To retain nurses and other staff, hospitals are opening childcare centers

When Jennifer Lussier and her husband found out they were expecting a child in 2016, they immediately made three phone calls.

The first was to his mother. The second was to her husband’s family. And the third was at the St. Francis Healthcare Learning Center in Roper.

That last call, she felt, was especially urgent. Lucier wanted to secure a spot for her unborn child on a long daycare waiting list.

Lucia Roper works as a cardiovascular ICU nurse at St. Francis Healthcare, the only hospital system in the vicinity of Charleston, South Carolina, that operates a child care center for the children of its employees.

The catch is there isn’t room for everyone. Roper St. Francis employs 5,000 people and can accommodate just 130 infants and toddlers in its day care. More than 100 children usually sit on that waiting list. Lussier’s newborns are found to be open before 9 months of age.

“We were ecstatic,” said Lucier, who also gave birth to twins in 2020. His children are still enrolled in education centers.

Roper St. Francis Healthcare launched the facility more than 30 years ago to address a perennial human resources problem: recruitment and retention. Currently, it is one of relatively few hospital systems in the United States that operates a full-time child care center for its employees, although that appears to be changing. Some hospitals are now considering child care centers as a way to solve one of the biggest challenges of the pandemic era: persuading employees to stay.

Nationally, 1 in 10 workers have access to employer programs that cover some or all costs for child care services — either on or off the job site — according to a report released last year by the U.S. Department of Labor. The health sector appears to be doing more: About one-third of US hospitals offer pediatric care.

But the data obscures the wide variation in those benefits. Some hospitals only provide access to backup care so parents can make last-minute arrangements for sick children. Even among hospitals that offer stronger facilities, many parents like Lussier spend time on waiting lists.

Hospitals scrambled at the start of the pandemic to accommodate clinical staff members who suddenly found themselves unable to both work and care for their children. More than two years later, most do not offer permanent solutions for parents facing the nation’s ongoing child care crisis. Meanwhile, thousands of childcare providers, from small, in-home programs to large daycare facilities, have closed since early 2020, making it even more difficult for families to afford care when she first gave birth. was more than that.

This challenge is felt across all business sectors. A benefits report published by Care.com this year estimated that at least 4 million U.S. workers quit each month in the second half of 2021, with nearly half citing that they were struggling with childcare or senior care challenges.

But retention has become a particularly pressing issue when it comes to nurses, who are overwhelmingly female and who have resigned in large numbers from hospitals during the pandemic, citing burnout, stressful work conditions and other workplace problems. In fact, the number of registered nurses in the U.S. fell by more than 100,000 last year — “the steepest decline over the past four decades,” according to a report published by Health Affairs. In a recent McKinsey & Co. survey of hundreds of nurses, 32% indicated they might leave their current position within the next year.

“People are leaving the industry because they can’t balance work and life,” said Priya Krishnan, senior vice president of client relations at Bright Horizons, the nation’s largest provider of employer-sponsored child care.

Bright Horizons operates 82 hospital-based child care centers out of 655 centers it operates across the country. Krishnan says most of the company’s recent conversations with potential clients have been with hospitals.

“Retention is the biggest reason they’re thinking about this,” he said.

The federal government offers businesses an annual tax credit worth up to $150,000 for providing childcare to employees. Indirect financial incentives also exist. According to the 2022 “National Healthcare Retention and RN Staffing Report” published by NSI Nursing Solutions, hospitals lose an average of about $46,000 when a bedside nurse resigns, which equates to about $7 million in nursing turnover costs for the average hospital in 2021.

But anecdotal evidence provided by St. Francis of Roper suggests that children of employees enrolled in learning centers are much less likely to leave. Melanie Stith, its vice president for human resources, said the system experienced significant turnover during the pandemic. But during that time, he said, only two employees whose children attended the learning center resigned.

In a recent survey of parents who use learning centers, 91% indicated that childcare facilities are the reason they stay in their jobs. Roper lost money to operate St. Francis Learning Center, but it is still considering expanding child care services as it builds a larger hospital in nearby Berkeley County.

It goes without saying that, historically, that money hasn’t been made in childcare. Bright Horizons, founded in the 1980s with investment from Bain Capital, has raised several million dollars for private equity firms. Now publicly traded, its shares are worth about half of what they were at their peak in February last year.

Some hospitals still consider pediatric care a good investment.

“I see it as a really, really important part of the benefits package, especially for families with school-aged children,” said Rebecca Gomez, a clinical health psychologist at Wellstar Health System in the Atlanta area. . Both her children are enrolled in Wellstar’s Learning Academy run by Bright Horizons.

“Everything about it made my life so much easier,” Gomez said.

Like the Roper St. Francis Healthcare Learning Center in Charleston, Wellstar staff often waits for an available space. And Wellstar doesn’t operate childcare facilities on every hospital campus, Gomez said.

Even so, the breadth of Wellstar’s childcare offerings makes it even more so. Other notable examples include Mass General Brigham and New York-Presbyterian in Boston, both of which have long offered childcare for employees. And while providing pediatric care on site remains rare, hospitals are increasingly exploring options for it

Ballad Health — an Appalachian hospital system with medical facilities in Tennessee, Virginia and North Carolina — recently announced it will invest $37 million over the next three years to build 11 child care centers in addition to the three it already operates. The expansion will allow the Johnson City, Tennessee-based system to increase its childcare capacity from 200 slots to 2,000.

For workers, hospital-based child care is usually not free. Roper St. Francis Healthcare in Charleston charges all parents who use the learning center a weekly rate of $200 to $220, slightly above the market average, based on the child’s age.

Some hospital systems create a sliding scale that takes into account employee pay. For example, a doctor may pay more to enroll a child than an x-ray tech. Ballad Health recently surveyed employees, who indicated, on average, they could pay about $145 per child per week.

Like many hospital systems, Ballad has struggled to keep nurses from leaving during the pandemic. But it is also competing with other regional employers for jobs. A new casino in Bristol, Virginia, recently hired 600 people, said Tony Keck, Ballad Health’s executive vice president of system innovation. He said thousands more are expected to be hired in the next few years.

“We’re not just competing for doctors and nurses,” Keck said. Hospitals must also attract housekeeping staff and other low-wage workers who are being targeted by casinos and others.

But nurses are especially important. Keck said Ballad Health has raised its starting nursing pay more than 30% in the past two years, but hospitals in nearby markets like Knoxville — which pay nurses more to start with — have also raised their rates.

“We can’t keep up with that,” he said. Ballad Health leaders hope the new child care centers will give the system a competitive advantage, “which is why we’re trying to move forward as quickly as possible,” he said.

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