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In-home day cares in Iowa among the least regulated in U.S.: Does that increase the risk of injury, death?

Des Moines Register logo Des Moines Register 1/13/2020 Jason Clayworth, Des Moines Register

© Copyright 2019, Des Moines Register and Tribune Co.

This is the third part in a series investigating Iowa's child care dangers. Read part 1 and part 2 here.

Iowa is among states with the least regulation of in-home day cares, and with one of the heaviest caseloads for inspectors of licensed facilities, records show.

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On average, each of its inspectors oversees at least 41 facilities more than the national workload.

Those numbers lead to child injuries and deaths that could be prevented, say people like Lindsey Hoover of Grimes, whose 6-month-old daughter, Annie, died in an unregistered in-home day care in July 2012.

Annie suffocated after rolling over in a travel crib. While there was no evidence of abuse and no criminal charges filed in connection with Annie’s death, the day care provider used a type of swaddle intended for children under the age of 3 months, Lindsey Hoover said.

For years after Annie's death, Hoover and her husband, Travis, advocated for changes in Iowa law that would require all in-home day cares to register with the state.

However, critics fear that increased regulation would drive up costs for providers and families. Reflecting national trends, Iowa already is short thousands of day care openings, and the fees are out of reach for many parents. And lawmakers say money for additional inspectors isn't available in the state budget.

The Hoovers believe the trade-offs would be worth it. Even requiring providers to answer a few simple questions about sleep arrangements for children at unregulated facilities could help prevent deaths, they said.

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But their efforts have gone nowhere at the state Capitol. In 2014, one version of a bill to require registration of all day cares, House Study Bill 609, did not have enough support to pass from a three-member subcommittee. 

“We discussed ways to fix the many issues,” Lindsey Hoover said. “… After so long, so many blank stares and so many times being told there is no budget, we gave up.”

MORE: 15 people have been arrested in Iowa since 2014 for violating day care licensing laws

1 Iowa inspector for 174 in-home day cares

In Iowa, a provider watching over five or fewer children is not required to be regulated by the Iowa Department of Human Services.

Only five states — Louisiana, Idaho, Ohio, New Jersey and South Dakota — have less restrictive thresholds for in-home child care registration, certification or licensure, according to a 2017 review by the National Center on Early Childhood Quality Assurance, part of the U.S. Department of Health and Human Services.

And for day cares in Iowa that are regulated, the state workers who inspect them have caseloads that far exceed the national average.

The national average caseload for each staffer responsible for licensing was 97 facilities, according to a 2014 study by the National Center for Early Childhood Quality Assurance and the National Association for Regulatory Administration.

The study, the most recent available, includes both centers and homes.

Information from the state Department of Human Services shows Iowa's 2014 ratios were 1-to-122 for licensed child care centers and 1-to-234 for in-home day cares.

The 2019 ratios in Iowa are 1-to-138 for licensed child care centers and 1-174 for in-home day cares.

Iowa has 11 full-time licensing staffers who conduct inspections on licensed child care centers and 16 who conduct inspections on in-home day cares, which has remained consistent in the past five years, said Matt Highland, a DHS spokesman.

Former Rep. Peter Cownie, a Republican from West Des Moines, worked with the Hoover family and filed the bill in 2014. He doesn't recall opposition — records show no lobbyists registered against the bill — but said DHS employees questioned how the extra responsibility would be staffed and paid for.

Iowa has shed nearly 3,000 state jobs since 2011, with DHS taking the biggest hit, losing 1,058 workers, a Des Moines Register investigation published in May showed.

Iowa's 150 legislators propose dozens of bills related to DHS each year, many involving issues that supporters believe could save lives or improve public health. It's not uncommon for many bills, even those with no opposition, to fail to become law, due at least in part to budget and staffing concerns.

Cownie, who primarily worked on the policy side of the bill, doesn't recall the matter receiving serious discussions during 2014 budget talks. Legislative records do not reflect the estimated costs associated with the bill.

"I was supportive of it no matter what," Cownie said. "It’s obviously a worthwhile cost.”

The Iowa DHS began formally tracking deaths and serious injuries in regulated child care facilities in 2016. There were no deaths in 2016 or 2017; at least four in 2018; and at least one so far in 2019, reflecting data collected through April 30, the agency’s tracking shows.

There have been at least two additional deaths of children at in-home day cares that were not regulated by DHS, one each in 2018 and 2019, the Register's investigation found.

The number of serious injuries reported in regulated Iowa child care more than doubled from 22 in 2017 to 57 in 2018. There have been 19 this year, through April 30.

A federal grant reauthorization in 2014 required states to publicly track deaths and serious injuries. But each state can define “serious injuries,” and there is no single place to obtain state-by-state data, noted officials from Child Care Aware of America, a national advocacy network that provides on-site consultation for child care facilities in dozens of states. The group advocates for more stringent regulation, including requiring background checks for providers.

Take a closer look at serious central Iowa violations found in day care inspections database

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Fears of fewer day cares, higher costs

Even without tighter regulation, available slots in Iowa day cares have shrunk in recent years, data show. And while the cost of care is already unaffordable for many families, low wages discourage people from seeking jobs in the industry. 

Iowa has 160,748 child care slots for children under 6, and a need for 173,476 slots, Child Care Aware’s statistics show. Between 2013 and 2018, licensed and registered child care providers in Iowa decreased from 9,384 to 5,426 — a 42 percent drop, according to Iowa Child Care Resource & Referral, which is part of the Child Care Aware network. Total child care slots dropped by 6 percent over that period.

Meanwhile, the average annual income of the 8,200 child care workers in Iowa last year was $20,520, about $1,800 below the national average, according to Child Care Aware.

Lora Patton, a regional director for the Iowa group, believes more providers are caring for five or fewer children to avoid hassles and costs associated with registration or licensing — or leaving the profession.

“It’s not looked at as this great career to go into because there’s often not a lot of money to be made in child care,” Patton said. “At the same time, in some areas — especially some of the rural areas — registered or any child care can be very hard to come by.”

More than 116,000 Iowans live in census tracts with no licensed care providers, according to a Center for American Progress analysis of U.S. Census and Iowa Department of Human Services data.

Child care is now the most expensive household budget item for many Iowa families, according to a study released last year by United Ways of Iowa. On average, a family of four — including one infant and one toddler — would need $1,031 monthly for child care expenses, higher than the $659 average to cover basic housing, the study showed.

Rep. Mark Smith, D-Marshalltown, lives in the town where infant Cohen Dankbar was found unresponsive at an in-home day care last year and later died. The day care had been previously warned it was caring for too many children with too few adults. 

The issue of child safety is so important that it behooves lawmakers to find solutions, Smith said. If more stringent regulations and stepped-up enforcement lead to higher costs, then lawmakers can take steps such as increasing child care subsidies for low-income families, he said.

"If we increase the cost of child care (due to enhanced regulation) that of course concerns me," Smith said. "But when choosing between conflicting and competing values, we always must side with protecting children."

Proposals that would increase Iowa's child care regulation have not generated a lot of legislative attention in recent years, and costs are a major concern, said Sen. Jeff Edler, R-State Center. Edler is the Senate's vice chairman of the Health and Human Services Appropriations Subcommittee, which oversees much of DHS' budget.

"I would have to take a deep dive to see the concerns and really apply the common sense approach to whether regulations would be beneficial enough to offset whatever costs they would bring onto the consumer," Edler said.

Iowa's reimbursement rate in the Child Care Assistance program — often referenced as CCA — for preschool-age children in child care centers increased to $13.53 per half day in January. That's about $135 per week for a child in a low-income family attending five full days. The market rate was $18.69, according to a DHS survey released last year.

Sheila Hansen, policy director at Child and Family Policy Center, believes the stated market rate is artificially low. The federal government does not allow child care providers to charge the difference between CCA and private pay so many providers end up losing money by taking those using CCA, Hansen said.

Her Des Moines-based group often notes that the $13,085 average annual cost of infant care at accredited child care centers in Iowa in 2018 exceeded in-state tuition at Iowa's three state universities. The disconnect between the cost of child care and what parents can afford to pay, coupled with sparse state and federal subsidies, is the main challenge of child care, she said.

“Our providers are woefully underpaid and lack benefits like health insurance and paid leave," Hansen said. "We see many providers leaving the field to work at the dollar store or Casey’s because they can make more money and receive benefits.”

MORE: Iowa mom on a mission to strengthen oversight after her daughter was injured at a day care

Kansas takes route of more regulation

Kansas' experience might offer Iowa some insights into the impact of increasing regulation for day cares. 

Kansas passed a law in 2010 that mandates day care facility inspections and worker training. The move eliminated a category that allowed people who cared for up to six children to avoid inspections unless the state received complaints. 

In its first year, the move led to 900 fewer day care providers in Kansas, but also resulted in more available child care slots as providers chose to pursue licenses, which allowed them to care for up to 10 children instead of six.

a close up of a map © Provided by Gannett Co., Inc.

The average annual income of child care workers in Kansas is $20,240, slightly lower than Iowa’s. Iowa also does better than Kansas when comparing the number of total slots for child care versus the overall need, according to Child Care Aware data.

Leadell Ediger, director of Child Care Aware of Kansas, acknowledges the availability and cost of child care in her state remain issues, but contends mandatory inspections have improved public safety and prevented child injuries and deaths. Kansas reported one death in a regulated facility since January 2018.

“There were strong voices in opposition,” Ediger said of the 2010 law, which was named in remembrance of a 13-month-old child who suffered fatal injuries at a day care in 2004. “It’s that philosophy that ‘government shouldn’t be in my house.’ And that may be true, unless you’re taking care of children for pay.”

MORE: 15 people have been arrested in Iowa since 2014 for violating day care licensing laws

Iowa's five-child cutoff is intended to avoid state overreach, so that a parent can care for a friend's children or a grandparent can watch grandchildren during the summer without having to navigate a thicket of government rules. 

But unintended loopholes or a lack of regulation can allow unscrupulous providers to dodge oversight by falsely claiming they care for fewer kids, said Jen Bump, a senior adviser of Child Care Aware of America, which believes stronger regulation can prevent injuries and deaths.

“Around the country what often happens is, unfortunately, a child is hurt and then a family member steps forward and it becomes their mission to do whatever they can to make a positive change for their child and other children in their community and state,” Bump said.

Seven years after her daughter's death at a day care, Hoover hopes the recent deaths in Iowa day cares can be catalysts to reform the state’s policies.

“I hope that it will create a topic that gets attention and hopefully can be fixed,” she said. “Seems to me in Iowa anyone can have a day care anywhere and under any condition.”

About the author

a man wearing a black shirt: Jason Clayworth, staff mug, staff photo, Jan. 2019 © Kelsey Kremer/The Register Jason Clayworth, staff mug, staff photo, Jan. 2019

JASON CLAYWORTH is an investigative reporter at the Des Moines Register whose focus includes government operations. He is an Iowa native and a graduate of Drake University's journalism school. 

Do you have an experience with Iowa child care that you want the public to know about?  Contact Clayworth at jclayworth@dmreg.com or call 515-699-7058.

This article originally appeared on Des Moines Register: In-home day cares in Iowa among the least regulated in U.S.: Does that increase the risk of injury, death?

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