Can a Nursing Home Hold an Adult Child Liable for Mom’s Unpaid Nursing Home Bill? The Filial Support Law in Pennsylvania

By Alissa B. Gorman

As the baby boomer generation ages, more and more Pennsylvania seniors will require nursing home care.  The average cost of nursing home care in Pennsylvania is $99,280.00 per year, and in the greater Philadelphia region, the cost increases to $120,633 per year, according to the Pennsylvania Health Care Association.  Aging couples faced with unexpected health issues and mounting medical bills can quickly drain their life savings on medical and nursing home care.  If aging parents are admitted as private pay residents and then expend all of their assets paying for care, can the nursing home hold the adult children liable for any unpaid bills?  A 2012 Pennsylvania Superior Court case says yes, citing a rarely used (until now) Pennsylvania statute.

Pennsylvania, along with 29 other states in the U.S., has what is commonly referred to as “filial support” laws (23 Pa.C.S. Section 4601, et. seq.), which state that certain family members may be required to financially support and maintain an indigent family member.  Specifically, a spouse, child, or parent of an indigent person may be charged with the responsibility of caring for the indigent family member, who is usually an elderly parent (but may also be a child with special needs).  For a family member to be considered indigent, he or she must lack “sufficient means” to pay for their care and maintenance.  Two exceptions apply which relieve the family member of the responsibility to financially assist the indigent person: 1)  if the family member herself does not have the money to support the indigent person, and 2) if the parent abandoned a child for more than ten years while the child was a minor (23 Pa.C.S. Section 4603(a)(2)).

A case decided in the Pennsylvania Superior Court in May 2012 illustrates how the filial support law can be used by nursing homes to recover unpaid bills from adult children of the nursing home resident.  In HCRA v. John Pittas, (2012 Pa Super 96, May 7, 2012), John’s mother entered a skilled nursing facility after a stay in the hospital.  Some time later, his mother withdrew from the facility and moved to Greece, leaving the nursing home with an unpaid bill of approximately $93,000.00.  HCRA sought repayment from John under the Pennsylvania filial support law, claiming that since John’s mother did not have sufficient means to pay the nursing home, John should be required to pay his mother’s bill.  The Superior Court held that the nursing home could collect the unpaid bill of $93,000.00 from John, as he had the financial resources to cover the cost of the nursing home bill.  The Court reasoned that John’s mother qualified as indigent since she did not have the means to pay for her own care.  Moreover, as long as John did have the means to pay the bill, the nursing home could collect the unpaid balance from him, and him alone, even though Mrs. Pittas had a spouse and multiple children.  John had the duty to join his siblings or other responsible parties as defendants in the lawsuit.

Aging individuals without sufficient means to privately pay for nursing home care may apply for Medical Assistance long term care benefits.  If an individual is certified by a doctor as nursing home eligible, and is financially eligible (generally, an individual must meet certain income standards and have less than $8,000.00 in resources to qualify), then Medical Assistance will pay the cost of the individual’s nursing home care.  Many nursing homes assist residents with applying for Medical Assistance once the resident no longer has the means to privately pay.  If the resident is approved for Medical Assistance, the nursing home typically does not look to third parties to cover the expense of the nursing home.  However, if the resident delays submitting the Medical Assistance application, or if fraudulent transfers of assets are involved before submitting the application, and a resident is denied Medical Assistance for a certain time period, the nursing home may look to the adult children of the resident to cover the gap in payment.

With the recent Pittas ruling and current state of the economy, nursing homes may turn to the filial support laws more often to recoup unpaid bills.  An Elder Law attorney can advise aging couples and consult with their adult children on how to financially plan for the future should skilled nursing home care be needed.