Child Care Scarcity Has Very Real Consequences For Working Families

Jan 3, 2017
Originally published on January 3, 2017 6:49 pm

One of the most stressful questions a new parent confronts is, "Who's going to take care of my baby when I go back to work?"

Figuring out the answer to that question is often not easy. When NPR, along with the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health, surveyed more than 1,000 parents nationwide about their child care experiences, a third reported difficulty finding care.

Searching far and wide, finding little

Megan Carpenter, a new mother who lives in Alexandria, Va., knows well the feeling of desperation that can come with the search for safe, quality infant care.

She had a hard deadline — 16 weeks after her baby was born her maternity leave would end and she would have to return to her job at a nonprofit that serves homeless and low-income women. So she and her husband started looking for child care early, only a few months into her pregnancy.

"At our first few interviews we were asking a lot of questions and were really trying to get a feel for the place," Carpenter recalls. "And by place 10 or 11, our only question was, 'Do you have a spot?' "

The answer to that question, time and again, was "no." That meant getting on a lot of waitlists — and paying a hefty, nonrefundable waitlist fee each time.

"There were a lot of places that were totally willing to take our $100 or $200 waitlist fee," Carpenter says. "We spent over $1,000 in waitlist fees — many of which I never heard from again."

By the time baby Cora arrived, the couple still had no prospects.

Ultimately, Carpenter and her husband persuaded their mothers to take time away from their jobs and fly out from Georgia and Missouri to watch Cora in shifts until a spot at one of the centers opened up.

Scenarios like this are playing out all around the U.S. An analysis of some 7,000 ZIP codes by the Center for American Progress describes roughly half as "childcare deserts."

While Megan Carpenter's experience is representative of what many working parents go through, Narinder Walia's is a worst-case scenario.

Walia lives in Fremont, Calif., and works in biotech. Her baby boy, Avin, was born on Halloween 2014.

During Walia's four-month maternity leave, trying to find child care nearly became a full-time job. "I made 70-some calls," she says. "Some were not accepting infants. Or they were full."

Of the roughly six dozen centers, only three were able to offer her a slot. Of those, she says, two were messy and disorganized. The third option, an in-home facility, set off some red flags. But it was the best available. Walia says her main reservation was that the center catered to toddlers and older children. Still, the owner assured her, it could handle a baby.

What ultimately happened on Avin's first day at this facility is every parent's worst nightmare.

"I was on the way to go pick him up," recalls Walia, "and the Kaiser ER called me." You have to come over, they told her. Your son is here.

To settle Avin for his first nap on her watch, the paid caregiver had put the baby belly-down in his bassinet — a move that goes against established infant-care guidelines set by the American Academy of Pediatrics and is against standard practice in the infant care field. Research has established that placing babies belly-down to sleep puts them at higher risk of sudden infant death syndrome.

The caregiver told Fremont police that she turned Avin onto his back after about 15 minutes, and that he stopped breathing a short time later.

On his first day away from his mother, Avin died — he was 3 months old. The coroner's report confirms SIDS as the cause of death.

"I couldn't wrap my head around it," says Walia, straining to recount the day. "He was smiling. He was a big baby, all chubby. There was nothing wrong with him. Even at the first and second checkup the doctor was like, 'Mama, keep doing what you're doing. The baby's doing really well.' "

What happened to Walia's family is rare. But it's the deepest fear of parents who face severely limited child care choices.

"The market really doesn't work"

These experiences — from disruptive frustration to tragedy — leave many parents wondering why the supply of quality, licensed infant care in the U.S. does not meet the demand for it.

The answer boils down to the fact that child care, particularly infant care, is an extremely low profit field. Costs are high, factoring in real estate, supplies, insurance and, above all, labor. Many states require a ratio of one caregiver to every three or four babies.

And, on the other side of the equation, centers can't significantly raise their prices. According to a recent report by the nonpartisan think tank New America, parents in the United States pay, on average, $9,589 a year for full-time care of children from birth to age 4 — that's more than the average cost of in-state college tuition ($9,410). Many parents can't afford to pay more. So, low profits — combined with high liability and the need to navigate complex regulations — make for an uninviting business climate. And, in this climate, the waitlist has become a tool necessary for providers' financial survival, to buffer against unfilled spots and lost income.

A select few providers are thriving, though. Over the past 30 years, the company Bright Horizons has grown to operate more than 1,000 child care centers in 42 states and the District of Columbia.

So, what's the company's secret?

"We've convinced employers to invest over a billion dollars, in either capital investments or subsidies, for their working families," says Bright Horizons CEO Dave Lissy. "That just didn't exist before we pioneered the model."

Some employers, including Home Depot, Starbucks and Chevron, have partnered with Bright Horizons to establish child care centers primarily for their workers. These employers pay most, or even all, of the cost to build the facilities.

"After that's all done," Lissy says, "on average, tuitions are funded 75 percent by parents and 25 percent through employer subsidies." That means parents pay their college tuition-like sum, and the employers that partner with Bright Horizons pay even more on top of that.

Bright Horizons is able to build these bright, cheerful centers because of this generous underwriting by employer partners. Without that cushion, the rest of the child care sector is largely operating on razor-thin profit margins, slow to grow and fragile.

That industrywide weakness was a central finding of New America's study of child care nationwide.

"The thing to remember about child care is that the market really doesn't work," says Brigid Schulte, an author of the study. "It's like education. When you look at the education market, it also doesn't work. It has to be subsidized. It has to be seen as a public good, and the same sort of economic logic works in the [age] 0-to-5 early care and learning situation as well. We just haven't thought about it like that."

An infrastructure investment?

The idea of child care as a public good has increasing resonance with policy thinkers from the left and right.

"There definitely is an issue of child care supply," says Angela Rachidi, research fellow at the conservative American Enterprise Institute. "It's an issue up and down the income scale."

Of all the ways the government could spend public money, investing in child care, she says, should be a priority. "Not only does that then benefit children," Rachidi says, "but it also helps the parents work."

Katie Hamm, senior director of early childhood policy at the left-leaning Center for American Progress, agrees. Without much greater public support of the child care industry, she says, demand for licensed infant care will continue to outpace supply. But she takes heart from a campaign season where heavy emphasis was placed on the challenges American workers face when it comes to child care and the need for infrastructure investment. She sees the two issues as interconnected.

"It seems like there might be some consensus, both with the incoming administration and among members of Congress, that we need an infrastructure investment," says Hamm. "A lot of people talk about that and mean roads and bridges. But before parents get on roads and bridges and support our economy, they need child care."

For Walia, the mother from Fremont, Calif., more good quality infant care can't come soon enough. She is expecting another child any day.

"I'm kind of being very hesitant even just thinking about the child care service right now," she says. "In my mind I just want to hold him tight and not let him go. But obviously that's not practical."

Copyright 2017 NPR. To see more, visit http://www.npr.org/.

ARI SHAPIRO, HOST:

New parents stress about a lot of things. One of the most common worries is about who will take care of their baby when they go back to work.

AUDIE CORNISH, HOST:

NPR, along with the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health, surveyed more than a thousand parents nationwide. One-third of them reported difficulty finding child care. NPR's Jessica Deahl wanted to unpack this problem, so she started out where most parents do - on a tour of a child care center.

TULLI NORRIS: Hi, good afternoon. I'm Tulli. I am the business manager here at Bright Horizons at Georgetown.

JESSICA DEAHL, BYLINE: Tulli Norris has a very important role at this child care center in Washington, D.C. She fields new applicants and mans a very long waitlist.

NORRIS: OK, we're going to start this way.

DEAHL: It's easy to see why this center appeals. It's clean and orderly. Big windows let the sunshine in, and you see a lot of teachers down on the ground playing with happy babies.

UNIDENTIFIED WOMAN: (Singing) Where is Quincy? Where is Quincy? There she is.

DEAHL: At any given time, this center could have 50 families waiting for an infant slot. I ask Tulli Norris if she ever encounters desperate families who she wants to help but can't.

NORRIS: It happens, like, all the time virtually. A lot of times what will actually happen is someone will call me very upset and crying that they have to go back to work in a month and what are they going to do? And I'll get off the phone and then I'll go cry to my director. What are we going to do? How are we going to help them? And all I want to do is be able to get them in, but I have to make sure I'm following a process that's fair for everyone. But yes, that happens all the time.

DEAHL: Megan Carpenter of Alexandria, Va., knows that feeling of desperation. She had a hard deadline. Sixteen weeks after her baby was born, her maternity leave would end, and she'd have to return to her job at a nonprofit, so she and her husband started looking for child care early, only a few months into her pregnancy.

MEGAN CARPENTER: You know, our first few interviews, we were asking a lot of questions and were really trying to get a feel for the place. And by place number 10 and 11, our only question was, do you have a spot?

DEAHL: The answer to that question time and again was no, so that meant getting on waitlists - a lot of them - and paying a hefty nonrefundable waitlist fee for each one.

CARPENTER: There were a lot of places that were totally willing to take our hundred-dollar or $200 waitlist fee. We spent over a thousand dollars in waitlists fees and many of which I never heard from again.

DEAHL: Ultimately, Megan and her husband convinced their mothers to take time off their jobs and fly out from Georgia and Missouri to watch the baby in shifts until a center spot opened up. Scenarios like this play out over and over around the country. An analysis of some 7,000 ZIP codes by the Center for American Progress describes roughly half as child care deserts. While Megan Carpenter's experience is representative of what many working parents go through, Narinder Walia's is a worst-case scenario. She lives in Fremont, Calif., and works in biotech. Her baby boy, Avin, was born on Halloween day 2014.

NARINDER WALIA: I was supposed to be going back to work after four months, but what I did not realize is it was not very easy to find child care. I made almost 70-some phone calls, and not many panned through.

DEAHL: If you're not sure you caught that number right, I'll repeat it. She says she called some 70 centers. Three of them were willing to take her baby. Of those, she says, two were messy and disorganized. The third option, an in-home facility, was the best available. It catered to toddlers and older children, but the owner assured her they could handle a baby. What happened on Avin's first day at this in-home facility is hard to hear.

WALIA: I was on the way to go pick him up, and the Kaiser ER called me. And they kind of said, you have to come over. Your son is here.

DEAHL: To settle Avin for his very first nap on her watch, the caregiver placed him belly-down in his bassinet. And while she told Fremont police that she turned him over after 15 minutes, the act of putting him stomach-down goes against established infant care guidelines set by the American Academy of Pediatrics, the thinking being it places babies at much higher risk for sudden infant death syndrome.

Shortly after Avin was placed belly-down in his bassinet, he stopped breathing. On his first day away from his mother, he died. He was 3 months old. The coroner's report confirmed SIDS as the cause of death.

WALIA: I couldn't wrap my head around it because he was totally fine. He was smiling. He was a big baby, all chubby. There was nothing wrong with him.

DEAHL: What happened to Narinder Walia's family is rare, but it happens, and it is the deepest fear of parents who face severely limited child care choices. So this leaves us with a question. Why does the supply of quality licensed infant care not meet the very great demand for it?

The answer's complicated, but here's the central rub. This is an extremely low-profit industry. Costs are high. There's real estate, supplies, insurance and, above all, labor. A lot of states require something like one caregiver to every three or four babies. And centers can't really raise their prices. What parents pay already rivals college tuition. So low profits and high liability make for an uninviting business climate. But some are making it work.

DAVE LISSY: Over the past 30 years, Bright Horizons has grown to operate over a thousand locations now in 42 U.S. states in addition to the District of Columbia.

DEAHL: That's Bright Horizon CEO Dave Lissy. That center we went to earlier - it's one of those thousand-plus locations. Bright Horizons has grown and been profitable. So what's their secret?

LISSY: We've convinced employers to invest over a billion dollars in either capital investments or subsidies for their working families. That just didn't exist before we pioneered the model.

DEAHL: A key word there - subsidies. Employers like Chevron, Home Depot, Starbucks have partnered with Bright Horizons to build child care centers primarily for their employees. They cover most or all of the cost to build these centers. And...

LISSY: After that's all done, on average, tuitions are funded 75 percent by parents and about 25 percent through employer subsidies.

DEAHL: So parents pay their college-tuition-like sum, and employers pay even more on top of that. Bright Horizons is able to build these bright, cheerful centers because they're cushioned from their industry's harsh economic reality by generous employer underwriting. Without that cushion, the rest of the child care sector - the vast majority of it - is weak. And that creates a problem recognized by left- and right-leaning policy thinkers.

ANGELA RACHIDI: There definitely is an issue of child care supply, and there's lots of reasons that sort of feed into that. But I think it is an issue, you know, up and down the income scale.

DEAHL: That's Angela Rachidi of the conservative American Enterprise Institute. She says this is a challenge worthy of government attention and funding.

RACHIDI: Not only does that then benefit children, but it also helps the parents work.

DEAHL: Katie Hamm of the left-leaning Center for American Progress agrees. She says without much greater public support of the child care industry, demand for licensed infant care will continue to outpace supply.

KATIE HAMM: We've heard a lot about infrastructure in Washington, and it seems like there might be some consensus both with the incoming administration and among members of Congress that we need an infrastructure investment. And a lot of people talk about that and mean roads and bridges. But before parents can get on roads and bridges and support our economy, they need child care.

DEAHL: For Narinder Walia, more good quality infant care can't come soon enough. She's expecting another child any day.

WALIA: I'm kind of being very hesitant even thinking about a child care service right now. In my mind, I just want to hold on tight and not let them go, but obviously that's not practical.

DEAHL: Jessica Deahl, NPR News. Transcript provided by NPR, Copyright NPR.