Overview

Adult children in Pennsylvania with aging parents might be shocked to learn that they can be financially responsible for their parents’ nursing home bills. Pennsylvania, along with many other states, has filial support laws that obligate adult children to pay for an indigent parent’s long-term care. Pennsylvania’s filial support statute, 23 Pa.C.S. § 4603, provides that a spouse, child, or parent (meaning that the statute applies to render parents of adult children liable) of an indigent person who has "sufficient financial ability” has the “responsibility to care for and maintain or financially assist such indigent person.” Filial responsibility laws have been around since 1771 and generally have not been enforced. However, as Medicaid funding continues to dry up and as it is becoming harder to qualify for Medicaid, it is more crucial than ever for families to be aware of potential exposure under filial support laws. The seminal case addressing filial responsibility in Pennsylvania is Health Care & Retirement Corporation of America v. Pittas (discussed below). 

Case Holding

In the 2012 Pittas case, the court held that John Pittas was liable for his mother’s nursing home bill of nearly $93,000 under Pennsylvania’s filial support statute.¹ The Superior Court held that (1) the son had sufficient financial ability to support his mother; (2) Pennsylvania’s filial support statute does not require other possible sources of income to be considered before proceeding against one of the relatives listed in the statute; and (3) the evidence presented was sufficient to support a finding that the mother was in fact indigent.²  

What Were the facts and legal issues? 

John Pittas’ mother entered a nursing home for rehabilitation following a car crash. Upon recovery, she left the nursing home and moved to Greece with her husband and adult daughters, and a large portion of her nursing home bills went unpaid. As a result, the nursing home instituted a filial support action against Mr. Pittas, the only child still living in the United States, for nearly $93,000, under Pennsylvania’s filial support law.

While John initially prevailed before a panel of arbitrators, the nursing home appealed, and the trial court ruled in favor of the nursing home. John appealed the decision to the Superior Court of Pennsylvania, arguing that the trial court improperly placed the burden upon him to prove his inability to financially support his mother. The nursing home presented four years of John Pittas’ individual and “S” corporation joint tax returns and bank account statements. The nursing home also elicited testimony from John that his net income was in excess of $85,000 (recall, this was decided in 2012). John testified that he could not financially support his mother because of other bills, but he failed to substantiate those other bills. Ultimately, the trial court found his testimony lacked credibility and that he had the financial ability to support his mother.³

The second issue raised on appeal was whether the trial court abused its discretion in refusing to consider alternative sources of income available to John’s mother before finding John liable to the nursing home. ⁴According to John, before finding him liable, the trial court was obligated to consider other income sources, such as his mother's husband, her two other grown children, and her application for medical assistance that was pending (on appeal) at the time. The Superior Court held that “the filial support statute does not require a trial court to consider other sources of income or to stay its determination pending the resolution of a claim for Medicaid.”⁵ The nursing home had the ability to choose which family members to pursue for the outstanding debt. The court concluded that if John wanted other family members to share in the burden, he should have brought them into the case as third-party defendants.⁶

The final issue raised on appeal by John claimed the nursing home presented insufficient evidence for the trial court to find the mother “indigent.” The statute is silent as to the definition of indigent, so the Superior Court applied the common law definition. The court found the meaning of indigent “includes, but is not limited to, those who are completely destitute and helpless. It also encompasses those persons who have some limited means, but whose means are not sufficient to adequately provide for their maintenance and support.”⁷ The nursing home argued that the mother’s bank statement established the amount of social security income received and her share of her husband’s Veteran’s Administration benefit. This showed that the mother’s income was limited to $1,000 a month, an insufficient amount to provide for her maintenance and support, according to the court. John argued that the nursing home needed to present more evidence of his mother’s indigence, but he failed to establish that any such evidence existed. Therefore, the Superior Court held that the mother was indigent and her son was liable for her nursing home bills.⁸  

What else should I know? 

Pennsylvania’s filial liability does not require a finding of fault against an adult child. It is simply enough to be the child of an indigent parent. 23 Pa.C.S. § 4603(c) allows an indigent elderly person or “any other person or public body or public agency having any interest in the care, maintenance or assistance of such indigent person” to bring a filial support claim. This includes nursing homes, hospitals, or any other interested individual, including another family member providing care to a parent when the family member wants financial contribution from the parent’s children.⁹

Pennsylvania’s law applies not only to children and spouses but also to parents. In Melmark, Inc. v. Schutt, the Supreme Court of Pennsylvania held that Pennsylvania’s filial support statute applies to a support claim brought by a Pennsylvania health care provider against parents domiciled in New Jersey for care provided in Pennsylvania to their disabled adult son.¹⁰ Melmark also is noteworthy because it concluded that as long as a loved one received treatment in a filial support law state, a spouse, child, or parent of an indigent person could still be on the hook under the statute even though she/he lives in another state.

When there are multiple children involved, the statute does not limit the obligation to pay to only one child. In Eori v. Eori, one of three siblings sued the other two because he was providing support for their mother, and the other two were not.¹¹ The court ruled that the other two siblings had the financial ability to support the mother and held them responsible for their mother’s support under the Pennsylvania statute.

“The clear language of the statute does not impose an obligation of establishing unpaid medical bills or liabilities to justify a claim for filial support … the statute just requires an inability to provide for one’s own maintenance and support with the income received.”¹² In Eori, the mere fact that the mother had been able to remain out of debt did not eliminate her from the definition of indigent. Ms. Eori received $1,789 in social security income each month and $400 a month from her daughter by a court order. Her total monthly gross income was $2,189. Ms. Eori needed 24-hour care. Joseph (plaintiff) paid $1,722 a month for individuals to care for his mother during the weekdays but had not been able to obtain care for her on the weekends because she could not afford it (therefore, this amount is not reflective of the full care that the mother needed). In addition, Joseph spent an additional $1,000 per month on hygiene items, cleaning expenses, and diapers. Ms. Eori’s basic needs already totaled more than her monthly income. Joshua (defendant) argued that a great amount of her monthly expenses were for luxuries rather than actual necessities, and therefore she was not indigent (referring to television sets and trips to the salon). The court did not find that the “simple pleasantry of a ninety-year-old woman maintaining her appearance to be a “great” amount.”¹³ The court held that although she is not extremely destitute, she does not have sufficient income to provide for her maintenance and support.¹⁴ Further, the court held that if her son has to provide at least 50 percent of her expenses to maintain her daily needs, then she, on her own, is clearly indigent, and this would invoke filial responsibility for her medical expenses.¹⁵

What are the exceptions? 

There are certain exceptions to the law. A family member will not be held financially responsible if s/he does not have sufficient financial ability to support the indigent person. In addition, a child is not required to pay if the parent abandoned the child and persisted in the abandonment for a period of 10 years during the child’s minority.¹⁶ The terms “sufficient financial ability” and “abandonment” are not clearly defined in the statute, leaving them up to interpretation by the courts. 

For example, in Eori, the court relied on the 23 Pa.C.S.A. § 5402 definition of “abandoned” as “left without provision of reasonable and necessary care or supervision.” Joshua testified that his mother was abusive and left him alone many times. However, Joshua did not provide details or time periods on any of the testimony presented. Therefore, it was not clear that his mother ever left for a 10-year period without provision for his reasonable and necessary care or supervision, and Joshua was still held liable under Pennsylvania’s filial support law.¹⁷

Pennsylvania’s filial support statute has faced some criticism over the years. The Pennsylvania Association of Elder Law Attorneys (PAELA) adopted a policy position in favor of the repeal of Pennsylvania’s filial support law. PAELA believes these laws are misguided, unfair, and counterproductive. PAELA’s position is that: 

1. holding a child liable for his parents’ debts may actually reduce the child’s ability to provide current and future support for his parents; 
2. liability accrues without notice to the child, and it is fundamentally unfair to hold a child liable for debts without giving the child notice and an opportunity to mitigate the liability; 
3. the law encourages family disputes by allowing a nursing home or other care provider to choose which child to sue, which then causes the child to sue their siblings and/or his parent’s spouse in order to get them to share the filial support duty; and 
4. the law makes the child a guarantor of his parent’s care-related debts, making the law at odds with the federal statutory prohibition mandating that a skilled nursing facility not require a third-party guarantee of payment as a condition of admission or stay in the facility.¹⁸

Despite many challenges to Pennsylvania’s filial support law, however, the statute remains in place. 

What can you do? 

If you (or one of your clients) is an adult with aging parents, make sure your parent or spouse qualifies for Medicaid. If Medicaid benefits are available, exposure and liability under filial laws decrease as Medicaid benefits will pay for the costs of your loved one’s long-term care. 

It is important to note that gifts made by parents within five years of applying for Medicaid can cause the parent to become ineligible for Medicaid. Even if the recipient does not receive the gift, the act of making a gift, including to tax-exempt public charities, can jeopardize Medicaid eligibility. 

While the impact of Pittas remains to be seen, adult children should familiarize themselves with filial support laws that could make them accountable for their loved one’s medical expenses. One thing is certain: the Pittas ruling provides yet another reason for individuals to take the time to plan for their long-term care.