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Feds Set Child Care Standards

Washington — After a growing number of high-profile media reports of children who have died or been injured in child care, the Department of Health and Human Services announced yesterday morning that it will for the first time impose tough national health and safety standards for all child-care facilities that accept government subsidies.

The proposed regulations will require workers in all subsidized child-care centers and homes to be trained in first-aid procedures, such as CPR, and safe sleeping practices. They call for universal background checks and fingerprinting of child-care workers. And they impose tough standards for monitoring and inspections to ensure that the regulations are being followed.

Although the new regulations apply only to the 513,000 child-care centers and family homes that accept subsidies for the 1.6 million children who receive them through the federal Child Care and Development Fund, HHS officials said the hope is that non-subsidized centers will follow suit.

“We frankly can’t wait any longer,” said HHS Secretary Kathleen Sebelius, making the announcement yesterday morning at CentroNia, a child-care center here. “Fifteen years have passed since we last updated our child-care rules, and we’ve had tragic stories of children lost and families devastated because there were no safety standards in place to protect them. We have a sacred responsibility to protect our children.”

The new regulations are “common sense” standards to both protect children and give parents more information to make informed decisions, Sebelius said.

President Obama, spurred by new science on how critical the early years are for brain development and by lagging academic achievement among economically disadvantaged children, has made early childhood development a key policy for his second administration, pushing for millions to fund universal pre-K programs.

HHS officials said the administration is “adamant” about instituting new regulations.

The new regulations would supersede the current patchwork of health and safety standards that each state now sets and that critics have long argued are too low and endanger too many children. As many as one in five children who receive the child-care subsidy are in unlicensed and unregulated child-care settings with no health and safety requirements at all.

“This is a huge deal,” said Grace Reef, policy director for Child Care Aware of America, a child-care resource and referral network. “There have been so many tragedies. It’s been 17 years since the law’s been reauthorized. It’s time we take a hard look and ask: ‘What can we do to promote the health and safety of children?’ ”

The current federal health and standards are minimal. They require only that subsidized providers prevent and control the spread of infectious diseases, that the building and physical premises are safe and providers have minimum health and safety training. Other than that, states have broad flexibility to set their own standards.

Standards are all over the map. In South Dakota, a family home child-care provider can care for up to 12 children without needing to obtain a license and meet any standards. In Virginia, the number is 5. In Maryland, one.

In California, child-care programs are inspected once every five years. In Michigan, it’s once every 10.

In Minnesota, a recent Pulitzer Prize-winning series recounted how children were dying at the rate of about one per week in family daycare homes.

In Indiana, Reef said, one child in a subsidized church-run child-care center wandered off and was later found drowned in a baptismal pool. Indiana, like Virginia, exempts child-care centers run by religious organizations.

In Virginia Beach, Betsy Cumming’s 7-week-old son was put into a small, overheated utility room with 14 other infants on a foam pad with an ill-fitting sheet and left alone for two hours while the caretaker went to lunch in another room. When she came back and found the baby had died, it turned out only a janitor had been trained in to perform CPR.

Local prosecutors charged the child-care workers with negligent homicide. A judge later dismissed the charges. Because of its religious affiliation, the center had been exempt from meeting health and safety licensing standards.

The Child Care and Development Fund was last reauthorized by Congress in 1996, when it was consolidated with three other federal child-care programs for the very poor. It was set to be reauthorized in 2002.

Although a bipartisan group of lawmakers, led by Sens. Barbara Mikulski, D-Md., and Richard Burr, R-N.C., held a series of hearings in recent years to rewrite the law and address these health and safety issues, their efforts never fully gained traction in Congress.

In testimony before Congress in 2012, Linda Smith, an HHS official, said 12 states do not require CPR training and 10 states that do not require first aid courses for teachers in child-care centers. Twenty-nine states, she said, do not require training on how to prevent Sudden Infant Death Syndrome.

“Far too often, this lack of accountability leads to tragedy,” Smith said. “Unfortunately, in too many cases, it takes well-publicized deaths in child-care settings to prompt state action to strengthen their licensing standards to better address children’s safety.”

Yesterday’s announcement to tighten health and safety standards will not fix all the problems with the Child Care and Development Fund, HHS officials said. Because of budget constraints, the $5 billion the government spends only covers about 18 percent of all low-income children who are eligible for the subsidy.

Reimbursement rates to subsidized providers are often so low that quality is poor or strapped centers and family homes are forced to close.

National studies have found that, while there is excellent child care in the United States, it is expensive and rare.