When Johnny Met Rosie--Women in EMS Part 3: Child Care & Shift Work

By the time I was pregnant with my son, I had been a night person for the better part of a decade. I worked nights by choice, not necessity. My life was developed around my lack of any organized sleep schedule. You know (or are) the breed. Night people cannot usually tell you the accurate date, because their shifts straddle two sets of numbers. Factor in shift work, when you work every other set of days, even those lose significance. Weekends don't mean that much to many EMS people--they're just days with more traffic, or less. Unless they work to counteract it, night workers have that slight pallor that comes from a life under artificial light. They are startled by bright colors and have a hard time navigating their own primary area during the daytime because it is unfamiliar terrain to them in the sunlight.

I spent a total of 14 years on nights, 7 pm to 7 am, and it remains my preference. I just prefer the rhythm and dynamic that comes with it, even if it is murder on your health and family life. Fortunately, my husband was of the same mindset, and we prowled the nights together, a happy pair of nightcrawlers eager to go home each sunrise and sleep the day away. Our entire routine revolved around a schedule that was essentially opposite the rest of the world, and that was just fine with us.

And then I had to go and get pregnant…

After the realization of this impending major life change came the obvious question: What are we going to do for child care? My husband and I worked a matching schedule--12-hour shifts, at night. Relatives were not an option; his lived 6 hours away and mine…well, you've never met my relatives or you wouldn't be asking that question.

Good friends will always help when you need them, but what you're looking at here is long-term commitment. This is a significant task, especially if you're considering maintaining an alternative schedule. There are the additional logistics of overnight arrangements, getting the baby to and from where they need to go and contingency plans for when something goes haywire. Without a formal arrangement, I'm not sure it's something that should be considered (at least if you want to keep the friendship).

Plus, I don't know about where you work, but here in the Garden State you will be hard-pressed to find a paramedic with only one job--most work at least two and in some cases three. Keeping all the schedules and availabilities balanced can be a Herculean task. It's even more fun when both of you are in the same business (see last month's article).

So what's a girl to do? Well, it's time to investigate reliable options and look for viable solutions that will not cripple you financially in the process.

How Bad Is It?

According to "Parents and the High Cost of Child Care: 2010 Update" prepared by NACCRRA (National Association of Child Care Resource & Referral Agencies), since 2000, the cost of child care has increased twice as fast as the median income of families with children. In 36 states, the average cost of center-based infant care exceeded 10% of the state's median income for a two-parent family. That's 10% of BOTH your salaries.

How Much Are We Talking Here?

• The average annual day care center cost for full-time care of an infant ranges from $4,550 (in Mississippi) to more than $18,750 (in Massachusetts).
• The average annual cost for full-time care in a family child care home for an infant ranged from more than $3,550 in South Carolina to more than $11,450 in Massachusetts.
• The average annual cost for PART-TIME care for a family child care home for a school-age child ranged from more than $1,800 in Mississippi to more than $9,400 in New York.

That's for one child.

How Does That Compare?

• Regardless of region, the average center-based child care fees for an infant exceeded the average annual amount that families spend on food.
• Center-based child care fees for an infant exceeded annual rent payments in 24 states.
• Center-based child care fees for two children (an infant and a 4-year old) exceeded annual rent and mortgage payments in 18 states.

And ready for this one? In 40 states, the average annual cost for center-based care for an infant was higher than a year's tuition and related fees at a four-year public college.

There is a definitive difference in cost, depending on what region of the United States you live in. Massachusetts, New York and Minnesota are the top three for least-affordable states for full-time infant care in a licensed day care center.

If a day care center is your primary option, do not settle. Get references, meet the people who not only run the facility but who will actually be directly responsible for your child. Use the list of questions below to your full advantage. If you are not satisfied, do not compromise or feel you must.

That's insane! I'd be working just to pay the fees! What about finding someone who runs child care services out of their home?

It's true, in most instances family child care homes are less expensive than centers; however, that comes with a significant caveat. The quality of care in many of those homes is virtually unknown because licensing requirements vary widely by state. Much of that care may be exempt from licensing regulation or any oversight. For example, 24 states allow providers to care for five or more children before a license is required. In South Dakota, the threshold is set at 13, so a provider may take on 12 children without ever obtaining a license. If the home does not meet the threshold for state licensing requirements, they are also not mandated to meet other basic standards, such as health or safety, background check or training. They aren't inspected and therefore cannot be evaluated.

(You can access the full report at www.naccrra.org/docs/Cost_Report_073010-final.pdf.)

Questions to ask your potential child care provider (center- or family-based):

• Are you certified/licensed/accredited?
• What is the child-to-adult ratio? What is your turnover rate?
• What is your level of education? Are you (and/or the staff) certified in infant CPR? First aid?
• What are your security/emergency procedures?
• What are your sick child policies?
• Will I be charged for days where my child is absent or if I need to pick them up late?
• What is your discipline policy?
• Which holidays are you closed? Is there a back-up provider?
• May I come in unannounced to observe my child? (Steer clear if they say no or have a strict visitation policy.)

Holy cow, thus far the options are expensive and/or frightening. How do I know where to look?

You need to evaluate your base needs first. If you are going to be returning to your previous schedule, what does that mean as far as care hours needed? For example, I work a 12-hour shift with an hour commute each way. Factor in time for dropping off and picking up, and I am looking at a need for approximately 15–16 hours at a time. Working nights, there is the whole … "I should get some sleep before I die" issue. So, in theory, I would need an entire night PLUS a few day hours if I want to remain functional.

I'll just sleep when the baby sleeps. OK, let me know how that works out for you...because I can tell you how well it doesn't work for hundreds of women just like you. Believe me, your family and your patients will thank you for actually getting some rest.

Let's face it, if you are going to remain full-time nights and you do not have some type of private arrangement, your chances of finding a day care center or even a family-run child care home that can accommodate a regular night schedule are close to impossible. I will also say that my personal preference is for my children to sleep in their own beds at night.

My family will help; they have told me so time and again.

There is nobody who loves your children more than you do, but the grandparents usually run a close second. That is because they get to give them back. Yes, they will help you, but if you are talking full-time hours, long term and especially at night, make sure that 1) your family is completely in agreement and committed to that level of help, 2) they have the resources to do so, and 3) you have a back-up plan when they aren't available. Eventually, they will need a break.

If you have a good relationship with your family and they are close enough to help, that is absolutely invaluable. Never take it for granted. Even if they are just there in case of scheduling emergencies (which we all know will happen), it is a weight off your shoulders to have such a safety net.

My friends are the best. I know they will be there when I need them.

Absolutely, nobody rocks more than your BFF. But just like never lending money if you want to keep a friend, I imagine leaning on them for full-time child care is likely in the same category. Talk with them first to find out if they're interested, or even available as back-ups.

Whether or not you are using formal child care, I cannot stress how important it is to have solid contingency plans. The "late job" is the nature of the beast we live with. You cannot count on coming home on time. In extreme circumstances, that "late job" could mean a day or more if a disaster is involved. Before you return to work from maternity leave, have a plan.

Do I have any other options that might allow me to stay on nights, or where I won't have to worry about flexible hours?

There is always the option of hiring in-home child care. Traditionally, a formal nanny is one of your more expensive options. When you hire a nanny, you become an employer, and there are additional considerations like income taxes, benefits and insurance. The upside is flexibility, the ability to keep the children at home and to have care provided to your requirements. Downsides, outside of cost, include the legwork, agency or not, background checks, additional duties, arrangements for time off, etc.

Even if you are not hiring a full-time nanny, there are plenty of alternative arrangements if you're willing to look. There are many resources that you can use yourself or agencies that will assist you in locating compatible care. Examples include (in no preferential order): www.sittercity.com, www.collegenannies.com and www.greataupair.com. Resource sites can help you match specific hours or needs, including things like housekeeping, pets, tutoring, language needs, etc. Some sites will do the legwork of background checks for you, or they will link you to reputable agencies that can assist you.

Do not rule out the local colleges either. The "starving college student" isn't just a myth; there are plenty of them out there looking for steady work, who are reliable, close by and have some flexibility in the evenings. Remember, though, that their schedule may fluctuate per semester and they could be unavailable during the summer months. Don't be afraid to approach the local school and contact student services for suggestions. (Tip: Many college students enlist on sites like Sittercity, which include their availability and references.)

If you have room in your home and are willing to have a reciprocal agreement, consider bringing in an au pair. Governed by rules set by the State Department, au pairs come over on a modified student visa. They are between 18 and 26 years of age and can stay a maximum of two years. In return for room, board and other amenities outlined by the State Department, they provide flexible child care and light cooking/housekeeping for up to 45 hours a week. You pay a stipend that is equivalent to the current U.S. minimum wage. They are paid by the hour, not by the number of children. While there are some significant fees in the beginning, plus the monthly stipend and other costs, most of the costs can be subsidized by a child care FSA (if your employer offers one), which works out over the period of one year to be approximately $3,000 cheaper than full-time day care for one child.

The downside to an au pair is that the screening can be difficult, since you have to settle on a choice after a series of phone interviews only. However, if you're working with a reputable agency, they will be of tremendous help in making the selection, and they monitor the au pairs year-round, acting as a liaison for the au pairs and their host families. It should be understood that there are also requirements for the host family. Au pairs come over for a variety of reasons, but most come to learn about America, increase their education and improve their English. You can find out more about au pair arrangements by visiting any of the major sites. Two that include lots of information are www.aupaircare.com and www.culturalcare.com.

(Sigh) I am going to have to come off nights, aren't I?

Perhaps not. The circumstances listed above operate under the initial assumption of a single parent or identical schedule situation, since they do exist and would absolutely have the hardest time of it.

In a two-parent household, schedule compatibility is the key to success. If you are unable to accommodate both of you working the same hours, something (or someone) has to give. If this means changing tours or jobs, so be it. After all, you can't just put out a hamster feeder filled with formula and some newspaper down in the kitchen and hope for the best until you come home. (No really, you can't --the formula clogs up the little ball in the drinking tube.)

If opposite schedules are possible, they can often be your most cost-effective bet. One parent is always with the child and very few external resources are necessary. The downside is that you will lose some personal time with each another. It can be hard to maintain intimacy when the bulk of your exchanges deal with grocery lists or giving a report on the household and child in passing, much like you report the condition of your truck to the oncoming crew. The advice here is to set your days off together each month as absolutely sacrosanct. This can be harder than you would think--life always wants to get in the way. Some weeks you may have to count your time off together in blocks of hours, not days, but do not write them off as not counting or not enough. They have to be enough, at least for now, so put your energy into making them count.

Most situations don't always allow for completely opposite schedules, so evaluate carefully where your overlaps will be. What are the hours, what will be easiest, should you do the infamous hand-off in the parking lot?

Does your facility support child care, and if so, what are the hours? If you are hospital-based, they will likely not accommodate overnights, but they may have extended hours to cover the large number of shift workers in the facility. If they have part-time coverage available, this may help you on the days during the week when you come up short for care.

Well, if I need time off for child care, they have to give it to me anyway, right?

We are fortunate in that most employers today are far more forgiving when it comes to child care issues, but the reality is that nobody has to give you anything. There may be policies in place that can assist you, but the shift has to be covered by someone. If child care results in your excessive absenteeism, it is not a stretch to say that you could risk losing your job over it.

Communicate with your manager. If you have a relatively reliable arrangement in place that might need a little flexibility from time to time, talk to them in advance. Speak to those you relieve, make sure that they understand what's going on, and do not take for granted that someone will be able or willing to stay for you all the time.

Be informed about the policies and processes that are in place to help you. FSAs (Flexible Spending Accounts) help you defer some of your money pre-tax into an account that you can then draw from for either child care or medical needs. Budget these out carefully and know what your anticipated spending will be. Money left over at the end of the year does not come back to you.

Some departments not only understand what a stressor child care can be, but they try to anticipate when it would hurt the worst. In Onslow County, North Carolina, an after-action review in the wake of Hurricane Isabel in 2003 overwhelmingly revealed that their providers were impacted by not having reliable child care, especially during a natural disaster when it was needed most.

The end result was a partnership with the Onslow County Partnership for Children, which implemented a process by which, during a disaster, child care would be provided for EMS workers who needed it in an approved family care home. I would love to see this happen in more counties nationwide.

The heck with this; I'll just stay home.

In all honesty, depending on your circumstances, that might be financially feasible. If you sit down and figure out what you will spend each month on child care versus what you are currently bringing in, it might actually work out on paper if one of you were to stay home or at least change your status to part time or per diem. I have friends who work two jobs, and their entire per diem paycheck goes to their day care fees.

It has actually been proposed to me that the reason many women do not stay in the business as long as their male counterparts is simply because they eventually give it up to spend time with their children. I have no hard proof of this, but I can see that it might have some validity.

I have been fortunate thus far. I had some extra room, so I struck a deal with a good friend before my son was born. In return for room and board, he would watch my son while my husband and I were at work. Because we were working nights, he was pretty much able to have a normal life and still ensure that my son was well cared for. He was with us for three years and is the only reason I was able to stay on nights.

When he finally moved back home, we tried the au pair route. The flexibility of home care is unbeatable, but there was still a financial and personal cost. At approximately $12,000 a year, it was a costly proposition, and it broke our hearts to see the girls go when it was time. If you do have the means and the room, I recommend this as an option worth investigating.

Before our first au pair, I had been sleeping an average of 3 hours between shifts. The day she started, I slept 8 whole hours (unheard of). I leapt out of bed, hyperventilating because I'd overslept and not gotten my son. I came downstairs to … quiet. The laundry was folded, my son was sitting at the table coloring, and she was making me a cup of coffee and quietly humming to herself. I will admit that for a brief moment, I worried that I might be dreaming, or dead.

When our second au pair left, we simply couldn't afford it anymore. We've been working opposing schedules for a couple of years now. It is draining on our personal time, but we carve out niches for ourselves and stick to it. Who needs to sleep when there are sports and dance and Scouts and groceries and laundry and every other little thing every one of us does to keep our families whole and functional.

After all, it's not like we have a choice.

Tracey A. Loscar, NREMT-P, is the training supervisor in charge of QA at University Hospital EMS in Newark, NJ. Contact her at taloscar@gmail.com.

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