Old law puts adult children on hook for parent's nursing home care
A law dating to 16th-century English Poor Laws is being used increasingly in Pennsylvania to force adult children to pay for their parents' nursing home care regardless of their personal relationship.
Many states have repealed what is known as the filial (family) support law, which generally holds that a spouse, child or parent of an impoverished person has a responsibility to care for or financially assist them.
It remains on the books in 29 states, but most don't enforce it.
Among the exceptions is Pennsylvania. Although not widely used, court rulings on the law have set precedent for nursing homes and/or patients' family members to sue other relatives for payment.
“The biggest problem with the approach that Pennsylvania takes is that no one knows about the law,” said Katherine Pearson, a law professor at Penn State University's Dickinson School of Law in Carlisle. “The people who are using it are not family members, but commercial entities. And the claims come after a large debt was accumulated.
“It's used too often as an after-the-fact, ‘gotcha' mechanism.”
The law does not apply if the indigent person's family isn't financially able to pay or a child's parent abandoned them for 10 years or more during childhood.
Pearson said she receives “several calls a month from individuals who are facing a claim or a lawsuit” under Pennsylvania's filial support law.
Daughter transfers hermom's money, must pay
Locally, Presbyterian Medical Center in Oakmont sued a resident's daughter for a $96,000 debt in 2003 after the woman's mother died.
The case differs from more recent cases because the daughter transferred $100,000 of the mother's money to various bank accounts and then another $60,000 after the mother died.
Ultimately, the state Superior Court found the daughter was liable for the debt under the filial responsibility law because the transfer of money left her mother legally indigent.
Elder law attorneys say they make their clients aware of the filial support law and nursing home providers educate patients and their families about the cost of care and payment responsibility.
Hillary Butts, administrator at Platinum Ridge Center for Rehabilitation and Healing in Brackenridge, said the nursing home has not had a case of a patient's child being held responsible for their debt.
“We make every effort to be up front with our patients and their families about the cost of care, the resources that we can assist them with and what to expect in terms of receiving bills,” she said. “By being proactive, we've been fortunate that we've not had to struggle with this particular issue.”
The majority of filial support cases, Pearson said, result from a nursing home, hospital or rehab center turning to the family because the patient has been unable to pay with private funds. Sometimes there is a payment gap that Medicaid did not cover.
It is in these circumstances that the National Center for Policy Analysis (NCPA) believes the use of filial support laws may be most appropriate. NCPA is a Dallas think tank promoting free-market alternatives to government regulation.
“Ideally, I think the concept of filial responsibility is a pretty good idea if you look at the original intent of the law, which was to prevent families from trying to hide assets,” said NCPA senior fellow Pamela Villarreal.
Problems arise, says Franklin County elder law attorney Ed Beck, when nursing homes seek funds from children who haven't been involved in arranging their parent's care.
He is handling a case for a man who was in regular contact with his mother, but he didn't have anything to do with arranging her nursing home care. The man's sister signed the original admission papers to the home, Beck said.
After the mother died, the nursing home sued the children to recoup about $5,500 still owed.
“In this case, we have two sons who weren't even cognizant to the financial situation being sued,” Beck said.
This approach, he said, is “unfair.”
“It's out of the blue; there's no interaction with the parent, no discussion about where they're going to live, how they'll be supported,” he said. “It should be a mediated process where … a support obligation is established and the parties agree to it.”
2012 ruling a turning point
A major turning point was a 2012 state Superior Court ruling that required a son to pay his mother's $93,000 nursing home bill after she moved to Greece to live with her other two children. The nursing home, owned by Ohio-based HCR ManorCare, sued the son still living in the United States.
A company spokeswoman said HCR makes sure patients and families understand their responsibilities and payment options.
“We do expect to receive payment,” HCR spokeswoman Julie Beckert wrote in an emailed statement.
HCR doesn't ask family members to commit to using their own funds, but advises those responsible for financial issues to gather documents necessary to apply for aid.
Unlike past filial support cases — in which a child had transferred the parent's money — the HCR case found the son had not done that, but still had an obligation to pay.
The man's mother was transferred to HCR for skilled nursing care and treatment after she was involved in a vehicle accident.
The nursing home sought to collect the debt while the mother's application for Medicaid was pending. The court found that the son “suffered no prejudice” by the court ruling on the matter before a decision on the application was made.
Estranged son must pay
In August the Pennsylvania Superior Court upheld a ruling that a Fayette County man had to pay his mother $400 a month in filial support.
Uniontown resident Joshua Ryan's appeal stated he was raised largely by his grandmother and did not have a good relationship with his mother.
A brother sued Ryan and his sister for support of their mother, Dolly Eori of Sutersville. The brother had been paying for in-home care not covered by his mother's Social Security. His sister agreed to pay $400 a month.
“The parties have had their family differences, and their relationship is certainly not ideal,” Westmoreland County Judge Chris Scherer wrote in his opinion. “(Ryan) is also a son of Ms. Eori who has an obligation to provide support and has the financial ability to provide that support.”
Ryan could not be reached for comment.
“It doesn't matter what kind of relationship you have with your parents (as an adult),” said Michael Girardi, a Lower Burrell estate and elder law attorney. “As long as they didn't abandon you as a child, then you could be held responsible to pay for their care.
“It seems like it's going to be occurring more and more,” Girardi said. “A lot of people are taken aback by it because they can't believe that's how the law is.”
Calls for repeal of statute
There has been push-back against the statute.
State Rep. Anthony DeLuca, D-Penn Hills, introduced a bill seeking to repeal the law.
“It's not right,” he said. “I don't understand how a child can be responsible for a parent's bills if you don't have a relationship.”
The Pennsylvania Association of Elder Law Attorneys also is advocating for repeal.
“It causes a lot of disharmony,” said elder law attorney Leslie Wizelman, association president. “It's being used as a collection service, and usually support is not done that way.”
Jodi Weigand is a Tribune-Review staff writer. Reach her at 724-226-4702 or firstname.lastname@example.org.