ELKO, Nev. — Brandy Holbrook spent April driving hundreds of miles across four counties in northeastern Nevada to deliver a plea to local leaders about a smoldering crisis in the regional foster care system.

A shortage of homes for children and teens in need of care in this sprawling rural corner of the state pushed officials to temporarily house kids in casino hotel rooms, where state workers watched over them while seeking foster homes. Holbrook, a state social services manager based in Elko, said it's normal to see fluctuations in need but that early 2023 was the worst she has witnessed during her 20 years working for Nevada's Division of Child and Family Services.

"For this whole county, it's a total of 12 beds, and there's zero open," Holbrook told KFF Health News in April. "Literally no kids in this county could stay in their community."

The agency housed seven children from rural Nevada counties in casino hotel rooms, each for a short stint, over an 89-day stretch that ended in May. During those emergency placements, the state paid staffers overtime to tend to the children in a 1-to-1 ratio.

Jails and emergency rooms for foster kids, too

The emergency in Elko County is not unique. More than half of U.S. states saw a decline in licensed foster homes from 2021 to 2022, according to a report on national trends by The Imprint, a nonprofit publication that reports on child welfare and family issues. The number of licensed foster homes declined by nearly 18% in Nevada, while South Carolina had a 61% decline, the largest of any state.

Leecia Welch, deputy litigation director for the advocacy group Children's Rights, says there's no question many states have been relying on inappropriate placements for children because of a lack of foster homes.

In North Carolina, where the number of licensed foster homes dropped 23% from 2021 to 2022, children are sleeping in jails and emergency rooms. State lawmakers there are working on a bill to give more funding to the child welfare system. In Montana, which also experienced a 23% decline in licensed foster homes, Republican Gov. Greg Gianforte signed legislation in May that provides $7,500 in state income tax credit to parents who adopt foster children. In Sacramento County, California, children have been placed in a former juvenile detention center being used as a temporary shelter.

Resorting to these kinds of placements is not only destructive for children, Welch says, but it also drains resources from state welfare departments. "It's not to say that I think any of these systems are choosing to rely on these practices, but the deeper they get into relying on them, they're just digging their hole deeper and deeper."

Good solutions are hard to come by, though. Nevada officials are looking at loosening licensing requirements for foster homes — a step some advocates say is needed. But proposals to relax oversight follow state audits that uncovered extensive problems even with venues already housing children.

Holbrook says by May there were five general licensed foster homes in 17,000-square-mile Elko County, where 54,000 people live. Four other homes in the county are licensed as kinship placements, in which relatives foster children who are in the system.

Because the counties neighboring Elko don't have foster home spots available either, Winnemucca, more than 100 miles away in Humboldt County, is the closest city where children from Elko County can be sent, Holbrook says. Many times, children are moved as far away as Reno, nearly 300 miles from Elko, or Las Vegas, 430 miles away. Moving children outside their community further destabilizes their lives, she says. Not only do they lose the normalcy of their routine with family, but they also lose contact with other critical people, like teachers, classmates, and coaches.

By April, Holbrook says, eight or nine children had been rotated in and out of casino hotel rooms, though they were relocated by May. As another temporary solution, the state purchased a house in Reno to avoid placing children in hotel rooms. It still requires caseworkers to stay with kids until the state finds a home for them.

The child welfare agency said there are 400 to 450 children in foster care at any given time in the rural parts of the state. Before the pandemic, there were 220 licensed foster homes in rural Nevada, but that's down to about 100 now — reflecting the acute challenges rural communities face, including higher poverty rates, greater geographical distances to services and between communities, limited infrastructure, and fewer social workers. Multiple state and federal reports have painted a picture of a beleaguered Nevada system beset by health and safety concerns.

Audit finds violations in foster homes

Last year, a report from Nevada's legislative auditor declared that, of 30 homes inspected, 33% had health or safety deficiencies and 79% of foster placements had at least one regulatory violation. Four of the homes didn't comply with medication management requirements.

Another audit, published in January, noted incomplete medication records, missing documentation, and safety issues at governmental and private facilities for children, including two of the state's nine advanced foster care homes. These places, known as AFC homes, provide specialized care for foster children experiencing severe emotional or behavioral issues. "Care and living conditions at the AFC homes did not meet certain minimum foster care standards established" in state law, the report states.

Despite the laundry list of issues detailed in investigators' reports, state officials, amid their scramble to find homes for children taken into state custody, have suggested relaxing regulations governing foster homes.

The Division of Child and Family Services held a public hearing in late April during which officials considered changing licensing and regulatory rules in response to an executive order from Republican Gov. Joe Lombardo requiring all state agencies to suggest regulations to cut.

In the hearing notice, the state agency said lowering minimum requirements for initial licensing could remove barriers to placement. The rules currently require foster parents to pass a background check, submit fingerprints, and be cleared through a state registry system that flags instances of child abuse or neglect. Another proposal would change a section of the law that requires tuberculosis testing for initial licensing, then once every two years after that.

6 months for a license to be a foster parent

Licensing can be onerous for families, says Nathan Hornback, the lead teaching pastor at Living Stones Church in Elko and an advocate for foster children and parents. It can take six to nine months or longer to become licensed, especially in rural areas where state agencies are understaffed. In addition to the lengthy paperwork process and background checks, 27 hours of training is required in Nevada to prepare foster parents to take in children or teens who may be experiencing serious emotional or behavioral issues.

Welch thinks it's a good idea to review existing regulations to see if there are ways to remove barriers for those who want to foster and find homes for children without compromising safety.

In the meantime, social workers like Holbrook continue the search for safe homes.

In April, she made rounds to rally help at city council and county commission meetings. Now, she's moving on to school boards and other local groups. Religious leaders are also stepping up.

Hornback says that, before the pandemic, he traveled across the region with social workers to raise awareness about children in foster care. Now, he's focusing his efforts, and his church's, on supporting would-be foster families during and after the licensing process.

A baby left on their front steps

Hornback knows the challenges of fostering and adopting. A few years after his wife had a miscarriage, the couple adopted their first daughter through a private process in 2015. Then, a year later, they became emergency foster parents when a 7-week-old baby was left on their front steps. It was a Sunday afternoon, Hornback says. He was preaching at church all day and needed to go back for another service.

The baby spent six weeks in the hospital being treated for neonatal abstinence syndrome. Eighteen months after the Hornbacks took the baby into their home, a judge ruled they could formally adopt her. She's 6 now.

Hornback says he knows fostering can be too much for families to take on without help. For him, that's where Foster the City, a California-based church coalition, comes in. The community support and encouragement it offers can be the difference between families renewing their licenses and not, Hornback says.

"We can mobilize," he says. "We can attack the loneliness and the discouragement of the process by surrounding people with love and care and support."

That looks like rallying church members to help foster families with child care, transportation needs, meals, or chores like yardwork. If the two families in Hornback's church who have stepped up to become licensed this year are successful, it will nearly double the number of homes available for foster kids in Elko.

Hornback says the coalition hopes to have a waitlist of homes in the community, not a waitlist of kids.

KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs atKFF — the independent source for health policy research, polling, and journalism.