Insurance Coverage Among Personal Care Aides at Residential Care Facilities

Background: As the American population ages, the demand for residential care facilities (RCFs), also known as assisted living facilities, is expected to grow. In this growing sector, demand for personal care aides (PCA) is predicted to increase almost 50% in the next decade. This expected growth in demand will provide new opportunities for employment for many low-skilled and semi-skilled workers; however concerns about ethical labor practices are emerging. Employment is an important source of health insurance coverage for many Americans, yet many lower-wage earners are not offered coverage or are unable to afford the premiums. As PCA develop as an occupation, the patterns of insurance coverage may be representative of coverage in other comparable fields.

Methods: Our study aims to identify key characteristics of RCFs associated with offering health insurance coverage to its PCAs. Preliminary exploratory analyses were conducted using the 2010 National Survey of Residential Care Facilities. The dependent variable was whether PCAs are offered employer-sponsored health insurance coverage. Several potential predictors were hypothesized based labor economic and organizational theory. Logistic regressions were performed on the data.

Results: About 60% of surveyed RCFs provided some form of health insurance coverage to its PCAs; however, insurance offering varied among RCFs. Not-for-profit RCFs were more likely to provide insurance than For-profit RCFs (OR=4.72). Larger RCFs (more than 25 beds) were more likely to provide insurance than smaller RCFs (<25 beds) (OR=6.08). Facilities with relatively high proportion of people of color as residents are also less likely to provide insurance (OR=0.31).