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Deadly Day Cares

Faces of some of the children who died in Missouri day cares.

Sweeping new federal regulations for child care facilities announced Thursday could bring oversight to hundreds of day cares in Missouri that have been outside the reach of regulators.

The proposed federal rules would for the first time mandate spot inspections, background checks and quality standards for more than half a million facilities and home-based centers nationwide that accept federal money.

The changes were drafted following news reports — including in the St. Louis Post-Dispatch — chronicling scores of child deaths and cases of caregiver negligence across the country.

The proposed rule changes pertain to the Department of Health and Human Services’ Child Care and Development Fund — commonly known as the child care subsidy program.

The program distributes $5.2 billion in aid and yet has historically left it to states to administer and enforce standards. Missouri and other states have opted to exempt vast numbers of centers from most any form of regulation.

“We feel these are businesses, and they are doing this work for money, and this money is federal money,” said Linda Smith, deputy assistant secretary for early childhood development in the federal Department of Health and Human Services. “There should be accountability here, and we’re not asking for outrageous things. We’re not asking for a Cadillac program here.”

In 2011, the Post-Dispatch documented 45 deaths of children, mostly in unlicensed Missouri home day cares, from 2007 through 2010. A review of many of those deaths revealed infants were dying most often accidentally in homes that lacked inspections and basic prevention standards, including those to deter sleep suffocation and other forms of sudden unexpected infant death.


The federal rules must still undergo a review process that includes public hearings. But federal officials say the rules do not need congressional action. They would become effective in 2015, with a launch date no sooner than 2016.

The rules would require:

• Mandatory unannounced health and safety spot-checks and monitoring of all child care facilities receiving federal subsidies.

• Training in specific areas, such as first aid, CPR and sleep safety for infants.

• Universal background checks and fingerprinting checks through an FBI database of all child care workers, including those in unlicensed home day cares. Missouri’s current family care registry uses background checks but not fingerprint checks.

• Development of quality indicators — covering curriculum, staff training and other factors — to be posted on a state website.

• Creation of a hotline complaint system for licensed and unlicensed child care facilities receiving subsidies. Currently, Missouri’s child care hotline chiefly targets licensed centers.

• New reporting that would document and analyze all deaths and major injuries at facilities that receive subsidies.

The Post-Dispatch’s 2011 series on deaths in child care revealed that parents and state officials have few, if any, ways to research or learn whether and how a child has died at an unlicensed home day care.

The series found at least three children had died in home day cares receiving state subsidies, one of them unlicensed.

“I think this is a game-changer for quality child care,” said Smith, who credited increasing media attention for propelling the federal standards.

In the announcement, Health and Human Services Secretary Kathleen Sebelius said safety standards for subsidized day cares have not been revised in 15 years.

“We know a lot more about what we need to be doing with children,” Smith added. “Parents assume (child care providers) have such things such as CPR training, safe sleep training, and regular inspections, but they sometimes do not.”

Last year, Missouri distributed $101.8 million in federal child care subsidies that would be governed by the new rules.

More broadly, the state paid out an additional $70 million in other forms of federal and state child care subsidies. In all, 41,851 children received some form of child care assistance.

The bulk of the subsidies went to licensed centers. But the Missouri Department of Social Services reported that $46 million was given for care in unlicensed settings.

State officials reached Thursday are reviewing the federal proposals and said it was too early to comment.

The new proposed federal standards would allow states to exempt certain child care providers from the rules, particularly in-home day cares using relatives to care only for kin, such as grandparents.


Missouri has a history of rejecting proposals that would broaden regulation of home and faith-based day cares. Providers have argued that it is too costly to conform to such standards, potentially forcing them out of business.

News of the standards had not yet reached those providers Thursday, but is likely to trigger a political backlash.

The Missouri Legislature, for example, has already pushed back against the very same type of quality rating system being proposed within the federal subsidy program.

Carol Scott, CEO Child Care Aware of Missouri, said the federal standards could advance state child care policy that has frequently stalled in the Legislature and state bureaucracy.

Scott said some of the standards proposed Thursday already are required in Missouri’s licensed facilities — such as unannounced inspections, CPR training and sleep safety rules.

But very few of the proposed federal standards are currently used in unlicensed and faith-based facilities. In that respect, Missouri will have a lot of work to do to come into compliance to continue receiving the subsidy, she said.

“We’re definitely ready to roll up our sleeves and get to work, but it’s not going to be a simple change here,” she said.


Editor's note: A prior version of this story provided the wrong amount distributed annually by the federal child care subsidy program. This version has been updated.