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DEPARTMENT OF HEALTH &. HUMAN SERVICES  Office of Inspector General 
MemoranduJ1 
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199 , 
JJ 
Date

row

From 
Inspector General 
Subject  OIG Management Advisory Report:  Boarder Babies" (OEI-03-89-01541) 
James O. Mason, M.

Secreta

Assistant 
for Health

PUROSE 
Th 
management adviory report descn"bes the extent of the boarder babies 
problem in severa cities around the country. 
BACKGROUN 
A boarder baby is an inant who remais in the hospita even though medicay 
ready for discharge. Babies stay in the hospita due to legal complications, 
' abilty to cae for the babies , and a lack of cae 
questions about the parents
alternatives. 
We obtaied new inormation on boarder babies as a by-product of a broader 
inspection on crck babies underten durig the last quaer of 1989. 
conducted site intervews with over 200 respondents in 12 metropolita are 
Chcago, Fort Wayne, Los Angeles, Miam, New York City, Newark, Oakand, 
Phiadelphia, Phoeni San Fracisco, Tacoma, and Washigton, D.C. We selected 
varg 
these sites for a perspectie on how cities of  size and location are afected 
by crack baby births. 
Respondents included chid welfare admitrators and caeworkers, hospital social 
te and loca 
servces sta, priate agency representatives, foster parents, and 
offcials who had a workig knowledge of crack babies and boarder babies. 
number of national expert. 
alo intervewed a 
FIINGS 
Boarder babies usua have serious medca prblems 
to drgs. 
Independent studies and an 
Most boarder babies show feta exposure 
expert intervewed estiate about 80 percent are drg exposed; overwhelmgly the 
drg 
is cocaine, or "crack"  Page 2 - James O. Mason, M. 
1988 one-day census in Philadelphia hospitals indicated 55 boarder babies awaiting 
placement. Six of these babies were listed as healthy. Fort-three had primary problems 
such as congestive heart failure, seizures, Down s syndrome, respiratory problems, and 
failure to thrive. Although many of these babies may have been drug exposed, only six 
were boarder babies based solely on their prenatal cocaine exposure. 
obstacles to placement 
There are complex lega 
Once a child has 
Legal abandonment must be proven before placement can be made. 
, it can take 12 to 18 months to begin the process 
been declared a dependent of the court
during this period 
of terminating parental rights. While most boarder babies are placed 
the situation is complicated by other laws. 
, D.C. report that temporary emergency care 
For example, respondents in Washington
orders signed by the mother expire in 90 days. After 90 days, the child welfare agency 
If the mother can t be located, the child has no legal status. Without 
loses legal custody.
, permanent placement cannot be made. 
legal status
In some instances, if no legal status for protective custody has been established, a hospital 
, if the mother can 
may have to release a baby upon the mother s request. In other cases
be located, a hospital may lack legal authority to release a chid even to a relative. 
Babies lacking legal status can remain hospitalized afer being medically ready for 
discharge. 
deag 
Some cities are effectiely  with the boarder baby problem. 
In the course of the Crack Babies inspection, some respondents raised the issue of boarder 
. babies. In five cities (Los Angeles, Miami, New York City, San Francisco and Tacoma),. 
placements. 
respondents report that they have boarder babies but are able to make timely 
Four cities (Chicago, Newark, Philadelphia and Washington, D.C.) report that they are 
not able to make timely placements. Respondents in three cities in our sample (Fort 
Wayne, Oakland, and Phoenix) did not raise the issue. 
New York City reported a total of 12 954 boarder babies during the 31-month period 
durg  raged 
February 1987 to August 1989. The number of boarder babies  this period 
from 312 to 547 per month. At the same time the length of overstay in the hospital was 
reduced from 38 days to 5 days. (Overstay is defined as the number of days the. child 
remains hospitalized after being medically ready for discharge.) New York City reports 
this reduced length of overstay is being maintained. 
In Miami, the number of boarder babies per day declined from 36 to 2 from March to 
June 1989. The average length of hospital overstay was reduced from 11.3 to 2.4 days.  . .
Page 3 - James O. Mason, M. 
Cities that are dealing with their boarder baby problem often use emergency foster care 
placements. These placements, sometimes involving shifting babies from home to home 
can last up to 2 years before permanent foster care placements are made. Additionally, 
some cities report using congregate care, increased foster parent recruitment and training, 
media promotions, and special placement teams. 
RECOMMNDATIONS 
We found that boarder baby problems are serious but localized. Some cities have 
developed mechanisms for addressing this problem. We believe it should be possible to 
capitalize on these successes. We therefore recommend that: 
the Offce of Human Development Servces and the Public Health Servce identif 
effective practices in those cities which have reduced their boarder baby problem 
and disseminate this information to other cities which need it. 
the Public Health Servce support research on ways to reduce boarder baby hospital 
stays. This could be done, for example, through the Early Childhood Intervention 
program. 
implementation of these recommendations could result in reduction 
of hospital overstays 
and faster placement of hoarder babies into appropriate care settings. 
In accordance with the Department' s confict resolution procedures, please provide a plan 
of action for implementing these recommendations within 60 days of receiving this 
memorandum, or explain why it is not possible to do so. 
If you nave any questions, please call me or have your staff call Alan Levine at 
FrS 619-3409.  t cl . 
Identical memo sent to the following: 
James O. Mason, M. 
Assistant Secretary 
for Health 
Martin Gerr 
Assistant Secretary for 
Planng and Evaluation 
Gail R. Wilensky, Ph.

Administrator 
Health Cae Financing Admistration