Childcare amid COVID: What’s a hospital to do?

2020-7-30 GettyImages-182058488 COVID childcare - blog.jpg

Christen Skaer, DVM, recently posted on the AAHA-Accredited Members Facebook page asking what other hospitals were doing about staff childcare during COVID.

Skaer, who owns Skaer Veterinary Clinic in Wichita, Kansas, told NEWStat that she heard from a number of people both on and off Facebook who suggested limiting her hospital’s hours of operation to give staff more time with their families. She thanked them, having already taken steps to do that on her own.

But she admitted that advice to adjust her hours wasn’t what she was looking for: “Childcare is an issue [all day]. I’m really interested to know if anyone’s come up with unique answers to this challenge.”

She didn’t find those answers on Facebook. And she needs them: She has a staff of 22, including 3 veterinarians, and a number of them have school-age children. “They’re scrambling to find childcare.”

Finding affordable, reliable childcare can be an issue at the best of times. During COVID, with many daycare centers closed and homeschooling via online classes the order of the day, it can be a nightmare.

It’s certainly complicated. For example: One of Skaer’s technicians is married to a teacher who works in a different school district than the one in which their children, five and seven years old, attend classes. He’s been home with the kids all summer, but that could change once school starts up again—what happens if he goes back to teaching in-person classes in one district while the children have to take online classes at home? The districts have yet to announce their intentions. “That’s a real problem,” says Skaer.

Or take her practice manager’s 12-year-old daughter. “She’s at home taking Zoom classes and trying to do homework by herself. Is my practice manager supposed to come to work all day and help her daughter at night? Are we going to rely on 12-year-olds to do [all their school work] at home unsupervised?” asks Skaer. “I’m not sure how this is going to work.”

Skaer says things were easier last spring, when her staff was divided into two teams to ensure social distancing: half of the staff worked in the hospital three days a week and the other half worked two days a week. “[Childcare] wasn’t as much of an issue because they were home more with their kids and could do the homeschooling then.”

She says money’s an issue, too, especially since her Payroll Protection Program (PPP) funds ran out: “[When] I had PPP money, I could afford to be more lenient. I was paying people for full-time work even though they weren’t necessarily working full time. Now that it’s run out, I can’t afford to pay someone for hours not worked.”

COVID childcare is an issue in hiring staff, as well. Skaer mentions a technician she really wants to hire: “She’s going to be fantastic but she’d need to leave at 5:30 to pick up her kids from daycare.” That will be difficult, as Skaer’s hospital is open until 7 several nights a week.

Skaer even called an office park near her hospital to see if there was any available space to rent so she could set up temporary daycare. She’s well aware of the potential pitfalls—childcare licenses, state inspections, and so on—but says, “I’m looking at all the options.”

Meanwhile, Skaer’s entire staff has been back working full time onsite since June—the hospital is only curbside for the moment—and school’s right around the corner.

Skaer says her staff doesn’t know what they’re going to do. “They’re scrambling.”

Angela Justice, office manager at Double J Animal Hospital in Hobbs, New Mexico, says her staff is not—but acknowledges that her hospital’s in a different situation. Her husband, Mark Justice, DVM, owns the hospital, and, when the local schools closed in March, she knew it was going to be a problem for their employees with school-age children. Fortunately, Double J was in a position to do something about it.

“As soon as we went curbside only, that freed up some exam rooms that weren’t going to be used as frequently.” She told NEWStat they also have a comfort room set up like a living room.

“We told our employees, ‘You can bring your kids to work with you each day, and they can hang out in the comfort room,’” she says. “As long as their safety’s not in jeopardy, nor the safety of our patients, we’re okay with you bringing your kids to work.’” Justice said those working mothers were very grateful: “They had no other options for daycare.”

Angela and Mark have children of their own, but because Angela has the option of working from home, she can do her job and still keep her eye on them. A grandmother who lives close by takes over when Angela’s needed at the hospital.

At the end of the school year, when it was all Zoom classes and homeschooling, Angela says her staff’s kids were able to do the homework that didn’t require adult supervision or assistance in the comfort room. Otherwise, their parents were able to help them at home in the evenings.

She says the kids were never left alone: “We had a staff member within 10 feet at all times, and their mothers would check in on them between appointments.”

Schools in Hobbs will resume classes online on August 10, and in-person classes are optional beginning September 10, although Angela expects the in-person classes option will likely change as the start date draws closer.

Nevertheless, she says Double J is prepared to continue hosting online classes and daycare in the comfort room as long as possible: “If we continue curbside, I don’t have a problem with that. But when we open the hospital back up to allow clients in, we’re going to have to come up with a new plan.”

That could be a while: they have three immunocompromised staff members. “So I think we might be more conservative than most hospitals about when we want to open up and let the public back inside.”

Beth Frank, DVM, is chief of staff at New Palestine Veterinary Clinic in New Palestine, Indiana, and says she’s lucky enough to have some say in things, including hours of operation.

“If you are set up to provide childcare, wonderful. If not, though, I think that re-evaluating your open hours or how much staff you need during those hours is important to keep your team feeling loved and to acknowledge their stress levels.” She closed the practice an hour early through April and May, and they’re now closed on Saturdays. She says sympathetic clients helped make that work.

Frank is a mom with two kids, a four-year-old, who was in full-time daycare until the shutdown in March, and a second-grader. “In many ways, I feel very privileged to have some options and money to throw at the situation.” Her husband was able to take off work from March through June to stay home with the kids, and they were able to afford a nanny for June through July, when he went back to work. Now that school in their area is going to online classes full time in the fall, Frank says they were lucky enough to find daycare for both kids: “It’s not cheap,” she says, “But it will be reliable.”

She knows how fortunate she is: “My options have been stressful and limited enough, even with some financial flexibility. I can only imagine trying to figure this out on a technician or other support-staff salary.”

Skaer doesn’t have the option of providing onsite daycare, and doesn’t think the option of drastically limiting her hours of operation is a good one. Although not a mother, she is a second-generation veterinarian—her father, William Skaer, DVM, opened Skaer Veterinary Clinic 51 years ago. “I grew up in this practice,” she says. “I took lots of naps in the cages.” And a big lesson she learned from her dad is: “You have to be available when the clients want you.”

She mentions that people at hospitals who have adjusted operating hours “say they have [closed early] and their businesses never dropped a beat, but these aren’t ordinary times in veterinary medicine.”

Skaer sees problems ahead if hospitals go that route: “Two years from now, if you’re not open at least until 6 and maybe a little later, it will hurt the practice.” She feels strongly about it: “I promise, it will hurt our practices not to be open when people need you.”

Nevertheless, she’s cut her Saturday hours, and says she did it for the sake of her team’s quality of life. “But you can’t have it both ways,” she says. “You can’t not be open when people need you. If they get off work at 5:30 and you leave at 5:30, you’re shooting yourself in the foot.”

“And right now, we’re busy—we’re busy regardless of what we’re doing. All veterinarians are. I don’t understand it; I don’t know why. But it won’t last. We’ll experience an economic downturn, and even though the profession tends to be recession-proof and weather economic storms pretty well, we still need to be conscious of the needs of our customers.”

Then she brings up what may be the central issue in the COVID childcare debate.

“We’re a profession of a majority of women now,” she says. And childcare responsibilities still fall maddeningly disproportionately on female shoulders. “We have to find ways to accommodate these women, who are working their tails off and trying to be mothers at the same time,” she says. “I knew [motherhood] was not right for me. I cannot run this practice and have children. Some people can do it, and more power to them.”

Skaer often wonders if it’s an issue the profession can address: “I don’t know,” she confesses. “I think yes.”

She says her goal as a practice owner is to be able to pay everyone on staff between $20 and $25 an hour. “That’s my personal mission,” she says. “I think that, as an industry, if we get out of the mentality that front desk people make $11 an hour and techs make up to $17 an hour, that will go a long way to help people afford high-quality daycare. [It certainly] gives them more options.”

Frank calls the conundrum of childcare during COVID “a terrible situation. And I do feel that hospitals owe it to their staff to recognize [that]. As an industry, we need to stop placing our clients first, no matter the cost, and take better care of each other.”

She understands that could require a possible sea change: “This may mean turning away some new clients, shortening some hours, or doing [fewer] surgeries. But by nurturing our team in this stressful time, we can be sure that we’ll all come out on the other side together.”

Photo credit: © Gettyimages/princigalli