In 2016, when Jennifer Lucille and her husband learned they were pregnant, they immediately made three phone calls.
The first one is for her mother. The second is her husband’s family. The third is to call the Roper St. Francis Healthcare Learning Center.
She felt the last call was particularly urgent. Lucier wanted a spot on the long waiting list for her unborn baby at daycare.
Lucier works as a Cardiovascular ICU Nurse at Roper St. Francis Healthcare, the only hospital system near Charleston, South Carolina, that runs a child care center for employees’ children.
The problem is that there is no room for everyone. Roper St. Francis employs 5,000 people and its day care can only accommodate 130 babies and children. There are usually more than 100 children on the waiting list. Lucier’s newborn only started opening at 9 months old.
“We are ecstatic,” said Lucier, who also gave birth to twins in 2020. Her child is still enrolled in the Learning Center.
Roper St. Francis Healthcare opened the facility more than 30 years ago to address a longstanding HR problem: recruitment and retention. Today, it remains one of the few hospital systems in the U.S. to operate a full-time child care center for its employees, though that appears to be changing. Some hospitals are now considering child care centers as a means of addressing one of the biggest challenges in the era of the pandemic: persuading staff to stay.
Nationwide, only about 1 in 10 employees have access to employer plans that cover some or all of the cost of child care services according to a report released last year by the U.S. Department of Labor— — Whether on-site or off-site. The health department appears to be doing more: About one-third of U.S. hospitals offer childcare benefits.
But the data masks wide disparities in these benefits. Some hospitals only offer back-up care, so parents can make last-minute arrangements for sick children. Even at hospitals that offer more generous benefits, many parents, like Lucier, end up spending time on waiting lists. Can neither work nor take care of children. More than two years later, most have not provided a permanent solution for parents facing the country’s ongoing childcare crisis. Meanwhile, thousands of child care providers, from small family programs to large day care facilities, have closed since the beginning of 2020, making access to child care more difficult for families than when Lucier gave birth for the first time.
These challenges are felt across all business units. A Care.com benefits report released this year estimated that at least 4 million U.S. workers will quit their jobs each month in the second half of 2021, with nearly half saying they are grappling with childcare or elder care challenges.
However, retention has become a particularly pressing issue for nurses, who are overwhelmingly female, and in large numbers during the pandemic, suffering from burnout, high job stress and other Resigned from hospital citing workplace problems. In fact, according to a report released by the Department of Health Affairs, the number of registered nurses in the United States fell by more than 100,000 last year—“a much larger decline than that observed over the past 40 years.” In a recent McKinsey & Company survey of hundreds of nurses, 32 percent said they were likely to leave their current positions within the next year.
“People leave the industry because they can’t balance work and life,” said Priya Krishnan, senior vice president of client relations at Bright Horizons, the country’s largest employer-funded child care service provider.
Bright Horizons operates 82 hospital child care services with 655 centers across the country. Most of the company’s recent conversations with potential clients have been with hospitals, Krishnan said.
“Reservation is the biggest reason they think about it,” she said.
The federal government provides annual tax credits worth up to $150,000 to businesses for providing child care services to employees. There are also indirect economic incentives. According to the 2022 National Healthcare Retention and RN Staffing Report published by NSI Nursing Solutions, when a bedside nurse resigns, the average hospital loses about $46,000, which equates to about $700 in nursing staff turnover costs for the average hospital in 2021 Ten thousand U.S. dollars.
But anecdotal evidence from Roper St. Francis suggests that employees whose children attend learning centers are far less likely to leave. Its vice president of human resources, Melanie Stith, said the system has experienced a huge turnaround during the pandemic. But she said that during that time, only two of the staff whose children attended the learning center resigned.
In a recent survey of parents who use learning centers, 91% said childcare was the reason they stayed at work. Roper St. Francis runs the learning center at a loss, but it is still considering expanding child care as it builds a larger hospital in nearby Berkeley County.
That’s not to say, historically, that money hasn’t been made in child care. Founded in the 1980s, Bright Horizons was backed by Bain Capital, earning the private equity firm hundreds of millions of dollars. Now publicly traded, its shares are worth about half what they were at their February peak.
Some hospitals still see childcare as a good investment.
“I think it’s a very, very important part of the benefits program, especially for families with school-aged babies,” said Rebecca Gomez, a clinical health psychologist at US-based Wellstar Health System Speaking of the Atlanta area. Both of her children attend Wellstar Academy of Learning, run by Bright Horizons.
“It all made my life so easy,” Gomez said.
As the Roper St. Francis Healthcare Learning Center in Charleston, Wellstar employees often wait for an open seat. Gomez said Wellstar does not operate childcare facilities on every hospital campus.
Even so, the breadth of Wellstar’s childcare services makes it an outlier. Other notable examples include Boston’s Mass General Brigham and NewYork-Presbyterian, both of which have long provided childcare for their employees. While offering on-site childcare remains rare, hospitals are increasingly exploring its options.
Ballad Health — a hospital system with medical facilities in Appalachia, Tennessee, Virginia and North Carolina — recently announced that it will invest $37 million over the next three years Construction of 11 childcare centres, in addition it already operates 3. The expansion will allow the Johnson City, Tennessee-based system to increase its childcare capacity from 200 to 2,000.
Hospital child care is generally not free for employees. Roper St. Francis Healthcare in Charleston charges all parents who use the learning center a weekly fee, which ranges from $200 to $220 depending on the age of the child, slightly above the market average.
Some hospital systems create a sliding scale that takes into account employee wages. For example, doctors may pay more to enroll children than X-ray technology. Ballad Health recently polled employees who said, on average, they could afford about $145 per child per week.
Like many hospital systems, Ballad has been working hard to keep nurses from leaving during the pandemic. But it is also competing for jobs with employers in other regions. A new casino in Bristol, Virginia, recently hired 600 people, said Tony Keck, executive vice president of system innovation at Ballad Health. Thousands more are expected to be hired over the next few years, he said.
“We’re not just competing for doctors and nurses,” Keck said. Hospitals also need to attract domestic workers and other low-wage workers targeted by casinos and others.
But nurses are especially important. Over the past two years, Ballad Health has increased its starting care salary by more than 30%, but hospitals in nearby markets like Knoxville have also increased their rates, Keck said.
“We can’t keep up,” he said. Ballad Health leaders hope the new child care center will give the system a competitive advantage, “that’s why we’re trying to move as quickly as possible,” he said.