Day Care Now Available for the Mildly Ill Child : Rainbow Retreat and Supercare Offer New Options for Working Parents

Pediatric nurse Gail Gonzales says that at least half a dozen mornings a year, working parents wake up to the dreaded words: “Mommy, I don’t feel good. . . .”

Suddenly, what might have been a carefully mapped-out day is shattered by desperate calls to sitters, grandmothers or neighbors, the dreary prospect of lost wages or missed meetings, calling in “sick” to an annoyed boss, expensive medical bills and even resentment toward the sick child.

Public-Health Risk

Some parents try to take ill children to day care anyway and unwittingly create a public-health risk, Gonzales said.

But a new option is now available, said Gonzales, who as a vice president of the Newport Beach-based National Pediatric Support Services last month directed the opening of Rainbow Retreat, a for-profit drop-in center for “mildly ill” children and the first in Orange County. It is one of 40 sick child-care operations in the country--some in private homes--that have sprung up in the last five years, she said.

In Los Angeles County, Torrance Memorial Hospital has registered 800 parents since it opened a 24-hour mildly ill child-care center in September. The cost to parents is $3 per hour plus $1.50 for a meal.

And last month, Transamerica Life Cos. opened Supercare for Kids, another center for mildly ill children, at California Medical Center-Los Angeles, for its employees’ children.

Transamerica Life loses $150,000 annually due to employee absence and tardiness resulting from children’s illnesses, according to David Carpenter, chairman of Transamerica Life Cos. Besides being able to work, parents who use the hospital-based center will also have “peace of mind” knowing the child is receiving proper care, he said.

Open to the public, Rainbow Retreat in Newport Beach offers combined nursing/teaching care for children ages 2 months to 12 years who can’t attend school or day care due to colds, fevers, ear infections, recuperation periods or temporary physical impairments such as casts.

Located at the former Eastbluff Elementary School, side by side with the National Pediatric Support Services corporate headquarters and a day care/preschool, the Rainbow Retreat is open from 7 a.m. to 6 p.m. Monday through Friday. The cost is a one-time $25 registration fee plus $5 an hour with a four-hour minimum.

The center is staffed by licensed vocational nurses and teacher’s aides in a 5-to-1 child-adult ratio, Gonzales said. Daily enrollment is limited to 15 children on a first-come, first-served basis, and 600 may be registered, Gonzales said.

To use the center, parents must first pay the $25 registration fee and fill out forms on their children’s medical history, including allergies, immunizations and chronic illnesses. When their child is sick, they call the center with symptoms. Children with undiagnosed rashes, wheezing, uncontrolled coughing or contagious diseases such as measles or early stages of chicken pox are not accepted, Gonzales said.

Transferring Diseases

Of major concern in such a center is the possibility of transferring diseases, according to Dr. David Kagnoff, a Newport Beach pediatrician and medical adviser to Rainbow Retreat. “We set up really rigid guidelines” to control infection, Kagnoff said, referring to proper screening of sick children, good hand-washing techniques and a large, airy room. In addition, children sleep head-to-toe, and toys, furniture, floors and linens are cleaned daily.

According to a three-page sheet of admission guidelines, acceptably “mild” illnesses include: colds, flu, diarrhea, vomiting, ear infections, reactions to immunization, urinary tract infections and sunburn.

Children who cannot attend school due to fractures or those recuperating from surgery are also admitted.

Instructions From Physician

Children with fevers of 103 degrees or more must have a diagnosis and instructions from a physician. Some other conditions requiring previous medical treatment include strep throat, stiff necks associated with headaches and fevers, earaches or conjunctivitis.

Children also are given a physical exam, including the measuring of blood pressure, by the nurse when they arrive at the center. The staff measures temperature, pulse and respiration every four hours and keeps a record of those vital signs--plus sleeping, eating and activity--that is presented at the end of the day to the parents, along with advice for further care.

Transamerica’s Supercare for Kids program, operated in a hospital near the parents’ workplace, is staffed by a pediatric nurse, other health-care professionals and bilingual volunteers who lead play activities as well as supervise health care. Family-practice physicians are available 6 a.m. to 6 p.m. Monday to Friday for children who need a doctor’s care. Unlike Rainbow Retreat and Torrance Memorial, Supercare is restricted to children of its sponsoring organization--the 4,000 employees at Transamerica Center two blocks away in downtown Los Angeles.

Rainbow Retreat is open to the public, and so far its customers have come from the adjacent day care/preschool, also run by National Pediatric Support Services.

A recent morning brought six toddlers to the center, three in pajamas. They had runny noses, ear infections, upset stomachs and diarrhea. Their energy barely dimmed, they scampered for toys, then sat in a circle listening to nurse Barbara Nackerud sing.

Around them, as in any day-care center, were books and tapes, wooden beads, pounding toys, riding and pushing toys. But there also were eight cribs, five beds and charts hanging on the walls with the children’s medical histories and records of illness, as well as a refrigerator for medication. Outside the center’s door, adult and children’s shoes were lined up. Stocking feet only are allowed inside to keep the rug as clean as possible, Gonzales said.

Gonzales believes that children’s illnesses should be treated as “a normal part of development.” As a hospital nurse, she said, she often saw sick children unnecessarily isolated, restrained or told “not to cry” when they were naturally frightened or hurt.

Started First Unit

“Burned out” and disenchanted, Gonzales started the state’s first comprehensive sick-child care unit in 1981 at the San Juan Bautista Child Development Center in San Jose. She is also a member of Gov. George Deukmejian’s Task Force on Sick Child Care, which has developed guidelines to license mildly ill child-care centers in California. Such centers are now required to be affiliated with other licensed child-care centers or health facilities.

Rainbow Retreat came about after Gonzales met Sherri Senter, a special education instructor and founder of National Pediatric Support Services, at a child-care conference two years ago. They both agreed there was a demand for sick-child care and Rainbow Retreat became the latest project of National Pediatric Support Services, a firm that specializes in developmental child-care programs, including state-licensed Step by Step Early Learning Enrichment Centers, educational products and consulting services to parents and employers.

The problem of sick child care is “monumental,” said Nancy Noble, child-care coordinator for the City of Irvine and instructor in the Early Childhood Department at Orange Coast College. “Up to this point in time, there has been little if no effort toward solving that problem.”

One ill-fated effort was the Irvine-based Tender Tender, a now-defunct baby-sitting agency that specialized in sick children. Owner Sherry Connolly said she “disincorporated” a year and a half ago, after a year of business, because it was too difficult to find sitters flexible enough to be on call at 6 a.m. Nevertheless, she said, the demand for sick child care is so high that her defunct business still receives two calls a day during flu season from distraught working mothers.

Also, she said, she charged $5 an hour and paid the sitter $3.50 an hour, which “did not leave a lot of profit margin.”

While the San Juan Bautista center was subsidized by private and public funds, the Rainbow Retreat relies on such business strategies as marketing and cost analysis to keep going and turn a profit, Gonzales said. The center has averaged three to four children per day in its first month, but it will need 10 per day to be profitable, Gonzales said.

Insurance Coverage

Liability insurance, a problem that has dogged family day-care centers and preschools the past year, is not an additional problem for the center, Gonzales said, since the center is covered under the policy for the adjacent preschool. Nurses carry their own malpractice insurance, she said.

Gonzales also works as a consultant to those interested in setting up their own mildly ill child-care centers, and she tries to interest local corporations in including Rainbow Retreat as an employee benefit. Employers can, for example, pay for sick child care each time an employee’s child uses the center, reserve one bed each day over a year for any of their employees’ children, pay the $25 registration fee, or simply make their employees aware that the center exists as an option, she said.

“We are definitely considering it,” said Geno Effler, public relations manager for Pacific Mutual Life Insurance Co., which already subsidizes child care for its employees. “Every child gets sick at some time in his life. We share that concern. If we are able to offer an option benefit to our employees that would help them in that area, it would be a worthwhile effort.”

At the Transamerica-sponsored center, the company pays the lion’s share of the $180,000 annual cost of running the center. Employees pay $10 a day for the service on the first day and $5 for subsequent consecutive visits. There are 15 beds that cost the company $45 a day each to maintain. There are no limits on how often employees can use the center, according to program administrator Joyce Montgomery.

Senter said she expects the Newport Beach Rainbow Retreat to be profitable by the end of the year. By the end of next year, several more Rainbow Retreats, owned and operated by National Pediatric Support Services, should be open nationwide, she said.

Elizabeth Wikholm, a research associate at UC Irvine, recently took her son, Paul, who had an ear infection, to Rainbow Retreat for the first time. Usually, she said, she has a flexible schedule and can stay home when Paul is sick, about once every other month. But that day she had a meeting she could not miss, and her husband, a surgical resident at UCI Medical Center, could not take time off.

“It’s really a good service for couples with rigid schedules,” she said.