Children’s Dental Health Month – Practice Taking Precautions during Pandemic: Don’t Postpone Your Child’s Dental Care
by guest contributor Rosie Kickish, DMD, Inspiration Dental in Riverview, FL Everyday life looks different…
Just before the new year, ICS released findings from a second round survey of child care providers in South Carolina to better understand how the continued spread of COVID-19 and resulting economic impacts are affecting the child care sector as of 2020. This survey was adapted from a previous version fielded in spring 2020, in the early days of the public health crisis.
In South Carolina and nationwide, the child care and early education sector is in a crisis, facing closures, reduced enrollment, increased costs, and new challenges for staff in the ongoing public health crisis of COVID-19 and its economic impacts on communities. While South Carolina did not require the mandatory closure of child care centers in the initial spring wave of virus transmission, many providers voluntarily closed out of health concerns and to take time to develop precautions and policies. As providers have reopened for business, they face a rapidly changing market.
Our fall survey found clear examples that staff members face difficult decisions regarding balancing the needs of their own families and health concerns alongside the realities of a low-paying field with an uncertain future. Our survey asked the 62 respondents questions to better understand the “new normal” of their operations, the challenges they face in quality, stable staffing, and the stressors their staff members face.
Firstly, staff members have had to rapidly adapt to new protocols, incorporating guidance from a new of federal, state, and local entities and experts to help mitigate the spread of the virus. Respondents were given a list of nine frequently recommended programmatic changes. Three of these measures were reported to be in use by more than 80 percent of respondents: taking temperatures of staff and children; creating a policy on how to handle any possible COVID-19 cases for staff and/or children; and requiring face masks for staff. While there is significant agreement among these adaptations, there is a significant drop-off among other responses, with no other change being utilized by more than 50 percent of centers:
|Taking temperature of staff and children||92%|
|Creating a policy on how to handle any possible COVID-19 cases for staff and/or children||84%|
|Requiring face masks for staff||82%|
|Reducing the number of children we will serve to allow for distancing||48%|
|Changing our operating schedule||47%|
|Hiring professional cleaners (daily or on another schedule)||32%|
|Requiring face masks for children who are above the age of 2||31%|
|Offering child care to more older children than previously, to oversee virtual learning||29%|
|Increasing the resources we send home with families (meals, supplies, etc.)||29%|
Many of these adjustments require providers to address complex staffing questions. How can providers achieve necessary staffing, and “within ratio,” if staff members have to call out sick or have a potential exposure requiring quarantine? How can a provider implement protective measures, like smaller group sizes or daily symptom screening for children, and will additional staff need to be hired to do so? How can providers keep children and staff from mixing across groups, increasing potential exposures?
The most common issue reported in our survey was that staff had missed work at some point during operations since March due to exposure (or potential exposure) to COVID-19 among themselves or a household member, with 47 percent reporting this issue which could result in the need to bring in substitute staff or shift staff, which may undermine attempts to distance or “bubble” groups.
Forty-two percent reported they had struggled with hiring new staff when needed. Providers have experienced a range of challenges in hiring, ranging from knowing their exact staffing needs at a time of rapid change, to delays in the hiring process, to difficulty recruiting high-quality professionals. In follow-up comments, respondents gave some insight into the challenges they had faced.
Those who want to invest in their staff have often been unable to, with one provider reporting they are struggling to give staff “needed raises or bonuses for working during COVID” and another acknowledging that they have struggled to provide professional development and support to staff.
Providers identified high turnover as a result of low pay or lack of benefits, a situation which has been worsened by centers’ current financial constraints. Their recommendations include introducing hazard pay or another financial incentive, both to compensate staff and boost morale and introducing medical benefits or sick pay, which is not financially viable for most providers on their own. One provider in Spartanburg County drove this point home: “Staff childcare workers want some type of Health Benefits to be issued and affordable for ALL childcare workers also like State health plan, Teachers Benefits. Childcare workers are needed just as much and often as other workers. People can’t go to work without childcare needs. So, WE must open and be here daily no matter what pandemic is going on. WE ARE FRONT LINE WORKERS ALSO!!” –
Providers are concerned about burnout among their staff, as one respondent reports: “[I]t has taken such a mental toll on all my staff. I can’t hire enough qualified staff, so the ones I have are overworked. Constantly worrying about who is exposed other than at work and them having to quarantine for a week or two is ridiculous. We are stressed to the breaking point and are no longer doing quality care because of it.”
Providers also feel the toll of public opinion on their work and their staff, as well as the lack of resources they have available to them compared to some other sectors to continue their essential work. Wrote one provider in Greenville County: “Public perception that we should be open no matter what can be draining and demoralizing for staff who are daily putting forth more effort, potentially exposing themselves and their families to COVID, and continuing to provide high-quality early childhood education. I wish there was a recognition of the sacrifices being made by these teachers.” The $10 billion in funding for child care in the latest federal relief bill to be divided nationwide is a welcome investment in the sector, but is a drop in the bucket of what providers truly need to operate safely and effectively in these times.
As policymakers and practitioners, we must consider the financial impacts on providers and the developmental needs of families and children. But the deep struggles facing this sector are not just economic, they are heartbreakingly human. In our survey of South Carolina providers, one respondent noted that four of its staff members had battled COVID-19 and, tragically, one had died from the illness. Any loss of a child care professional is too many, even if contracted outside of the workforce, and can have a profound impact on other staff members and children in care. Despite all this, when providers were asked to rank their stress and concerns on a scale of 1-10, with 1 being “not at all stressed” and 10 being “the most stressed I have ever been,” on three areas, the area of highest concern was not financial stability (6.2) or the safety of staff, including themselves, (6.7) but the well-being of families they serve (7.1)