The Exceptional Parent, February 2000 | Go to article overview


Nurse Janet Carroll is the EXCEPTIONAL PROFESSIONAL behind Nurses 'n Kids, Inc. daycare that provides a cost-effective alternative to extended hospital stays for children who are technology dependent.

Witnessing the smiles and giggles of the children seated at the little tables at Nurses 'n Kids, Inc., in Delaware, observers might think they were standing in any daycare center. Nurses 'n Kids, however, is a state-run pediatric daycare facility for children who are medically fragile.

Nurses 'n Kids was started by Janet Carroll, a pediatric nurse. Janet identified the need for such a program while working as a NICU (neonatal intensive care unit) nurse. Janet recalls her encounter with parents who were concerned over their daughter's pending discharge from the hospital. "The mother explained to me that the daycare center they had chosen for their daughter would not accept her because of her medical needs. Their daughter had been diagnosed with cerebral palsy and had several apneic episodes (the temporary cessation of breathing) while in the NICU, and therefore, would be going home on an apnea monitor. Both parents needed to work, so it was not an option for one of them to quit to take care of their child. That night, I went home and started thinking. There had to be options for this family and all other families who, unfortunately, would face similar crises."

How to make dreams come true

What Janet had in mind would not be simple, and would require major planning as well as backing from other sources, such as state government agencies. She did some research and found a program in Florida that provided the kind of high-level services she hoped to make available in Delaware. After visiting the facility there, she learned that it was made possible under legislation passed in Florida called Prescribed Pediatric Extended Care, or PPEC. Janet explains, "The purpose of PPEC was to reduce the financial burden associated with chronic illness; ease the loneliness of homebound isolation; and lower the number of hospital admissions for chronically ill children. Referrals to the facility came from hospitals and physicians."

Most children who receive services at PPEC centers require sophisticated technological interventions. Without this support, these children would have to remain hospitalized to receive the level of care they need, even though they are stable enough medically to be discharged. The costs associated with extended hospitalization can be devastating to a family. PPEC centers represent an alternative to this. Facilities are staffed by experienced pediatric nurses who can provide the prescribed technological care for their clients. In addition, prescribed therapies (physical, occupational, speech/oral, and motor) are provided on site by registered pediatric therapists. Centers support the children until they are healthy enough to enter mainstream child care.

According to Stephen Towne, RN, Director of Nursing at Nurses 'n Kids, shortly after the first PPEC Center was opened in the United States, independent evaluators found significant differences when healthcare expenditures of families with children receiving PPEC services were compared with control families--those whose children either remained hospitalized or were receiving in-home care. PPEC families also reported dramatically lower stress levels than those of the control families. Towne adds, "Results of this study support the cost effectiveness of PPEC."

Findings like these helped support PPEC as a worthwhile endeavor. Working with Delaware's Department of Health and Social Services, Janet enabled similar PPEC laws to be introduced into the state legislature. Janet was subsequently asked to help develop the rules and regulations for PPEC in Delaware, paving the way for her dream to become reality. In 1988, Nurses 'n Kids opened its doors and has been growing ever since. Janet recalls, "In May 1990, the facility obtained a contract with Medicaid for PPEC, and soon the first expansion took place to accommodate the numbers of clients that needed PPEC services. …

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