Fatalities are concentrated in home-based providers. Officials are trying to find out why.
The number of children dying in Minnesota's licensed child-care facilities has risen sharply in the past five years, from incidents that include asphyxia, sudden infant death syndrome (SIDS) and unexplained causes.
In that time period, 51 children have died in licensed child-care facilities, most of them infants. That's more than double the 24 who died during the previous five years, according to records maintained by the state Department of Human Services (DHS).
All but three of the deaths over the past decade occurred in family child-care settings, which include about two-thirds of the Minnesota children in licensed day care. Family providers are licensed by the state but, unlike larger center-based facilities, they operate out of private homes and usually have a single caregiver with little outside supervision.
Already this year, there have been six deaths in licensed facilities, all of them in family care.
"If we have this many children that are dying in the care of a licensed provider, it's time for us to take a very serious look at this to figure out what is going on," said Jerry Kerber, DHS inspector general, who heads the licensing division.
No one knows why day-care deaths have risen, but one cause might be a regulatory change several years ago that loosened SIDS prevention standards in Minnesota, said Kathleen Fernbach, director of the Minnesota Sudden Infant Death Center.
The state used to require a doctor's approval if a child-care provider was going to let an infant sleep on its stomach, but the Legislature changed that requirement to parental approval.
"We shouldn't be trending up,'' Fernbach said. "We should be trending down -- so trying to get a handle on what are all the factors that are contributing to this trend is concerning."
Last month, a facility in Coon Rapids where an 8-month-old boy had died was cited by the state for failing to follow SIDS-reduction guidelines. It was unclear whether the infant mentioned in the regulators' citation was the one who died. Officials would not release additional details, citing the ongoing investigation.
Industry leaders point out that thousands of family providers care for children every year without incident. And many parents prefer family-based providers because of their lower fees and homey, neighborhood settings.
The increasing number of deaths, however, has caught the attention of licensing officials at DHS, who say they have begun closer monitoring of violations at home-based child-care settings and are considering stronger licensing rules.
In the licensing division's annual report for 2011, regulators noted eight cases in family care where an infant died in a home with a suspected licensing violation. The deaths were part of an array of serious licensing violations noted in the report.
The agency, which oversees child-care licensing across Minnesota, has already revamped its communication system with county regulators, who conduct inspections of family care facilities, to help improve response times for suspension orders when there is immediate risk of harm to children.
In addition, a proposal before the Legislature this session would increase skills standards required before an applicant can get a child-care license.
DHS is also beginning to analyze the increase in deaths with hopes of spotting patterns to develop solutions. And it is stepping up communications with county regulators and family care providers to emphasize safe sleeping practices.
"This is very serious," Kerber said. "Obviously our licensing standards are designed to promote the health and safety of kids in care above all other goals.''
The family child-care industry has taken issue with any suggestion that their homes are unsafe, noting that only a tiny share ever has licensing violations and arguing that they are being unfairly portrayed. In a recent meeting with DHS officials, representatives from the industry voiced concern about the release of death and license suspension statistics, saying the figures were not placed in proper context.
Family providers point out that Minnesota has more family care homes (11,500) than center-based child-care facilities (1,600), and they care for more children.
"When you do the math, if you present that appropriately, there's actually fewer deaths per program in family child care than per center," said Katy Chase, executive director of the Minnesota Licensed Family Care Association.
Chase and others say the number of sanctions proves that the system is catching those who break the rules. They also say Minnesota's two-tier inspection system -- with the state inspecting centers and counties inspecting family-based facilities -- can lead to disparities in enforcement.
"It's always devastating to hear about any caregiver not doing the best that they can for children," Chase said. "My reaction is again to be careful of the actual numbers of children being served versus these horrible incidents.''
Enrollment figures, however, don't seem to explain the stark disparity in deaths between home-based child care and center-based child care.
Across the state, 91,370 children are enrolled in family child-care facilities and 60,890 children enrolled in center-based care, according to figures compiled by the Minnesota Child Care Resource & Referral Network. Data also show only a slight disparity in the number of infants cared for by home-based facilities versus center-based facilities.
Chad Dunkley, president of the Minnesota Child Care Association, which represents center-based operations, said his organization has long believed that centers had fewer serious licensing problems than family providers. But it wasn't until DHS started posting licensing actions online in 2010 that the disparity became clear, he said.
Dunkley said centers have more rigorous staff education and training standards than family care homes. He said children are segregated by age in centers and the youngest ones are always within sight and sound of an aide, which is "near impossible" in a home.
"As a result, the facts kind of speak for themselves," said Dunkley, who is chief operating officer at New Horizon Academy, which operates more than 50 centers.
Kim Bartick, president of the Hennepin County Licensed Family Child Care Association, said she believes family child-care homes are safer than centers, and said she knows family providers who have left center work because they believed it was not as good an environment for children.
Bartick said family care providers undergo training on safe-sleeping procedures and SIDS prevention, and that she always follows SIDS best-practice guidelines, even if parents request otherwise.
"It's a huge risk," said Bartick, who operates a family care facility out of her Bloomington home. "Not only liability-wise, but for the child as well. I just show them statistics and say this is why I won't do it. For the safety of your child, while in my care, I prefer not to have them sleep on their tummies.''
Brad Schrade • 612-673-4777