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Could You Be Forced to Pay Mom's Nursing Home Bill?

It happened in Pennsylvania — and it could happen to you if you don't take proper precautions

By Elizabeth Hanes

Would you be shocked if a nursing home sued you to collect your mother's unpaid bill?

It can definitely happen.

Consider the case of John Pittas, who was sued by a nursing home in Allentown, Pa., that wanted him to make good on his mother's unpaid $93,000 bill, accrued during her six-month stay in 2007 and 2008. A few months ago, the Superior Court of Pennsylvania agreed with the nursing home and ruled that Pittas did indeed owe the money. Pittas is appealing and has not paid the bill.

Son Hit With Mom's $93,000 Nursing Home Bill

Here's the backstory: Pittas' mother, Maryann, who was living on $1,000 a month, was in the nursing home recuperating from injuries sustained in a car accident. Although she had filed for Medicaid, she left the nursing home and moved out of the country while the application was still pending. So the nursing home sued her son to recover the cost of care before her Medicaid application was approved. The application is still pending.

The justification? Pennsylvania and 28 other states, including California and Massachusetts, have what's called a "filial support" law that says adult children have a duty to care for their indigent parents. The Pittas case was the first time a Pennsylvania court confirmed such a substantial, lump-sum liability on an adult child without any record of fault on the child's part and while the mother's Medicaid application was still pending.

(MORE: What to Look for When Touring a Nursing Home)

Katherine Pearson, a professor at Penn State's Dickinson School of Law, says she has also seen hospitals and assisted living facilities use filial support laws to get reimbursed by adult children of patients or residents. Typically, though, these suits are filed because a parent's money for medical care has been misappropriated by a child, who should have been using the money to pay the nursing home.

According to a recent Forbes article on the Pittas case, most filial support statutes take into account an adult child's ability to pay a parent's expenses. But in this instance, the court only looked at Pittas's income, not whether he had the cash to pay the bill or could come up with it.

Why You Could Be on the Hook

Even if you don't live in a state with a filial support law, you could be on the hook. Nursing homes, rehab hospitals and other medical facilities can sue adult children or other family members (if there are no adult children) for unpaid healthcare debts using other types of legal justification. "If a bill is unpaid, it's very likely the facility will sue other family members to get it paid," says elder law attorney Robert Clofine of York, Pa.

The Medicaid Morass

Pittas got tangled in this web — and you could too — because of the complexities of Medicaid, the federal government's safety net program for indigent medical patients.

Problems can arise, as they did in this case, when expenses accrue between the time a nursing home patient runs out of money (or private insurance coverage or Medicare reimbursements) and the time his or her Medicaid application is approved. While Medicaid tends to approve or deny applications within two to three months, the application process can take longer if the forms are incomplete.

Here's how it can happen: Say a woman over 65 sustains an injury, like Pittas' mom. After a short hospital stay, she might be transferred to a nursing home or rehab facility. Medicare then picks up the tab for the first three months or so, but eventually Medicare coverage runs out. At that point, the patient must either pay the bill out of pocket or, if she is indigent, file for Medicaid. "Often, the nursing home staff says they'll file on the person's behalf," Pearson says.

But the government might deny the Medicaid application because it's incomplete, or the application could be delayed by red tape. Meanwhile, the nursing home's fees continue to accrue — and if the elderly patient can't pay the bill, the facility might sue her children.

How to Avoid Getting Hit With a Bill

There are three ways you can avoid getting caught in this type of mess.


If your parent enters a nursing home and might have trouble paying the bill, consult an elder law attorney. The lawyer can help you and your parent file for Medicaid on behalf of your parent to cover the nursing home bills. There are free online directories of attorneys around the country specializing in Medicaid cases at sites like and, the site for the National Academy of Elder Law Attorneys.

Don't let the nursing home file the Medicaid application on your parent's behalf. Otherwise, you run the risk that the facility will be too slow submitting the complete application, delaying Medicaid approval and potentially leaving you responsble for the home's fees.

Instead, handle the paperwork with your attorney. "I'd venture to say many of the cases we see are the result of neglect at the time of the Medicaid application," Clofine says.

(MORE: 7 Questions to Ask About Long Term Care)

If the nursing home proactively fills out the Medicaid application for your parent, be sure to scrutinize the document — don't sign it on the spot. Medicaid applications require detailed information about an applicant's finances. Since this is information the nursing home isn't likely to have, the application submitted by the facility will probably be incomplete — and it will eventually get denied or delayed.

Take the application home, gather the required information, and have an attorney review and submit it.

If the Application Is Denied

If, for some reason, your parent's Medicaid application is denied, appeal the decision immediately.

You may have only 30 days to respond. Medicaid applications are often denied for simple reasons: a missing receipt or the lack of a written explanation for a particular expense.

Once you determine the problem, address it with your eldercare attorney, send back the application and hope for a speedy approval.

If you don't take these steps, you might get stuck with a staggering and unexpected bill which could whack your financial future.

Elizabeth Hanes is a registered nurse who writes regularly about health, wellness, nutrition and caregiving. She won a 2010 Online Journalism Award for "Dad Has Dementia," her 36-week journal about caring for her late father. She lives in New Mexico where she also writes about art, antiques and collecting. Read More
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