ST. LOUIS — A teenage boy paralyzed by a 2023 shooting has remained at a St. Louis children's hospital for months after his medical needs were addressed because no safe home or foster placement was available, according to his mother, Quette. The boy became a ward of the state after his paternal grandmother, who was his legal guardian, died.

Quette dialed 911 when she found her son struggling to breathe at their Illinois home near St. Louis. He had rolled his wheelchair to the oven to keep himself warm and was drenched in sweat from an apparent infection.

Quette, who once worked as a paid caregiver and now works as a custodian, said she and the boy's grandmother, who used a wheelchair herself, could no longer meet his medical needs. "I had to wake up out of my sleep to rotate him. And I couldn't do it. I was oversleeping," Quette said. When the family requested a home health aide, hospital staff accused them of neglect.

The boy's stay is known as a social stay, or hospital boarding. Children stuck in hospital boarding include those with mental health or behavioral issues and those with chronic physical conditions or disabilities requiring technology, equipment, or other assistance. Children in foster care have spent nights in casino hotels in Nevada and in offices in Georgia and Maryland while awaiting placement.

"It's definitely a national problem. Every state has different options in terms of where kids can go post-acute care. But in general, there's many of our kids with medical complexity who just don't have access to the appropriate home nursing to bring them home safely," said Elaine Lin, a pediatrician at Boston Children's Hospital and chair of the American Academy of Pediatrics' Section on Home Care. Lin said a shortage of home healthcare workers forces families to keep children in hospitals even after they are well enough to go home.

When a child no longer needs hospital-level care, insurers are not obligated to pay for the stay. Some hospitals absorb the cost, while others hire sitters or assign chaperoning duties to hospital workers. Hospitals may seek state reimbursement if a child is in state custody.

The Missouri Department of Social Services reimbursed 19 hospitals a total of $16.3 million for 9,943 boarding days last year at a rate of more than $1,600 per night, according to the Missouri Hospital Association. Dave Dillon, a spokesperson, said the figure undercounts the problem and that hospitals often are not reimbursed for housing children.

Last year, Georgia officials said 500 children had been relinquished by their parents and turned over to the Georgia Division of Family and Children Services due to complex behavioral or psychiatric needs. In Colorado, a hospital worker emailed a state representative for help after an autistic 13-year-old boy spent weeks at UCHealth Longs Peak Hospital in Longmont awaiting placement, and officials said it would take months to find a safe place for him to go. In the last fiscal year, the Illinois Department of Children and Family Services logged 304 cases of youth in psychiatric hospitals beyond medical necessity, with about 43% of those cases among patients ages 13 to 16.