Tots and Tubes: Tender Health Care is one of a new group of day care centers that offer services and social interaction for medically fragile children.
Adeliz Vicens had misgivings about leaving her child at day care. Tiny Alexa had been born 4 months premature, with all the special needs that entails. But a new day care center designed especially for medically fragile children offers additional options for parents like Vicens. Tender Health Care opened in 1992 in Marietta, Ga, extending the services of its parent company, Pediatric Services of America (PSA), which began providing day care for children with medical needs in the late 1980s at a center in Florida. PSA now also operates three centers in Georgia, delivering nursing, developmental therapies, and education to special-needs children from birth to 6 years of age. The Florida centers serve children up to age 21. At Tender Health Care, most of the children were born 3 to 4 months premature, and many are on ventilators.
Children with tracheostomies or other medical needs take part in field trips, napsand time outsjust as do kids in other day-care center environments.
Parents dont always see the things were telling them, and sometimes they get angry, says Kathy Vargulic, director of medical day treatment for Tender Health Care. I had a mom come into my office and cry because she didnt see why her 3-year-old belonged here. She thought her son looked so much better than the other children. Mind you, he had spinal bifida, we didnt know if he would walk, he had a tracheotomy and a gastrostomy tube. He ended up coming because she didnt have anywhere else to put him. Now, hes walking and talking and shes one of our biggest advocates.
The children at Tender Health Care spend time out on the playground, taking field trips, having lunch and naps. It is very similar to being in a regular child care center, except for the tubing, says Vargulic. They may be tube feeding, but theyre still sitting at the table with their peers during lunch time. When they misbehave, theyre redirected and they sit in time out. PSAs whole philosophy is that medically fragile and special-needs children are children first. You might see kids sitting in circle time getting a breathing treatment, something you dont normally see in regular child care, but for our kids, all these things are normal; they dont know any different.
The Marietta centers daily census runs between 45 and 60 patients, divided into classes according to chronological and developmental ages. It maintains a three-to-one ratio of staff to patients to tend to the childrens physical needs, in addition to education professionals to help with their mental development.
Our whole goal is to rehabilitate the children and to mainstream them into whatever kind of program works for them based on individual needs and disabilities, Vargulic says. They do finger plays and songs and art projects. Theyre developmentally delayed, so whereas you might have a normal 2-year-old who knows all the colors, youre not going to see that here. But by age 3 or 4, we work on colors, ABCs, recognizing your name if your teacher holds it up.
Children at Tender Health Care receive regular speech, physical, and occupational therapy. Patients also have an opportunity to interact with each other.
We use gestures with some of our nonverbal kids, says occupational therapist Sarah Phillips. Especially our kids who have tracheotomies and are unable to talk can use gestures to communicate with their peers.
Children who spend the whole day at home may miss out on the benefits of peer interaction. Usually, once children are medically stable, they need to socialize and interact with other children, says Vargulic. So, the kids were being serviced for years in the home with one-on-one private-duty nursing, which was developmentally inappropriate. These families socially isolated the kids, thinking they were doing really good things for them, and that just increased their developmental delays. They were getting developmental therapy, but it was maybe once or twice a week when and if the therapist could make it.
Tender Health Care bases admissions on a childs need for medical skilled nursing and developmental care and the potential for rehabilitation. Children without rehab potential are not candidates for medical day care. Of course, theres a big difference between limited potential and none, but children without rehab potential really need to be at home with one-on-one care.
Having an established track record has enabled Tender Health Care centers to find reimbursement that eluded them in the early days, Vargulic says.
We track every single infection, hospitalization, and emergency department (ED) visit. Preemies such as mine have fewer ED visits and fewer rehospitalizations than peers who are not in medical day care, she says. Its less costly, and they have better developmental outcomes. Were getting more and more insurance companies interested. Some companies hands-down approve it, others we manage on a case-by-case basis. A lot of children are covered under Medicaid because almost all my kids were born under 1,500 grams, with many of them under 1,000.
Vargulic foresees a growing need for care for medically fragile and technologically dependent children as premature births increase. These kids didnt survive 25 years ago, she says. We didnt save 23-weekers. Now, a lot of them have pretty decent outcomes. Also, with fertility drugs, you have multiple births. Very few women are going to carry those to term. One in every nine births now is a preemie. A very conservative estimate is that 10% of those kids are going to need long-term services initially.
And, she says, the day will come soon when no one will question the value of pediatric day care for medically fragile children. Ten years from now, this will be the norm, she predicts. Parents will be beating at the door to get their kids in these types of programs.
Many people are already convinced. Today, Adeliz Vicens expresses no misgivings about her childs experience with Tender Health Care. I can compare Alexas development to another child who stayed home and see how much farther along Alexa is, she says. I know it was the right thing.
Keith Bush is a contributing writer for RT.