Can my dad's nursing home come after me for payments, when his money runs out?

Anytime you sign a contract on behalf of another person be very careful how you sign it. For instance, I was a conservator for my uncle. I was instructed by my attorney to sign my name as conservator of my uncle (his name). For my father, I sign my name as "Power of Attorney" or " Health Director/Directive of my father ( his name). You do not want to become financially responsible for the person you are trying to look after. Therefore, speak to an attorney in your area on how to protect yourself financially while trying to assist your loved one. This is especially necessary when your loved one is no longer competent, can not sign legal documents and you have to sign your name on their behalf.

Unfortunately, the filial responsibility laws are being enforced. Please see an attorney, it will be money well spent.
Son Liable for Mom's $93,000 Nursing Home Bill Under 'Filial Responsibility' Law


Some 29 states currently have laws making adult children responsible for their parents if their parents can't afford to take care of themselves. These “filial responsibility” laws have rarely been enforced, but six years ago when federal rules made it more difficult to qualify for Medicaid long-term care coverage, some elder law attorneys predicted that nursing homes would start using the laws as a way to get care paid for.

It looks like this is starting to happen. In May 2012, a Pennsylvania appeals court found a son liable for his mother's $93,000 nursing home bill under the state's filial responsibility law. Health Care & Retirement Corporation of America v. Pittas (Pa. Super. Ct., No. 536 EDA 2011, May 7, 2012). In March 2013 the state's Supreme Court declined to hear the case, meaning that the ruling is final.

Facts of the Case

John Pittas' mother entered a nursing home for rehabilitation following a car crash. She later left the nursing home and moved to Greece, and a large portion of her bill at the nursing home went unpaid. Mr. Pittas' mother applied to Medicaid to cover her care, but that application is still pending.

Meanwhile, the nursing home sued Mr. Pittas for nearly $93,000 under the state's filial responsibility law, which requires a child to provide support for an indigent parent. The trial court ruled in favor of the nursing home, and Mr. Pittas appealed. Mr. Pittas argued in part that the court should have considered alternate forms of payment, such as Medicaid or going after his mother's husband and her two other adult children.

The Pennsylvania Superior Court, an appeals court, agreed with the trial court that Mr. Pittas is liable for his mother's nursing home debt. The court held that the law does not require it to consider other sources of income or to wait until Mrs. Pittas’s Medicaid claim is resolved. It also said that the nursing home had every right to choose which family members to pursue for the money owed.

First of a ‘Wave of Lawsuits’?

The Deficit Reduction Act of 2005 made it much more difficult for the elderly to transfer assets before qualifying for Medicaid coverage of nursing home care. With enactment of the law, advocates for the elderly said that nursing homes would likely be flooded with residents who need care but have no way to pay for it, and that in states that have filial responsibility laws, the nursing homes might seek reimbursement from the residents' children.

After Pennsylvania re-enacted its filial support law in the mid-2000s, Williamsport ElderLawAnswers member attorney Jeffrey A. Marshall forecast that the new Medicaid law would trigger a wave of lawsuits involving adult children.

"Litigation between nursing homes and children is likely to flourish," Marshall wrote in the January 20, 2006, issue of his firm's Elder Care Law Alert. (To read Marshall’s recent blog post on the Pittas ruling, click here.)

In 2005, the National Center for Policy Analysis, a conservative policy group, released an issue brief proposing that states begin enforcing filial responsibility laws in order to reduce long-term care costs.

Striper, would he be open to another arrangement, such as a senior citizen apartment building? Some of them have meals available as well. This was the first step with my aunt. Next came Adult Day Care or if he's functioning well cognitively possibly even a Senior Center with activities and a nutrition program. If he is a veteran, he may qualify for assistance with paying for the Day Care ... they can be quite costly. Senior Centers are usually free or something nearly free, like $10 per year.

Striper, you're getting lots of help with your Medicaid question. I'd like to suggest you keep him at home as long as possible, since that is what he wants. There are many 'helps' out there for him. He can get in-home help with personal hygiene and housework. We used Home Instead, but there are many companies who offer this service. They will do laundry, cook, vacuum, play board games to engage him, talk, listen, and help with/encourage bathing. Also, as he ages be prepared for him to be open to things that may have been out of the question before. When the choice is an ALF or in-home help, he may choose -in-home help. I would look in to a panic button, too. Your Dad would wear a button he can push if he needs help and can't reach the phone. The service will call you, if you like, or whatever you tell them to do. Adult day care is an option in many areas. Meals-on-Wheels or going to the local community center for a meal might help keep him social. Good luck and God bless.

This topic is also so helpful for my situation with my 93yr old Dad. He lives alone in his home, does fairly well, though has some mobility issues and uses a walker. Neighbors and friends check on him regularly. After much resistance he finally agreed to an agency to help, so a woman comes in one day a week for only 3 hours. It's a start and even that little bit makes such a difference.

I'm concerned for if/when he can't walk anymore and needs a NH or Ass Living. He has only SS and a small Shell pension and no other assets. The house was reversed mortgaged years ago, so he doesn't even have that. I'm the only child and live out of state. I too wondered if I would be responsible for his debts.

In my opinion, "yes".
I'd suggest you do a headline search for 'Son Liable for Mom's $93,000 Nursing Home Bill Under 'Filial Responsibility' Law'. At least 29 states have laws making adult children responsible for their parents if their parents can't afford to take care of themselves. Previously, “filial responsibility” laws have rarely been enforced.
In May 2012, a Pennsylvania appeals court found a son liable for his mother's $93,000 nursing home bill under the state's filial responsibility law. [Note: Health Care & Retirement Corporation of America v. Pittas (Pa. Super. Ct., No. 536 EDA 2011, May 7, 2012].
Very simply, John Pittas' mother entered a nursing home for rehabilitation following a car crash. After recovering, she left the nursing home, moving to Greece. She then applied to Medicaid to cover her care. (I'm not sure how or if this was ever resolved. Regardless, the nursing home sued her son Mr. Pittas for $93,000 under the state's filial responsibility law, which requires a child to provide support for an indigent parent.
In my opinion, the bottom line is that I foresee this case is "the tip of the iceberg". It is the beginning of a wave (of Tsunami proportions) of nursing home filing lawsuits to recover unpaid nursing home bills from the children of parents who can't pay their nursing home bills.

Allan

Striper, is it possible since he is still able to care for himself that he might be open to a social worker coming in. It sounds to me like he may be depressed and looking for some control in his life since he knows that he's losing. My mom is the same way what we seen as being difficult may be (his way, and my mom's way :) to stay in control of their life. In the long run if there is someone who is not (the kid) whom he builds trust in that can help you when it's time for the transition to a NH. just food for thought.

Thank you very much ... everyone here is so helpful. I'm sorry you're going through this with your Aunt as well. What if we start the process, and it's too soon? His situation certainly seemed more dire on the day he went into the hospital - and now he's back home with visiting nurse. He CAN do things for himself, but chooses not to. He chooses not to follow any diet, takes his meds when he wants to, STILL SMOKES ... ugh. He could be doing so much better, but chooses not to. So, I don't really want him in a facility, and he really shouldn't need to be there, but I fear it will come to that. So when do you know it's the right time to actually start?

Striper, I'm in NJ also, although my experience is with my aunt, not a parent. I have been going through the Medicaid process for over a year, so start it soon! My aunt had to be place in a nursing home a few months ago and I made sure to write on top of a page of financial responsibility I AM NOT FINANCIALLY RESPONSIBLE FOR _____________ I am her POA and there are many unscrupulous NHs out there that will try to trick you into paying or try to convince you that you are responsible. You might also want to check into Global Options which is a Medicaid plan that will allow your dad to live in Assisted Living ... because a NH is a rough place to be unless he really needs that level of physical assistance. Many facilities will accept patients as "Medicaid Pending". Still others will only accept Medicaid if you are able to private pay for the first $100,000 or so.

Thank you very much, DGinGA!! Everyone here is so helpful and it really is comforting to know that other families are experiencing similar things. (not that I want other people to go through this!) The info on NH vs. rehab is helpful. He did go into rehab 2 years ago after bypass surgery, and because he's so stubborn and unwilling to do anything, he had to stay longer, because he wasn't improving. Then, they discharged him because he wasn't making any effort and he was at the end of his full Medicare coverage (it was going to go to 80/20 ... I think he had a few days that AARP had to make up for the reduced Medicare coverage.)

thanks again ... :)

Striper, we've been looking into the Medicaid/long-term-care issues for our own parents, and my understanding is that the only way the state or the nursing home could come after the children is if the parent(s) GAVE assets to the children in the five years prior to beginning nursing home care. This is called the "look-back" period - check out the Medicaid /Medicare website in your state. As far as Medicare is concerned, they will pay for up to 100 days of skilled nursing care, provided your parent was referred there after a minimum 3-day hospital stay. If it is for "rehabilitation" of an injury, they will pay as long as the patient is compliant and is making progress - or 100 days, whichever is less. The nursing home will be happy to keep him longer, but then he will have to pay the full rate himself.

I know in my state if your dad goes into a nursing home, and his spouse is dead/no longer living in the home, the house has to be sold to pay NH expenses. If the house is inhabited by a child - who has lived with and cared for the parent for a number of years prior to the NH admission and has no place else to go - it's possible the state will merely put a lien on the house for the Medicaid payments until such time as the house is sold, at which point that money has to be repaid to the state.

Now, it sounds like your dad can live somewhat independently, but doesn't care much about his own hygiene or cleaning the house. He needs someone to monitor his meds. You CAN hire someone to come in and do that for him - give him his meds every day and do some light cleaning. It's a LOT cheaper than a nursing home. Have you looked into Assisted Living? They won't let him smoke, but they can help him with the small daily personal care issues. Again, Assisted Living is expensive, but if you're that worried, it would be worth looking into.

As far as the endless cycle of hospitals/rehab/etc., when my dad was in a rehab center after a bad fall, once Medicare ran out at 100 days, they offered to keep him - at their standard rate and completely self-pay. Frankly, you can refuse to let him check out of the NH once he's in there. But then he will have to pay.

igloo, that's a great post, and I can't thank you enough! Yes, Dad is still at home alone. My mom passed away last year. Basically, he CAN or I should say COULD do things for himself if he chose to take some action. But he won't follow his medications regularly, still smokes (UGH!) and has no sense of personal or house hygiene. He adamantly refuses to even hear the words assisted living or NH. So if it ever comes to that, it's going to be a real battle. I don't want him there either, but he won't listen to reason that if he does nothing to take care of himself that he's going to end up in an endless cycle of hospitals and rehab, etc ... and then what. He avoids any conversation about any of it.

Good times, eh? :-) I love him, but man can he drive me crazy. My mom was an awesome "patient", LOL. He's a whole other situation.

I'd just like to mention that the allowed asset level is different for married couples, if one is still "in the community" (i.e, not in a care center).

Striper - it's good you are thinking of this now rather than having to deal with all this under duress and emergency situation.

NH cost between 5K - 15K a month so realistically unless you are generationally wealthy, you are going to run out of money if you live long enough. There is planning you can do but again realistically it is very hard to get your parents to do what's needed easily or have them give up what they feel is control of their life. It's probably one of the most difficult situations for a child ever to do for their folks.
Its a balance of doing for them while still safeguarding your life & livelihood.

Getting into a NH on Medicaid requires that they qualify both medically (for skilled nursing care) and financially (basically impoverished). The financial in general is under 2K in income & 2K in non-exempt assets but varies by each state as Medicaid is a joint federal & state program but managed by the state. The medical you have to work with his MD's. Is your dad still living at his home alone? It sounds like that is the case, if so you may have some challenges in getting him into a NH. The vast majority of NH admissions are from a hospital discharge to the NH for "rehab". The rehab is a MediCARE paid benefit and then after maybe 3 weeks it;s determined that they either are OK to go back home OR usually stay in the NH and then family either applies for Medicaid or does private pay. For those who are @ home, there can be a issue with medical history as it doesn't show the imminent need for skilled nursing. This is what we faced with my mom…if this is you, post that & I'll let you know how I approached this hurdle.

About Medicaid, there should be a list on-line of what your state requires for financial documentation to accompany the Medicaid application. Their SS & retirement statements, all life insurance policies, banking (my mom's review was 3 years & 6 months), citizenship, health insurance info, and details on all other assets. You want to make sure that the NH accepts residents as "Medicaid Pending". The NH will likely give you a list of what they want to see (which they look over to see if they detect any problems) and then they companionize your application with their bill to the state Medicaid program. It is the Medicaid caseworker who ultimately reviews all this.

His home - if it is his homestead - is an exempt asset. He does not have to sell the house but if he keeps it, then someone other than him will have to pay for everything on the house for the rest of his lifetime or as long as you have the house. The state requires them to do a co-pay of all of their monthly income to the NH less the small personal allowance they get ($ 35 - 90 a month) so he will not have any $$ to deal with the house if you all decide to keep the home. The house can be subject to estate recovery when he dies (MERP). Just how this part is done really depends on your state law on death and probate. For these reasons, family usually sell the home and then the proceeds from the sale (which the state WILL know about as all real property info is in the state's database) is used towards a spend-down for dad to get qualified for Medicaid. If you are going to sell the house and plan to wait for dad to go into the NH before it goes on the market (which makes sense as it;s hard to sell a house with elderly living in it plus all their stuff), you need to make sure you do whatever you can to get a diversion of dad's required Medicaid co-pay for a period of time that the house is on the market.

About the NH, just make sure that you never ever sign anything as your name. Every item you sign needs to be "Jane Smith Jones in her limited capacity as DPOA for John Smith" and wait to get copies of everything you sign.

If you have other siblings, I'd really suggest that you have a family meeting to go over dad's finances & health before the move to a NH. This site is filled with posts from all sorts of family friction so whatever you can do now to deflect that the better. Good luck and keep your sense of humor going…...

Thank you ... :)

Thirty states have what is called a filial law. This is an old law based on English law in which the child is responsible for the parent's debt. New Jersey is one of those states. That said. The law has nothing to do with Medicaid and the government doesn't look into the child's assets when determining Medicaid eligibility.

These filial laws are hard to, if ever, enforce. I would pay for nothing and sign nothing making me responsible for any debt. Also, don't let any nursing home bully you into thinking you are responsible.

So I guess the answer would be no way.

No, nothing has been signed. I'm just in the thought process at the moment. Dad's health is declining and he probably cannot live at home by himself much longer. I just want to be sure that his expenses are kept separate from any of the children. We know that if it comes to NH situation, his money and his house would need to fund this. THANKS! BTW, to Sharynmarie.... where is a good place to start to check on my state's legal position? I'm in NJ.

Definitely start the Medicaid application process before the money runs out!

Also look over carefully the contract for the NH. Did you sign anything agreeing to be responsible?

Medicaid is designed for the situation when an elder's money runs out and he needs care.

You would need to check on the net to see if the state you live in allows this. Many states do allow a NH to come after the children for payments. I suggest that you also check into Medicaid for your father before his money runs out so then medicaid can take care of it for him.