Extra Charge For High Needs Child???

[MN Day Mom]

You are awesome, Blackcat. Thank you for taking the time to do some research.

The only thing I'm questioning, is that it seems this was written for child care centers - not in-home daycares. I could be wrong though.

Here is what I found....http://www.mnchildcare.org/issues/ada.php

[Blackcat31]

Here is what I found....http://www.mnchildcare.org/issues/ada.php

Since diabetes can be either Type 1 or Type II, there are certain requirments that each provider must follow in each state and EVERY single state differs in those rules and regulations.

As Sharlan mentioned, California does NOT allow child care providers to administer insulin or glucagon injections where as Minnesota does allow it.

I also think that having diabetes, as ohters have stated, doesn't automatically mean someone is disabled therefore, not always having to follow the rules and guidelines of the ADA.

I know from experience that having Type I diabetes is a whole different ballgame than having Type II. Each requires a completely different type of care. Then if you add having an automated pump, the rules again would be different. So I would automatically assume that different rules/regulations would apply in almost every situation.

[Kelly]

How much time does it take to deal with this child's diabetes? My son has Type 1 diabetes and I have never found it to take an excessive amount of my time.

[MarinaVanessa]

Actually the ADA separate FCC from center care in two groups:

Right. Each have their own conditions but either way they are both covered under the ADA. That's the point that I was trying to make since you had already covered the differences.

this has nothing to do about disability, its obvious that this child needs 2 people to care for her. Sometimes you can't be everywhere and monitor this childs diabetes, so this is where a second person is required.

Yes, she can always hire another staff member and bill the parents for the extra money that this will cost or she can bill them just a portion. The only problems that I can think of with going this route is that the parent's may not be able to afford to pay the tuition and the full amount of money for the other staff member. Also if the parent's are billed for the full amount of the new staff member then this staff member's responsibilities need to be with only this one child. If the parent only pays for a portion of the cost then the staff member can be given other duties to do when she's not assisting this child.

If a new staff member is not hired then she won't be able to charge more without risk of a potential lawsuit because the staff member is already employed and so asking an already employed staff member to take on more duties to care for this child would constitute "reasonable accomodations" to me. Giving one staff member more duties does not itself cost more even though the staff member may not like it. Paying the staff member more may keep her happier but it in itself is not necessary, it;s something extra that the provider can offer to help keep her employee happy. If her employee quits because she doesn't like the added duties another employee can be hired and told from the beginning that this child will be a part of the duties and still be paid the same wages as the previous employee. I've worked at centers and administering medication while getting paid minimum wage is typical, it's not special (although of course here in CA only a nurse can administer a shot).

I'm thinking about this from a subjective viewpoint because if something like this goes to court then I see something like this happening:
Judge: Why did you charge them more?
Provider: Because I had to give my staff member more duties so I gave her a raise so she wouldn't quit.
Judge: Why didn't you just hire someone else willing to do the work for the same price if your staff member quit?
KWIM?

Oh and I wanted to add ... could you see this as a selling perk? If you employ someone that familiar with administering shots and medication or train one of your employees to be really familiar with administrating shots and handling medications and treatments you can potentially attract more parents that have these needs. You can have a special niche so to speak. It sounds like a lot of responsibility but if your staff is properly trained then it's not so scary. I had never had a DC kid with any type of medical condition until I recenty took on a child with a peanut allergy. Everyone told me about the liability and I took this very seriously. I went as far as to speak with the child's physicial to get a run-down of how to prevent an allergic reaction and I took a small class through Rainbow Connections (our local special needs parent's group) which covered peanut allergies specifically. I paid a small $45 fee for the training but I now feel that I know more about it and how to prevent and react to reactions and that makes me feel ALOT better. SOmetimes just not knowing is scarier than actually doing it KWIM?

[texascare]

How much time does it take to deal with this child's diabetes? My son has Type 1 diabetes and I have never found it to take an excessive amount of my time.

It isn't that difficult. Did the OP know this child had Diabetes before accepting them into care? I lost the name of the OP in all the posts....sorry.

[SilverSabre25]

It isn't that difficult. Did the OP know this child had Diabetes before accepting them into care? I lost the name of the OP in all the posts....sorry.

From the sounds of it, this child needs quite a bit of care and watching--this is by the OP, who btw is CheekyChick and this is from post #25

She is not overwhelmed or afraid to care for her, she is overwhelmed by the time and responsibility it would take to care for her AND 9 other children. For example: She has to be tested in the morning, tested before morning snack, tested before she plays outside, tested after she plays outside, tested before lunch, tested during naps, tested before afternoon snack. Oh, and tested it it is too cold outside or if she's acting different in any way.

It is not only the testing, it is watching her like a hawk for signs of going low, agitation, stomach upset, sweating, etc. It is also responding to the parents who call or text throughout the ENTIRE day with questions/concerns. It is also sitting with her at every meal, encouraging her to eat enough because she has to be full enough to last until the next meal/snack which HAS to be spread 3 hours apart, and then calculating the carbs. It is making sure she doesn't eat anything from someone else's plate (not easy for a 23 month old). The list goes on and on...

Those are the reasons it would be fair to my Assistant to get a small wage increase for the additional work. It truly is a HUGE job.

[texascare]

Thank you SilverSabre25...my thought was did she know about the medical condition before she accepted the child into care? I was wondering what the parent would think if the provider came back after knowing all this and raised the rates? No dealing with a type 1 is not that difficult as my son is type 1. Do we then raise rates on a child who has asthma and needs breathing treatments or a child who has an allergy to certain foods? Just thinking.

[MrsB]

Over the years I have had several children with special needs. In fact I pride myself in always trying to have one or two children with special needs enrolled, usually Aspergers or Autism. Along time ago when I ran my contract by my lawyer, he suggested I word my contract, that my rates are based on the needs of each child/family. Same as the contract has custom hours to meet the families daycare needs, the rate is a custom rate based on the hours/days/ and needs of the child. Also in my contract, I have that at anytime the rates are subject to change based on me meeting the needs of the child, if the parents dont agree then they have the option to give two weeks notice and find other care. My rates are not based on the disability itself, but the needs of the child. I am totally up front with my parents about this. In my experience when you are up front with parents and communicative with parents who have children that have special needs whether it be a disability or not, they are very receptive as long as they dont see you as just trying to nickle and dime them. To justify the rate increase you have to provide examples of the extra time spent.

I have charged more on screaming infant, a child that isn't potty trained, and a child that increased their time at daycare because they required more attention than my base rate, same as I might consider raising the rate for someone that required special monitoring whether they had a qualified "disability". But you can't just have a "disability rate".

My opinion for this case is either you do as a previous poster suggested and get an additional assistant and charge the parents more, just let it go, or change everyones rates to those based on needs.

[countrymom]

From the sounds of it, this child needs quite a bit of care and watching--this is by the OP, who btw is CheekyChick and this is from post #25

thats ALOT of care for a child. By the sounds of it, you truly need another helper just to deal with her diabetes. For those whose kids are diabetic, is this normal to do so much testing and such, I've only worked with older adults (when I was a nurse) and we never did that much testing. And why test if its cold outside.

[SilverSabre25]

thats ALOT of care for a child. By the sounds of it, you truly need another helper just to deal with her diabetes. For those whose kids are diabetic, is this normal to do so much testing and such, I've only worked with older adults (when I was a nurse) and we never did that much testing. And why test if its cold outside.

I was also wondering how much of it is medically necessary and how much of it is her parents being overcautious and over-protective.

OP, I think that if you were to word your rates as one poster suggested--that they are based on family/child's needs, then you could probably manage to levy the charge a bit higher to compensate for the much higher level of attention and care that their daughter needs. You might want to consult a lawyer though, to be on the safe side.

Are there any other things you could do that would help ease the strain on her teacher? What about moving kids around so that the teacher has 1 or 2 fewer kids in her class, or could you go in and take care of the testing and some of the other care?

[wahmof3]

In my state (Ohio): My state assistance program pays 5% more for special needs. A form signed by a doctor stating the special need is required.

[Unregistered]

It wouldn't matter if it was legal or not, charging a sicker child's parents a higher rate wouldn't sit right with me.

It's not their fault she's sick, and the price their child pays in life enduring her illness is infinitely high enough.


I'm sorry but IMHO you need to suck it up. Some kids need almost no care at all, they are smart and play well, are well behaved, eat well, clean up after themselves...then there are those who need loads of extra supervision because they can't play independently, are into and onto everything, are picky or messy eaters and buck clean up every single time. There are also those with long hair that need tending to throughout the day. Those who wear glasses or hearing aids that need special attention. Those with eczema that need creams put on daily. Those with allergies who need medications administered and reactions monitored etc. etc. etc.

If you start nit picky charging for everything that adds a bit more to your plate you better start doing that for all AND be willing to discount the parents of the easy streeters to boot.




DHS in MN has instituted DOC rates for special needs kids in foster care. Is that what you're talking about? Children that become wards of the state are assessed, given a number and that number corresponds with a reimbursement rate beyond the regular daily rate. Sure, if I've got a drug addicted detoxing newborn who doesn't sleep but two hours a day, needs to eat a specially prepared formula every one to two hours, baths several times a day to keep their bottom clear of the feces that literally burn their skin, doctors appointments several times a week and specialists coming into my home almost daily then that child will have a higher DOC number and I'll be reimbursed for the "extra" care I need to provide.

Not that it's necessary, I certainly didn't need or expect to make more money off the backs of sicker kids as opposed to healthy ones.

I don't know how that would relate to daycare though. Unless perhaps that child's rates are paid via county assistance?


K-12 teachers don't make more for kids in their classes that are more "difficult" to teach or handle. I'm not sure why preschool teachers should be able to.




When you talk about "giving" a wage increase to the next teacher just because she was a bit more work for you....frankly, I'd sue if I was the girl's parents and I was ever presented such a notion.

AMEN I completely agree with you and glad there are daycare providers like you. As a parent of a special needs child I would NOT be happy to find out I had to pay a higher rate because my child was more work.

[thatdivalady]

As one poster above stated, my rates are based on individual/family situation and needs of the child. I charge more for a preemie infant because they usually require more care. I charge more for an infant who is under 6 weeks old for the same reason. It's all based on what that particular child's needs are. I think if you word it that way and make it a common practice to apply those principles across the board it is not discriminatory.