionately likely to feel the brunt of lacking access to child care and work nontraditional hours, which many licensed child care centers are not able to accommodate.

The hospital systems I spoke to for this article were effusive in how well their programs ran — how well cared for and engaged the children were, the high parent satisfaction level, and the fact that it’s often available and affordable to staff.

Yet there can be drawbacks to even well-intentioned employer-sponsored child care. Any disruptions in work become a double setback when child care is removed. Or a health center can simply reverse course with a change in economics or leadership. The Hackensack Meridian Health system in New Jersey made headlines after it moved to close down its staff child care in 2022. Parents balked, and the system ultimately reversed course after raising fees, but not before becoming the poster child of how and why child care is complicated, expensive, and not quite the same as other workplace perks.

Frankly, hospitals shouldn’t have to do this. A patchwork child care system leaves many Americans, not just those who work in health care, vulnerable to job disruptions, turnover, and absenteeism. Across all industries, child care remains one of the top reasons employees cite for leaving their jobs — and it’s even more critical for people who work in frontline “deskless” positions, which aren’t able to reap the flexibility (and different child care arrangements) that come with remote work.

Yet it’s because our national system for child care is so absent and broken that it requires private employers to solve what is considered in many high-income countries to be a “public good.” We all rely on health care employees to be present in their work and to provide the best care possible. Yet they have families too, and children require care. Hospitals stepping in and providing child care makes sense for their employees, and it’s particularly commendable when health systems like Ballad Health open up their child care centers to the larger community, much of which is located in what is considered a “child care desert.”

But hospitals shouldn’t have to do this, and it’s not a solution we can expect to scale to other industries — or even other health centers. It’s time to recognize the need for federal child care infrastructure for what it is: a necessary function of our economy.

Rebecca Gale is a writer for the Better Life Lab at New America, where she covers child care.


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