Myths & Realities

MYTH — Health insurance is not a major issue for caregivers.

Reality:

  • Health insurance is a top concern (pdf) for direct-care workers.[1]
  • Caregiving is dangerous work. Direct-care workers are frequently injured on the job, most often while lifting their clients. Nursing aides, orderlies, and attendants have the highest rate of injuries requiring days away from work in the nation. They are 800% more likely than a roofer to suffer a back injury and 280% more likely than a sheet metal worker to be bruised.[2]
  • Caregivers belong to demographic groups which suffer disproportionately high rates of chronic medical conditions. Nine out of ten direct service workers are women, their average age is approximately 40, and nearly half are people of color. A recent survey found that 37 percent of African American women over the age of 45 report poor health and 29 percent have diabetes.[3]
  • Health insurance reduces turnover. Health benefits provide the security that workers need to stay in their jobs. Studies show that turnover rates fall when workers receive health insurance benefits.[4]

MYTH — Caregivers aren’t any different than other Americans that need health insurance.

Reality:

  • Direct-care workers are twice as likely to be uninsured than the general population under age 65.[5] Caregivers frequently fall between insurance systems - they can not afford private plans and they do not meet eligibility requirements for Medicaid or other public programs.
  • One in every four nursing home workers [6] - and more than one in three home care workers[5] - lack health insurance coverage. They are far more likely to be uninsured than workers who work in other health care settings. For example, nursing home workers are two times more likely to be uninsured than hospital workers.[7]
  • Without health insurance, chronic medical conditions go untreated. One study[8] found that one-third of uninsured home care workers with diabetes were not getting regular care. Left untreated, diabetes and other chronic conditions often cause serious problems that can force workers out of the direct-care workforce, either temporarily or permanently.
  • When caregivers have no choice but to go to work sick, it puts their clients at risk. Workers who can’t afford not to often report to work even when they are contagious. Without health insurance and proper care, asthma can become bronchitis or even pneumonia, endangering both caregiver and client.

MYTH — It’s the workers’ fault for not taking advantage of insurance offered through their jobs.

Reality:

  • Many caregivers are not offered insurance by their employers. direct-care workers frequently work for temporary agencies or very small businesses that do not offer insurance benefits, or they are self-employed, independent providers hired directly by consumers — and the rising cost of insurance means that even larger employers are finding it more difficult to offer coverage. The percent of long-term care employers offering health benefits declined from 69 percent in 2000 to 60 percent in 2005.[8]
  • Many are ineligible for the plans their employers offer because they are part-time or newly hired. For example, only 34 percent of home care aides work full time, frequently making then ineligible for coverage.[9]
  • Many can not afford to participate in their employer’s insurance plan. On average, workers are asked to contribute $600 a year toward employer-based health care plans and much more for family coverage.[10] For direct-care workers, these costs are a significant percentage of their income.

MYTH — It’s the employers’ fault for not offering affordable insurance to their employees.

Reality:

  • The cost of premiums is rapidly increasing. The average premium cost for employer-sponsored coverage rose to over $4,000 a year for an individual in 2007. Family health insurance premiums were nearly $12,106 a year, more than a minimum-wage worker’s total take-home pay.[10]
  • Premiums are even higher for long-term care employers. Many providers of long-term care services are small employers who have difficulty negotiating effectively with insurance companies for lower group rates — and high costs mean less coverage.
  • Many long-term care providers rely heavily on payments from the government for the services they provide. Medicaid rates do not adequately account for the cost of health insurance or other benefits for workers.

MYTH — The public health safety net will take care of direct-care workers who don’t have insurance.

Reality:

  • Despite low incomes, most direct-care workers are not eligible for either Medicare or Medicaid. Most workers aren’t old enough for Medicare benefits (to qualify, you must be 65 and older or have a significant disability) or poor enough for Medicaid (which is designed primarily for women and their children and people with disabilities). In 36 states, parents with poverty-level incomes — less than $15,260 for a family of three — cannot qualify for public health insurance. In 42 states, adults without children are ineligible for Medicaid regardless of their income, unless they are severely disabled.[11]
  • Even in states with subsidized insurance programs for the working poor and small employers, there are often obstacles to obtaining coverage. For example, Maine’s DirigoChoice program requires that 75 percent of eligible workers enroll, a threshold many long-term care organizations can not achieve. Also, part-time workers are excluded, and workers can be responsible for up to $4,000 a year in out-of-pocket costs.[12]
  • Resorting to the “free care” available at some hospital emergency rooms and clinics is not the answer. Direct-care workers cannot rely on charity care for preventive health care services or ongoing treatment of chronic conditions. The proportion of physicians providing charity care dropped from 76 percent in  1994 to 68 percent in 2004.[13]

MYTH — Long-term care workers can find other jobs if they really need insurance.

Reality: The sad fact is that this is not a myth.

  • Direct-care workers are often forced to leave caregiving work for jobs that provide better pay and benefits. In nursing homes, turnover rates can be as high as 100% a year.[14] In home care, 40-60% annual turnover is the norm.
  • High turnover undermines quality and disrupts the continuity of care. Due to the intimate nature of personal care work, clients often grow close to their caregivers, who learn to respond to their particular needs and preferences. When a worker leaves, the client must start from scratch with someone new.
  • Expanding health coverage is essential in order to stabilize this workforce and prepare for the caregiving needs of the future. Between 2000 and 2030, the elder population is expected to increase by 104%, while the traditional caregiving workforce (women age 25 to 44) will increase by only 7%.[15]

Endnotes

  1. Health Insurance and the Recruitment and Retention of Direct Service Workers in Virginia (pdf)
  2. Nonfatal Occupational Injuries and Illnesses Requiring Days Away From Work, 2006, US Bureau of Labor Statistics
  3. Women and Health Care: A National Profile (pdf), Kaiser Family Foundation
  4. Fact Sheet: Health Insurance Vital to Job Retention (pdf)
  5. Invisible Care Gap: Caregivers without Health Coverage (pdf)
  6. Health insurance coverage for direct-care workers: Riding out the storm (pdf), Better Care Better Jobs Issue Brief
  7. No Care for the Caregivers: Declining Health Insurance Coverage for Health Care Personnel and Their Children, 1988-1998 (pdf), American Journal of Public Health
  8. Providing Health Insurance to IHSS Providers (Home Care Workers) in LA County (pdf)
  9. R. Montgomery et al, 2005. “A Profile of Home Care Workers from the 2000 Census: How it Changes What We Know,” The Gerontologist (Vol. 45, No. 5).
  10. Employer Health Benefits: 2005 Annual Survey (pdf), Kaiser Family Foundation
  11. Working without a Net: The Health Care Safety Net Still Leaves Millions of Low-Income Workers Uninsured (pdf), Families USA Special Report, April 2004
  12. Health Insurance for the Home Care Sector: Experience from Early DirigoChoice Enrollment in Maine (pdf)
  13. Physicians Pulling Back from Charity Care, Center for Health Systems Change
  14. A survey conducted by the American Healthcare Association (AHCA) in 2002 found an average annual turnover rate of 71.1percent for certified nurse aides in nursing homes.
  15. Interim State Population Projections, 2005, US Census Bureau, Populations Division