The Coming Tsunami of Parental Nursing Home Costs

In general it's difficult to argue against the notion thateven have sufficient minimum contacts with a distant
children who have the means should be willing tostate for the courts there to have jurisdiction over you.
contribute to keep mom & dad when they noThe Supreme Court has said the Constitution requires
longer can live on their own: the question is do wethat you reasonably expect to be in court in a state or
want the state forcing that when costs have becomeit's unconstitutional to take you there--but if you default
astronomical? Well, 30 states have laws like that onon a distant lawsuit and there's a judgment rendered
the books that come under the heading of "filialit's presumptively valid. You will have it on your credit
responsibility" and these laws date back to whatreport and you will have to fight it if they try to bring it
England put on their books in the 1600s. If the parentsto the state where you live. An important caveat: if
can't or won't pay, then to the extent adult childrenyou set foot in the other state at any time, you could
have the ability to pay, these states' laws say theybe served with papers and you would be able to be
must.sued there, regardless of your otherwise-minimal
Between 1965 and 2005, medicaid essentially coveredcontacts with the state.
nursing home care costs for the elderly, few questionsThese statutes present a painful Catch-22: If you don't
asked. But the Deficit Reduction act of 2005 changedhave the money to pay, you could be relieved of
the parental asset transfer lookback to 5 years, nowliability by showing up in court and fighting the situation,
parents entering a facility are required to prove theybut you may not have the money to fight.
haven't made any asset transfers to children in thatPennsylvania has been the most aggressive state, but
time so the nursing home can collect state medicaidthe statutes have also recently been enforced in
and the state can get reimbursed by the federalSouth Dakota. Pennsylvania's code says half your
government. All children have to be accounted for anddisposable income is accessible to the nursing home. If
sign paperwork. Any asset transfers reduce medicaidyou don't pay, you could spend 6 months in jail for
funding dollar for dollar.contempt of court. 27 Pa. CSA s. 4603. Laws vary in
As a result, nursing homes have been dusting offthe 28 other states.
these old statutes and using them against patients'The laws can also produce a nightmare scenario: a
children when there are unpaid balances to collect. Thefavored sibling could take mom's money within the 5
statutes pre-date the Constitution, and although theyyear lookback, spend it all and then more responsible
have been ruled constitutional despite attacks onsiblings would also be on the hook for her care--the
several grounds, one notable ground that has not beenlaws look for a deep pocket, not who might be at fault
used to attack them is the constitutional prohibitionfor the nonpayment.
against acts of attainder. The notion would be that ourIf Pennsylvania medical providers remain successful in
Constitution stopped people from being preventedusing the statute other states will probably dust off or
from inheriting from individuals who are out of favoreven reenact their filial responsibility statutes. But even
with the government; it's perhaps a stronger case toif that doesn't happen, when parents go in the nursing
say that the government shouldn't allow money to behome children are often asked to obligate themselves
taken from the descendants of a parent who has(if the place isn't a run down establishment), regardless
done nothing wrong.of whether there's a filial responsibility statute.
In many ways the statutes seem surprising and unfair.A dozen or so states including Florida have
You have no control over who your parents are andstate-administered insurance program to help families
little control over where they decide to live. Unlike aplan for nursing home care and another twenty are
divorce situation, you didn't voluntarily enter into anylooking at them. Florida's program allows you to shelter
relationship with them, and unlike your children you didn'ta dollar of assets by buying a dollar's worth of
choose to bring them into the world. But in most cases,coverage.
your parents will have supported you for a eighteenIf you have aging parents, it's vital that you and your
years or more, and from that viewpoint there is ansiblings begin to think now about what you may be
argument in favor of the nursing homes.facing in the future. Planning can make all the
Even if the statutes are enforceable, you may notdifference.