University of Pittsburgh psychiatry professor Richard Schulz has been one of the nation’s foremost researchers on caregiving stress for
David Ellenwood has spent the past six years building from scratch a 281-employee business in one of the nation’s most vital, growing fields — personal care assistance for elderly and/or disabled individuals in their own homes.
Cindy McDonald is one of the most valued employees of his Peters-based operation, Sunny Days In-Home Care. Without complaint for $10.25 an hour, with no sick days or paid vacation, the 62-year-old Scott resident spends 40 or more hours a week assisting clients — preparing meals, performing housekeeping, running errands, providing companionship, helping them safely in and out of chairs and beds.
The company president and trustworthy caregiver have no direct interaction for a family owned business that helps some 200 consumers across seven counties, but they share common traits. Both are hard workers who have succeeded in their roles. Each describes the care of needy people as their calling. They want to do well for others as well as themselves.
But their interests diverge on America’s No. 1 topic of national debate: health insurance coverage.
Who should pay for it? Who should receive help with it? What should be mandatory? What’s an employer’s role vs. the individual’s and government’s?
And what’s appropriate, in particular, in a field that has historically offered meager pay and benefits to hundreds of thousands of workers who may be exposed to injury and illness in helping others navigate their own health difficulties?
Following the debate
Both Mr. Ellenwood, 64, and Ms. McDonald have tried to follow the complex and divisive wrangling among political leaders in Washington over the existing Affordable Care Act, commonly branded as Obamacare, and the Republican leadership’s “repeal and replace” legislation known as the American Health Care Act. No one yet knows what the outcome will be of the GOP’s desire to eliminate both individual and employer mandates, but this much is true under Obamacare:
Because Sunny Days has more than 50 full-time equivalent employees, Mr. Ellenwood must offer business-supported health insurance coverage to Ms. McDonald and others working at least 30 hours a week, or else Sunny Days would face financial penalties.
Mr. Ellenwood, who owns the business with his wife, is praised by many on his staff for running the business with family and Christian values and caring more about the clients and employees — at least those who do their jobs right — than he does money. He chafes at the government mandate, however, and can’t wait to be rid of it.
He contends the Medicaid reimbursements of $17.52 an hour received by Sunny Days, which cares primarily for individuals who qualify financially for government help, offers too little income to have him shoulder the additional cost of health insurance for those caregivers who want it.
“I’d pay them all $12 to $15 an hour plus health insurance if I could, but you can’t keep the doors open if you don’t make money,” Mr. Ellenwood, 64, said in his Peters office, musing about how much worse off those workers would be if government-mandated costs led to shutdown of a company that earned more than $7 million in revenue last year.
One fact that has resulted in less of a financial impact than he first feared, however, is that relatively few of his eligible employees opt to take the coverage. Of 77 who qualify, based on full-time status and having worked for the company for at least a year, only 11 caregivers and 15 managers accept the employer health plan. Unlike caregivers, managers have always been provided a health plan option due to their “more professional” status, Mr. Ellenwood said.
As for the bulk of caregivers, who generally are in their 20s and 30s and make $9 to $10 an hour, he said most seem unwilling or unable to see their paychecks reduced to cover their own share of the health insurance cost. They decline it, even at the risk of a financial penalty for violating the federal government’s mandate, though some also may be covered by a spouse’s plan instead.
“With this employee base, they have more need for immediate gratification through their wages rather than seeing a reduction for a benefit such as health insurance,” Mr. Ellenwood said.
Unlike those generally younger co-workers, Ms. McDonald embraces the coverage even though it reduces her modest paychecks by $150 every two weeks. She also has out-of-pocket costs from the insurance deductible and co-pays. Still, having the plan subsidized by Sunny Days is saving her about $200 monthly from what she was paying for individual coverage before Sunny Days’ mandate kicked in.
“When it comes out of your paycheck, you don’t even think about it. It just happens,” said the divorcee who lives alone. “I can live with what I’m paying right now.”
Ms. McDonald said too many health care expenses add up for someone like her, a few years shy of Medicare coverage, to go without insurance. Last year included a cyst removal, broken wrist, colonoscopy, mammogram and other screenings and treatment, though she said none of her health issues were work-related.
She has worked for Sunny Days about four years after being with another agency before it. She was previously a homemaker caring for her own family. Before that, she recalls nostalgically, a job with Prudential Insurance in the 1980s provided her a grand employee health care plan that did not cost her a cent.
Ms. McDonald volunteers that she knows she could receive better income and benefits working at a fast food restaurant or supermarket, “but that’s not my bag. I’m doing much better work than slopping cans of fruit around or dishing out burgers.”
She’s generally in good health, but her age means she’s also among those who could be hurt most by changes proposed in the American Health Care Act if faced with purchasing insurance on her own. The GOP plan’s proposed tax credits do more for people with higher incomes than for her, and it would allow insurers to impose an age-adjusted rate on her that is much higher than current limits.
“It’s people like me that are gonna be in deep doo-doo,” she says, suggesting that any loss of employer-aided insurance could force her to leave a field where recruiting and retaining quality workers is a constant challenge for people like Mr. Ellenwood.
How good is Ms. McDonald at her work? Good enough that Sunny Days nominated her for the 2017 Pennsylvania Direct Care Worker of the Year Award, one of 10 such individuals to be feted statewide at a luncheon in Harrisburg April 4.
Mr. Ellenwood said he was personally involved in nominating Ms. McDonald. He wishes every worker were like her, and he hopes federal officials work out some affordable insurance option for people like her if he drops coverage of caregivers. He would likely pursue the latter option, if he has the chance, to avoid or reduce a current expense that he said amounts to $11,000 monthly.
A growing business
He had no experience running such a large business when starting Sunny Days in his late 50s. He said his own instincts and ability to manage overhead and control costs have enabled its growth. The company landed on the Inc. magazine list of America’s 500 fastest-growing companies last year, during its fifth consecutive year of substantial revenue growth. That’s something more important for a workforce than is health insurance, in his eyes.
“When my business grows, it means I’m hiring more people,” he said. “We provide a lot of jobs to people who need them.”
Sunny Days is far from the only home care provider affected by the mandate and with an owner closely watching the debate in Washington. There are about 1,500 in-home personal care services in the state. An additional 500 home health agencies offer some of the same assistance but also have aides, therapists and nurses able to provide medical-related care, according to the Pennsylvania Homecare Association.
Many of the personal care agencies were too small to fall under the mandate, but for the larger ones, they have been less likely in the past than home health agencies to offer employer-backed health insurance. Those that had not offered insurance in some cases began reducing workers below 30 hours a week to sidestep the health coverage requirement. Some others dropped out of the Medicaid program to focus on the private pay market, where clients are charged more.
But those employers that began offering the coverage have generally adjusted to accommodate it, said Jennifer Haggerty, chief operating officer of the state association. She said they may not want to backtrack to drop the insurance even if they gain that option again.
“If you ask our members, probably 99 percent would say recruitment and retention is their No. 1 challenge, and this is something that would ultimately help with that,” Ms. Haggerty suggested.
Mr. Ellenwood, who is not a member of the association, isn’t so sure about that advantage, though it could certainly apply in the case of someone with value to him like Ms. McDonald.
How they, and the government, work that out remains to be seen. Ms. McDonald just knows that she’s got to keep working for someone, with the ability to provide herself some kind of insurance coverage, one way or another.
“I’m going to keep working as long as I can — I have to,” she said. When asked if she’s worried her own health will force her out of the work she enjoys, she said with a chuckle, “I’m the new 40 ... though my bones don’t always feel that way.”
Gary Rotstein: email@example.com or 412-263-1255.