A caregiver is denied medical care

She bathes and dresses him in the morning, prepares his breakfast and helps him into his wheelchair. Smith, 28, who has cerebral palsy, does data entry for a nearby doctor's office from 9 to 1.

Goroncy returns to make Smith lunch, and again at night to put him to bed.

"Without Shorty," says Smith, using one of his nicknames for her, "I'd be stuck in bed. I couldn't work."

Goroncy, who earns $10.30 an hour, has a hernia from lifting clients like Smith for 25 years. She is 51.

She describes the pain as "a knife sticking in your stomach." Her doctor wants it repaired immediately. But she does nothing about it.

She says she can't afford to.

She has no health insurance.

"It's pretty sad that we take care of people and we can't even take care of ourselves," she said. "I'm going to fall apart and not be able to work. Somebody's going to have to take care of me."

Goroncy's boss, Mike Cogley, the executive director of Tri-County Patriots for Independent Living, said Goroncy is "an exemplary employee, the cream of the crop, a heart as big as all outdoors. I wish I could clone her."

She's a longtime employee in an industry with high turnover. "It's low pay and there are no benefits," he said. "It's dictated by reimbursement rates from the state, and they're notoriously low."

He said his agency offers workers like Goroncy a "health-maintenance plan" for $20 or $30 a week that covers very little. "There's no major medical" for serious illnesses, he said.

Lack of health insurance is a common problem among home health aides.

Two-fifths of Pennsylvania's estimated 100,000 direct-care workers - people who work in nursing homes and for home health agencies - have no health insurance, according to surveys by the Paraprofessional Healthcare Institute, a nonprofit advocacy group.

Goroncy is divorced with three children in their 20s. She said her annual income is about $28,000. Her application for medical assistance from the state has been rejected twice, because her income is too high.

She lives in a small efficiency apartment. When her grandson Dominick, 8, comes over, she said, he asks her, "Grandma, where's your bedroom?"

"My living room is my bedroom," she tells him.

In late 2006, she couldn't catch her breath, and her doctor told her to take a stress test - which cost her $3,500. That test came back negative.

Then she went to a lung specialist, who did more tests, also negative.

"The lung specialist concluded I was having anxiety attacks," she said, "probably from the stress of having no medical insurance and working all the time."

All her life, Goroncy has driven clunky cars that break down, but last year, because her old car stopped running and she was walking to Smith's three times a day and having difficulty breathing, she decided to splurge and bought a new Ford Focus. She pays $300 a month on it, along with an additional $100 in insurance.

Goroncy loves Elvis Presley, and a portrait of Elvis is on each of her personal checks, which she routinely wrote out for $10 to the radiologist and the hospital, trying to chip away at her bills.

The Washington Hospital set up an installment plan, requiring her to pay just $25 per month on her $3,545 bill. With her car payment and $350 in rent, Goroncy said she couldn't even afford the $10 anymore.

When she stopped paying the hospital altogether, her account was sent to a collection agency.

Chief financial officer Michael J. Roney said the hospital's policy is never to send an account to collection as long as the patient is paying something. Roney said his hospital's bad debt totaled $7.4 million last year, up from $7 million in 2006. A growing portion comes from working people asked by employers to pay more medical costs.

"People increasingly can't pay their portion," he said. "It's huge."

Goroncy started out in the early 1980s working in nursing homes, but preferred being a home health aide. She felt she could provide more care and attention to people by working one-on-one in their homes.

"I had been pretty healthy up until the last five years," Goroncy said.

Left untreated, her hernia could block her intestine or cause an infection. The bulge in her stomach could worsen.

That is just the beginning of her health problems.

"My eyes are going bad. My hearing's going bad, and my teeth are going bad, and I can't take care of none of it," she said. "It makes me mad."

She has a painful bladder condition, known as interstitial cystitis, which makes her go to the bathroom. A urologist ordered a series of diagnostic tests years ago, which she got, to rule out other diseases.

"I had to quit seeing the urologist because these tests were too expensive," she says. "I count my blessings for the good days and suffer through the bad days."

Some days, Goroncy says, "I think I have a terrible life. But then," she adds, "you look at some people with disabilities, and they're always full of life and joy. Larry has taught me so much about life. He's always positive, always smiling. He has taught me to appreciate life because things can be so much worse."

She finds it hard to stay so positive about health insurance.

"The health-care system sucks," she says. "I'm sorry but there's no other way to put it."

"I am not here for the money," she said of her job. "I enjoy the work I do, caring for my client, but we must start taking care of those who care for others!"

What Went Wrong

Home health aide Karen Goroncy has spent many years caring for others. But like many of her fellow workers, she lacks health insurance. At 51, she has a hernia that hurts like "a knife" but doesn't have the money to get it fixed. She also has many other medical problems.

Next Installment

Kevin McKenzie, 27, plays guitar in an up-and-coming rock band, Liam and Me. When his heart would not stop racing, he refused to go to the hospital because he was uninsured. At the urging of ambulance workers, he says he gave a fake name and was treated. He's still troubled by the debt and promises one day to repay it. And he's still uninsured.