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Wednesday, Jan. 9, 2008


Day-care centers for sick kids few, strapped

Staff writer

It's a dilemma many working parents face when their children fall ill.

News photo
Eiko Kezuka, a nurse at Chez-Moi, a day-care center in Setagaya Ward, Tokyo, specializing in ill children, reads a picture book for her charges in late November. The center is run by Dr. Yoshiya Yamaguchi in the same building as his pediatric clinic. KAZUAKI NAGATA PHOTO

Dr. Yoshiya Yamaguchi, who runs a pediatric clinic in Setagaya Ward, Tokyo, has seen his fair share of parents who can't miss work but don't know who to turn to for help taking care of their children.

So in 2004 he offered them a helping hand by establishing the Chez-Moi day-care center for sick children in the same building as his clinic

"I wanted to do something to support their child-raising," Yamaguchi said.

While day-care centers like Yamaguchi's are a blessing for working parents, most have a hard time financing their operations.

According to Zenkoku Byoji Hoiku Kyogikai (National Association of Day Care for Sick Children), at the end of 2006 there were 682 such facilities nationwide subsidized by the government.

"I would say probably 80 percent to 90 percent of these centers operate in a deficit," said Kensuke Yabuta of the association.

These centers come in several kinds. At those attached to clinics or hospitals, nurses care for the children and doctors are on call.

Some regular day-care centers also have separate facilities or rooms for sick children. Here, too, nurses are available, but doctors are not. As a result, these facilities usually only accept kids in the recovery stage.

There are also day-care centers, which likewise lack doctors, set up specifically to take in sick children, and organizations that send nurses to the homes of sick kids.

Yabuta, who also works in a pediatric clinic's administrative department in Osaka, said he thinks managing these facilities, regardless of the type, is quite difficult.

The clinic where Yabuta works has been running a day-care center for sick children since 1994. It operates in the red.

In most cases, medical institutions offset the deficits run up by their attached day-care centers with profits from their main operations.

A problem many centers face is that they must remain open and ready to take in sick children, even though demand may be seasonal, Yabuta said.

"There are not very many (ill children) in summer, but we can't close or decrease staff," he said.

Then when it gets busy in winter, the center has a limited capacity: One nurse can only care for two children. And a lot of such centers operate with only two nurses.

Setagaya Ward, with a population of about 800,000, currently sponsors three such centers, including Yamaguchi's. The ward hopes to support two more to meet the high demand.

"Five may not be enough, but the ward is making efforts to meet the demand and that's something. There are other areas that hardly make an effort to create this kind of day-care center," Yamaguchi said. He added, however, that subsidies fall short of covering personnel and other costs.

Subsidies vary by local government, but the average is about ¥6.6 million per center per year, according to Yabuta.

Yamaguchi's center, which has two nurses, receives a monthly subsidy of ¥800,000. It just about breaks even with a lot of cost-cutting efforts, he said.

"We don't really have a problem with the subsidy we receive, although I wouldn't say I am happy with it," he said. "I have heard that some doctors spend quite lot of their own money to maintain their day-care centers."

Subsidized centers are required to offer a fixed service fee set by local governments. In most cases, the charge is ¥2,000 per day.

While this may be a user-friendly price, if a center takes care of a child from 8 a.m. to 6 p.m., it earns only ¥200 per hour.

"If business owners saw what we are doing, they would ask 'why are you doing this?' " Yamaguchi said.

Yabuta said running day-care centers for sick children is more of a social welfare service than a business, so the government should put more effort into helping those who run or want to run the centers.

Because the centers are likely to run in the red, many interested parties hesitate to launch such services.

Hiroki Komazaki, who in 2005 founded Florence, a nonprofit organization that dispatches nurses to homes to look after sick children, also believes the current subsidy system doesn't help sustain the services.

Florence, which receives no subsidies, came up with its own price system by asking users to pay a monthly membership fee, ranging from ¥5,000 to ¥20,000 depending on the service. The fee includes the cost of the first use for that month. Starting with the second time, users are charged hourly rates.

Under this system, even if a certain season is not busy, the monthly fee can ensure some degree of cash flow, said Komazaki, who used to run an information technology company.

Florence started in Koto and Chuo wards in Tokyo and now operates in 10 other wards, serving about 300 member households.

"I think it's important to create a sustainable service system," Komazaki said. Although Florence ran up deficits in its first two years, it is expected to turn a profit in 2007, he said.

Florence also supports those who wish to start similar services through sharing information and knowhow so services are more accessible, Komazaki said, adding there is a lack of communication among people who are in the field of providing day care for sick children.

"Whether it's facility-type or nonfacility type, people in this field should communicate and cooperate more with each other," he said.

Komazaki said he established Florence after hearing about a woman who was laid off because she took several days off work to care for her sick children.

There are people spearheading solutions to working parents' frustrations, and the Health, Labor and Welfare Ministry plans to increase day-care centers for sick children to 1,500 by the end of 2009, or an increase of about 800 from current levels.

However, many think this is a difficult goal, considering the current situation.

Occasionally, a negative stigma about such facilities rears its head: Some people believe parents should care for their ailing kids themselves.

Yamaguchi said some pediatricians have voiced the same opinion.

He said it would be best if working conditions for parents were improved so they could take time off from work more easily when their children get sick.

But the reality remains that many working parents find it difficult to get days off for child care. According to a 2006 survey conducted by Nomura Research Institute on working parents, 91.4 percent of the 441 women and 79.3 percent of the 203 men said they want paid leave specifically set aside for days when their children get sick.

"Some people may oppose the idea of day care for sick children, but they may not have an alternative," Yamaguchi said. "So when I think about what I can do for working parents, it is to help them so they can work without having to worry about where or to whom to turn."

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