The Effects of COVID-19 on Children Living in Congregate Care

Orphanages and pandemics:  A brief history

Orphanages originated, in part, to care for children whose parents had died in epidemics.  In the early twentieth century, orphaned teens who had to work during the day returned to their orphanages infected with the “Spanish Flu,” or influenza.   Understaffed and overcrowded, these buildings became incubators where children easily fell ill.   For example, the first British victims of the influenza pandemic in 1918 were eight children who lived in a Catholic Scottish orphanage; the children caught the sickness from a resident 15-year old boy who worked days as a general laborer.  Similarly, in September of that year, a young working teen brought influenza back to his Baptist orphanage in Virginia, causing thirty-five of the other children to become ill.

Orphanages became transformed in the first half of the twentieth century, as child welfare advocates campaigned for foster children to live in “family-like” smaller group homes.  This campaign led to the government-funded congregate care system that houses foster youths today.  Designed to provide children and youth with a placement that addresses their specific emotional and behavioral health needs, the term  “congregate care” refers to a wide variety of living settings, including group homes, residential treatment facilities, and emergency shelters.  Of the more than 400,000 children living in the American foster care system, approximately 55,000 live in congregate care settings.  This post examines how the pandemic affects children living in these settings.

Threats to Physical and Mental Health

Most states have enacted social distancing and stay-at-home orders in order to protect their vulnerable populations from infection by the coronavirus.  However, these orders simultaneously create a unique blend of mental and physical risks to the health of children living in congregate care.

First, the facilities are at a higher risk for transmission of the illness because of the close quarters shared by residents and the challenge of quarantining staff.  Social distancing in congregate care remains difficult.  Children share bedrooms, bathrooms, and living spaces in one section or cottage and they are not allowed to mingle with residents from other dorms.  Additionally, most places have staff members who come and go, meaning that each time a staff member re-enters the building, he or she might be a contagious threat to others without yet showing symptoms.  If a staff member must remain quarantined or isolated at home, that staff member must be replaced to maintain child/staff ratios.  But new hires need to pass federal and state background checks and because fingerprinting facilities are not open in most areas, replacing staff becomes a hurdle.

Second, this virus poses a unique threat to foster children living in these facilities.  CDC guidance indicates that those with underlying chronic health conditions like asthma, diabetes, high blood pressure, or obesity face a higher risk of severe COVID-19 illness.  Most children within the foster system have experienced lives of trauma and stress.  Stress and trauma make these children more prone to some of these chronic conditions  Additionally, the stress and trauma of the current situation lowers the immune system, in general, making them more vulnerable to contracting the virus should it enter the facility.

Congregate care living during the pandemic also heightens the risk of mental stress for these children.  For safety reasons, some quarantined youth are allowed out of their homes or facilities only briefly during the day, and some do not go outside at all.  But going outside can be vital to mental health.  Additionally, most of these children visit therapists and the pandemic’s travel and staff restrictions mean that some children cannot continue with their therapy.  Most congregate care homes are doing what they can to protect children’s mental health.  Some youths engage in art and music therapy activities, while some have built small gardens or participated in fun exercise activities to relieve stress.  Both the activities and maintaining structure in this unprecedented time promote good mental health.

Family Visits

Congregate care homes are not meant to be the end of the road for foster youth.  The ultimate goal is either reunification with their families or placement with a new family.  Prior to the pandemic, most children regularly visited with their parents, either at the congregate care facilities or at an offsite location.  When COVID-19 hit, many of these facilities adopted highly restrictive visitor policies to prevent the spread of the virus.  Pennsylvania’s Office of Children, Youth, and Families urged congregate care facilities to make exceptions for immediate family members to visit, but ultimately the office placed the decision in the hands of each facility.  Consequently, many parents have not physically been with their children in close to five weeks.

Without in-person visits, families must rely on virtual visits using video-calling apps.  But internet access is not always available because the congregate care homes do not all have reliable internet service.  Even when the facility does have internet, virtual visitation does not take place when families cannot afford dependable or sufficient internet.  Even with these alternative means, experts worry that Google and Zoom hangouts or other video apps are not adequate substitutes for physical contact or for the security that came with regular, routine in-person visits.

This continued separation from families creates feelings of anxiety and uncertainty in these children.  While these children are able to speak frequently with their families using the telephone, it is a markedly different experience from many children in this country who have enjoyed a month at home with the comfort and security of their own families.

Older Youth Transitioning Out of the Congregate Care Foster System

Approximately 700 foster youth between the ages of 18 and 21 “age out” of the Pennsylvania dependency system each year, unless they participate in activities like work or higher education.  Nationwide, the number is closer to 22,000.  Unfortunately, the pandemic has made most school and work impossible.   Most of these youths lack a strong support system to help them through this rough time and find themselves with no safety net, couch-surfing, and homeless.

Some areas have implemented ways to protect these youths.  In California, the governor has extended foster care payments for youths who would otherwise age out.  Similarly, Philadelphia has declared a moratorium on discharging youths who cannot meet the work or education requirements because of COVID-19.  Currently, Pennsylvania Governor Tom Wolf is reviewing a proposal submitted by advocacy groups to protect these older youths.  Specifically, they are asking him to suspend the work and school requirements and to expedite requests from youth to re-enter care if they had previously exited before reaching 21 years of age.


The move from orphanages to congregate care happened because advocates wanted foster children to live in protected, family-like environments.  Most of us under stay-at-home orders are likely experiencing the security of being protected and the luxury of being able to live with one’s loved ones.  For the children and older youths living in congregate care facilities, the pandemic brings its own set of complications and problems.  Governor Wolf should adopt the recommendations to protect those aging out of the foster care system here in Pennsylvania and the rest of us should be sure to maintain social distancing guidelines.  Governor Wolf released a plan for regions of Pennsylvania to open back up in stages, beginning on May 8;
relaxing congregate care restrictions remain the last step in each region.
By maintaining social distancing guidelines and “flattening the curve,” we can open up the state more quickly and help these children and youth regain a sense of normalcy.


Sources Consulted

National Conference of State Legislatures:  Congregate Care, Residential Treatment and Group Home State Legislative Enactments 2009—2013

Do Orphanages Still Exist in America?  A brief history of orphanages in the United States.

First British Spanish Flu Pandemic Victims Were Children At Scottish Orphanage

A National Look at the Use of Congregate Care in Child Welfare (U.S. Department of Health and Human Services, Administration for Children and Families, Children’s Bureau)

What State Advocates Can Do: Policy Advocacy In Response To Covid-19 On Behalf Of Older Youth In And Aging Out Of The Child Welfare System (Juvenile Law Center)

Do more to ‘keep young people safe’ during the pandemic, foster alumni tell Gov. Wolf

‘We’re On The Front Lines Too’: N.H. Youth Residential Facilities Prep For Pandemic

Children in foster care are especially at risk

Children of the COVID

Six KidsPeace employees test positive for coronavirus; no children are infected, organization says

At-risk youth keep clean, stay busy to cope with coronavirus

No-visitor coronavirus policies separate kids in residential treatment from families

Can videoconferencing replace family visits? Philly foster kids seek comfort, support and housing amid pandemic

Working with Children and Youth with Complex Clinical Needs: Strategies in the Safe Reduction of Congregate Care

Author: Jill C. Gorman

Jill Gorman is a 3L at Dickinson Law and has worked as a certified legal intern in the Children’s Advocacy Clinic and the Community Law Clinic since January 2019. Jill plans to work in poverty law, either working on public interest policy or by being an advocate for the indigent at a legal aid firm.  In addition to working at the clinics, Jill has served as research assistant to Professors Megan Riesmeyer and Katherine Pearson.  In Fall 2019, Jill’s law review comment entitled “Expanding Third-Party Standing in Custody Actions: How the Opioid Crisis Has Impacted LGBTQ Parental Rights in Pennsylvania” was published in Volume 124 of the Dickinson Law Review.