Home Sick No More

By Eugenie Allen

One morning last winter, a first-grader named Elizabeth awoke with a nasty cough. While she took her prescribed asthma medication, her mother reviewed their options. Neither parent could stay home that day. Elizabeth's mother had to be in the lab, and her father was out of town on business. School was risky: although she didn't feel sick and wasn't contagious, Elizabeth sounded sick, and her mother knew from experience that the nurse would probably call for a pickup just before dismissal time.

So Elizabeth and her mother took the only way out: they went to work. Elizabeth sat at her mother's desk and colored and cruised www.americangirl.com while her mother, a research scientist, worked in a glass-walled lab a few feet away. Elizabeth drank plenty of fluids, got lots of hugs and ate lunch with Mom in the employee cafeteria. The next day she went back to school while her mother played catch-up at work.

Thanks to a shortage of alternatives, every day is a potential "Take Your Sick Child to Work Day." Plenty of employers endorse the practice or look the other way, despite the obvious drawbacks: the lack of pillows and blankies, the hypochondriac in the next office, the difficulty of actually getting anything done. But a handful of companies practicing enlightened self-interest are taking the lead in covering all or part of the cost of other options, including in-home care, stand-alone facilities and day-care centers with adjacent infirmaries. And while such care can be notoriously expensive, the payoffs include peace of mind for their working parents and, not coincidentally, increased productivity for employers.

Every day, according to the Work & Family Connection, a news-and-information clearinghouse in Minnetonka, Minn., some 500,000 American children are sick enough to stay home from school or day care. While some of those kids are seriously ill, a fairly large percentage simply need to be isolated to prevent the spread of minor illnesses such as pinkeye and chicken pox. Or they need one more fever-free day after a bout of flu or strep throat before returning to school or day care. "In a perfect world, you wouldn't give it a thought. You'd stay home," says Gail Johnson, immediate past president of the National Association for Sick Child Day Care. "But in the real world, when you went back to work, you might not have a job."

According to Johnson, all the best facilities combined can accommodate just a few thousand of those sick kids per day. So what happens to the rest? Many of those who can't stay home or go to work with a parent wind up with a helpful friend or relative. And while it's tough to sneak even mildly ill babies and toddlers into day care, every parent knows a little cough suppressant and Tylenol can work wonders for school-age children. Worst of all, thousands of older sick kids stay home alone.

Johnson and other advocates would like to see several options for sick-child care in every community, ranging from informal networks of family day-care providers to more clinical settings. Here's an overview of some of those options:

IN-HOME CARE

Dozens of employers across the country have contracts with New York City-based Caregivers on Call, a home-health-care agency that has branched out to offer sick-child care too--for a price. Managing director Marsha Cooper justifies the cost to employers, which includes an annual administrative fee of several thousand dollars plus some or all of the $17 hourly rate (employees pay the balance). "If you're a lawyer and you have to be in court, you can't get that day back," she says. "We come and put the Band-Aid right there so you can go to work." For parents who are reluctant to leave their children with a stranger, Cooper says her company checks its workers more thoroughly than most parents check their regular caregivers.

One happy customer is Kim Robinson, a human-resources assistant at a Los Angeles law firm. "I'm a single mom, and both my kids are asthmatic, so when they're sick and can't go to school, I use the service." But Robinson's employer pays for just 50 hours a year. Once her time is up, she sighs, "push comes to great big shove, and I bring them to work with me." (Parents can also hire a last-minute baby-sitter through a child-care agency, but the worker won't necessarily have health-care credentials.)

CARE FOR SICK KIDS ONLY

Often affiliated with a hospital, these centers boast top-notch medical care, great germ control and kid-centered accommodations. At Children's R&R in Rochester, Minn., for instance, nurse practitioners can diagnose an ear infection or strep throat, fill a prescription at a nearby pharmacy and start the medication--all while parents are working. Says Dawn Stein, a nurse and mother of three: "Unfortunately, we're on a first-name basis with everyone there. I know my kids have faked it a few times because they like going there so much." Free to employees of the Mayo Clinic (and closed to the public), the center has room for up to 60 kids. Similar facilities nationwide, which are sometimes located within children's hospitals, are much smaller and cost upwards of $50 a day, though employers often foot the bill. The main drawbacks: first-timers have to adjust to a new environment, and if kids get sick at school or day care, parents still have to interrupt work to bring them to the center.

INFIRMARY WITHIN A DAY-CARE CENTER

Since 1986, says Johnson, the number of these facilities has jumped from a few dozen to a few hundred, but that doesn't begin to meet the need for this hybrid, which offers appropriate medical care in familiar surroundings. For example, children who get sick during their regular day at one of Johnson's three Rainbow Stations in Richmond, Va., can be moved to the adjacent Get Well Place, where they're sorted by symptom: the Sniffle Stop for respiratory ailments, Whoozy Station for tummy trouble, the Spot Stop for chicken pox and the Rest Stop for convalescing. The center also picks up older kids at school, free of charge. Fees are typical of centers nationwide: besides a one-time $20 registration fee, walk-ins (or their employers) pay $40 for a full day of care or $27 for a half-day, while Rainbow Station families pay $25 for a full day and $18 for a half.

DOUBLE-DUTY PARENTS

Finally, telecommuting is often touted as an indirect benefit for parents of sick children. Says a New York City lawyer who occasionally works from home when one of his three kids is sick and his wife has to work: "It's a lousy way to spend a workday, but I'm glad I have a job that gives me the freedom to do it when it's essential." Several years ago, his employer started offering in-home care for sick kids, but he never signed up for the service, and he hopes he never has to.

Such ambivalence is painfully familiar to Amy Ladd, former director of a sick-child facility in Terre Haute, Ind., that closed because its sponsoring hospital needed to cut costs. "Everybody screams for sick-child care, but they absolutely won't touch it unless they have to--and then only if Grandma can't do it and Mommy and Daddy can't change their schedules and the baby-sitter is not available. Parents just prefer to stay home."

What's more, says Ladd, the benefit can be a double-edged sword. While employees are initially grateful, eventually they start to realize, "Wow, they'd do anything to keep me at work. They don't care if I have to leave my sick baby." When that resentment starts to build, says Ladd, "I tell folks to stay home."

Those contradictions will never be fully resolved, but in the meantime, parents can try an ounce of prevention. The first order of business: the chicken-pox vaccine. It's not 100% effective, but at the very least it shortens the illness, which can last a week or more. And even toddlers can learn good hygiene: besides cutting down on colds, your family may also dodge the flu, which strikes roughly half the school-age population in any given year. Clean hands and plenty of tissues have worked for our friend Elizabeth, who is rarely sick--despite what the school nurse thinks.