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Pulse of Longwood takes you inside one of the nation’s largest hubs of hospitals and biomedical research.

The school day lasts only one hour. Machines beep in the room. The teacher comes right to the student’s bed — though she might have to wear gloves and a mask.

That’s what “school” can look like for kids who are stuck in the hospital for days and weeks on end.


Armed with clipboard, iPad, and hospital gown, Elaine Klingensmith led STAT through a typical school day one recent morning at Boston Children’s Hospital, where she works as a full-time tutor for Education Inc.

The company aims to streamline what can be a frustrating process for parents: wrangling school officials to send the schoolwork — and money for tutors’ wages — so that sick kids don’t fall behind in school.

Klingensmith and two other tutors teach one-hour lessons to up to 20 kids per day. Some are frequent visitors with chronic illnesses, while others are newcomers in for a complicated surgery or transplant.


Klingensmith started her morning on the ninth floor of Children’s. Caleb Hassan, a playful 8-year-old who suffers from cystic fibrosis, sat in a hospital bed in tiger-themed pajamas.

Wearing a hospital gown and latex gloves to protect Caleb from infections, Klingensmith read a book with him and helped him calculate the perimeter of an 8-by-4 rectangle. Caleb yawned. “Can we do something different?” he asked.

His reward for finishing was to watch an episode of BrainPOP on Klingensmith’s iPad about healthy eating. The animated video series, with quizzes at the end, is among the tools Klingensmith keeps in her back pocket in case she needs to supplement students’ schoolwork.

Boston Children's -- education
Klingensmith works with Caleb Hassan, 8, during his stay at Boston Children’s. Kayana Szymczak for STAT

While some schools, like Caleb’s, are good about sending schoolwork, others aren’t. Massachusetts requires public schools to pay for tutoring if a child is confined to home or hospital for at least 14 school days due to illness. Other states have different versions of that law, but making sure that required education happens can be difficult.

Founded at Children’s in 1995, Education, Inc. now employs tutors in eight states and 46 health facilities, including hospitals, eating disorder clinics, and drug rehab centers, according to assistant director Natalie Curran.

Tutors aren’t always certified. Curran said the organization hires tutors who have experience teaching a wide range of ages. Klingensmith, who’s 27, is certified to teach only kindergarten through sixth grade, though she also teaches older students.

Keeping kids on pace with their classmates can be tough. If the school doesn’t send work to the hospital, Klingensmith said, she calls the teacher to ask which concepts the class is working on. If she can’t get an answer, she resorts to asking the students what they last remember working on.

“Sometimes they have no idea,” Klingensmith said. In that case, she falls back on the Common Core national standards, and a variety of worksheets and online programs that Education, Inc. provides.

Parents who are already managing their kids’ health often take on the extra role of ferrying schoolwork to and from the hospital. That’s what Napoleon Silva did when his two daughters, Christiana and Nicolette, who have cystic fibrosis, spent their latest stint at Children’s for antibiotic treatments to clear out their lungs.

Klingensmith knocked on the sisters’ hospital room door at 10:30 a.m.

Klingensmith helps Christiana Silva with a math lesson. Kayana Szymczak for STAT

“Noooooo!” called out 6-year-old Christiana, who had been watching the Mickey Mouse Clubhouse on TV. Despite her initial protest, she quickly immersed herself in a math worksheet.

Nicolette, who’s 9, worked alongside her sister in the face of various distractions in their “classroom”: As she set to work on geometry, Nicolette’s IV pump started beeping, signaling an occluded line. Her dad called a nurse, who swooped in to fix it.

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Christiana kept coloring while nurses flushed the tube through which she received antibiotics. Studying in the hospital has other challenges: Nicolette had to skip breakfast to prepare for general anesthesia later that afternoon, which made her more easily frustrated.

“I don’t get this,” she protested, staring at a math problem about parallel lines.

She said that compared to her school in Mashpee, Mass., she gets more help during the hospital lessons, because the tutor has just two students. But she misses science — a subject that’s often omitted in the hospital — and seeing her friends.

Keeping kids connected to the classroom is key to maintaining a sense of normalcy during chronic illness, research has found. Some teachers have tried beaming kids into the classroom using Skype or high-tech apps.

Aislynn Burns, who’s 9, has used FaceTime to videochat with her classmates during her long stints at Children’s for chronic intestinal pseudo-obstruction, said her mom, Tara Woodbury. But Woodbury said Aislynn spent so much time at the hospital — nearly two full school years — that she had to change from a private to a public school, because it wasn’t worth continuing to pay tuition.

Aislynn has done a ton of schoolwork at Children’s, including writing a biography of her favorite forefather, Benjamin Franklin.

But the tutoring isn’t a replacement for school, Woodbury said: “One hour is great, believe me, but there’s six to eight hours in a school day.”

While frequent visitors to Children’s often start tutoring immediately because they have prior authorization from their schools, newcomers can face a delay before their school district completes the paperwork to pay for it.

Children who are hospitalized for mental health treatment face additional challenges. Hospitals often block their access to the Internet for fear of threats like cyberbullying, so they can’t complete online assignments, said Lisa Lambert, executive director of the Parent/Professional Advocacy League, a Massachusetts-based network of 8,000 families of children with emotional, behavioral, and mental health needs.

Boston Children's -- education
Aislynn Burns, 9, has missed nearly two full years of school while being treated for a chronic intestinal condition. Kayana Szymczak for STAT

And parents may not even tell the school their child is in the hospital, for fear the information will leak out, Lambert said. She said adolescents who were hospitalized after cutting themselves, for example, have returned to school to find that “everyone in the entire school knows.”

Not all kids are well enough to take on schoolwork, Lambert added. “If there was a suicide attempt, the focus is going to be a lot more on their safety, rather than if they are up to speed academically.”

Transitioning back to school after hospitalization “is always tough, not just emotionally but also academically,” she said. While younger students may be able to keep up with their classmates, high school students often can’t.

Nicolette, who’s in fourth grade, is determined not to fall behind. She has already lost time: She and her sister were admitted on a Tuesday and didn’t start tutoring until the following Monday. She rattled off a list of work she has to do, including taking two tests and reading a history book.

She said it was hard to focus on her lesson with Klingensmith, because her stomach hurt from skipping breakfast.

“I was a little more whiny this morning,” she confessed. But “once you get into the work,” she said, “the pain starts to go away.”

Correction: A previous version of this story mischaracterized the tax status of Education, Inc., which is a for-profit company.

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