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DEPARTMENT OF HEALTH &. HUMAN SERVICES Office of Inspector General 

"""''''0 MemoranduJ1 JJ 199 , 

Date


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From Inspector General 

Subject OIG Management Advisory Report: Boarder Babies" (OEI-03-89-01541) 

James O. Mason, M.


Assistant Secreta


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, 

questions about the parents' abilty to cae for the babies , and a lack of cae 

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 

these sites for a perspectie on how cities of varg size and location are afected 

by crack baby births. 

Respondents included chid welfare admitrators and caeworkers, hospital social 

servces sta, priate agency representatives, foster parents, and te and loca 

offcials who had a workig knowledge of crack babies and boarder babies. 

alo intervewed a number of national expert. 

FIINGS 

Boarder babies usua have serious medca prblems 

Most boarder babies show feta exposure to drgs. Independent studies and an 

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. 

There are complex lega obstacles to placement 

Legal abandonment must be proven before placement can be made. Once a child has 

been declared a dependent of the court, it can take 12 to 18 months to begin the process 

of terminating parental rights. While most boarder babies are placed during this period 

the situation is complicated by other laws. 

For example, respondents in Washington, D.C. report that temporary emergency care 

orders signed by the mother expire in 90 days. After 90 days, the child welfare agency 

loses legal custody.If the mother can t be located, the child has no legal status. Without 

legal status, permanent placement cannot be made. 

In some instances, if no legal status for protective custody has been established, a hospital 

may have to release a baby upon the mother s request. In other cases, if the mother can 

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. 

Some cities are effectiely deag 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),. 

respondents report that they have boarder babies but are able to make timely placements. 

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 

February 1987 to August 1989. The number of boarder babies durg this period raged 

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