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."