You could inadvertently leave your children with a hefty medical bill if you neglect to engage in long-term-care planning. Laws known as “filial responsibility laws” are present in 30 of the 50 states, including Connecticut, Massachusetts and Rhode Island and can hold children legally responsible for their parents’ long-term care expenses like nursing home bills. While most people are not even aware of their filial responsibilities, it has become more and more important for parents to be aware of these stringent regulations.

A little about filial responsibility laws

Filial responsibility laws are modeled after the “Elizabethan Poor Laws of 1601” which made blood relatives the primary source of support for family members. Seeking public assistance in this day was acceptable only as the last resort.

Today, “filial responsibility laws”:

• Obligate adult children to provide necessities like food, clothing, housing and medical attention to their ailing parents.
• Are present in 30 U.S. states:
  • Alaska, Arkansas, California, Connecticut, Delaware, Georgia, Indiana, Iowa, Kentucky, Louisiana, Maryland, Massachusetts, Mississippi, Montana, Nevada, New Hampshire, New Jersey, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Dakota, Tennessee, Utah, Vermont, Virginia, West Virginia, and Puerto Rico.
• Are only strictly enforced in a few states currently (Pennsylvania, namely)
• Must be complied with or the adult child will face legal action in certain cases.

Health Care & Retirement Corporation vs. Pittas

Just because the laws are unbeknownst to many Americans doesn’t mean they aren’t enforced. Just take a fairly recent case- Health Care & Retirement Corp. vs. Pittas.

Pennsylvania resident Maryann Pittas was involved in a car crash which left her in a nursing home for rehabilitation. When she left the nursing home and moved back to her home in Greece, the nursing home bill went unpaid, though Ms. Pittas did have a pending application for Medicaid to cover the care.

Meanwhile, her son John Pittas was found liable for his mother’s $93,000 nursing home bill under Pennsylvania’s filial responsibility law. Since his mother’s application for Medicaid was not approved in time, The Health Care and Retirement Corporation of America (which owns Liberty Nursing & Rehabilitation Center where Maryann was staying) found him responsible for covering the expense under PA’s filial law. Mr. Pittas did appeal, but the court ruled in favor of the nursing home, leaving him responsible for the hefty bill.

The court found that Pittas’ mother’s monthly income of $1,000 (from Social Security) coupled with her husband’s Veteran’s Administration (VA) benefit was not sufficient enough to provide for the bill, establishing her as “indigent,” or impoverished, essentially, which placed the responsibility directly on to her kin. In surmising that Mr. Pittas’ annual income of $85,000 would be able to comfortably support his mother’s nursing home bills, the court neglected to take into account his expenses. With a growing family and his own restaurant, footing this bill on behalf of his mother was next to impossible—but the court refused to waver on their decision.

The importance of long-term-care planning

John Pittas’ case, though seemingly extreme, definitely points out the importance of communication and planning to prevent this worst case scenario. Some best practices for preventing such a situation:

• Decide if you’d like to continue living at home after you become unable to care for yourself—Is your home age-friendly? What would it cost to make it so? Will you move in with your children—is their home equipped to provide adequate care? Will you need to hire a home health aide?
• Have your children decide who will be responsible for managing your accounts to pay bills, home maintenance, driving, etc. in the event that you must enter a nursing home.
• Consider purchasing long term care insurance while you’re healthy. Medicare does not cover long-term custodial care, contrary to popular belief, so it helps to have coverage in place as early as possible (experts recommend in your 50s and early 60s). The younger you are when purchasing the policy, the lower the annual premiums will be.
• Enroll in Medicaid if you cannot pay for your care. States cannot pursue family members if their parent/relative is eligible for Medicaid. If you neglect to do this,nursing homes will send letters to your children alerting them of past-due bills, and threatening filial law enforcement, so take heed of this before it’s too late.

As Medicaid begins to become more of a burden on taxpayers, and as more states become more strapped on their ability to provide Medicaid, states will likely be forced to pay closer attention to these filial responsibility laws, and might begin enforcing them more adamantly.

If you’d like to learn more about filial responsibility laws, please feel free to reach out to any member of our KLR Wealth Management Team.