In 2007, Elnora Thomas of Tampa, Fla., received a disturbing letter in the mail. She was being sued by her mother’s nursing home in Philadelphia for nearly $50,000 in unpaid bills. “I have no money,” says Thomas, 58. “But I have a house. They told me they would put a lien on my house to get me to pay the nursing home bill.”
Thomas and her sister Peggy Crowder, who received a similar letter despite being unemployed at the time, were snared by a little-known law that requires adult children to support their indigent parents. Thirty states have such statutes, known as filial support (or responsibility) laws. Most are rarely implemented, though Pennsylvania’s statutes have been used by nursing homes in at least 50 cases to compel families to cover unpaid bills or to pressure them to become more involved in getting Medicaid coverage for their elders. While such laws could be used by a parent to sue an adult child, “all the lawsuits I’m seeing are filed by long-term care facilities against some family member,” says Katherine C. Pearson, professor of law at Penn State who studies filial support laws.
In Thomas’ case, the nursing home went after her and her sister after their stepfather refused to cooperate in the Medicaid application process. Her mother, who only receives $300 a month in Social Security benefits, was denied assistance because her husband refused to divulge his own modest income and assets.
Only after Pam Walz, director of the Elderly Law Project at the nonprofit Community Legal Services of Philadelphia, went through several appeals on Thomas’ mother’s behalf did Medicaid come through. Had she not gotten involved, Walz says, Thomas would “absolutely” still have the threat of a lien on her house today.
“Not only was this family not at fault in any way, they did everything they could to get the medical assistance approved,” say Walz, who has handled three similar cases in which families were sued under a filial support law. “It was completely out of their control.”
The laws can also be used to encourage those who can help their parents to do so. John N. Kennedy, a Harrisburg, Pa., attorney who represents nursing homes, frequently uses the law primarily as a tool to persuade family members to help get their elders on Medicaid. “Nursing homes have to get paid for their services,” he says. “If people aren’t going to cooperate and help out their parents, and if there’s a law on the books that I can use, I use it.”
Filial support laws raise provocative questions about who should be responsible for costly eldercare. Families? Society at large? What about the individual’s own role in planning for long-term care needs? The growing numbers of older people, their increased longevity and increasing care costs continue to make those questions that much more pressing.
Whose bright idea?
Although few people are aware that filial support laws exist, they have been on the books since the birth of the United States. Based on England’s Poor Law Act of 1601, the laws originally held that the father, grandfather, mother, grandmother and children of “every poor, old, blind, lame and impotent person” had to step up and support their indigent relative to the extent of their ability. Only people in need who had no family members to support them were eligible for public assistance.
Today, the laws vary by state. In California, for example, “every adult child who, having the ability so to do, fails to provide necessary food, clothing, shelter, or medical attendance for an indigent parent, is guilty of a misdemeanor.” (“Indigent” is not defined.) Rhode Island’s law only applies to older people who are indigent through “misfortune” or no fault of their own. So if Granddad is destitute after a lifetime at the racetrack, he’s out of luck.