The average private room in a nursing home costs over $100,000 a year according to a new study from Genworth. If that’s not shocking enough, a little-known legal doctrine in about half of U.S. states, called filial support laws, could hold the children of nursing home patients responsible for the long-term care bills.
People who are moving into old age must attain large savings accounts, buy long-term care insurance or rely on family or Medicaid to avoid the outrageous pricing of nursing home care. And while Medicaid serves as a de-facto safety net if you run out of money in retirement, the heavy reliance on the program is putting stress on state budgets and taxpayers to fund the system.
Filial laws are decades old state laws that impose the responsibility of fulfilling long-term nursing home care costs to the children or siblings of the patient. As baby boomers, the largest generation in American history, move toward the age of needing long-term care, these old rules and overall issues of underfunding are being looked at more closely.
The most widely discussed case of filial laws (as applied to long-term care costs) is the 2012 case Health Care & Retirement Corporation of America v. Pittas in which Pennsylvania appellate division upheld a lower court ruling that found an adult son liable for his mother’s $93,000 nursing home bill. The mother had left the country and was not covered by Medicare. In a more recent case, Eori ex rel. Eori v. Eori, a Pennsylvania court upheld a finding of filial-support obligation from one brother to another to help pay for the long-term care support of their seriously ill mother.
Passing Bills to Tax Payers
If the nursing home patient can’t make the payment, the costs need to be passed to someone. One of those places is state taxpayers in the form of Medicaid. If nursing home residents didn’t save for their long-term care, taxpayers have to cover it, increasing the debt passed on to future generations and truly unrelated parties.
In the past, attorneys have downplayed filial laws by arguing that if the bills would otherwise be covered by Medicaid, it would be less worrisome to aging people and their families because Medicaid can’t go after family members for the bill. Medicaid itself won’t likely be using filial laws to recoup bills it covers.
However, the issue is not about Medicaid going after a child, it’s about the nursing home or other provider going after the money. Pennsylvania courts in Eori said it doesn’t matter if Medicaid would have covered it. Under the law, if the cost is there, you can recover it from family. The nursing home could ask Medicaid or the family member for support. So, while Medicaid itself can’t come after the child, the nursing home can, could, and most likely will.
Keeping Costs in the Family
Laws on this matter vary significantly by state. Some state laws apply only from parents to children and children to parents. Others include siblings. Some, like Pennsylvania, have a very broad scope of what costs you could be liable for. Others, like Arkansas, limit it only to mental health care. Meanwhile, while some states do not have filial support laws, different doctrines may require spousal support for medical or other necessary expenses, like burial costs.
Those who oppose filial laws would say it is unfair and unjust to require children to cover their parents’ costs. Requiring the children to pay for them would push the burden onto a new generation and could create new hardships. On the other side, if the parents are unable to pay their bills, who else will?