Photos by Stephanie Klein-Davis | The Roanoke Times

Kim Sexton does household chores for paraplegic David McCollough and his wife, Lois.

Kim Sexton calls in prescriptions for David McCullough. Sexton receives no health care benefits. She is self-employed and doesn't get paid sick days or vacation time.

Kimberly Sexton is a health care worker who isn't sure who would pay for her medical bills if she were to get sick.

At 36, Sexton is a personal care assistant. Medicaid pays Sexton to be an alternative to a nursing home for people such as David McCullough, a 64-year-old paraplegic whom she cares for in his Southeast Roanoke home.

Sexton told of her concerns Monday morning sitting in a dimly lit living room as McCullough snoozed in the next room.

Tonight, she will take the podium in a town hall-style meeting organized by the Virginia AARP, to discuss shortcomings in the health care system.

Sexton receives no health care benefits. She is self-employed and doesn't get paid sick days or vacation time.

"If I ever get sick, I'm just going to be lying in bed, praying it away," Sexton said. "I don't want to go to the hospital. That's going to be another bill."

Her plight is one of many experienced by home-based care workers across Virginia who feel their services are essential but undervalued by government programs that pay their wages.

AARP, an advocacy group for people 50 or older, is calling on Roanoke Valley residents to share such tales -- and grievances -- about their encounters with the health care system. The forum will begin at 7 p.m. at the Holiday Inn Tanglewood on Starkey Road in Roanoke County.

No sign-up is required and anyone can speak, as long as presentations are less than three minutes.

The goal is to take these stories and translate them into policy changes at the General Assembly session in January, said Tony Hylton, an AARP spokesman.

A similar event in Virginia Beach last month drew about 150 attendees, many of whom told their stories in heartstring-tugging detail, Hylton said.

Organizers say they are expecting about the same number in Roanoke. Another meeting is planned for Charlottesville later this year.

Speakers from several organizations, including the Roanoke-based Local Office on Aging, plan to be at tonight's meeting.

During her three-minute slot, Susan Williams, executive director of the LOA, said she plans to talk about long-term care and transportation for seniors, which she described as lacking in the Roanoke Valley.

She also noted "a big gap" in the need for long-term care and the availability of workers willing to provide it in the Roanoke Valley. Long-term care, she said, ranges from nursing homes to independent in-home care.

Karen Roberto, director of Virginia Tech's Center for Gerontology, will moderate the discussion.

The meeting's agenda will align with topics already being addressed by the Governor's Health Care Reform Commission Report, which came out in September.

Those included medical quality and transparency, access to health insurance, work force improvements and long-term care options, Roberto said.

Within these broad-brush topic headings will come testimony from people such as Sexton.

Sexton said she typically works seven days a week. She does laundry, calls in prescriptions, changes bed linens and lifts McCullough in and out of bed -- all for $8.60 an hour, the going rate for home-based workers paid by Medicaid.

If it weren't for Sexton, "we would probably wind up in a box in the street," McCullough's wife, Lois, said.

"I would never put him in a nursing home," Lois McCullough, 69, said.

Even so, Sexton is asking for wage increases and health care coverage. While she says she enjoys the difference she's making in the lives of her clients, her lack of health insurance is daunting. She makes too much to qualify for Medicaid health coverage, a federal program for the poor, and too little to afford a private insurance plan.

As a health care worker, her well-being directly affects her job. "If we have a quality job with quality care, we can give that to the client."