Helping disabled children go home - hospital boarder children

They're called "hospital boarder" children--severely disabled children who remain hospitalized months--even years--after they're medically ready for dicharge. They are those without families or whose families can't meet the complex economic, physical and emotional demands of bringing them home. The number of childre in this category is increasing in the United States. Their developments disabilities, along with a range of social, ethnic and environmental considerations, make care and discharge difficult.

New Alternatives for Children, Inc. (NAC), a non-profit social service agency in New York City, was created last December to act as a bridge between hospital and home, provide family support, and be a link between the family and other medical and social services needed to care for such a child at home.

Arlene Goldsmith, executive director of NAC, observes: "We delieve that when intensive, multidisciplinary social services are made available to families, a large percentage of children who are hospitalized can return to their own or substitute families. By offering a wide network of services, and by recruiting, training and licensing its own adoptive and foster families, NAC promotes more timely and appropriate discharges, enhancement of child/family adjustment and relationships, and the integration of these children into their own communities. Until now, no single agency has had the personnel, resources or time to provide these services."

NAC uses a team approach, which Goldsmith calls "a more effective and creative approach" to problems faced by the children and their families. Each Family--whether biological, adoptive or foster--works with a specially trained social worker, physician, nurse practitioner and, often, a homemaker. Services provided vary with each family and may include arranging for orthopedic or neurological consultations; finding a specialized dentist; acting as advocates with the welfare system, Medicaid or legal problems; and arranging special school transportation, recreation and respite care.

Clients include children from infancy to age 18 whose chronic physical impairments and socioeconomic circumstances are delaying their hospital discharge, those who are unable to return home or to another appropriate setting, and those who have completed in-hospital care and are ready to live in the community with support services. During the first year, NAC expects to serve 20 to 30 families in the metropolitan New York City area.

Goldsmith concludes: "Studies confirm the extremely negative social and fiscal consequences of continued hospitalization of children after they are ready for discharge. The verified average cost of hospitalization for a 'hospital boarder' child is $345 to $550 a day. Since this is a nationwide problem, replication of our model can be expected."

Funds for the program have been provided by the New York State Department of Social Services, Citibank and private foundations and donations. Further information is available from Mrs. Arlene Goldsmith, Executive Director, New Alternatives for Children, 149 Madison Ave., New York, N.Y. 10016.

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