Can You Be Responsible for a Family Member's Nursing Home Cost?

We know that a power of attorney (POA) laws are well established and a person legally acting as POA is not personally financially responsible.  Most of us know that when a nursing home asks us to sign a guarantee of payment agreement, it is not required but rather a personal ethical choice.  So it is clear you can not be held responsible for Mom's nursing home bill, right?  Not so fast.  Pennsylvania and twenty-nine other states have a little known law on the books called the Indigent Support Law or Filial Support Law.  Language for the Pennsylvania law can be found at 23 Pa.C.S.A §4603.  

Let's look at the case of John Pittas.  John's mother went to Liberty Nursing Home to rehabilitate for six months after an auto accident.  While there she applied for Medicaid benefits to cover the costs, as she did not have the means to cover the costs.  As sometimes happens the application was pending at the time of discharge in March of 2008.  John's mother left for Greece shortly after discharge, the Medicaid application still pending and the bill outstanding.

Liberty Nursing Home sued Mr. Pittas for his mother's care:  $92,943.41.  Mr. Pittas did not sign a guarantee of payment nor did he agree to private pay for his mother.  How can he be liable?  The Indigent Support Law establishes that certain family members, including a spouse, child, or parent, have a responsibility to care for and maintain or financially assist an indigent person.  Pennsylvania courts have allowed nursing homes and other providers to sue children under this law for unpaid costs.  When appealed, the Pennsylvania Appeals Court upheld the ruling noting the Mr. Pittas' mother was indigent because she could not pay for her own care.  She was neither destitute nor helpless.  The inability to pay her bill was sufficient to declare her destitute for the purpose of this law.  The court further noted that a child (spouse, or parent) can be liable if they have the means to pay the bill.

The court also noted that Liberty Nursing Home was allowed to sue even though the Medicaid application was still pending and there had been no determination on the status of that funding.  Mr. Pittas questioned why he was sued but a spouse or other children were not.  The ruling also noted that a provider can determine the financial ability of each family to pay, and to decide which member(s) to go after.

While these laws have been on the books for a while, it is only recently that providers have been using them.  As funding and payments to nursing homes and other providers decline I expect to see an increase in these law suits.

Most families are shocked to learn they could be financially liable for the care of a family member.  Providers aren't telling us before services are rendered.  It isn't contained in the informational materials distributed by local, state, or federal agencies.  Social workers and admission coordinators don't seem to know.  Many "experts" are as surprised as families are.  

The bottom line?  Determine if you (or your loved ones) live in a state (including Pennsylvania) where an Indigent Support Law or Filial Support Law is on the books.  If you believe your parent or other family member may require expensive care that is not covered by insurance and they may be unable to pay for, find out now what you may be liable for and what to do about it.  While you may not be able to change the law you can use this information to better understand the issue and plan accordingly.  

It is also important to note here that applying for Medicaid, or any other, benefits can be a trying experience for the resident, the family, and the facility.  You will be asked to provide specific information including financial information.  The longer it takes to provide this information, the longer the process takes.  I have also noticed that a cooperative family typically fairs far better than a family that is difficult to work with.  Though there are strict guidelines they follow, there can be leeway for a reasonable, documented explanation.