HHS announces first nationwide safety standards for child care

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 Thursday morning that it will for the first time impose tough national health and safety standards on 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 quality-rating systems that parents can have easy access to and universal background and fingerprint checks of child-care workers. And they impose tough standards for monitoring and unannounced inspections to ensure that the regulations are being followed.

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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 in many states 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.

Can’t wait any longer

“We frankly can’t wait any longer, “ said HHS Secretary Kathleen Sebelius, making the announcement Thursday morning at CentroNia, a child-care center that serves subsidized, low-income children in the District. “Fifteen years have passed since we last updated our child-care rules — years of 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 care for our children,” she said. “And we can’t wait if we know what needs to be done to meet it.”

The proposed 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. That fund, authorized by Congress in 1996, expired in 2002.

The new regulations also seek to “encourage” states to streamline the cumbersome process of trying to get a subsidy, giving low-income parents access to online filing and a grace period while they look for jobs.

Sebelius said that she didn’t know how much the new regulations would cost states to implement but that the standards are a “common sense” floor that every state should meet.

In addition to prompting by growing media coverage of child deaths, HHS officials said they were spurred to action by emerging science on how critical the early years are for brain development and future success.

Thursday’s announcement came as a surprise to lawmakers on Capitol Hill, where a bipartisan group of senators has been negotiating a bill that would reauthorize the child-care fund.

Sen. Barbara A. Mikulski (D-Md.), who led previous reauthorization efforts that failed to gain traction, said in a statement that though she appreciates the administration’s efforts, regulations are not enough.

“It remains imperative” that Congress reauthorize the child-care subsidy program, she said, “that not only addresses health and safety standards, but also improves the quality of our nation’s child-care programs.”

Rep. John Kline (R-Minn.), who chairs the House Education and Workforce Committee, said he will monitor the regulations closely. “The latest announcement by HHS is yet another effort to usurp Congress and move forward with the administration’s preferred policies.”

But Sebelius said polls show that most parents think child-care providers are licensed and have to meet some health and safety requirements. Many, however, do not. “This is long overdue,” she said.

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 that providers have minimum health and safety training. Other than that, states have broad flexibility to set their own standards.

Rules vary by state

Guidelines are all over the map. In South Dakota, a family home child-care provider can care for up to 12 children without needing a license or meeting any standards. In Virginia, the number is five. In Maryland and the District, one.

Many states, including Virginia, require only state, not federal, background checks of providers. For Elly Lafkin, a Virginia mother who appeared Thursday with Sebelius, it took the commonwealth’s attorney investigation into the death of her infant daughter in an unlicensed family care provider’s home to find out that the provider had several aliases and previous felony charges.

“No parent wants to leave their child with a criminal,” Lafkin said.

Virginia is among the states that exempt child-care centers run by religious organizations from meeting health and safety licensing standards. 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 for two hours while the caretaker went to lunch in another room. When she came back and found that the baby had died, it turned out only a janitor had been trained to perform CPR.

Local prosecutors charged the child-care workers with negligent homicide, but a judge dismissed the charges because of the center’s religious affiliation.

Thursday’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 covers only 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. Officials in the District pay providers 40 percent of the current cost of child care, one of the lowest reimbursement rates in the nation. As a result, about one-third of all family homes and 12 percent of child-care centers closed from 2010 to 2012, a recent report by the University of the District of Columbia found.

 
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