Why You Might Be Responsible For Paying Your Parents’ Medical Debts, by Kelly Phillips Forbes In her five years as a Democratic member of Pennsylvania’s State House, Kristine Howard has fought for gun control, abortion rights, environmental protections and greater funding for public education. But this year, after the death of a colleague, Anthony M. DeLuca Sr., she took up his decade-long crusade to change an obscure state law under the provocative bill title: “Stop Bankrupting Pennsylvanians Over Family Medical Bills” Act. Filial responsibility laws oblige a person’s children, spouse, and parents to protect, care for, and support impoverished family members, thus holding family members financially responsible for medical
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Why You Might Be Responsible For Paying Your Parents’ Medical Debts,
by Kelly Phillips
In her five years as a Democratic member of Pennsylvania’s State House, Kristine Howard has fought for gun control, abortion rights, environmental protections and greater funding for public education. But this year, after the death of a colleague, Anthony M. DeLuca Sr., she took up his decade-long crusade to change an obscure state law under the provocative bill title:
“Stop Bankrupting Pennsylvanians Over Family Medical Bills” Act.
Filial responsibility laws oblige a person’s children, spouse, and parents to protect, care for, and support impoverished family members, thus holding family members financially responsible for medical expenses.
This is by no means a hypothetical concern: in the 2012 case of Health Care & Retirement Corporation of America v. Pittas, the Superior Court ruled that corporate nursing homes can sue the children of patients for outstanding medical bills. Given that Pennsylvania nursing homes average a cost of nearly $400 per day, this can quickly lead to bankruptcies.
Filial responsibility laws first emerged in the 17th century and became common in the colonies. While they have generally fallen out of favor elsewhere, Pennsylvania stands as the only state to have enforced its filial responsibility law in the past 25 years. To update our laws for the 21st century, I will soon introduce legislation modernizing our filial responsibility laws to ensure spouses, children, and parents are only held liable for outstanding medical bills if the indigent individual has colluded with the family member to hide assets within the past five years, or if the family member fails to cooperate in the Medical Assistance process.
Pennsylvania’s outlier status in this regard is shameful, and I look forward to your support in eliminating this antiquated and abhorrent practice.The law Howard is seeking to change is Pennsylvania’s “filial support” law–a concept dating to colonial days, with the current version written into state law in 1937. It makes those with financial means legally responsible for nursing home, medical and other bills of destitute family members, including aging parents, adult children and a spouse.
“It can be a rude awakening for many people,” says Howard, a 62-year old lawyer representing Chester County in eastern Pennsylvania.
More than half the states and Puerto Rico have such laws on the books. Elder law expert and law professor at Pennsylvania State University what Katherine C. Pearson, refers to them as “scarecrow” laws. It means they’re rarely enforced but left in the state code as a warning. In this case, to warn those who might consider shirking familial responsibility, whether it’s helping to pay parents’ bills or providing hands on care themselves. (An estimated 42 million Americans, the largest group of them women in their 50s, but increasingly men and younger folks too, provide caregiving to aging relatives.)
Two significant Pennsylvania cases, combined with the rising costs of long term care nationwide and yawning gaps in coverage for healthcare, reveal these scarecrow laws can turn into a live threat. This goes beyond “just to Pennsylvanians.”
The Keystone state’s law provides an exemption, if your parents abandoned you for 10 years or more while you were a child. That’s when the Pennsylvania Superior Court held John Pittas liable for his mother’s full $93,000 unpaid nursing home bill (resulting from a car accident), after she’d moved to Greece to live with two of her other children.
In 2019, the Pennsylvania Supreme Court ruled that a Princeton, N.J. couple could be held liable for an unpaid $205,000 bill for the care of their severely disabled adult son at Melmark, a residential care facility in Delaware County, Pennsylvania. (New Jersey had been paying the tab, but stopped paying because it wanted him moved to a cheaper New Jersey facility. The couple would not have been liable under New Jersey law. The Pennsylvania’s high court decided it could hit the parents with Pennsylvania’s harsher rules.
There is no uniformity in the filial laws. While in Pennsylvania, the potential hit is wholly financial and includes a possible lien on your property. in some states failure to support a parent can be prosecuted as a criminal offense. Massachusetts’ law, written in 1915, imposes a fine of up to $200 and a prison term of up to one year (or both) for “neglect or refusal to support a parent.”
North Carolina’s law, which has been in its current form since 1955, makes it a misdemeanor. It could result in jail time for a person to “without reasonable cause, neglect to maintain or support his or her parent or parents. If such parent or parents become sick or not able to work and have insufficient means or ability to maintain or support themselves. The law is still on the books, though recent history suggests it is not often enforced.
Ditto in Kentucky.
Even in states where there has not been an appetite to enforce filial support laws, there also hasn’t been much movement to repeal them. Economics and the desired scarecrow effect are likely the primary reasons.
While the federal Medicare program pays for the majority of medical care for those over 65, it does not (despite what many middle class Baby Boomers think) cover long term custodial care. The confusion over Medicare stems from the fact the federal program will pay for up to 100 days of rehabilitation in a skilled nursing care facility (after a three-day hospital stay) and some skilled nursing or physical therapists visits at home. It will not pay for custodial care or the kind of help referred to the activities of daily living (such as bathing, dressing and eating) which a majority of elders end up needing either in a nursing home or their own or their children’s home.
It’s hard to predict whether any one individual will need extended long term care support. About four in ten of today’s 65-year-olds won’t need such care at all. However, more than 20% of Boomers will need five or more years of care. The cost of nursing home care varies based on geography and level of care, but it’s steep: on average, a semi-private room in a nursing home runs around $8,669 per month (I would check on this rate). A private room will cost you $9,733 per month, according to Genworth’s annual Cost of Care survey. Home health care aides now average $33 per hour, with homemaker services running at $30 an hour, the survey found.
At those rates, many seniors who need years of care will run out of money. Private long term care insurance isn’t much of an option these days. A raft of carriers have stopped selling the policies because the risk is so high and healthy consumers aren’t buying policies because they fear premium increases. (The Obama Administration killed plans for a voluntary public insurance program after concluding the premiums in them would be unaffordable for most people.)
That is where Medicaid, a joint federal-state program, comes in. It is primarily geared toward low-income families. It picks up long term care costs for elderly once-middle class folks who have exhausted their assets.
More of this at Forbes. I carry my own plan for my wife and I. It is good for 4 years. According to the insurers it cover 95 percent of room and board. Our own funds could pick up the rest. It still is a lot . . .