"In Tennessee, chronically hospitalized minors under DCS care extend stays due to lack of placements. One child spent 276 days, exceeding discharge date. H
TENNESSEE: Chronically Hospitalized Minors Languish Due to Lack of Placements by DCS
NASHVILLE, TN - Minors under the care of the Tennessee Department of Children's Services (DCS) are spending extended periods in hospitals, with some remaining for months, despite being medically cleared. This situation arises due to a lack of alternative accommodations for the minors, leading to the occupation of hospital beds that could be utilized by other patients, particularly during periods of increased demand.
One child spent 276 days at a children's hospital, exceeding the discharge date, while some hospital officials have expressed concerns about becoming de facto shelters for children that DCS is unable to place. The Children's Hospital Alliance of Tennessee (CHAT), which represents children's hospitals across the state, stated these children account for "many hundreds of additional days in which hospital care is not needed."
TennCare, the state's Medicaid program, covers the costs associated with hospital care for minors in DCS custody, but declined to disclose the exact amount spent on extended stays. The Department of Children's Services (DCS) attributes the difficulty in placing these children, who are medically fragile, in foster care and explains that they cannot be housed in DCS office buildings like other children due to their medical needs.
The situation often begins in a pediatric emergency room, where a DCS caseworker brings a child with a genuine medical issue, typically removed from an abusive or neglectful home. Once the hospital determines the child is ready for discharge, DCS reports they have no suitable placement available. State Senator Heidi Campbell (D-Nashville) expressed concern upon reviewing the details presented to her, stating, "Our state is failing. I think we've failed these children and we've quite frankly failed DCS."
Examples of such cases include a 10-year-old with Muscular Dystrophy who stayed for 103 days at the East Tennessee Children's Hospital in Knoxville, as DCS was unable to find a placement for the child following his mother's incarceration.
A 10-year-old boy with severe autism spent 51 days in a hospital due to the unavailability of appropriate care following his father's COVID-19-related death. Subsequently, he was transferred to an out-of-state facility due to Tennessee's Department of Children's Services (DCS) lacking suitable accommodations.
Similarly, an insulin-dependent diabetic child remained hospitalized for extended periods because DCS declined to take the child to their office due to the necessity of administering insulin shots. Senator Campbell expressed concern, stating that such a choice between office floors and hospitals was unreasonable.
A child with a mental health diagnosis stayed at Vanderbilt Children's Hospital for 270 days from May 2021 to February 2022, while another child remained in a hospital in Johnson City for 243 days beyond the expected release date.
DCS Commissioner Margie Quin, who assumed her role in September, confirmed during budget hearings that the agency has received calls from hospitals expressing concern over children staying long-term. Quin noted that these children, who are difficult to place due to their complex needs, often stay for more than 100 days in hospitals, which are not conducive to their recovery, and are inappropriate for transitional homes.
DCS is facing a shortage of foster care homes, resulting in some children sleeping in office buildings. A DCS attorney acknowledged that placing children in wheelchairs and those with both medical and behavioral/mental health needs can be particularly challenging. Commissioner Quin requested more than $8.7 million to fund Assessment Treatment Homes across Tennessee, aimed at providing specialized care for these medically hard-to-place children.
In a budget hearing, Tennessee Senator Campbell expressed concern over the state's frequent prioritization of office space over hospital care for children. "We must demonstrate responsibility by allocating necessary funds to the Department of Children's Services (DCS)," said Campbell. He underscored that the state currently holds substantial reserves, eliminating any excuse for failing to address the needs of its most vulnerable citizens.
Senator Lee indicated openness to funding DCS's budget requests, yet even an approved allocation may not immediately alleviate the current situation, prompting concerns about immediate action. Campbell emphasized, "These are matters we should be competently addressing within the Department of Children's Services, without placing children in hospitals."
In a statement, the Children's Hospital Alliance of Tennessee (CHAT) highlighted the increasing number of youth requiring mental health treatment, largely due to a scarcity of accessible services and a disjointed service delivery system. Additionally, CHAT pointed out that children under DCS custody often end up in pediatric emergency rooms due to urgent medical or behavioral needs, yet face challenges finding appropriate post-discharge placements, thereby prolonging hospital stays. These extended hospital stays, the statement continued, prevent resources from being utilized for other children across the state.
In the past two months, a children's hospital reported a prolonged stay of 276 days for one patient. Collectively, these extended stays amount to hundreds of additional days where hospital care is not necessitated. The Department of Children's Services (DCS) frequently attributes this issue to limited to no placement options and struggles with insufficient resources for adequate staffing and support.
The newly appointed DCS Commissioner, Margie Quin, has acknowledged the problem of extended hospital stays for some children and proposed a strategy to address this and other challenges faced by DCS. The plan includes securing additional funding, increasing training opportunities, and enhancing support for case workers.
Mary Nell Bryan, President of the Children’s Hospital Alliance of Tennessee, expressed appreciation for the efforts made by DCS employees to find foster homes for children with medical fragility or chronic conditions such as diabetes. However, she noted that there are often not enough suitable placement options for these transfers to occur promptly.
Bryan commended Commissioner Quin's request for more funding and her comprehensive plan, which includes increased training and support for case workers. She underscored the critical role played by DCS staffers and hospital employees, despite the challenges they face in their roles.
The President of the Children’s Hospital Alliance of Tennessee encourages families to consider fostering children with medical fragility or chronic conditions like diabetes.
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